Health Bill
Public Bill Committee, 16 June 2026.
Roger Gale (Conservative, Herne Bay and Sandwich)
Before we begin, I remind Members please to switch all electronic devices off or to silent. I also have to tell you that tea and coffee are not allowed during the sittings.
We will consider first the programme motion, as on the amendment paper, and then the motion to report written evidence for publication and the motion to allow us to sit in private to discuss questions before the oral evidence sessions begin. In view of the timetable, I hope that we can take those matters formally, without any debate. I call the Minister to move the programme motion standing in her name, which was discussed yesterday at the Programming Sub-Committee for the Bill.
Roger Gale (Conservative, Herne Bay and Sandwich)
Copies of the written evidence that the Committee receives will be made available in the Committee Room.
Roger Gale (Conservative, Herne Bay and Sandwich)
We are now sitting in public again and proceedings are being broadcast. Before we start to hear from witnesses, do any Members wish to make a declaration of interest in connection with the Bill?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
I am a member of the Royal College of Paediatrics and Child Health, a member of the British Medical Association and an NHS consultant paediatrician.
Sojan Joseph (Labour, Ashford)
I used to work in a mental health trust for many years, and I am still its employee—I am on an extended career break from the trust.
Helen Morgan (Liberal Democrat, North Shropshire)
I am a vice-president of the Local Government Association.
Karin Smyth (Labour, Bristol South)
I am a member of the Managers in Partnership trade union, which is giving evidence this afternoon.
Liz Twist (Labour, Blaydon and Consett)
I am co-chair of the Unison group of MPs, which is linked to Managers in Partnership.
Peter Prinsley (Labour, Bury St Edmunds and Stowmarket)
I am a retired ENT surgeon and a fellow of the Royal College of Surgeons.
Roger Gale (Conservative, Herne Bay and Sandwich)
Thank you very much. It will be helpful if you reiterate those declarations at the start of any speech or question, if they are relevant.
Examination of Witness
Roger Gale (Conservative, Herne Bay and Sandwich)
We will now hear oral evidence from NHS England. I am afraid that we have to stick to the timings very rigidly because we have a lot to get in this morning, and we have until 9.55 am for this session. Dr Dash, could you be very kind and briefly introduce yourself for the record and make any very short opening remarks you wish to make?
Roger Gale (Conservative, Herne Bay and Sandwich)
You are, absolutely. Normally, as a courtesy, I allow a very brief comment if you want to say anything.
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q Good morning, Dr Dash. What effect is the abolition of NHS England having on its current day-to-day functioning? What sort of number of people are working solely or mostly on the transfer, and is that affecting your ability to deliver on your core business?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q You wrote a report about the CQC that was not hugely flattering, and you have also written a report about the patient safety landscape. First, why did you choose to roll HSSIB into the CQC, given what you said about the CQC and the clear and obvious conflicts of interest that it creates? Secondly, you identified in your findings that a large number of clinical nursing staff were being moved into more managerial roles, with an effect on clinical capacity. Which of your recommendations would have dealt with that, or what would you recommend now?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q What about the risks of that—the conflict?
Karin Smyth (Labour, Bristol South)
Q As you outlined in your review, there are 150 organisations in this area. How do you see the new patient experience directorate in the Department working to give confidence in this area and to try to make sense of some of that and improve it?
Helen Morgan (Liberal Democrat, North Shropshire)
Q Good morning, Dr Dash. Since hearing the evidence that was given to the Health and Social Care Committee, have you reflected on the concerns that the driver of confidence in HSSIB is its operational independence? What concerns do you have that it will lose that perception of independence and its safe space approach to learning when something goes wrong?
Helen Morgan (Liberal Democrat, North Shropshire)
I should have declared that I am a member of the patient safety APPG. Let me turn to similar concerns about Healthwatch and its independence. If it is absorbed within ICBs locally or within the Department of Health at a national level, do you have concerns that those organisations will essentially be marking their own homework rather than listening to impartially collected evidence about patient experience?Q
Sureena Brackenridge (Labour, Wolverhampton North East)
On that point, Dr Dash, what would you say to concerns that have been raised with me by Healthwatch Wolverhampton that patients and service users will be reluctant to raise concerns from within the system? How will your recommendations help with thatQ ?
Gregory Stafford (Conservative, Farnham and Bordon)
I should declare that I am a member of the all-party parliamentary group on patient safety. Apologies, Dr Dash, I have questioned you on this many times, but I am going to continue to do so. When the King’s Fund, the Nuffield Trust and the Health Foundation were in front of the Health and Social Care Committee and they talked about bringing HSSIB into the CQC, all three of them said very clearly: “Don’t do it.”. In fact, I can find almost nobody apart from you and the Department who thinks that moving HSSIB into the CQC is a good idea. Does that give you any pause for thought about whether you are recommending the right thing?Q
More specifically, if, as you said to the Health and Social Care Committee, the safe space element would be retained and HSSIB would operate as an independent organisation, how can you square the fact that it would remain independent and yet be part of the CQC? If it does remain independent, what is the need to bring it into the CQC?
Gregory Stafford (Conservative, Farnham and Bordon)
Q What happens if the problem is the CQC?
Liz Twist (Labour, Blaydon and Consett)
Q Dr Dash, you have explained why you believe that the changes to Healthwatch will strengthen patient responses. How do you think that could be strengthened to ensure that the levers really are being pulled for patients? That seemed to be the case.
Roger Gale (Conservative, Herne Bay and Sandwich)
For a final brief question—and a brief answer, please—I call Joe Robertson.
Joe Robertson (Conservative, Isle of Wight East)
HSSIB is obviously an investigator and CQC is obviously a regulator—two different roles. I suspect there was a good reason why you were asked how the CQC can be investigated by a body that becomes part of it. Are you aware that the Air Accidents Investigation Branch and the UK Civil Aviation Authority are separate? If you are, why should that fundamental separation, which benefits air passenger safety, not apply to the safety of patients in the NHSQ ?
Roger Gale (Conservative, Herne Bay and Sandwich)
Dr Dash, thank you very much indeed. The Committee is indebted to you. I am afraid that brings us to the end of this panel and we will now move on.
Examination of Witnesses
Roger Gale (Conservative, Herne Bay and Sandwich)
We will now hear evidence from the King’s Fund and National Voices. Again, I fear that we will have to stick to the timings, as we have very limited time. We have until 10.25 am for this session. Could you please identify yourselves for the record?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q Sarah, the King’s Fund report said that the potential cost savings of abolishing NHS England
“would be minimal in the context of the entire NHS budget”.
