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1. 16 Jun 2026·Parliament·Dr Caroline Johnson

   Health Bill (Second sitting)

   Q Of course, it would need to be viewable across the whole country for people who travel around. What about the security of this data? Lots of people have expressed concerns about the security of the data, both from people who are a bit nosey and who want to have a look, and from people who would wish to do the country harm, hacking large volumes of data. How do we keep it safe? Dr Cocker: That is a pertinent question. I know that that has been the focus of a lot of concern since the Bill was publicised. I believe that the structure of the SPR would be recognised as a critical national infrastructure-type of project, so it would have access to more resource to protect it. But there will always be inherent risk, when you have something centralised, that it is a single target rather than multiple targets that could be attacked—for example, in a cyber-attack. Role-based access would be important—for example, having an understanding that the information should be accessed only for the provision of clinical care. How it would be delivered on a technical level would have to be finalised; that was not the type of the prototyping work we did, because it was more about a proof of concept than those more minute technical challenges. Dr Byrne: I am glad that Dr Cocker took that question first, because he has given you a helpful technical answer. As National Data Guardian, my mission and concern is primarily around public and professional trust. Trust in whether this system can be relied on in terms of people’s confidentiality is something that concerns me very much, as well as people’s trust and confidence in secondary purposes, how the system will be used and what the safeguards around it will be. I would be happy to answer from that perspective when it comes to people’s confidence. I think you have heard a lot about the potential benefits of this system, but it is important to bear in mind that if people do not trust it, the programme will fail, however great the potential benefits are. As a clinician, I would share the excitement, and I am very supportive of the ambition, but people will not trust it if they perceive the risks to the security of their data and confidentiality to be too great. With that in mind, I want to draw attention to two things that concern trust. I want to emphasise that trust is not simply important—I know that the word “trust” has come up repeatedly today—but absolutely foundational to the success of this. The question about how demonstrably trustworthy the system is should be the primary foundational question; all other questions, including the technical ones, flow from that one question. On the confidentiality aspect, I think there is a provision under clause 47 that potentially has very significant unintended consequences. I understand that that is not the intention of the drafting, but I have concerns about it and I have a potential solution to suggest. In clause 47, proposed new section 250E(3) creates the power for the Secretary of State to remove the duty of confidentiality for any processing in the SPR in line with regulations. I need to register my concern about that wholesale lifting of the duty of confidentiality from the entire system. At a system level, there are two risks. One is to patient and professional confidence in the confidentiality of the data once it is accessed or in a system. Confidentiality is absolutely the cornerstone of all clinician-patient relationships. It means that people are comfortable to share the most sensitive information about themselves and often loved ones—it is not just information about ourselves on our records; it is often also information about our loved ones. If people do not trust that that confidentiality is a constant ethical constraint for anyone accessing the record further on, they may be less able to share information about themselves or their loved ones. Clinicians may also be less likely to document that information if they have ethical concerns about who may access it further on if it is particularly sensitive. That will negatively impact on care and the quality of data for any secondary purposes in future. The second point I will make about that confidentiality provision is that I understand that the drafting intent is to remove any ambiguity in terms of people’s concerns about duty of confidence when allowing access to their data at an organisational level. However, as currently drafted, the provision could be interpreted to remove the duty of confidentiality for not just direct care but secondary purposes. Secondary purposes in future could be dealt with by regulations. That lack of clarity poses a risk. The solution I suggest is to redraft that provision, drawing on the precedent already set in the Health and Social Care Act 2012. Section 259 prevents disclosure of data from an organisation from being a breach, so people could allow access at an organisational level with confidence. You have removed that ambiguity, but it does not remove wholesale that duty of confidence—that ethical safeguard for the data in the system itself. I think that that is important for people’s own direct care, and, as I said, it is particularly important if there are any questions around secondary uses in future. Dr Imam: That was a comprehensive answer; I have nothing to add.

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2. 16 Jun 2026·Parliament·Dr Caroline Johnson

   Health Bill (Second sitting)

