Dr Caroline Johnson

Conservative and Unionist Party MP for Sleaford and North Hykeham since (elected).

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  1. ParliamentDr Caroline Johnson

    Continuity of Care in the NHS

    Continuity of care is desirable but not always possible, and in circumstances where it is not, a single patient record offers an opportunity to improve care, but it also brings the risk of unauthorised access to <span id="955" class="column-number" data-column-number="955"></span>notes. We have seen recent high-profile cases where notes have been accessed that should not have been. That has led to people across the country worrying that this issue could affect them personally in less high-profile cases and about what will happen when the single patient record will be available nationally. How are the Government going to protect patient confidentiality?

    Hansard source
  2. ParliamentDr Caroline Johnson

    Continuity of Care in the NHS

    Another issue that affects continuity of care is when patients remain in the emergency department for prolonged periods after a decision is made to admit them to a ward. That has gone up by over a third since the general election. Can the Government say why?

    Hansard source
  3. ParliamentDr Caroline Johnson

    Infants, Parents and Carers Bill

    It is a pleasure to serve under your chairmanship, Dame Siobhain. I start by congratulating my right hon. Friend the Member for New Forest West on introducing this important Bill. I also recognise the contributions of Members of both Houses, and that of the former Members of Parliament Andrea Leadsom and Will Quince, who have done so much work in this area. I declare an interest, Dame Siobhain, as a consultant paediatrician in the NHS and a member of the Royal College of Paediatrics and Child Health. I put on record that the Opposition support this Bill. Child development is hugely important; that is why Committee members are here today. It is also why I am in this place at all, as it was a major motivator for me to become an MP. As a paediatrician, I saw the profound effect that children not receiving the care that they need in the early years can have. Some cases were of deliberate neglect, and I saw children who had delayed growth, delayed development or physical changes. I remember one little boy who was admitted with vomiting, but he was not ill with a medical condition. We discovered that he had learnt to vomit because nobody came when he cried. Those children need us to step up in a way that we do not always do at the moment. There is a spectrum, and most of the children are thankfully not in that situation, but it does demonstrate the profound changes that can occur if children are not looked after. However, we also see the profound improvements that can occur if children receive all the things that they need to thrive to their best potential. Sometimes parents may not understand the importance of certain interventions, or they may need support to deliver them. That is where this Bill comes in.

    Hansard source
  4. ParliamentDr Caroline Johnson

    Infants, Parents and Carers Bill

    I think it is important that we have both women and men in politics, because fathers have an important role to play with babies too, and gentlemen can talk about their experiences of fatherhood. <span id="16" class="column-number" data-column-number="16"></span>One of the challenges that some babies face is the lack of that male role model. It is a balance between the two. And, of course, women and men can talk about each or either topic if they wish to do so. The other thing I want to talk about is interaction and play—the serve and return. Being played with and stimulated is very important for brain development, and a lack of it can lead to reduced attention span, reduced memory and weaker impulse control in the long run. People might believe that interaction and play come instinctively, and to some they do, but to others less so. Support and understanding of what they can do to help their baby is something that I think women and men value, because almost everyone loves their children intently, so they will want to do the best for their baby, and sometimes it is helpful to know what that is. I often get patients in clinic who come with one problem, but if they have a small infant, they will often say, “While I am here, doctor, can you just look at this? Can I just ask about that?” I am sure the hon. Member for Stroud, as a GP, will tell us the same. Parents ask because there are so many questions, and having the opportunity to have them answered is very important. I also want to talk about inequalities, because we have talked a lot about them this morning. There is now inequality between the services provided in cities and those provided in rural areas. Does the Minister have any comments on how those services will be provided in rural environments? Very often the average income for a postcode may be good, but there will be hidden poverty within it, because of discrepancies within postcode averages that are seen less in cities. Transport can also be more difficult in rural areas. How will the Minister ensure that the services are accessible to those who need them? I want to talk about the money, because if we invest £1 in a child’s life at this age, we can get £10 in return owing to better outcomes in the long run. Will the Minister confirm that the money for those services will be provided in full, and that there will be a workforce plan to ensure that there is a workforce to deliver them? The hon. Member for Washington and Gateshead South, who I know has done a lot of work in this area over the years and cares about it very deeply, talks about outcomes. Outcomes are important, but so is value for money, because we must be careful with taxpayers’ money. What interventions are making the most difference, and how do we focus on achieving them? We need to think carefully about what we measure. Overall, however, this is a good Bill that will help infants and children to develop their full potential and have equality of opportunity, and therefore I will support it.