Many MPs across the House have struggled to get numbers and costings in questions both oral and written, particularly in relation to staff redundancies. We have not received information on the full arrangements of where NHS England’s functions are going to go yet. How can we be sure that its abolition will save any money at all?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q Yes, although yesterday we received an answer to a written parliamentary question saying that the abolition of NHS England is causing no disruption to the development of new services. That is the Government’s view.
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q Thank you, Sarah. That was also the view of the Darzi report. He said that it was “neither desirable nor necessary”.
Jacob, what effect will the abolition of Healthwatch have on people’s confidence in the independence and reliability of views of patient experiences?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q The Bill requires that Healthwatch be abolished, to an extent, and that local authorities do their own inpatient engagement instead, but they do not seem to be mandated to do so in quite the same way. Local authorities are under financial pressure. Do you believe that such engagement will happen at all, or to the same extent that it does now?
Karin Smyth (Labour, Bristol South)
Q Accepting what you have said about delays with staff—we absolutely recognise that—do you think that the abolition of NHS England is the right thing to do?
Karin Smyth (Labour, Bristol South)
Q Sarah, I think you described the single patient record as “genuinely transformative”, and National Voices has also been really supportive of it. How critical do you think it is that we grasp that opportunity?
Karin Smyth (Labour, Bristol South)
Q Finally from me, you highlighted your 15 years in the patient voice landscape. We could discuss at length whether you think that is going well and whether the situation that we inherited was a good one. What needs to happen to give patients confidence that the new system will be better?
Helen Morgan (Liberal Democrat, North Shropshire)
Q Good morning. Sarah, the Bill transfers a lot of NHSE’s powers to the Secretary of State. Do you have any concerns about the additional powers conferred upon the Secretary of State? Does that go too far?
Helen Morgan (Liberal Democrat, North Shropshire)
Q Jacob, how prepared are ICBs and local authorities to take on the healthwatch functions? Is there a concern that splitting the local healthwatch function will lead to a lack of joined-up focus on health and on the social care element that resides with local authorities?
Peter Prinsley (Labour, Bury St Edmunds and Stowmarket)
Q I am an ENT surgeon. Why has there been no effective single patient record in the past? If there were such a thing, who would you give ownership of the data to?
Peter Prinsley (Labour, Bury St Edmunds and Stowmarket)
Q Who would the data belong to? Would it belong to the patient or to the healthcare provider?
Peter Prinsley (Labour, Bury St Edmunds and Stowmarket)
Especially if it were the case that the patient were the data controller.
Gregory Stafford (Conservative, Farnham and Bordon)
Q Sarah, when we were at the Health and Social Care Committee, you and your fellow panellists seemed to suggest that the Government could achieve what they needed to in the 10-year plan without this reorganisation. Could you delve into that a bit more and tell us why you think that is the case?
Gregory Stafford (Conservative, Farnham and Bordon)
Q Would you agree with that, Mr Lant?
Sojan Joseph (Labour, Ashford)
Q Mr Lant, I am trying to understand a bit more about the patient experience and improvement in care that Healthwatch brings. My understanding is that when a patient raises a complaint with the local provider, it usually gets investigated by a local service manager or a matron, but when somebody is not confident about raising a complaint with the local provider, they go to Healthwatch, and that complaint usually filters down for the same local service manager or matron to investigate it—we have seen that happening. Patient experience is not being improved without local accountability or local change. Can you explain why you are concerned about abolishing Healthwatch and bringing more accountability to local ICBs or local authorities, which may improve patient experience and patient care?
Liz Twist (Labour, Blaydon and Consett)
Ms Woolnough, you have talked about the abolition of NHS England, and, as I understand it, you are dealing with what the position is rather than taking a stand. Beyond the legislation, what are the key things that we should be looking at to get the transfer of functions to ICBs and DHSC right?Q
Liz Twist (Labour, Blaydon and Consett)
And do you think—
Roger Gale (Conservative, Herne Bay and Sandwich)
Order. We have run out of time again. That brings us to the end of this session. Thank you both very much for joining us; the Committee is indebted to you.
Roger Gale (Conservative, Herne Bay and Sandwich)
We shall now hear evidence from the Academy of Medical Royal Colleges and the Institute of General Practice Management. Once again, I am afraid we have to stick to the timings. This session will end at 10.55 am. Will the witnesses briefly introduce themselves for the record?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q I should perhaps reiterate that I am a member of the Royal College of Paediatrics and Child Health. Dr Dickson, NHS England has responsibility for workforce and workforce planning. How will the Bill affect that, and what effect is the delayed and delayed and delayed workforce plan having on the ability to plan the workforce now and for the future?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q So, in essence, the fact that NHS England is being abolished, whether that is the right or wrong thing to do, will have an effect on the delivery of new services?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q I want to move on to the single patient record. Do you feel that general practice has had enough information about its role in terms of who is responsible, who is accountable, who will be editing and who will be responsible for checking that the editors are right on this single patient record?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q I have one small question. Dr Dickson, even in paediatrics I have looked after patients who have ring binder after ring binder of notes. Clearly, when seeing a patient for 20 or 30 minutes in clinic, there is not time to read ring binders and ring binders of notes. To what extent will the single patient record oblige clinicians to have read and understood everything for every appointment? Is that really practical?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
The question is, how do you find it within the way it is structured?
Karin Smyth (Labour, Bristol South)
Q Dr Dickson, can you describe how you think the single patient record could be transformative for patient care, given where we are?
Helen Morgan (Liberal Democrat, North Shropshire)
Q Can I also ask about the single patient record? We have heard concern from GPs about their role in being the data controller and what that might mean when data is shared beyond their initial remit. What do you think is most desirable: for the GP to remain the data controller, or for that role to sit elsewhere?
Helen Morgan (Liberal Democrat, North Shropshire)
Q Do you think anything else should be on the face of the Bill to give us clarity so that that GP concern is mitigated?
Sojan Joseph (Labour, Ashford)
Q I want to touch on the single patient record. I declare that I used to work in mental health services. In my experience, mental health patients often navigate between A&E, GPs and mental health services during weekends. Often the clinicians do not know what medication they are on, or what kind of contact patients had on the Friday or Saturday. Also, during the discharge process, getting medication from the GP can be delayed until the discharge notification gets to the GP. Yes, there are concerns about who will own this data, but do you not think that the single patient record will bring a huge benefit for patient safety and continuity of care?