   Q Does it surprise you that the Bill is being brought forward before it has been properly and completely designed? We have tabled some amendments to clause 47; I appreciate that you will not have had a chance to look at those yet, but we would be interested in your thoughts if you could provide them to the Committee afterwards. We keep hearing that it is difficult for people to have to repeat their story. I understand that stories can be traumatic and repeating them can be unpleasant, particularly if it must be done many times, but is there sometimes a clinical value in asking people to go through their story? If so, what is it? Dr Imam: My specialty is frailty, which is a medical condition characterised by a loss of independence. Although it is associated with ageing, it is not an inevitable part of ageing. The treatment that I deliver as a clinician is called a comprehensive geriatric assessment. It is evidence-based and we know that it improves patient outcomes and maintains independence. What it describes is a multidisciplinary team approach to a holistic assessment that focuses on what matters most to the patient. One of the issues that we have right now, however, is that the NHS does not consistently identify people who are living with frailty right across the system from community to hospital. If we are identifying people and diagnosing them with a condition, you would expect treatment options to be offered, yet we do not consistently do that across the country. That is essentially driving ineffective and inefficient care. Sometimes, therefore, when a crisis sets in—we have seen this in other reports around corridor care—that can ensue in older people living with frailty. In my day job, where I look after people in a busy A&E department, I see people who have may have had a fall or become confused, or where there has been a breakdown in their social situation. My practitioners and I are spending hours trying to piece together information from multiple different sources. Those could be paper-based, digital or telephone—we could be trying to phone people to get up-to-date information. As you can imagine, sometimes they do not pick up the phone, so we are sometimes working from incomplete information and things that are not up to date. Once we have done that, we try to create a care plan for a patient that allows them to be looked after in the community. However, that care plan may not follow the patient, because everyone uses different electronic patient record systems. Some important partners in that care, like social care or ambulance services, cannot actually see the care plan that I have developed for my patient. Unfortunately, if a patient with frailty then succumbs to a crisis of some kind, the default setting is, in many cases, to trigger an admission to hospital. If a patient does not need to be in a hospital environment and they are frail, they can end up becoming more frail and weak, and lose their independence. That means that they will need even more social care than would otherwise have been required. Where the solution comes in is that a nationally rolled-out single patient record system could fundamentally reshape this form of care, because we would be moving it from the fragmented, reactive model that I just described to one that is proactive, co-ordinated and truly centred around a patient. Another thing about frailty is that there are so many different people involved in that person’s care, so we need to try to restore the continuity of care for that type of patient, which has become eroded over time. The SPR addresses that with a single up-to-date view of a patient. It enables earlier risk identification, faster clinical decision making and that whole-system integrated response I have been describing, which is lacking at the moment. There is often duplication; one of the other issues is that assessing patients in this manner can take a long period of time—up to two and a half hours is often quoted by the British Geriatrics Society. You can imagine that if you had an electronic record that could be auto-populated or could rely on the most recent, up-to-date plan done by someone else, that would avoid reassessment as we would be working from contemporaneous information. Over time, you can see how, for frailty and many other conditions, that could lead to a more preventive approach that is more community based, that reduces the need for admissions, and that provides a better overall experience for staff and patients. Importantly, there needs to be a shift towards neighbourhood working on frailty, and this allows the multidisciplinary team to work towards one plan. You have also heard today about patient voice and carer voice, and this type of care plan also gives them the opportunity to become partners in looking after themselves. Dr Cocker: The brief answer to the original question would be that communicating and getting a history from a patient are the cornerstone of the patient-doctor relationship. I do not think that the SPR is ever intended to replace that. Where I see its value within maternity, although I am sure that this is the same across all specialties, is that it would form a reliable means of cross-referencing information and being able to get information that—as we have alluded to previously—is often held on many separate systems. As a clinician, you will often not have the ability or the credentials to access that. For example, in maternity care at my trust we use a certain piece of software. If you do not work in maternity, although you might be able to get generic access to it, you might not be able to navigate that system. The idea of the SPR is that it would pull out those key bits regarding current concerns about the pregnancy or what follow up has been arranged—all those kinds of things. That would not rely on the ability to use lots of different systems; instead, the information would be available. If there is information that requires cross-referencing or checking, it would also give you the ability to do that rather than replacing the process of taking a history and working out what is wrong with someone. Dr Byrne: It is a terrific question. Healthcare is a relationship; it is not simply a transaction of facts. At its best, it is a working relationship between a clinician and a patient, but that is also why it is so hard sometimes. Our stories are a combination of two things: the facts and the interpretation of those facts. We heard a moving example earlier of someone saying that they had had five miscarriages and those facts were then not known and how distressing it was that they were not. That is a good example of why getting the facts from conversation to conversation could be really helpful. Our life story changes over time, however, as does the interpretation that comes up in a conversation. As a doctor in the moment with a patient, I am sometimes as interested in what they are choosing not to tell me at a particular time as what they are choosing to tell me. For all of us, the story changes and is fluid. I think that is a potentially helpful distinction to make.

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3. 16 Jun 2026·Parliament·Dr Caroline Johnson

   Health Bill (Second sitting)

   Q Do you have any thoughts on the separation of elements of the record such as safeguarding records and sexual health records? We have heard about carers being able to see parts of the record. Surely there are circumstances where we may want people to see parts of the record but not others, or people may wish to share some parts and not others. Are you aware of any provision being made for that? Dr Byrne: At the moment, I think it is too early to say. Those are absolutely important questions that will have to be addressed in the design. At the moment, I am not sure how the programme intends to deal with those questions, but clinically, that needs to be thought about. There are complications that need to be thought about very carefully in terms of the record and the access. Sometimes that is clinically complicated, but I am not aware of what the plans are for that.

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4. 16 Jun 2026·Parliament·Dr Caroline Johnson

   Health Bill (Second sitting)

   Thank you. You are nodding, Dr Cocker. Dr Cocker: I was just going to say that we did do some exploratory work in relation to safeguarding, because that is quite a key part of safe maternity care, but because of the issues with confidentiality for other involved parties—say, a mother’s partner or someone else in the family—and the risk of that information being pulled through to someone else’s single patient record, it was felt that we could not include any information that contained information about anyone else. That aspect has been considered, but as Dr Byrne said, it would need careful consideration of all those different sources and whether there would be any option to change what feeds in. The only one I am aware of that we have looked at specifically was safeguarding, and it was primarily due to confidentiality issues for other involved parties.

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5. 16 Jun 2026·Parliament·Dr Caroline Johnson

   Health Bill (Second sitting)

   Q Presumably, the obstetrician may need to be aware of previous pregnancies, but the patient may not want their current partner to know about them. Dr Cocker: Yes, and those are concerns with the existing systems. There are multiple sources of information we record on a clinician-facing basis that might be deemed sensitive or confidential that are not available from a patient-facing perspective. It might be sexually transmitted infections or previous pregnancy history that a mother does not want someone else to be able to access on the patient-facing aspect of the record. Being able to provide that is very important in realising the end product of the SPR.

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6. 16 Jun 2026·Parliament·Dr Caroline Johnson

   Health Bill (Second sitting)

   Q Good afternoon, Mr Restell. When the NHS has been reorganised in the past, it has become more centralised or less centralised. Which do you think this Bill does? Jon Restell: There are lots of different ways to answer that. Obviously, some functions of NHS England moving into the Department, with powers going to the Secretary of State, feels like a centralising measure. I know that the ambition of Government is to give local NHS bodies more freedom and autonomy, but the Bill is very careful and goes into a lot of detail to leave powers with the Secretary of State to intervene in the running of those local bodies. On the whole, it is probably more of a centralising measure. Another way that some changes outside the Bill process are centralising is through the merger of ICBs and, arguably, quite a lot of providers. Whereas before you might have two or three ICBs covering an area, you now have half the staff covering much bigger geographies. I would argue that that centralises decision making to a higher level than formerly.

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7. 16 Jun 2026·Parliament·Dr Caroline Johnson

   Health Bill (Second sitting)

   Q What effect is that having on managers and their ability to do the day job and deliver care? Presumably, a lot of time, effort and energy, and perhaps a lot of worry, are going into the process of reorganisation. What effect does that have on the delivery of services and the development of new ones? Jon Restell: This, for us, is the crux of what is going on. The Bill is the Bill, but there is a finite management resource in the health service. I think that, internationally, it is considered to be quite low. Certainly, Lord Darzi, the Institute for Government and Institute for Fiscal Studies have all pointed to a shortage of management being one of the potential weaknesses of the NHS, so what is going on right now is knocking another big hole in an already limited resource of managers in the health service. That has the potential to create very large workloads for people in the new system, such that, inevitably, certain things will not get done or will not get done well enough. It certainly feels like we have gone into an environment where we are cutting a management cost without thinking about the management capability the health service needs to innovate, deliver reform, and do basic safety and resource management.

