Karin Smyth

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Parliament's party history for this member: Labour (7 May 2015 – present).

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1. 28 Oct 2026·Parliament·Karin Smyth

   HCRG Care Group: Performance in the South-west

   It is a pleasure to serve under your chairship, Ms Lewell. I thank the hon. Member for Chippenham (Sarah Gibson) <span id="196WH" class="column-number" data-column-number="196WH"></span>for securing this debate and for her well-informed and considered set of proposals about a contract of which I am aware. I will try to address most of her points. The contract was signed just after the general election, but it was on my radar before then, partly as a local MP. As I think the hon. Lady said, there are staff here today, and I am conscious that this remains a concern for staff and some of the trade unions—not least because my hon. Friend the Member for Swindon North (Will Stone) has kept it on my radar. I am absolutely aware of the genesis of the process by which this contract came forward, and I want to make sure that people know that. I will not rehearse it, however; we are where we are now. As I think the hon. Lady said, now we need to make sure that what was promised is delivered. That is what we all want to see for the people of her community and across the wider ICB. I want to be clear on our general expectations of community services: they are really vital to the left shift, particularly in rural areas. A wide range of services is delivered under that umbrella—from district nurses to services provided by allied health professionals, such as physiotherapy and occupational therapy—for adults and children where they live, in local communities. They also provide really good local jobs. Those services are vital to supporting our ambitions for neighbourhood health, which is why we set out clear ambitions for them in our medium-term planning framework. For the first time, we have set a target for systems to reduce long waits for community health services: by 2028-29, at least 80% of activity delivered by community health services should take place within 18 weeks, bringing community health services in line with targets for elective care. We have also published guidance outlining the core components of community health services for children, young people and adults that ICBs should provide. That guidance is hugely important for many of the issues that the hon. Member for Chippenham has raised today. We know that there is variation in the services available across the country, and that people are waiting too long to access community health services. That is why this Government are taking action to reduce unwarranted variation, cut waits and improve access to high-quality community services. That is where we want to get to. Moving on to HCRG Care Group’s performance, as we know, it has taken on the contract to bring together more than 130 community health and care services across the ICB area. It is a large-scale “transformation” programme, as it is called. Since the contract was awarded, the ICB has obviously had to work very closely with it. The ICB is responsible for managing the contract, and I met it in advance of this debate to hear from it as well. As I understand it, the ICB has arrangements in place—the hon. Lady alluded to how many there are—to oversee quality, safety and performance across all those commissioned services, and performance is regularly monitored. I recognise the concerns about delays, callbacks and referrals across the teams, and about getting people through the single point of access. Single points of access have been worked on for many years under many different contracts. Generally, they should do what they say on the tin and actually help people move forward, so HCRG does need to make its work. I understand that, as a result of some of the issues that have been raised, the ICB is increasing its oversight, bringing together the provider and the system to support <span id="197WH" class="column-number" data-column-number="197WH"></span>improvement. It is really important that that work also brings together patients, carers, the local community, staff and other stakeholders as it develops. The ICB assures me that it remains committed to engaging openly with those communities, with MPs and with Healthwatch throughout the delivery and development of those community services.

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2. 28 Oct 2026·Parliament·Karin Smyth

   HCRG Care Group: Performance in the South-west

   I will come on to some of that, because it is also tied up with the Health Bill and the things that we are proposing to do for the future. The hon. Lady also touched on one of my favourite subjects: the accountability of local health systems. The hospital at home services are also important—as it says on the tin—to keep people out of hospital when they do not need to be there and to support early discharge. They remain an important part of the community services offer across Bath and North East Somerset, Swindon and Wiltshire ICB. There have been changes to the service provision and I am assured by the ICB that there are no plans to reduce capacity or withdraw the hospital at home service—I am sure that the hon. Lady will correct me if that is wrong. The ICB is currently undertaking a review of the services following concerns raised, and will continue to monitor the impact of those changes to ensure that safe and effective care is maintained. Again, that is absolutely the direction of travel in that we want to see those services change and improve.