Joe Robertson (Conservative, Isle of Wight East)
Q If responsibility for managing and safeguarding the single patient record is to sit with general practice, if that is what the Government want, can you tell us, Kay Keane, as chair of the Institute of General Practice Management, what the implication would be for workload, and particularly workforce, in practice management?
Sureena Brackenridge (Labour, Wolverhampton North East)
Q My question is to Dr Dickson and is about education and training policy, responsibility for which will be transferred from NHS England to the Secretary of State. I know that you have a lot of interest in medical training and education, so what do you feel would be the impact?
Roger Gale (Conservative, Herne Bay and Sandwich)
We have come in under time for a change. Thank you both very much indeed for joining us. Your contribution is invaluable.
Examination of Witness
Roger Gale (Conservative, Herne Bay and Sandwich)
We will now hear oral evidence from the Health Services Safety Investigations Body. Again, we must stick to the timings, but we are doing rather well at the moment—let us hope we can stick to that. Would you be kind enough to identify yourself for the benefit of the record?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q Good morning, Dr Benneyworth. There seems to have been a bit of a muddle in how some of this has been expressed this morning. For clarity, could you explain how a regulator is different from an investigatory body, please?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q Earlier on it was asked what would happen if the HSSIB was rolled into the CQC, yet the problem with the healthcare was a failure of the CQC to properly regulate or investigate. I was a little bit lost for words at that point. How would that work in practice? Or would it not?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q Another question that has been raised about independence is the choice of what to investigate. The Secretary of State can direct, but the impact assessment suggests that the Government intend to direct the vast majority of investigations. Is it currently the case, or has it been the case in the past, that the vast majority has been directed by the Secretary of State, or has that been unusual?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q Earlier in this session we heard concerns that you keep some information secret. You have the safe space legislation in place. Does that improve or weaken safety?
Karin Smyth (Labour, Bristol South)
Q What are the key things we need to get right to ensure that safety investigations in general and safe space in particular are made to happen in the new arrangements?
Karin Smyth (Labour, Bristol South)
Q Those things obviously are manageable in another system, but people need that safe space to come forward. You rightly outlined reality and perception, and perception is often important for confidence.
You talked about the culture of fear, which I think we have recognised over time. We are all constituency MPs, so we recognise that. Can you say something about the opportunities for learning that could arise from working with the CQC, which is in that regulatory space?
Helen Morgan (Liberal Democrat, North Shropshire)
Q I re-declare that I am a member of the all-party parliamentary group on patient safety. We have heard this morning about a tension between needing to be able to report when something has gone wrong that HSSIB has become aware of to ensure that it is dealt with—the example given by Dr Dash earlier was a maternity failing—and the importance of a safe space, so that people can report to HSSIB when something has gone wrong and then HSSIB can make the appropriate recommendations to change the problem within the system that has led to that issue. Can you talk a bit more about that tension? What is the best way to manage that?
Helen Morgan (Liberal Democrat, North Shropshire)
Q What could be changed in this legislation to ensure that HSSIB can retain trust and independence from the regulatory body?
Sureena Brackenridge (Labour, Wolverhampton North East)
Q I feel that my question may have just been answered, but you may wish to add something, Dr Benneyworth. Will patient safety accountability be improved when a patient’s care spans different organisations within an ICB?
Edward Argar (Conservative, Melton and Syston)
In her evidence earlier, Dr Dash said that one of the reasons for her recommendations in her second review of changes to the regulatory and investigatory landscape is that it is a problem for the provider landscape that there are so many different organisations making so many recommendations. You have just said that HSSIB makes very few recommendations. Will the merging or folding—however you wish to characterise it—of HSSIB into the CQC lead to any meaningful reduction in the number of recommendations that organisations have to cope with?Q
Janet Daby (Labour, Lewisham East)
Dr Benneyworth, you mentioned protected disclosures, and you said that individuals or organisations may have a fear of reprisals. Would you like to say anything more on that? What would you like to see from the CQC or in the Bill?Q
Gregory Stafford (Conservative, Farnham and Bordon)
Q I reiterate that I am a member of the all-party parliamentary group on patient safety. Dr Benneyworth and I have had many conversations about this issue.
I have two questions. The first is about the safe space. We have seen written evidence, and we have heard when others have attended the Health and Social Care Committee, about the fact that if HSSIB is placed inside the CQC, you could have the farcical situation of one set of CQC lawyers, who are representing HSSIB, suing or attempting to sue another set of CQC lawyers, who are looking out for the CQC situation, because they are trying to get information out of part of their own system. Is that parody or is it a possibility and real problem?
Gregory Stafford (Conservative, Farnham and Bordon)
Q Just so that I am clear, you have internal protocols that would raise stuff if you saw something criminal, and if you were investigating something and potentially could not share the information, that would not prevent any of the multitude of other regulators that we have out there from investigating on their own something similar. Your investigation would not preclude them from being able to investigate as well.
Gregory Stafford (Conservative, Farnham and Bordon)
Q Dr Dash, in her evidence, said that—I am slightly paraphrasing, so I hope I have not got this wrong—NHS England has a number of investigatory bodies that it has established recently, and that although they were not perfect, they were much better, and they could be doing this job. What is your response to that?
Gregory Stafford (Conservative, Farnham and Bordon)
Q You are saying that you are a world leader.
Roger Gale (Conservative, Herne Bay and Sandwich)
Very quickly.
Gregory Stafford (Conservative, Farnham and Bordon)
I think the answer was, “We are.”
Roger Gale (Conservative, Herne Bay and Sandwich)
I am afraid we have come to the end of the session. I am sorry and I apologise to colleagues whom I did not manage to accommodate this time. Thank you very much for joining us, Dr Benneyworth. That was most helpful.
Roger Gale (Conservative, Herne Bay and Sandwich)
We shall now hear oral evidence from Sir Jeremy Hunt MP. Again, we must stick to the timings and we have to finish at 11.25, so we have got just 15 minutes to put our colleague through the mincer. For the benefit of the record, would you like to identify yourself?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q Good morning, Sir Jeremy, and thank you for coming to the Committee this morning. You are our longest serving Health Secretary and you focused much of your tenure on patient safety. I understand you are still part of the all-party parliamentary group on patient safety, so that focus is continuing now. How does HSSIB improve patient safety and what are your thoughts on whether moving it into the CQC is a good idea?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q We have the Hughes report that is two years from recommendation and we have not got an answer to that one yet. Our previous witness talked about a repository for recommendations—a sort of national hub to put them all into. Do you have any thoughts on that?