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8. 16 Jun 2026·Parliament·Dr Caroline Johnson

   Health Bill (Second sitting)

   Q That does not sound very good. The Government said that they were going to regulate NHS managers. What impact do you think that would have? Jon Restell: Our members have been on a bit of a journey on this one. I think that they would broadly support the regulatory proposals that the Government will bring forward after the consultation. I think the real impacts will be very limited, covering a relatively small number of people and being used in very exceptional circumstances, so I do not think that they will transform management culture and deal with the management capability issue we have. They are a very personal form of professional regulation that will have very limited impact.

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9. 16 Jun 2026·Parliament·Dr Caroline Johnson

   Health Bill (Second sitting)

   Q We have heard a lot today about things not being quite finalised yet; we are not quite sure where the destination is. Is it difficult for managers to be asked to transform from a current service to a new service if there is no well explained vision and understanding of what “new” looks like? Jon Restell: That is probably driving most of the anxiety and uncertainty that people are experiencing, and it is why, for some members, this is becoming psychologically very difficult. You have a change programme that started in March last year with the announcement by the Prime Minister of the abolition of NHS England and the halving of the staff of NHS England and ICBs. For 18 months, that process has dragged on, with lots of design decisions still to be taken about how the organisation will look, what functions it will have, what will be going to the Department and what might be going elsewhere, and what will potentially go to trusts from ICBs and from ICBs to regions. Despite all that uncertainty, people are being told to make decisions about voluntary redundancy and the future where they do not understand where that future potentially sits for them. That is undoubtedly driving a lot of people to feel psychologically unwell and distressed, and they are leaving. People are beginning to leave, because they need to protect themselves. There is another part to this. Obviously, that is a very personal issue for our members, but the other thing is that they are really worried about the service to the public, the safety of the changes and what will happen to various functions that they are responsible for, if teams get halved and responsibilities are taken to a higher level in that more centralised model. For example, we have a lot of members working in ICBs who have really hands-on roles in the care of individual children, particularly where providers fail. Those kinds of concern are not being properly addressed in terms of risk and continuity of service to those people. We are going to survey our members—we will share the results with the Committee—in the next week or so about what specifically is worrying them about the way that change is being managed. With due respect to the Minister, this was all announced without a plan, and we are now waiting for a plan to emerge, 18 months into the process.

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10. 16 Jun 2026·Parliament·Dr Caroline Johnson

    Health Bill (Second sitting)

    Q We do not have a plan of where we are going, but you have been asked to go somewhere. Jon Restell: Obviously, we have the 10-year health plan, which most people broadly see as a good vision for the service, but there are too many key design questions around the new department, the role of the department’s regions, what ICBs will be doing and what trusts will take on as part of this reorganisation. Behind it, there is a lot of capacity and resource organisational memory being taken out of the system. We do not talk nearly enough about the work of the commissioning support units staff, who are providing internal consultancy and a huge range of business services to the health service, including overseeing child immunisation programmes in some cases. It is really unclear what the future of those functions is. We are taking out a lot of staff who have skills, expertise, organisational memory and commitment, but we do not quite know yet what the precise form of those organisations will be. It is a very difficult change to manage.

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11. 16 Jun 2026·Parliament·Dr Caroline Johnson

    Health Bill (Second sitting)

    Q Good afternoon. Social care is one area that is absent from this Bill. To what extent is it possible to make the health service more efficient without tackling problems in adult social care? Sir Andrew Dilnot: It is largely absent from the Bill—indeed, when I was asked to come and give evidence to this Committee, I was initially somewhat puzzled, since it is so largely absent. The question you ask is absolutely to the point: certainly, we can improve the efficiency of the NHS without doing anything about social care, but we cannot really address many of the fundamental problems facing the NHS if we do not sort out social care. That is partly because not having a good social care system means that we are not achieving the levels of human flourishing that are the objective of the health service and the social care system. It is also the case that the social care system is now under such pressure that it is leading to direct challenges for the NHS. We hear a lot about delayed transfers of care, which are an important part of this, but it is not just those; it is people who end up needing healthcare because they have not had appropriate social care support. The short answer to your question is that we can make the NHS a bit more efficient without reforming the social care system; but until we address social care we have at least two hands, and probably one foot, tied behind our back. It seems pretty astonishing to me that we have a 10-year NHS plan but no real plan for social care.

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12. 16 Jun 2026·Parliament·Dr Caroline Johnson

    Health Bill (Second sitting)

    Q We have heard evidence today that the Bill weakens links between local authority working and the ICB. Does that help social care, or could that actually make it worse? Sir Andrew Dilnot: I would not claim to be expert here, but I have read the Bill and the briefings. The role of local authorities in social care is a very interesting one. If we were to stand way back and honestly answer the question, “Why is social care managed by local authorities at the moment?”, we would say, “Because it was forgotten in 1948, when the rest of the modern welfare state was created.” At that stage, social care was a pretty small activity, and it was just left with local authorities. What has happened since then is that it has grown and grown, and it is now putting enormous strain on at least many local authorities. I think we should draw a clear distinction in something that is definitely appropriate—that is, care being provided within a local context. The kind of care that is appropriate in Camden will be different to the type of care that is appropriate in the highlands of Scotland. Local delivery seems relevant, but whether local financing makes sense in 2026 is a very big question. That is the context. On its own, it is hard to see the potential reduction in the role of local authorities in ICBs making things better. It will not necessarily make things significantly worse, but I do not think it will help local authorities and the NHS in trying to integrate these two essentially non-integrated functions.