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3. 28 Oct 2026·Parliament·Karin Smyth

   HCRG Care Group: Performance in the South-west

   I am going to finish my comments, if I may.

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4. 28 Oct 2026·Parliament·Karin Smyth

   HCRG Care Group: Performance in the South-west

   Industrial relations are also important. We cannot run a health and care service without good staff who are well supported, nor without maintaining good industrial relations at a local level. That is a matter primarily for the group, its employers and recognised trade unions. The ICB needs to continue to monitor that and go through those established processes for doing so. It needs to keep working with them and we certainly support that at a national level. On the wider issues about supporting ICB performance, I sympathise. I have spoken many times in Opposition and Government about the frustrations of local Members of Parliament in understanding the very fragmented system left under the Lansley reforms. I appreciate what the hon. Lady is saying from her position in Chippenham, and that may be different from other positions—it is a large geographic area. That is one of the issues that we need to get right. We are working closely on it in the Health Bill, where we are devolving responsibility and accountability for commissioning and providing services <span id="198WH" class="column-number" data-column-number="198WH"></span>at a local level. That is the right thing to do. We also need to get right the link to neighbourhoods and place through local authorities while strengthening health and wellbeing boards. That is the direction of travel in the Bill and what we are currently trying to make happen. ICBs are held to account nationally for delivering for patients. The oversight framework provides a transparent approach for assessing performance. Another thing that we have changed since coming into power is that from 2026-27 every ICB will be placed in a delivery segment based on national performance measures. That will help to identify when greater support, scrutiny or intervention is needed at the national level. That will be complemented by an annual assessment of how effectively each ICB is discharging its statutory functions. Where performance is falling short, oversight can be increased and support can be targeted at the areas of challenge and, where necessary, formal intervention powers are available. That brings ICBs into line with other providers. At the same time we are strengthening ICBs’ commissioning capability, partly through the Health Bill. We have the strategic commissioning framework setting out what effective strategic commissioning looks like, and the strategic commissioning development programme provides targeted support to strengthen those capabilities in local systems. We recognise that there is variability across the country. To be clear: ICBs are responsible for assuring the quality, effectiveness and value of the services that they commission, while NHS England oversees the performance of ICBs through the oversight framework, including consideration of how effectively they discharge those commissioning responsibilities. Finally, we have heard about issues with palliative and end-of-life care. Patients approaching the end of life and those important to them—their closest friends and family—should absolutely receive compassionate, dignified and personalised care in an appropriate environment. That is why the Government are committed to improving access to high-quality palliative and end-of-life care, and to shifting more care from hospitals into the community and, where appropriate, the home. NHS England requires ICBs to commission appropriate palliative and end-of-life care to meet the needs of their local populations. To support ICBs in that duty, NHS England has published statutory guidance and service specifications. In addition, we are developing a modern service framework for palliative and end-of-life care, which will be a clinically led, evidence-based framework to support sustained improvement in outcomes for patients and carers, including identifying, measuring and reducing health inequalities, and reducing unwarranted variation in access, experience and outcomes. We continue to work hard to strengthen community care services and shift care closer to home. As the hon. Lady said, what was promised to her population and the wider ICB area must be delivered. All too often, community health services do not get the attention that they deserve, and staff on the ground do not get the recognition that they deserve. This debate has raised some important questions about how we hold organisations delivering and commissioning services to account. The hon. Lady asked two questions about comparable data. If anyone has not read the transformation and opportunity packs that I sent all MPs last year about their local systems, I recommend that they do that. <span id="199WH" class="column-number" data-column-number="199WH"></span>I will continue to get information on their local systems to them. The hon. Lady probably knows that we cannot compare like for like, but she should have that information; we are getting it on stream. I am happy to write to her with details of what is or might be made available. The hon. Lady asked about the CQC. As she knows, it is an independent regulator, but I will ensure we write to her about it. I thank her and other Members who contributed to the debate. <em>Question put and agreed to.</em>