Karin Smyth (Labour, Bristol South)
Q You have leant into my next question, Sir Jeremy. You are a former Chancellor of the Exchequer, so you understand some of these tensions. My question is about the number of recommendations and outstanding actions. As you said, honestly recognising that it happened during your time as well, this has all arisen over time. As a result, we are in the situation of having several independent bodies that are not required to take action, but the National Quality Board, which is outwith the legislation, is the place this could happen. Do you want to comment further on that?
Karin Smyth (Labour, Bristol South)
Q To move on to the transfer of NHS England’s functions, in your time in office NHS England was a new independent body. What are your reflections on how we can use the transfer of those NHS England functions back into democratic oversight to improve impacts on patients, particularly patient safety?
Helen Morgan (Liberal Democrat, North Shropshire)
Q I am a member of the all-party parliamentary group on patient safety, and one of the things we have heard is that the idea behind HSSIB and the air accidents investigation branch is, in the long run, to reduce the need for public inquiries to save money. Can you elaborate on that a little bit?
Helen Morgan (Liberal Democrat, North Shropshire)
Q As a former Secretary of State for Health, what are your reflections on the abolition of Healthwatch and the absorption of its functions into the Department of Health, ICBs and local authorities?
Dave Robertson (Labour, Lichfield)
It is always a pleasure to see you in the Chair, Sir Roger. Sir Jeremy, I want to turn to NHS England’s accountability, or lack thereof. I know you made the point that you did not want clinically advised decisions to be overly politicised, but I had the reverse in my constituency when a decision was made after the lease on a doctors’ surgery ran out. It could not be extended because of some rule in NHS England, but due to that lack of accountability, there was nothing that we could do. The surgery closed, and one in six of its patients was just redistributed to another surgery, so that accountability clearly failed in that space.Q
If you are concerned that accountability ends up too close to the Department, where else should it land? I am quite comfortable with a Minister being accountable for that decision, because they are accountable to MPs, who are ultimately accountable to the people that it affects. Can you pare back your answer a little bit and talk about where that accountability should lie, and how we can ensure that it works?
Joe Robertson (Conservative, Isle of Wight East)
Q The safe space principle is arguably under threat by the merging of HSSIB and the CQC. From the evidence you gave to the Health and Social Care Committee, I understand your argument that if you get rid of the independence of HSSIB, staff members who have witnessed wrongdoing and unsafe practices will not feel there is anywhere they can go, when they feel compelled to disclose things they see, where there is no consequence to them. Can you just comment on that?
Roger Gale (Conservative, Herne Bay and Sandwich)
Sir Jeremy, thank you very much for coming—once again, we are out of time, but we are indebted to you. The Committee will sit again in this same room this afternoon at 2 pm. The room will be locked, if Members wish to leave papers or anything else in here.
Examination of Witnesses
Roger Gale (Conservative, Herne Bay and Sandwich)
We will first hear oral evidence from the NHS Alliance and the Royal Berkshire NHS foundation trust. We have until 2.30 pm for this panel. Gentlemen, I will be grateful if you would be kind enough, from left to right, to introduce yourselves for the sake of the record.
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Good afternoon, gentlemen. My first question is to the NHS Alliance. In a survey published last month, your organisation found that two thirds of trusts and integrated care board leaders are likely to need to cut or reduce patient services to meet their financial plans. Given the financial pressure that ICBs are clearly under, what do you make of their ability to become more strategic commissioners and to innovateQ60 ?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q The ICBs and trusts are going to operate under the spectre of direct intervention by the Secretary of State, who is taking much more interventional powers in this Bill. What effect will that have on the health system?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q Mr Blythe, what value does your council of governors add to your trust?
Karin Smyth (Labour, Bristol South)
Q To pick up on Sir Ciarán’s comments about experiences being extremely rare, the changes in the Bill sit alongside changes to the national centre and clarity for ICBs, with very little change to providers. What would make the biggest difference to providers and commissioners to improve things?
Karin Smyth (Labour, Bristol South)
Q Sir Ciarán, may I clarify a point with you? I think you are not objecting to the abolition of NHS England—yes or no?
Karin Smyth (Labour, Bristol South)
Q Because you also said that the risk of not having financial control is high. I would say that, over the last few years, financial control has been a massive problem, and we have put in much better financial control. I think that your concern is with the future rather than the legislation.
Karin Smyth (Labour, Bristol South)
Q Mr Blythe, what does the single patient record mean for you in running a big hospital?
Helen Morgan (Liberal Democrat, North Shropshire)
I am a member of the all-party parliamentary group on patient safety and I am also a vice-president of the Local Government Association.Q
Can I ask about Healthwatch? We heard this morning that ICBs will be taking on a chunk of the current operations of local healthwatches, but that they will not have any additional budget to enable them to do that. In fact, we know that their budgets have been significantly reduced. Could you elaborate on how you think that will work, and will it be as effective as the current system?
Helen Morgan (Liberal Democrat, North Shropshire)
Q My second question is similar. In reality and in practice, how do you envisage ICBs will be locally accountable once these legislative changes have taken place?
Liz Twist (Labour, Blaydon and Consett)
SirQ Ciarán, the 10-year health plan, which is behind a lot of this, demands that we are really ambitious in involving patients and communities in shaping the services that they need. How can we best support ICBs, local authorities and other organisations to drive that change?
Liz Twist (Labour, Blaydon and Consett)
Q Do you think that there are any good examples we can learn from?
Gregory Stafford (Conservative, Farnham and Bordon)
This question is to the Royal Berkshire. In response to my colleague, you talked about the benefits of your council of governors. As a foundation trust, you have significant autonomy. The Bill will allow the Government to cap your day-to-day spend, strip away your FT status and make governance changes. What impact will that have on how your boards can carry out their dutiesQ ?
Roger Gale (Conservative, Herne Bay and Sandwich)
Sir Ciarán and Mr Blythe, thank you very much indeed. Sadly, we have just about run out of time for this session, but we are most grateful to you.