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13. 16 Jun 2026·Parliament·Dr Caroline Johnson

    Health Bill (Second sitting)

    Q You have talked a lot about adult social care in terms of the very elderly and frail and people with dementia, but it also affects younger people. For example, Swallow Lodge, which is a facility for working-age adults in my constituency, is under threat of closure. I and others have made the arguments about how it is a lifeline that allows the families to have a break and the individuals using the service to flourish and enjoy life, but there is an economic argument too. How well do you think that is understood? Closing such a place could lead to higher costs for the NHS in mental health or physical health support, further social care admissions and the like. Sir Andrew Dilnot: You are absolutely right to emphasise the importance of non-elderly adult social care, which is roughly half of all of the expenditure and growing. One reason that we see particular pressures in the elderly care sphere is that the less-elderly need has grown very dramatically, again because of the scope for increased human flourishing. On the whole, as far as I can see, there is very little understanding of the integrated nature of these costs between social care and the NHS, so I think there is very little thinking in budgetary terms about the consequences of the squeeze on social care leading to increased expenditure and needs elsewhere in the NHS. That is not easy to resolve. Moving to a system that properly integrates those trade-offs will be difficult, and it requires a different sort of funding regime, but while we do not, those costs exist. My sense is that they are second order at the national level, but where they are certainly not second order is for the individuals concerned and their families, for whom this kind of thing is an eruption of anxiety and grief, in the context that families are already under pressures that most of us would find hard to imagine.

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14. 16 Jun 2026·Parliament·Dr Caroline Johnson

    Health Bill (Second sitting)

    Q Minister, you have previously said: “The reorganisation of health services always distracts from people’s jobs, destroys morale and wastes money”.—[Official Report, 22 September 2020; Vol. 680, c. 809.] In response to a written question this week, though, which asked what assessment you have made of the disruption of development of new services caused by the abolition of NHS England, you said: “The abolition of NHS England is causing no disruption to the development of new services.” I wonder which of those statements you agree with the most and whether you want to change your mind in the light of any of the evidence you have heard today. Karin Smyth: I do not know exactly what year you are quoting from, but I am happy to take that full on. Of course, change, reorganisations and changes in legislation have consequences at different times depending on what they are. That will determine changes to some services at local level. I think that quote probably relates to the 2012 changes, which, as I have often said, brought me into Parliament. The entire infrastructure of the health service was destroyed and changed in order to bring forward that legislation. I can never find anybody—I think I have heard Lord Lansley say this—who thinks that was a good thing. I am very happy to say that part of the rationale was the fact that, despite lots of warnings about the damage to that infrastructure, that lesson was not learned. We will not go through the history of the passage of that Act. It even had to be paused mid-way through to enact other ways of making things work. I am sure that you will come back in your second question to decisions about some of the provisions in this Bill. It is true, and a matter of record, that as an incoming Government we did not intend to abolish NHS England as an organisation; in our determination to change the outcomes of the health service, that decision was made some eight months into our being in government. Today, we have not heard a single person suggest that that decision is wrong. Dr Johnson is from the Opposition. The Bill was not opposed in principle on Second Reading. There is overwhelming consensus on the major provision in the Bill—the abolition of NHS England—and on the single patient record. I am mindful, on a personal level, of the consequences for individual people’s jobs and of trying to get that right. I accept much of the criticism from Mr Restell about how it would be better to do it much more quickly, and about making sure that it is done in a different way, but the consequences of abolishing NHS England are some of the things that we are seeing.

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15. 16 Jun 2026·Parliament·Dr Caroline Johnson

    Health Bill (Second sitting)

    Q May I press you on the answer to my first question before I move on to the next? In the light of what you have heard today, do you want to correct your statement this week, in response to a written question, that the abolition of NHS England is “causing no disruption”—yes or no? Karin Smyth: In terms of service delivery—I think the written question was about delivering services— I stand by that.

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16. 16 Jun 2026·Parliament·Dr Caroline Johnson

    Health Bill (Second sitting)

    Q My next question is about the vision. My right hon. Friend the Member for Melton and Syston spoke earlier about his reforms of the past, and there was a coherent vision to those, but today we have heard that there is not really a plan. On the single patient record and other aspects of the Bill, lots of decisions have yet to be made. You are asking people to move from here to there without specifying where “there” is. Is this ready? Are you trying to get to a landing place that you understand as a coherent vision, or are you just trying to unpick things that somebody did before and that you did not like? Karin Smyth: Do you mean the future state of ICBs?

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17. 16 Jun 2026·Parliament·Dr Caroline Johnson

    Health Bill (Second sitting)

    No, I mean the system as a whole. My right hon. Friend the Member for Melton and Syston spoke earlier about how ICBs were designed to link in with upper-tier local authorities, and he gave a reason why. Under these reforms, Lincolnshire ICB, which was part of a mayoral authority, will now link in with Derbyshire and with Nottinghamshire, which are part of another mayoral authority but not a complete mayoral authority. You have things jumbled up. I wonder whether that is because, rather than having a vision, you have started to unpick somebody else’s work because you did not like it. Likewise, with the single patient record, we have heard that lots of necessary decisions were not made before the Bill was introduced, so people are being asked to deliver things that have not been properly considered. Is that fair? Karin Smyth: I think they are two separate things. On the provision made in the Bill, abolishing NHS England brings with it a lot of technical detail to ensure that the legal responsibilities and duties are placed, rightly, on the Secretary of State and into ICBs. It clarifies the landscape on very technical matters such as licences and foundation trusts, and there is a large chunk of detail on the consequences of abolishing NHS England. Alongside that, there is a move to give ICBs a larger footprint, in parallel with the Government’s agenda on devolution. I accept that that is a lot of change in all our constituencies and for all our areas. We are making sure that we make the most of mayoral authorities to allow mayors to be on ICBs, as they are largely determiners of a lot of economic development, transport and indeed the wider determinants of health. We are still going through some of that change; you will recently have been written to for your views on it as local Members of Parliament, along with local government. We need to make sure that that is embedded as quickly as possible so that we can stabilise that side of the system. On the single patient record, the Bill will provide enabling powers to bring it forward in regulations. There will be further detailed consultation both with clinicians and with patients and the public, as we have heard, because building trust is critical. That will come next, which is usual in parliamentary terms: as legislators we understand that primary legislation makes provision and secondary legislation sets out regulation. I thought Dr Byrne was very helpful earlier on the point about bringing public trust with us and explaining the two stages of bringing this forward.