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5. 22 Oct 2026·Parliament·Karin Smyth

   NHS Maternity Services

   I thank the hon. and gallant Member for North Devon (Ian Roome) for raising this very important matter. He calls attention not just to his own constituency but, as we have heard from others, to a broader issue that we face, particularly in our rural and coastal communities. I want to stress that the Government are clear that all women have the right to receive the same high-quality, safe and compassionate care, wherever they have their babies. We need to ensure, <span id="1366" class="column-number" data-column-number="1366"></span>and mums need to know, that services are there for them when they need them, including at the time they go into labour. I thank the hon. Member for North East Fife (Wendy Chamberlain) for sharing the experiences of her constituents Kristie and Tammy today, and I agree that we need to bear such experiences in mind. That is why my right hon. Friend the Secretary of State has chosen to prioritise maternity, and why the work of the national maternity and neonatal taskforce is so important. In particular, the new modern service framework will define the standards needed to deliver care across the country, whether in large inner-city areas or small rural places. I know the hon. Member for North Devon understands that the North Devon maternity unit was closed for a good reason: the trust could not provide a service that it knew was unsafe. It is really important that we all bear that in mind as we discuss this issue. We must support good, sound clinical assessment, particularly in this area. However, it is unacceptable that, as we have heard from the hon. Member for Honiton and Sidmouth (Richard Foord), expectant mothers are travelling all the way to Exeter or Bristol, and the current situation is not sustainable. I have given birth very healthily three times, and I am grateful for the care that I had. I had to travel only a short distance down the road and, frankly, that was enough, so I empathise deeply with women who have to endure long journeys. I will not rehearse the recent history that led us to this point, because I know the House is well acquainted with that. As the hon. Member for North Devon knows, the responsible Minister is the noble Baroness Merron, but I will do everything I can to take this opportunity to update him and the House on where we are, and follow up in writing on any specific questions, if necessary. The trust has set the following three tests before the unit can reopen: first, there must be 24/7 consultant and registrar cover in place through an on-call rota; secondly, three quarters of those staff must be employed full time; and thirdly, new staff must have gone through employment checks, onboarding and induction. Today I can update the House that the outlook on safe staffing was more positive last week, but unfortunately some recruitment has fallen through since then. The trust is still seeking the additional clinical staff that they must have to provide a safe service. As hon. Member for North Devon knows, the issue is not that the roles are not funded. They are generously funded, and the trust has even gone so far as to offer salary top-ups, but the roles remain unfilled. The question is how we attract the best talent to our rural and coastal communities, and show them that Barnstaple and other similar places are among the best in the country to build a life. I want to thank partners that are working with the trust on recruitment, including the Royal College of Obstetricians and Gynaecologists. The trust is also exploring hiring international candidates, but ultimately we want the unit to have enough staff to provide a safe service that is sustainable—another point that has been well made today—even if a doctor is unwell or otherwise on leave. Every week, the chief medical officer at the trust conducts an assessment to see whether the unit is ready to reopen its doors. Every two weeks, the trust updates key stakeholders on the status of the unit. Once safe staffing is secure, there will be a short period of <span id="1367" class="column-number" data-column-number="1367"></span>time to stand up rotas and put services in place. I have had assurances that, during that period, the trust will get in touch with every mother and give them the chance to change their birth plans to Barnstaple, should they want to do so.

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6. 22 Oct 2026·Parliament·Karin Smyth