Roger Gale (Conservative, Herne Bay and Sandwich)
We will now hear oral evidence from the Patients Association, Together for Short Lives and Healthwatch England. We have until only 3.10 pm for this panel of three people. Would you be kind enough to introduce yourselves for the record? Let us start from the left.
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q My first question, which is about specialist commissioning, is for James. Your charity is involved with palliative care for children. What effect do you think the changes in the Bill will have on the commissioning of very specialist, low volume and high complexity services?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q My second question is for Professor Croisdale-Appleby. The CQC has been reported to be in a relatively difficult place, facing challenges at the moment. It is being asked to take on event healthcare supervision and roll the HSSIB within it. Is that asking too much?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q What are your thoughts on the abolition of Healthwatch? Does Healthwatch have teeth? Does it influence people? Is it influencing the decision makers? Could it be reformed or should it be abolished?
Roger Gale (Conservative, Herne Bay and Sandwich)
Q Ms Tilsed, you have been very patient. Before I call the Minister, do you want to add anything to what has already been said?
Roger Gale (Conservative, Herne Bay and Sandwich)
Thank you. Those opening comments were extremely helpful, but I now ask for brevity in your answers, as several Members wish to put questions to you.
Karin Smyth (Labour, Bristol South)
Q As we have heard, despite 52 years of independent patient voice, 20,000 reports and many hundreds of recommendations, we have some of our worst ever patient satisfaction. We are also now more than 10 years on from the Francis report, but recommendations are not being followed through locally or nationally. It is pretty clear that the landscape does not work. Like many other Committee members, I represent communities that are not in that space and need to be represented in new way. What are the barriers to that? How can the single patient record, and the information we can create in different ways, help to reverse what is a shocking landscape for patient experience and patient voice?
Karin Smyth (Labour, Bristol South)
Yes.
Helen Morgan (Liberal Democrat, North Shropshire)
Q Sarah, the Patients Association has said that it is concerned about this reorganisation distracting from patient priorities. Could you elaborate on where those concerns come from and what should be done to mitigate that?
Helen Morgan (Liberal Democrat, North Shropshire)
Q My second question is about Healthwatch. The Committee heard this morning about the variability of Healthwatch’s effectiveness at a local level. What could be done to ensure that the best and most effective Healthwatch practice is rolled out across the whole of England?
Laura Kyrke-Smith (Labour, Aylesbury)
To go back to the single patient record, I see huge potential—at least in my constituency, where we have real challenges with GPs and hospitals not talking to each other or sharing information. Nor do trusts and local authorities across Buckinghamshire, Bedfordshire and Hertfordshire share that information. Sarah has touched on this a bit already, but I am interested to hear from our other witnesses on how they think the single patient record would improve patient experience, and on how we would go about building public understanding and trust in a new systemQ .
Roger Gale (Conservative, Herne Bay and Sandwich)
By all means.
Joe Robertson (Conservative, Isle of Wight East)
Professor Croisdale-Appleby, the local healthwatch on the Isle of Wight has proven invaluable in amplifying patient voice, gathering patient experience and helping those who are democratically elected—MPs and councillors—to hold health leaders to account. My concern about that function being folded into the ICB is that the ICB has often been on the sharp end of critical analysis by Healthwatch, and so the ICB will end up marking its own homework. We will lose the critical voice that has, I am sure, led to better decision making. How can we possibly resolve that fundamental issue, if Healthwatch is folded into ICBsQ ?
Sojan Joseph (Labour, Ashford)
Sarah, you mentioned that the patient should be the centre of all this. I do not think that anybody disagrees—including any politicians—that making these changes is in the best interest of the Q patients. However, many changes have happened over the decades, but data for the last 10 years shows that patient safety incidents and complaints are steadily going up, so those changes have not made any impact on patient care, safety or experience. We need to do something here.
After each incident, there is a recommendation or an action plan, but clinical staff or patients do not have much involvement with those and do not see any difference. Healthwatch helpfully finds the issues, but it may not actually go back and see what changes are made following its recommendations. The CQC physically goes into clinical areas to see the difference, and has the power to take action against those responsible, so is it not a good change that more accountability will sit with the providers, and the CQC—or local authorities and ICBs—can take action against them?
Sojan Joseph (Labour, Ashford)
I asked whether it is not a good change to streamline these bodies so that fewer of them have powers to take action like the CQC?
Gregory Stafford (Conservative, Farnham and Bordon)
Q On the streamlining point, you have articulated very clearly why you think it is inappropriate, as have members of this Committee, and most of the evidence we have received suggests that it is not appropriate. What do you think is the reasoning behind the Government’s real push for this, when the evidence against it is so clearly strong? Is it simply that they want to save money, in your opinion, or is there an alternative motive?
Roger Gale (Conservative, Herne Bay and Sandwich)
Let us see if either of your colleagues would like to be less cautious. Mr Cooper?
Sureena Brackenridge (Labour, Wolverhampton North East)
I would like clarity on a few views that we have heard, not just in this session but in previous ones. There is one mindset that says that by bringing patient voice into ICBs, they are going to be marking their own homework. Equally, I think about places like Wolverhampton, where we have such baked-in inequalities and we simply have not shifted the dial for far too long, as can be seen in the differences in life expectancy. I have also heard that if you want to bring real change, it is best to bring that change from within the system. I will open that up to you, SarahQ .
Edward Argar (Conservative, Melton and Syston)
I know that in this conversation some have highlighted that patients have stated that their experience has worsened or not improved, but I would argue that is not a Healthwatch failure; it is actually down to the NHS or ICBs not acting on Healthwatch recommendations. It seems to me perverse to give that voice to the organisations that are actually part of the problem through not acting.Q
As a Minister, I was on the receiving end of some quite sharp recommendations from Healthwatch, but they were always constructive. Whether right or wrong, my fear is that this measure risks a perception among patients that it will be down to NHS managers and ICBs essentially to make recommendations that reflect their priorities, rather than the priorities and voices of patients. Professor, even if the principles that you have enunciated that might mitigate that risk were applied to the new model, are you really confident that they could mitigate the risk to patients’ confidence that their voice is genuinely and independently heard, loud and clear, however unhelpful it is perceived to be by bits of the NHS?
Liz Twist (Labour, Blaydon and Consett)
Q You all represent patient organisations in different ways. I would like to put this in the context of the 10-year plan and the shift to involve patients and communities in shaping services. From your patient perspective, how can we best support ICBs, local authorities and other people to drive that change for patients?