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18. 16 Jun 2026·Parliament·Dr Caroline Johnson

    Health Bill (Second sitting)

    Q We have heard a lot about independence: the independence of HSSIB, its ability to independently investigate and independently recommend, and Healthwatch’s ability to independently describe patient voice without interference from those whose homework it is marking. Do you have any reflections on the Bill and what it contains in the light of what you have heard? Karin Smyth: There is a fundamental philosophical, and perhaps political, difference in the approach that this Government are taking compared with what has gone before, in terms of the notion of responsibility and accountability for both commissioning and delivering services, and the position of independence. We talked earlier today about perception and reality. The system has not worked. To my earlier question— I think I said this on Second Reading—we have had what is called an independent voice in some of these bodies for over 50 years, and we have had numerous recommendations. I disagree with Jeremy Hunt on this. Under his stewardship of the new NHS England, we had a plethora of recommendations and new organisations, and layer upon layer of bureaucracy, totally remote from any kind of democratic accountability or oversight. That is not working, and I do not think that anybody is really defending that. It is the job of the NHS—both providers and commissioners—to include patient voice and patient experience in their work. I think Ciarán Devane from the NHS Alliance said that getting boards right, in terms of their managerial, clinical and patient experience work, is their responsibility. Outsourcing lots of that work to other bodies has not worked, and I think it is outsourcing that responsibility. We have to make boards work at a local level; they have to step up to the plate, and I think they want to. They are certainly equipped to be able to do that—not taking into account that people will need some skilling in some of these areas. There is a debate to be had about independent organisations, and I think we will have a good debate on it in Committee. As a final comment before you come back, this is a bit of a bugbear of mine, and perhaps as I am speaking on behalf of the Department I should not say it, but I will: none of my constituents are hard to reach—not a single one of them. We know exactly where they are; we largely know what is wrong with them; we largely know what their health outcomes are going to be; we know their ethnicity, demographics and so on. What are hard to reach are the remote organisations that have not served them well, and that is what we are determined to put right. Putting that right in this Bill is the start of doing that.

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19. 16 Jun 2026·Parliament·Dr Caroline Johnson

    Health Bill (Second sitting)

    Q The question was really about trust, and how people can be trusting of figures. For example, with Healthwatch, if you internalise patient experience into an organisation, do people then trust you when you say that it has got better? They will have only their own experience and the experience of their own family to work on; that will be the lens through which they look at things. We know that the waiting list numbers have come down, and there is not widespread trust in those numbers, for all sorts of reasons. If the numbers for patient experience are governed by the Department of Health, or the ICBs themselves marking their own homework, will the public trust them? Whether they should trust them is one question, but will they trust them? Karin Smyth: I will come back to the waiting lists, but you are absolutely right about trust. In saying that I expect this to be the board’s job, I think it is its job to get this right, and we need to support it to do that. We heard a bit from Penny Dash about the national quality board and the patient experience directorate inside the Department of Health and Social Care reporting directly to the chief executive and the permanent secretary. That has to be part of the wider architecture, which is of course outside the Bill, so we need to be able to tell that story to the wider public. We know from all the recommendations, reviews and the support that we give as Members of Parliament to our constituents that trust is really important. Getting that right and bringing people on that journey with us will be really important. Independence helps with that, and that it is why it is good to debate it as we consider the Bill—it is good to be able to air some of it—but I think people accept that things are not working and have not been working. I think your question about waiting lists is about the data and the information that says where we are at. It is really complex. To follow NHS England’s data, of which there is a lot—I commend the amount of data that is available—you need to be quite clever at spreadsheets, and at finding and articulating data, in order to bring it back to your own constituency and local place. These things are complex. It is complex to record, track and recognise how people move through a waiting list, for example. It is good that we are transparent about that. One thing that I am keen to push out is data on performance in trusts. Making so-called league tables is controversial, but the more information that we have out there, and the more we have honest debates about how complex and difficult it is—I am happy to take your questions around how that moves in order to for us to explain that—the more that helps to build trust.

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20. 16 Jun 2026·Parliament·Dr Ben Spencer

    Thames Water

    Will the Secretary of State guarantee that no taxpayer money will be used to bail out Thames Water or its shareholders?

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21. 16 Jun 2026·Parliament·Dr Ben Spencer

    Cyber Security and Resilience (Network and Information Systems) Bill

    Before I begin, I would also like to make some remarks in commemoration of the 10th anniversary of the murder of Jo Cox. I never met Jo Cox. I never knew Jo Cox, and I am very sad that I did not, because having seen the impact she has had on our politics, on this place and on the people who knew her, she was clearly an incredible person. I do not think anyone can disagree with what she stood for, and in particular, that we have more in common in our politics. Our politics is worse off without her. Yet again, we return to this Government’s vacant vacillation regarding our national security. I urge the Minister again to take this opportunity to strengthen UK cyber-security from the threat posed by foreign state actors. Protecting the UK and its citizens is the primary responsibility of Government, but still, in the face of clear evidence of increasing threats, this Government fail to act. The risk of physical threats and the need to invest in defence are clear to all, yet the Government prioritise increasing welfare spending over the safety and security of armed forces personnel and our country. The situation is so serious that the Defence Secretary had to resign, as he could not defend the inaction of this Government or the risks they are taking. While the dangers presented to our cyber-security may be less visible, they are no less real. Hostile state actors are working every single hour of every single day to undermine our democracy and our security. These are risks that every Member across this House will be aware of. It is chilling to know that when Iran shut down its internet access, social media accounts purporting to be pro-independence Scottish people stopped tweeting. Expert analysis has estimated that thousands of similar accounts could originate in Iran and that as much as 26% of such accounts could be fake. Social media is now a weapon. We know that hostile state actors have sought to attack and undermine Parliament. Just last week we were told that spyware had been discovered in Government buildings linked to recent high-profile decisions regarding China’s controversial mega-embassy project in London.