   NHS Maternity Services

   Yes, of course, and that is what the trust does. I would gently urge all hon. Members to work very closely with the entire trust on these issues to solve these problems. It is absolutely right that the trust is working with MPs. It is reviewing its decision on a weekly basis, and it is important that it communicates openly and transparently with all its partners when those decisions happen. I am always very clear that Members of Parliament speak on behalf of their constituents and can be helpful in communicating those messages, because we want to make this work. In the meantime, the trust continues to offer a range of maternity services, and it has taken steps to help the women covered by its duty of care. There is a dedicated helpline for women to discuss their birth plans, a maternity triage line for urgent help, special appointments to talk about travel costs and accommodation, free taxis for women who do not have their own transport and are advised by the triage line to go to hospital, and mental health support. These are good and sensible steps, but it is still unacceptable for women to have to travel for two hours while they are in labour. Trusts in our rural and coastal communities do face systemic pressures, because they have fewer births and because it can be hard for the local NHS to recruit. Last year I visited North Devon district hospital, as part of my remit in overlooking the new hospitals programme, <span id="1368" class="column-number" data-column-number="1368"></span>to see how it is using the £30 million the Government have made available to support the rebuild of the 50-year-old staff accommodation block and invest in MRI scanners. We are committed to those services in Barnstaple, and it is important for all hon. Members’ constituents to be clear about that. Our 10-year health plan, produced last year, clearly set out the issues for rural and coastal communities, which the right hon. and learned Member for Torridge and Tavistock (Sir Geoffrey Cox) noted. We particularly highlighted those communities in the 10-year health plan because we recognise that they have specific needs and do not benefit from a one-size-fits-all approach. However, the broader systemic issues they face, particularly in staffing, must be addressed in our upcoming workforce plan, and I do agree that retention is a key part of that. Ministers have made it clear to the NHS that we must do everything possible to help reopen North Devon maternity services. NHS England, the ICB and the regional team in the south-west are working with the trust to resolve these issues as soon as possible. As I have said, my right hon. Friend the Secretary of State has rightly made maternity a national priority for this Government. She is chairing the national maternity and neonatal taskforce to drive forward reforms, and to deliver systemic and sustained improvement across maternity and neonatal care, including in relation to the failings exposed in the south-west of England in recent months. The Barnstaple maternity unit will reopen. I cannot give the hon. Member for North Devon a guarantee from this Dispatch Box of the date when that will happen, because it will depend on securing safe staffing. That is the problem that everybody needs to focus on, and this Government are focused on doing that with the local system. We will do everything we can to help the hon. and gallant Gentleman get those services back on track on behalf of his constituents. <em>Question put and agreed to.</em>

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7. 20 Oct 2026·Parliament·Karin Smyth

   Northern Care Alliance NHS Foundation Trust

   I absolutely endorse your comments about our colleague, Mr Speaker. I know that my hon. Friend and many other colleagues are deeply concerned about the issues at Northern Care Alliance. As of June this year, the trust has been placed under the highest level of regional oversight and support from NHS England. It is imperative that rapid movements are made, governance systems are strengthened and that every patient receives the standard of care that they deserve.

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8. 20 Oct 2026·Parliament·Karin Smyth

   Northern Care Alliance NHS Foundation Trust

   My hon. Friend rightly highlights on behalf of her constituents the number of issues that have led to this significant regulatory intervention and support. If necessary, further action is available to NHS England and the Care Quality Commission. We want to ensure that the focus now is on supporting and challenging <span id="944" class="column-number" data-column-number="944"></span>the trust to make the rapid and sustained improvements necessary in those key areas. I know that my hon. Friend and our other colleagues will work closely with the trust on this; I always encourage MPs to work closely with their trust to ensure that that happens. If necessary, other measures will also be available.

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9. 20 Oct 2026·Parliament·Karin Smyth

   Step-down Intermediate Care: Community Hospitals

   My hon. Friend makes an excellent point about the importance of intermediate care, which is a key component of supporting patients into discharge to recover outside of hospitals. Community beds play an important role, but we are clear that home-based intermediate care also needs support, particularly for frail people, through neighbourhood health. That should be the default pathway, and we will continue to work with the system to make that happen.

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10. 20 Oct 2026·Parliament·Karin Smyth

    Step-down Intermediate Care: Community Hospitals

    I am, of course, happy to meet my hon. Friend to discuss that issue further. I am clear that all changes to services should be based on clear evidence that they deliver better outcomes for his constituents and people across the country. He is absolutely right that we want to extend care closer to home. As I said, the default is to get more care into people’s homes, and I am happy to discuss that further with him.

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