Roger Gale (Conservative, Herne Bay and Sandwich)
Q Do panel members have any further comments?
Roger Gale (Conservative, Herne Bay and Sandwich)
Thank you very much. On that note, Mr Cooper, Ms Tilsed and Professor Croisdale-Appleby, thank you very much for attending, and for your guidance and wisdom—we appreciate it.
Roger Gale (Conservative, Herne Bay and Sandwich)
Good afternoon. We shall now hear oral evidence from the Local Government Association, the Association of Directors of Adult Social Services, and South East London ICS. We have until 3.50 pm for this panel. Could you identify yourselves for the benefit of the record, please?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q Does removing local authority representation from ICBs weaken the link with local elected representatives, or is it beneficial?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q Thank you. Maria, how do you think the Bill and all the changes around ICB funding will affect local services? To what extent does the process in itself cause disruption—or not?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q Thank you. Sally, what would be the impact of the removal of the pooling of better care funding among local authorities and ICBs?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
So you are losing a protection with the Bill.
Karin Smyth (Labour, Bristol South)
Q Councillor Wright, the Bill will essentially abolish NHS England. Do you have any comments about how that works at the moment in terms of local government? How can we unlock some of the potential in the Bill, with the changes to NHS England, with regard to local government, particularly on health and wellbeing boards and the entire place agenda?
Karin Smyth (Labour, Bristol South)
Q May I come to you, Sally, particularly on social care and the opportunities that might arise from it?
Karin Smyth (Labour, Bristol South)
Q Can you say a little more about what those opportunities might be, particularly for social care, with better focus on health and wellbeing boards?
Roger Gale (Conservative, Herne Bay and Sandwich)
Q Ms Higson, you clearly had an interest in the Minister’s last question. Is there anything you would like to say about that?
Helen Morgan (Liberal Democrat, North Shropshire)
Q I am a vice-president of the LGA, and I am also on the all-party parliamentary patient safety group, just to declare that interest up front. I will use the example of my own local authority, Shropshire, which is a unitary authority. It is extremely financially challenged and operates with an ICB in a similar situation. The hand-off that Sally described between continuing healthcare and provision of social care is really problematic because neither organisation really wants to pay for the care for the people who need it because they do not have the funds. It is a really tense relationship between the two.
I am really concerned that that will become even more problematic because they cannot work together, given that we are not a combined mayoral authority, that we will not have a mayor sitting on our ICB and that our ICB merged footprint does not fit with our local authority geography. How can the health and wellbeing boards work between the two organisations to deliver good social care?
Roger Gale (Conservative, Herne Bay and Sandwich)
Is that directed at any particular witness?
Helen Morgan (Liberal Democrat, North Shropshire)
I am directing it at all three, if that is okay.
Roger Gale (Conservative, Herne Bay and Sandwich)
Let us start with our councillor in the middle.
Helen Morgan (Liberal Democrat, North Shropshire)
Q Do you think that the health and wellbeing boards, as envisaged by the Bill, will be the right structure to deliver those relationships, and how do you ensure that they have the right skills?
Edward Argar (Conservative, Melton and Syston)
Q Having been both a local councillor and a Health Minister, I am very conscious that the real test of any joint working arrangements between different bodies comes when budgets start getting a little tighter. We see that tension growing a little bit with the cuts made to ICBs’ budgets.
I was the Minister who created ICBs, and I sat on that Bill Committee with the current Minister for Secondary Care. I am getting a sense of déjà vu—we are on different sides of the Chamber now, but we sat through the Committee stage of the Health and Care Act 2022 together. I deliberately created ICBs to match the geography of upper-tier authorities because health and social care is essentially one system. If one bit does not work, the other bit does not work.
Since then, we have seen significant mergers and larger areas, further removing them from that direct relationship and read-across. Although the good ones do, I fear that a lot of NHS ICBs do not fully reflect the intention behind their creation, which was to see them as a genuinely collaborative exercise with equal voices in the room.
My question is: if we see ever-larger areas or fragmented areas, whether through neighbourhood health plans or mergers and acquisitions among ICBs, how do we maintain genuine local accountability and the relationships that underpin any structure written in law, on a piece of paper or in guidelines?
Notwithstanding what is being done about the health and wellbeing boards’ increasing involvement, do they actually have the teeth they need? In my experience, however good the collaboration, it is within the ICB boardroom that the decisions are actually made. However well things have been discussed beforehand, the ICBs will make their own decisions based on their own priorities. Does the removal of that voice from the ICB strengthen or weaken the ability to see this as one local system and to deliver a genuinely holistic local solution?
Sureena Brackenridge (Labour, Wolverhampton North East)
Q Constituents have raised issues with me about when elderly patients or patients with dementia, in particular, come to discharge and the transfer of care, because of the lack of effective data and information sharing. To what extent do the provisions in the Bill on the single patient record allow data to be shared with social care providers? I will ask Councillor Wright to start off.
Gregory Stafford (Conservative, Farnham and Bordon)
Q Ms Higson, given that you are a director of transformation, and that this is, in a wider sense, a transformation of the NHS, if you had the money, resources and political capital that the current Government have, would you do this or would you do something else?
Gregory Stafford (Conservative, Farnham and Bordon)
Q Can you give a couple of examples?
Jo White (Labour, Bassetlaw)
One of the concerns of my local healthcare trust is around the release of elderly patients into the community, as it finds that relations with the ICB are sometimes difficult. How can neighbourhood health plans work well and cohesively with healthcare trusts to release patients into community care?Q
Roger Gale (Conservative, Herne Bay and Sandwich)
I could not hear the question from this end of the room; I do not know if our witnesses could.
Jo White (Labour, Bassetlaw)
I was talking about bed-blocking in hospitals and how neighbourhood health plans can work more cohesively with hospital trusts.
Janet Daby (Labour, Lewisham East)
SallyQ , you have said a bit on this already, but could you say a bit more about how the single patient record could change and improve day-to-day experiences of the health and social care system, and the safeguards that you might be concerned about?
Laura Kyrke-Smith (Labour, Aylesbury)
Q I come from a county with really significant health inequalities—people in the wealthy parts of the county live 10 or 12 years longer than people in some of the more deprived parts of Aylesbury, which I represent. I would love to hear your thoughts on how we ensure that local authorities, ICBs and the voluntary sector continue working well together through this, and specifically how we do that in a way that drives the reduction we need in health inequalities.