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22. 16 Jun 2026·Parliament·Dr Ben Spencer

    Cyber Security and Resilience (Network and Information Systems) Bill

    I thank the hon. Gentleman for the knowledge and experience he brings to the background of that particular case. I entirely agree that it is incumbent on all parties across the House to strengthen our national security and to be clear-eyed about the threat of hostile state actors. I will continue to develop that point in my wind-up speech. The evidence is clear that we face an increasing threat from foreign state actors. We need to take action to recognise those risks and to prevent such attacks. Cyber-security should be at the forefront of our defences, and for that reason, His Majesty’s loyal Opposition have focused again on amending the Bill, particularly with new clauses 14 and 15. We table them in the hope that the Government will not squander another opportunity to act in this Bill. New clause 14 would require the Government to directly identify the threats we face, ending the prevarication we have seen in recent months by obliging the Secretary of State to establish and maintain by regulation a list of foreign powers presenting a significant cyber-security risk to the UK. The amendment would strengthen the link between intelligence agencies and policy enforcement, ensuring that decisions by the Secretary of State to deploy special national security direction powers are based on GCHQ’s verified risk assessments regarding hostile states and state-affiliated groups. It is not about reacting after an attack occurs, but creating a proactive framework to evaluate and mitigate threats, built directly into UK supply chains. That would ensure that the UK is better prepared to deal with cyber-threats and attacks from hostile state actors. With the risks continuing to grow, these decisions cannot remain at the political whim of a Government who are reluctant to act. Let us talk about the dragon in the room. In 2024, the National Cyber Security Centre confirmed that China state-affiliated actors were responsible for cyber-attacks on the UK’s Electoral Commission and Parliament in 2021 and 2022, yet this Government continue to refuse to recognise China as a threat to the UK. New clause 14 would compel the Government to recognise formally what is readily apparent to those on these Benches, to our security services and to the many Members across both Houses who have expressed urgent concern about the security risks that China and other foreign state actors pose to the United Kingdom. The new clause would force the Government to acknowledge that China is a threat. In view of this established and growing threat, our new clause 15 would compel the Secretary of State to review state-sponsored cyber-threats to the UK’s infrastructure, including the cyber-security risk to surrounding critical networks in the vicinity of the super-embassy site in the City of London. As I said in Committee, there is simply no point in granting the Secretary of State powers to issue directions on the basis of national security if the Government are not willing to be clear-eyed about the most critical national and cyber-security threats to this nation. The new clause also strikes an important balance between ensuring parliamentary scrutiny and recognising and protecting the sensitive nature of some of the material that may be unearthed, by making provision for such information to be sent to the Intelligence and Security Committee of Parliament. I am pleased that, having resisted calls to address this risk during previous stages of the Bill’s progress, the Government have now taken some action to address risks from foreign state actors. The publication last week of their National Security (State Threats) Bill comes in response to a sharp spike in state-backed intelligence operations, sabotage and proxy violence. Their own explanatory notes to that Bill state: “Threats to the UK from foreign states are persistent and take many forms, including espionage, foreign interference in the UK’s political system, sabotage, disinformation, cyber operations, and even assassinations. Collectively these are referred to by the Government as state threats.” However, the Bill itself does not once mention cyber-security, and contains no provision requiring assessment of the risks posed. It does not apply to states themselves, and therefore can only be complemented and strengthened by new clauses 14 and 15, which no responsible Government or Member of the House could vote against. Amendment 3, which would insert a provision headed “Exemption from disclosure: right to a fair trial”, was tabled by my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith). As a Member of Parliament whose constituency includes Runnymede, I am proud both to call him a friend and to work with him on, in particular, his fight for the rule of law and fair trials. The amendment would prevent the sharing of information with overseas authorities for the purpose of prosecuting crimes not committed in the UK, if the Secretary of State determined that the receiving country was one in which the right to a fair trial could not be guaranteed. It would address genuine human rights concerns, and would close a loophole in the Bill that currently fails to anticipate politically motivated requests from authoritarian states. It would help to block hostile state actors such as Russia, China and Iran from probing our systems to detect firmware back doors or vulnerabilities within, for instance, the UK’s utility networks, healthcare systems and data centres. It would also create a statutory duty for the Secretary of State to submit an annual report to Parliament justifying decisions on which foreign jurisdictions are trusted or barred from intelligence sharing. That alone would be invaluable, and would end the many fruitless hours of questions and debate in the Chamber initiated by Conservative Members seeking a clear answer from the Government on whether they see countries such as China as a threat—per my earlier remarks. I am therefore pleased, on behalf of His Majesty’s Opposition, to support my right hon. Friend’s amendment. Let me also pay tribute to the Chair of the Science, Innovation and Technology Committee, the hon. Member for Newcastle upon Tyne Central and West (Dame Chi Onwurah). I thank her for her comments, which were echoed by others, about the risk from the internet of things and cellular modules. That is an important area, and we need to get it right. I will conclude by addressing the amendments tabled by our Liberal Democrat colleagues regarding digital sovereignty and the impact that this approach could have on the UK. New clause 13 is the clearest demonstration to date that the Liberal Democrats do not understand the tech sector or global supply chains. Of course it is right to support British business, but it is not feasible or possible to achieve full sovereignty in a global market or supply chain. Rather, we should prioritise capacities and capabilities, and ensure that the UK has an indispensable role in global supply chains.

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23. 16 Jun 2026·Parliament·Dr Ben Spencer

    Cyber Security and Resilience (Network and Information Systems) Bill

    I refer the hon. Member to her new clause 13, particularly subsection 3(c), which makes it very clear that companies would need to deviate from “foreign technologies”, which would be quite a burden. We need to back Britain in key sectors, from quantum and photonics to chip design and innovation. In so many areas, we lead the world. We should not try to restrict the influence and access of global markets. We must engage not in protectionism, but in leverage, to back Britain and position ourselves so that we are indispensable in the modern global tech sector and supply chains.

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24. 16 Jun 2026·Parliament·Dr Ben Spencer

    Cyber Security and Resilience (Network and Information Systems) Bill

    I do not want any part of the UK to be subject to the awful AI Act that has been passed by the European Union. Northern Ireland, and particularly Belfast, is a technological powerhouse of which we should be very proud. We need to ensure that it continues to go from strength to strength as part of our fantastic Union. We on the Conservative Benches will not back new clause 13, because we understand how markets and global supply chains work. We believe in Britain.

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25. 16 Jun 2026·Parliament·Dr Andrew Murrison

    Strait of Hormuz

    Iran has demonstrated that it can close the strait at will, and it probably will threaten to do so in the future when it wants something, so what can we do with international partners, particularly in the region, to engineer alternative routes that will allow oil, gas and fertiliser to exit the Gulf overland, thus neutralising the strait?