    Hansard source
  5. ParliamentDr Caroline Johnson

    Underperforming NHS Trusts: Government Oversight

    It is a pleasure to serve under your chairmanship, Mr Stuart. I congratulate the hon. Member for Chelmsford (Marie Goldman) on securing this debate on a subject important not only to her constituents but to all of us right across the country. The performance of the NHS is key to the health of the nation. It gives us all the best chance of good health and recovery, which is important for our social wellbeing and brings economic benefits. The first question is this: how do we know which trusts are performing well and which are not? First, we need to decide what good performance looks like. We can look at that in a couple of ways, in particular in relation to outcome and experience, both of which are important. The outcome, for example, may be a death. That will come to us all eventually, but the experience might be one of comfort, in line with the wishes of the individual—as good as can be delivered. Conversely, one could on the face of it have a good surgical outcome from a trust but a poor experience of care during that experience. Experience is measured in a number of different ways: individual staff, such as consultants, have patient feedback as part of their appraisal and revalidation; the friends and family test enables people to give anonymous feedback; the number of complaints or compliments can be measured; and trusts do their own surveys—but those are all to some extent internal processes.

    Hansard source
  6. ParliamentDr Caroline Johnson

    Underperforming NHS Trusts: Government Oversight

    Sorry, the microphone went off, but it has just come back on again. The processes are mostly internal. Healthwatch is an independent patient voice, which looks at people’s experience across the health service in a way that is independent of Government. As part of the Health Bill, however, the Government plan to abolish Healthwatch and to bring it inside the Department. Will the Minister comment on whether they still plan to do that? When he was Mayor of Greater Manchester and in charge of its integrated care board, the Prime Minister wrote to the Government to suggest that they might be on the wrong path. As Prime Minister, does he still think so? What instructions has the Minister had in relation to that? People are sometimes frightened to provide feedback to trusts, but they will be more willing to do so when they have confidence in being heard independently.<span id="180WH" class="column-number" data-column-number="180WH"></span> Other ways in which the Government measure experience relate to waiting times—how long it takes to be seen in clinic, how long it takes to be seen in A&amp;E, how long it takes from the decision to admit a patient to actually admitting them, or how long it takes for a procedure or an operation. The Government produce lots and lots of figures but many of them, I am afraid, go in the wrong direction. The Government have a dashboard for the referral to treatment statistics, and the waiting lists are rising. The number reached a low point in March 2026, just after the reports of exceptional numbers of removals, but it has now risen by 222,000 in the past four months. I am afraid that the numbers waiting for a procedure or operation are higher now than at the general election. This year, many more people than in 2024 waited more than 12 hours in A&amp;E after a decision to admit them. Staff sickness rates, mentioned earlier in the debate, are also consistently higher than they were before the general election. Statistics across the NHS are not going in the right direction. The Government also measure outcomes through the financial management of a trust, leadership and Government metrics, the number of procedures performed, the number of “never” events, and CQC inspections. Again, the Government are planning to fold HSSIB into the CQC, which many commentators have warned against; the Liberal Democrats and we the Opposition have spoken against the abolition of HSSIB. When the Government take the Health Bill through the Lords in Committee in the next week or two, I hope that they will think again. The Government also plan to roll a number of other things into the CQC at the same time, including events management; I wonder whether they are asking an organisation that they acknowledge has been struggling to take on too much. If poor performance is identified, who is responsible? Is it the consultant or the matron? Is it the directors’ suite—the chief executive or the chair? Ultimately, if a trust is underperforming at the moment, governors are supposed to hold the board to account. The Health Bill abolishes those. The ICBs—the commissioners—can hold the trust to account but their budgets have been halved, so will they have the capacity to do so? Many of them have merged, and some of those mergers have been paused by the Government. This is all a distraction. NHS England has a role, but it is being abolished too. Apparently, the overall headcount in the DHSC and NHS England is to be halved. How will they have the bandwidth to provide the scrutiny that the Government say they will have? Having identified the management of poor performance, the Government chose five trusts—North Cumbria, Mid and South Essex, Hull University Teaching Hospitals, Northern Lincolnshire and Goole, and East Kent—to have a special intensive recovery programme in March 2026. However, it is not clear what has been instituted in those trusts, what outcomes that programme is developing, how long it will last or what the Government will do for those trusts that fall just outside that group of five. How will the Government improve the variability between trusts that do not fall into the bottom cohort? How did they choose the five trusts that were chosen? As we heard earlier, there are several metrics by which some trusts could be considered in the bottom five, but they were not chosen, and some metrics by which those <span id="181WH" class="column-number" data-column-number="181WH"></span>that were chosen may not be in the bottom five. How has the Minister chosen those trusts and how does she intend to improve those that do not fall into her chosen few? The Government have promised a workforce plan, but the workforce is the most important thing. Right hon. and hon. Members have spoken in this debate about the really good staff in their trusts working extremely hard in very difficult conditions. The previous Conservative Government developed a long-term workforce plan. This Government decided that they wanted their own workforce plan—they won the election so they are very much entitled to make one. But they have still not written it. They promised it by the end of 2025; we are rapidly approaching the end of 2026 and it is still not with us. Can the Minister—<em>[Interruption.]</em>