Peter Prinsley (Labour, Bury St Edmunds and Stowmarket)
Which organisations or people do you envisage running the neighbourhood health centres? Will they be run out of general practice organisations, or will the local authorities themselves be best placed to run them, so as to join up hospital care with community servicesQ ?
Peter Prinsley (Labour, Bury St Edmunds and Stowmarket)
Q So the ICB will commission it, but somebody will have to run it. Who should run a neighbourhood health centre?
Roger Gale (Conservative, Herne Bay and Sandwich)
Last word, Sally Burlington.
Roger Gale (Conservative, Herne Bay and Sandwich)
Thank you, ladies. The Committee is most grateful to you.
I will just explain now, while we are changing over witness panels, that after I introduce the next panel there are likely to be—in fairly short order, because the Minister is on his feet—four Divisions in the House. I shall suspend the Committee from as soon as the first Division is called until 10 minutes after the start of the last Division, when we will start again. I hope that is clear. It does mean, I am afraid, that we will have to ask our witnesses to be very patient. It is extremely tedious and very discourteous, but that is the way this place operates, I am afraid.
Roger Gale (Conservative, Herne Bay and Sandwich)
We will now take evidence from Carers UK, Age UK and Tommy’s. Could you introduce yourselves for the record, please?
Roger Gale (Conservative, Herne Bay and Sandwich)
Thank you all very much for joining us.
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q My first question goes to all of you. In principle, the single patient record offers opportunity, but people have expressed reservations, as have each of your charities. What are your thoughts on the single patient record?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q I have a question for Emily about digital exclusion and the app. What can be done to help people not to be digitally excluded? How do you see this working in areas of the country with poorer broadband connections, for example? Also, what about the record? Sharing your medical records is not an all-or-nothing thing, is it? It may be that someone is happy to share their current illness or current medical circumstance with their carer, but may perhaps want aspects of their history to remain a secret. Have you had any indications from the Government on how that might work?
Roger Gale (Conservative, Herne Bay and Sandwich)
Paul Farmer, you have been given the floor.
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q As a Lincolnshire MP, I am delighted to know that that is operating, if not necessarily in my constituency, then certainly in the county. I have a question for Kath: how does the single patient record apply to maternity in terms of safeguarding and access to that sort of information? As an aside, this Bill allows the Secretary of State to set targets. How would you see that working in maternity care?
Karin Smyth (Labour, Bristol South)
Q I will follow on from Dr Johnson’s questions. You have all expressed support for the single patient record, which is great, but that is not universal. Obviously, the Bill has to be enacted for that measure to go forward. It would be helpful to hear about your current experiences in your different areas—older people, maternity and carers. Your examples gave a bit more detail on why not to have this, Ms Abrahams—let us not assume, because although the process of the Bill is to make this happen, we have heard some concerns today from people who do not want that. What is happening in your world that this will help with?
Helen Morgan (Liberal Democrat, North Shropshire)
Q We have talked a lot about the single patient record, but I want to touch on whether the Bill does enough for people who have historically not been listened to, as we have heard has been the case for carers and women who have suffered in the maternity system. Does the Bill deal with the problem of people not being listened to? What opportunities are there to improve the Bill in a way that improves the situation?
Roger Gale (Conservative, Herne Bay and Sandwich)
I do not think there are any further questions. I am sorry to have kept you waiting so long for what has been a relatively short period of time, but it was important that all Front Benchers, and any other Members who wished to do so, had the opportunity to question you. Thank you all very much for being so patient and for giving us the benefit of your thoughts and wisdom.
Roger Gale (Conservative, Herne Bay and Sandwich)
If everyone is ready, we will proceed to the next panel; as you will see, one of our guests is on the screen. We have Dr Michael Cocker, from East Lancashire hospitals NHS trust, Dr Towhid Imam, from Croydon health services NHS trust, and Dr Nicola Byrne, the National Data Guardian for Health and Social Care. We will get through this as reasonably swiftly as we possibly can without cutting corners, if that is all right. I will try to bring this to a logical conclusion within—[Interruption.]
Roger Gale (Conservative, Herne Bay and Sandwich)
For the sake of the record, starting with the two people in the room, will you identify yourselves, please?
Roger Gale (Conservative, Herne Bay and Sandwich)
Thank you all for joining us. Again, I apologise for the disruption.
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q I should say that I also work as an NHS consultant paediatrician. The single patient record offers a great opportunity for doctors, clinicians and patients to all be much more joined up, but I have a quote from the Secretary of State on Second Reading:
“rather than data being transferred from where it exists at the moment to a new system, it will remain where it is—in GP surgeries, hospitals and so on—but it will be linked up so that one person, including the patient, can see all that data”.—[Official Report, 1 June 2026; Vol. 786, c. 890.]
How easily will that work in practice? In the trust that I work in, we have different systems for blood results, results, tracking patient appointments, maternity and A&E. Is it realistic to expect someone to be able to log on from one part of the country and to understand all the different systems in all the other parts of the country, or do you think that it needs to work in a different way?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
That would be moving it on to a new system.
Caroline Johnson (Conservative, Sleaford and North Hykeham)
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?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
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?
Karin Smyth (Labour, Bristol South)
Q My questions around the benefits that you might see have been really well answered, so I will not go back to that issue. Dr Cocker and Dr Imam, in your work on maternity and frailty, what early lessons have you picked up on how this might work for you?
Karin Smyth (Labour, Bristol South)
Q Dr Byrne, you talked about the issues around trust, which we absolutely recognise. We hear quite a lot about the work going on to try to get the legislation right technically, but, further to what you have suggested, how would you advise the Government to communicate clearly about the benefits, while understanding people’s concerns about getting a single patient record, should the legislation become law?
Helen Morgan (Liberal Democrat, North Shropshire)
Q I think everyone is agreed about the transformative potential of the single patient record, and we have heard various concerns around privacy and the types of use. I am interested in how all these different systems can speak to each other, because, in my experience as an accountant, you can have interoperability, but if the data that you are interoperating with is not consistently curated, you have a problem, because you have something that looks the same for everybody, but that actually means something very different to each person who inputs that data.
Do you have any advice for us on the development of that single patient record and how we make sure that the data is clean and consistent between trusts and different systems, so that the single patient record is actually meaningful? I will ask Dr Cocker first, if he is the technical expert.