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26. 16 Jun 2026·Parliament·Caroline Nokes

    Cyber Security and Resilience (Network and Information Systems) Bill

    I call the shadow Minister.

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27. 16 Jun 2026·Parliament·Caroline Nokes

    Cyber Security and Resilience (Network and Information Systems) Bill

    I call the shadow Secretary of State.

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28. 16 Jun 2026·Parliament·Caroline Nokes

    Cyber Security and Resilience (Network and Information Systems) Bill

    I call the Liberal Democrat spokesperson.

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29. 16 Jun 2026·Parliament·Caroline Nokes

    Cyber Security and Resilience (Network and Information Systems) Bill

    I thank the hon. Gentleman for his point of order. I have had no notice that the Government intend to bring a statement, but I am sure that those on the Government Front Bench have heard him, and should that change, we will doubtless hear before the Adjournment.

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30. 16 Jun 2026·Parliament·Caroline Nokes

    Business without Debate

    I thank the hon. Gentleman for his point of order. He will know that comments made outside the Chamber are not a matter for the Chair, but he has put his point on the record.

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31. 16 Jun 2026·Parliament·Bob Blackman

    Topical Questions

    In Pakistan-occupied Kashmir, Pakistani security forces have fired on peaceful demonstrators who were standing for human rights, and the right to food and proper security in their area. More than 30 people were killed, and more than 200 injured, including British nationals. What action has the Secretary of State taken to call in the Pakistani high commissioner and say not only that that is unacceptable, but ask what action is being taken to protect innocent bystanders?

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32. 16 Jun 2026·Parliament·Bob Blackman

    Thames Water

    The Secretary of State is absolutely right to put customers at the forefront, but the problem, as she said in her statement, is that this will all take rather a long time to unwind. At present, uncertainty is the real concern for customers, especially the uncertainty about whether they will be charged extra on their bills. The Secretary of State has given a letter to Ofwat, but what specific changes does she want to see in the deal to encourage her to agree to it, so that we can move forward rather than having uncertainty?

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33. 16 Jun 2026·Parliament·Alison Griffiths

    Community Hospitals

    The hon. Lady is making a powerful point about trust and promises being made but not delivered. Twenty years ago, Littlehampton hospital in my constituency closed, with the promise that a replacement health service would follow. In Rustington, there has been a lack of consultation and the hospital has closed; we are hoping it will reopen. Does the hon. Lady agree that consultation, trust and following through on promises are so important?

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34. 16 Jun 2026·Parliament·Alison Griffiths

    Community Hospitals

    It is a pleasure to serve under your chairmanship, Sir Jeremy. I congratulate the hon. Member for South Cotswolds (Dr Savage) on securing this vital debate. I also commend the hon. Member for Cumbernauld and Kirkintilloch (Katrina Murray) for sharing her experiences in a community hospital setting, which were really interesting to hear. When I think about community hospitals, I think about trust. I think about the residents in my constituency who lost Littlehampton hospital more than 20 years ago. They were told it would be rebuilt. They were told not to worry. Yet to this day, many local people, like my constituent Sandra, still talk about what was taken away from them. The site is still cordoned off, unused. When local NHS leaders ask my constituents to trust them today, they are speaking to people who have heard those reassurances before, only to see valued community hospitals taken away from them. That brings me to Zachary Merton hospital in Rustington. For many of my constituents across Bognor Regis and Littlehampton and our villages, Zachary Merton is not simply a building: it is somewhere they received treatment, welcomed children into the world and visited loved ones receiving palliative care. It is somewhere that provided those services close to home when they were needed most. The decision to permanently close in-patient services and remove beds at this much loved community hospital has caused enormous concern. Residents packed a public meeting that I organised last month. Hundreds more have signed petitions, written to me and contacted my office. They are not asking for special treatment; they are asking for a voice. West Sussex county council’s health and adult social care scrutiny committee has already determined that closing Zachary Merton was a “significant variation” in service provision. That is vital because Parliament has established a statutory process for a reason. Residents trust those of us who sit in this place to ensure that those processes are followed. We are not talking about moving a cupboard from one room to another; we are talking about the permanent loss of healthcare services. What on earth is the point of Parliament setting rules around consultation if local NHS leaders can simply decide that they do not apply? What is the point of local authority scrutiny committees examining those decisions if their conclusions can be brushed aside? What is the point of telling residents that they have a right to be heard if services can be removed from them before they are ever given that opportunity? That is what my constituents simply cannot understand. Frankly, neither can I. I have formally asked the Secretary of State to call in the decision to close Zachary Merton hospital. I raised it again at Health questions only last week, and I will continue pressing until my constituents get the answers, consultation and respect they deserve. My constituents have heard this story before. They were told that Littlehampton hospital would close temporarily, but temporary became permanent, and 25 years later people still talk about the services that were lost. So when residents are told not to worry about Zachary Merton, can Ministers really be surprised that they are sceptical? Community hospitals should be part of the future NHS, and they should help keep care close to home. They support rehabilitation and reduce pressure on acute hospitals. Most importantly, they give people confidence that local healthcare services will still be there when they need them. They must not become easier places from which to remove services. My constituents have already seen one community hospital disappear. Their trust must not be taken for granted again, either by local NHS decision makers or by this Government. They are determined not to see history repeat itself, and so am I.