    Hansard source
  7. ParliamentDr Caroline Johnson

    Underperforming NHS Trusts: Government Oversight

    Before the interruption, we were talking about the importance of workforce to the health service and to any improvements that we wish to make to services. The previous Conservative Government developed a long-term workforce plan. This Government decided to develop their own, which is fair enough, but it is very delayed. Can the Minister tell us, without using the words “in due course”, “imminently” or “soon”, when it will be published, preferably giving a date? Returning to other plans, the Government say that maternity and neonatal care is their priority, which is good, but when they came into government, they said that they had a plan to improve it. They spent the first 12 months writing their 10-year plan, which said that they would produce a maternity and neonatal plan. They did a review, which took six months longer than it was supposed to. They were then two years into a parliamentary term. That plan says that they will have a commissioner, who they have yet to appoint, and another plan for a modern service framework, which is apparently due by Christmas. Can the Minister guarantee that, two and a half years into the Parliament, they will have a delivery plan for maternity improvements? The bottom line is that I am concerned that the Government are too busy reorganising the NHS to deliver on their promises. NHS performance is declining in many areas. There is huge variability between trusts and departments. The Government picked five for intensive treatment. What about the others? Can the Minister clarify that it works? The Government are internalising patient experience, which means that it may suddenly look much better, but how will anyone have confidence in the figures if they are produced by the Government marking their own homework? The abolition of NHS England has been badly planned. ICB cuts, mergers and paused mergers are simply a distraction. The removal of the need for governors removes another layer of accountability and scrutiny. The Government say they are working at pace, but it is a very slow pace. The workforce plan and the maternity plan have been delayed, but so have things like the Hughes report. People suffering from valproate and mesh have been waiting and waiting. It is getting towards <span id="182WH" class="column-number" data-column-number="182WH"></span>three years since that report was published. They have waited long enough. I urge the Minister to say when the Government intend to respond to that report. The Government need to get a grip of who is holding the trusts to account, so that when the Health Bill comes out the other side of the Lords, there is a clear chain of command. Perhaps it will lead up to the Secretary of State, but it is clear that they will not be able to micromanage every detail. There needs to be a clear path so that people know who is accountable, who will drive improvement, who to congratulate when improvements are made and who to hold accountable when it goes wrong.

    Hansard source
  8. ParliamentDr Caroline Johnson

    Underperforming NHS Trusts: Government Oversight

    Will the Minister give way?

    Hansard source
  9. ParliamentDr Caroline Johnson

    Inheritance Tax

    It is clear that the hon. Member is taking this issue very seriously and thinking about it very deeply. What does he think about inheritance tax on businesses? I give him the example of a bandage factory making sterile bandages, owned by a family, where the 40-odd-year-old gentleman currently running that factory stands to lose quite a lot of money when his father dies. That will mean laying off people or selling the factory. How does that help the people who work there?

    Hansard source
  10. ParliamentDr Caroline Johnson