Helen Morgan (Liberal Democrat, North Shropshire)
Q My other question is about digital exclusion. This is particularly for Dr Imam, because we associate older people with being digitally excluded, although I know it is not exclusively older people who are digitally excluded: how would you envisage the digital record interacting with something more analogue for people who cannot use the NHS app for whatever reason?
Sojan Joseph (Labour, Ashford)
Q I was listening to Dr Byrne’s concerns about confidentiality and trust. I want to declare that I have worked in the NHS in the mental health sector for many years. I worked in one of the biggest mental health trusts, Kent and Medway mental health NHS trust. We use an electronic patient record called Rio. As Dr Cocker said, before anyone is given access to the record, they have to have training on information governance and data protection, and access is given based on their role. That system creates an audit trail, so patients can request to see how many people have accessed their information in the last month or two—there are facilities on the system to check that. Is staff training and raising awareness among patients important for creating trust and confidentiality?
Peter Prinsley (Labour, Bury St Edmunds and Stowmarket)
Q I am an ENT surgeon. What do you think about giving the patient ownership of the single patient record as well as discretion over whether the information in that record is revealed to the clinical team?
Peter Prinsley (Labour, Bury St Edmunds and Stowmarket)
I would love to amend the figures in my bank account—I would like to be able to go into my Lloyds bank account and add a nought to the end of the balance figure—but I cannot, because the bank controls that. But I am the one who has access to the data.Q
Caroline Johnson (Conservative, Sleaford and North Hykeham)
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?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Thank you. You are nodding, Dr Cocker.
Caroline Johnson (Conservative, Sleaford and North Hykeham)
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.
Roger Gale (Conservative, Herne Bay and Sandwich)
Dr Byrne, Dr Imam and Dr Cocker, thank you very much indeed for your patience and for affording us the benefit of your experience and wisdom. The Committee is most grateful to you.
Examination of Witness
Roger Gale (Conservative, Herne Bay and Sandwich)
We will now hear oral evidence from Managers in Partnership. We have until we have exhausted ourselves—I will say that for the moment—for this session. Would you be kind enough to introduce yourself for the record?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
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?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
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?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
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?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
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?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
Q We do not have a plan of where we are going, but you have been asked to go somewhere.
Karin Smyth (Labour, Bristol South)
Q It is always good to have a doctor from the NHS supporting managers in the NHS, having been one. I declared my interest earlier that I am a member of Managers in Partnership.
We had a lot of change with the Health and Social Care Act 2012, and the Bill seeks to reverse that in terms of the architecture of the NHS. We absolutely appreciate as a Government that that is very difficult for staff working in it. I appreciate that the operating model and so on is coming forward, but could you say a bit about people’s feelings about the Bill? There will be more clarity to the centre and the role of providers is not changing, while the real change is around commissioning functions and, as you said, commissioning support organisations. We heard earlier that everything is being reorganised. That is not true, but there is a big change in the geography and the functions of ICBs and commissioners, and the Secretary of State’s role will clearly be different. What might people’s approach to that be?
Helen Morgan (Liberal Democrat, North Shropshire)
Q I will ask about the additional responsibilities that the Bill confers on ICBs. There are additional commissioning responsibilities and an additional requirement to look after what was Healthwatch—the patient voice element. As you have described, you have lost a large number of staff, you have a bigger geographic footprint and you have also lost quite a lot of budget. What do you stop doing, and what is being transferred out to other provider organisations? If the role of such organisations is changing to include some things that the ICB was doing, does that need to be clarified in the legislation?
Helen Morgan (Liberal Democrat, North Shropshire)
Q If I may ask a related question, one element of the Bill is the reorganisation of who sits on the ICB. We have seen the removal of local authority representatives and their replacement by a mayor or his or her appointee. What concern does that cause to your members—or do they think that is the right way to go?
Helen Morgan (Liberal Democrat, North Shropshire)
Q I am a vice-president of the Local Government Association. With changes to the better care fund pooling and the link-up with local authorities, are there concerns at ICB level that the partnership with social care will start to become more difficult?
Roger Gale (Conservative, Herne Bay and Sandwich)
Thank you very much indeed, Mr Restell. Thank you for your patience, thank you for coming and thank you for the evidence you have given. It is greatly appreciated.
Roger Gale (Conservative, Herne Bay and Sandwich)
We shall now hear oral evidence from Sir Andrew Dilnot. Sir Andrew, for the benefit of the record, could you identify yourself, please?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
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?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
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?
Karin Smyth (Labour, Bristol South)
Q As you say, the Bill does not deal with social care, but it is great to have your expertise here. Do you think the Bill should or could have included social care at this stage?
Helen Morgan (Liberal Democrat, North Shropshire)
Q You just used the phrase, “instrumental damage to the NHS”. Can you elaborate a bit on that, and perhaps explain how the NHS might be able to function better if there were a mechanism within the Bill to sort out social care?
Helen Morgan (Liberal Democrat, North Shropshire)
Q I will put words in your mouth, and you can disagree with me. Do you think the Bill should tackle the point about having a properly funded care service so that the transition from hospital to the community can actually take place? As you have just said, if people are not cared for properly, they end up back in hospital, and everyone here agrees that is what we are trying to avoid.
Joe Robertson (Conservative, Isle of Wight East)
Q Hospital pressures on the Isle of Wight are particularly severe, and part of the way of dealing with so-called corridor care is for the hospital and local authority to look at discharging some frail patients to the mainland, including those living with dementia, which is plainly not a solution by anyone’s normal interpretation. Is there anything in this Bill, notwithstanding that it does not deal with the fundamental problems of social care, not only that can help to resolve those sorts of situations, but that could help to resolve them if it went a little further? I am looking for opportunities to use the Bill to try to do a little more in and around discharge and social care.
Caroline Johnson (Conservative, Sleaford and North Hykeham)
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.
Roger Gale (Conservative, Herne Bay and Sandwich)
Thank you very much indeed, Sir Andrew, for affording us the benefit of your considerable knowledge in this area, and thank you again for your patience. We are most grateful to you.
Roger Gale (Conservative, Herne Bay and Sandwich)
Minister, for the sake of the record, would you identify yourself, please?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
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.
Caroline Johnson (Conservative, Sleaford and North Hykeham)
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?
Caroline Johnson (Conservative, Sleaford and North Hykeham)
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?