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35. 16 Jun 2026·Parliament·Alison Griffiths

    Access to Dental Services: West Sussex

    It is a pleasure to serve under your chairmanship, Sir Desmond. I congratulate the hon. Member for Chichester (Jess Brown-Fuller), my constituency neighbour, on securing this very important debate. Access to NHS dentistry is one of the issues that my constituents raise with me most often, and when they do, they are not talking about contract reform, commissioning arrangements or NHS structures. They are talking about pain, cost, worry and ringing practice after practice but still not being able to get an appointment. Anthony in Littlehampton contacted me after being told that he needed a crown. He is on personal independence payment and employment and support allowance. The treatment that he needs would cost hundreds of pounds. His question was simple: how is he meant to afford that? Clare in Bognor Regis did everything that patients are told to do. She remained with her NHS dentist and kept up with her appointments. Yet she was then told that NHS provision at her practice was being reduced and that she would be placed on a waiting list. Jill in Middleton-on-Sea is a pensioner who has spent years trying to navigate a system in which practices close, go private or stop taking NHS patients altogether. She is still trying to find care that she can afford. Those are not isolated cases. They show what happens when NHS dentistry becomes too difficult to access. People wait, put treatment off and make compromises that they should not have to make, and then routine problems become urgent ones. We too often talk about dental care as though it sits separately from the rest of the NHS. It does not. Poor oral health affects confidence, nutrition, wellbeing and wider health outcomes, including in respect of heart disease and septicaemia. One constituent who contacted me, Andrew from Bognor Regis, was undergoing treatment for two separate cancers. Through no fault of his own, regular dental appointments had—understandably—fallen by the wayside while he focused on fighting those illnesses. When he later tried to access NHS dental care again, he found himself in effect locked out of the system—abandoned at precisely the moment he needed support the most. What struck me was not simply his concern about finding dental care, but the wider impact that poor access can have on a patient’s healthcare journey. A patient battling cancer should not also be worrying about whether they can access a dentist. However, there has been some local progress and I would like to recognise it. In Bognor Regis, mydentist is now delivering additional NHS dental activity and offering about 56 urgent appointments each week. That matters. Urgent appointments help people to get treatment when they need it the most, and stop problems becoming even more serious. The local ICB has also confirmed that new NHS dental contracts have been awarded for both Bognor Regis and Littlehampton, with services expected to open next year. That is welcome. But let us be honest: we are not where we need to be. My constituents should not have to become dental detectives simply to find treatment. They should not have to wait until pain becomes an emergency before the system responds. Urgent care is important, but must not become a substitute for routine access. We also need to get much more serious about prevention. That starts with children. It starts in the early years with good habits, education and helping families to understand the importance of looking after their oral health. Prevention is better for patients, and it is also better for taxpayers. Finally, we need to make every appointment count. I recently met Katie Cook, the practice manager at the new mydentist in Bognor Regis, and she told me that around 5% of appointments each week are lost because patients simply do not attend. This is not about blaming people—life happens—but a cancelled appointment can often be reused; a missed appointment cannot. When so many residents are desperate to be seen, that lost time matters. The national dental contract still needs reform, access needs to improve and patients need clearer routes to care when they cannot find an NHS dentist. I will finish by asking the Minister three questions. First, what further steps will the Government take to improve access to routine NHS dentistry so that people are not forced to wait until a problem becomes an emergency before they can be seen? Secondly, what more can be done to support prevention, particularly among children and young people, so that we stop problems from developing in the first place? Thirdly, what assurances can the Minister give that areas such as West Sussex will receive the additional capacity needed to bring down waiting lists and improve access to NHS appointments? My constituents do not expect miracles—they understand the pressures facing the NHS—but they do expect to be able to see a dentist when they need one. They expect a system that prevents problems rather than simply responding to crises, and they expect access to NHS dentistry to be determined by need, not by whether they can afford to go private. That is the standard my constituents deserve, and it is the standard they expect this Government to deliver.

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36. 16 Jun 2026·Parliament·Alison Griffiths

    Access to Dental Services: West Sussex

    As this is a debate on dentistry in West Sussex, I invite the Minister to share the numbers that relate specifically to West Sussex rather than to the country.

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37. 16 Jun 2026·Parliament·Alison Griffiths

    Access to Dental Services: West Sussex

    In Bognor Regis and Littlehampton, and in significant parts of Chichester, we have coastal areas. In our manifesto, the Conservative party pledged golden handshakes to attract dentists to coastal constituencies, because we know that is one of the issues. Could you tell please me what specific proposals you have to attract dentists to coastal constituencies?

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38. 16 Jun 2026·Parliament·Alicia Kearns

    Draft Immigration (Leave to Enter and Remain) (Amendment) Order 2026

    It is a pleasure to serve under your chairmanship, Mr Betts. I am grateful to the Minister for his remarks. The Conservative party supports this order and the sensible operational change that it makes. e-Gates were rolled out across our major airports under successive Conservative-led Governments, with 264 e-gates operating by 2019. They now process the majority of arrivals at our busiest ports of entry, freeing up border officers to focus on genuine threats and concerns at our borders. We lowered the minimum e-gate age from 12 to 10 in 2023, following a successful trial, so we support the Government continuing in that direction. This is a practical change. As anyone who has stood in a Border Force queue at Stansted, for example, on a Sunday night in August with tired children knows, we want to get our children home as quickly and safely as possible. Where changes can be made safely and can ease the burden, we will support them. However, the effectiveness of e-gates relies on public confidence in the system, so can the Minister expand on whether the Home Office will monitor the impact of lowering the age threshold, particularly on processing times and accuracy rates, and the experience of families travelling with younger children? Will the Minister confirm whether the Independent Anti-slavery Commissioner has been formally consulted on the change, given her work highlighting the challenges that Border Force faces in identifying trafficked children, particularly at ports of entry? Will the Government commit to a review after the first year of operation to look specifically at the ability of Border Force to identify trafficked or vulnerable children at the gates, particularly those subject to modern slavery, and commit to broader safeguarding regarding children at those gates? We recognise the measure is a positive change. Our border must remain welcoming to legitimate travellers and robust against those who try to abuse it, particularly anyone with a malevolent interest in children.

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39. 15 Jun 2026·Parliament·Sir Julian Lewis

    Topical Questions

    How can it be justified for a unitary authority to be formed that rips the waterside away from the New Forest, and places it under the control of Labour-dominated Southampton, when the building blocks of the new unitary authorities were stated by the Government to be the existing areas covered by district and borough councils?

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40. 15 Jun 2026·Parliament·Sir Julian Lewis

    Defence Investment Plan

    I know the Minister accepts that I have criticised successive Governments for not spending anything like the 4.5% that Margaret Thatcher used to spend on defence at the height of the cold war throughout the 1980s, but does he accept that the service chiefs have made an objective assessment of the Government’s own strategic defence review, and have arrived at the conclusion that the sum of £28 billion is necessary to implement it over, I believe, a four-year period? If he accepts that, how can he possibly go along with an offer from the Treasury of less than half the total needed?

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