The Committee consisted of the following Members:
Chairs: Sir Roger Gale, Dr Rupa Huq, Emma Lewell, † Sir Jeremy Wright
† Argar, Edward (Melton and Syston) (Con)
† Brackenridge, Sureena (Wolverhampton North East) (Lab)
† Chambers, Dr Danny (Winchester) (LD)
Daby, Janet (Lewisham East) (Lab)
† Foody, Emma (Cramlington and Killingworth) (Lab/Co-op)
† Irons, Natasha (Croydon East) (Lab)
† Johnson, Dr Caroline (Sleaford and North Hykeham) (Con)
† Joseph, Sojan (Ashford) (Lab)
† Kyrke-Smith, Laura (Aylesbury) (Lab)
† Morgan, Helen (North Shropshire) (LD)
† Prinsley, Peter (Bury St Edmunds and Stowmarket) (Lab)
† Robertson, Dave (Lichfield) (Lab)
† Robertson, Joe (Isle of Wight East) (Con)
† Smyth, Karin (Minister for Secondary Care)
† Stafford, Gregory (Farnham and Bordon) (Con)
† Twist, Liz (Blaydon and Consett) (Lab)
† White, Jo (Bassetlaw) (Lab)
Sanjana Balakrishnan, Rob Cope, Committee Clerks
† attended the Committee
Public Bill Committee
Tuesday 23 June 2026
(Morning)
[Sir Jeremy Wright in the Chair]
Health Bill
Clause 1
Abolition of NHS England
Question (18 June) again proposed, That the clause stand part of the Bill.
I will finish by talking about the use of data. Clearly, there are different uses of data when assessing where there are gaps—in this case, gaps or issues around health inequalities. Different Governments can and do use different data, and they reassess and re-evaluate the sort of data that they want to rely on; this Government will, and do, use slightly different data from the previous Government, but I want to raise the issue of different Departments in the same Government using different data.
My detailed knowledge of the way in which data is used within the Department of Health is probably too scant for me to say anything particularly meaningful in the context of this debate, but I will use an example that again relates to my local area and to health inequalities: MHCLG’s use of data to assess local government funding to deliver adult social care and children’s services. Both pockets of money clearly relate to health inequalities and their removal. Amendment 30 tries to tackle that by placing a duty on the Secretary of State to
“have regard to the need to involve all departments”,
But even then, within one Department, MHCLG, different data is used to assess the connectivity and remoteness, of, for example, the Isle of Wight when funding the Isle
of Wight council and the way it delivers adult social care and children’s services. I have yet to find a logical explanation why the remoteness of the island on which I live, the challenges of which are known in terms of cost, remoteness, crossing water and recruiting people to work in schools, hospitals, care homes and so on, should be dealt with differently when dealing with children’s services or adult social care.Using one dataset to decide funding from one pot of money, and another for another pot of money seems quite arbitrary—or at least not joined up. If that happens within one Department, there is greater scope for it happening across different Departments—indeed, it is certain that it will. By my reading, that is what amendment 30 is designed to address. Whether this is the right place for that, and whether it will actually achieve anything, I am not sure, but it is certainly a debate that needs to be had. It may well be that here is better than anywhere else in terms of including it somewhere in law.
Every medical practitioner knows that choice is important for care, because patients need to choose which type of care that they receive. When patients receive elective care—planned procedures and treatments that are not emergencies—there is often more than one option, and different options carry different trade-offs. Those might be surgical options or radiation therapy for people with a basal cell carcinoma, for example—they may decide to have it removed or to have radiotherapy. They can make different types of choices, and the right one depends on the patient, their condition and their individual preferences. Clinicians can or should provide information so that the patient can make a fully informed choice, but the patient knows their preferences.
That is why choice and patient involvement is so important. It was first enshrined in the NHS constitution published in 2009, which set out that patients have a right to make choices about their care and the right to the information necessary to support those choices. The successor Government amended the National Health Service Act 2006 so that the Commissioning Board—now NHS England, which the Committee has agreed to abolish—had a patient choice duty.
Clause 5 will impose an equivalent patient choice duty on the Secretary of State. As I mentioned, NHS England is being abolished, so the clause is a necessary continuity measure. In addition, it will not be possible for the Health Secretary to improve the health service unless he focuses on patient choice. Choice can reduce bottlenecks, and people may pick providers for which demand is weaker so that they can be seen more quickly, relieving pressure on the more stretched hospitals. When people can choose based on rankings, waiting times, reputation and so on, providers have an additional incentive to improve quality. Money follows the patient, and no signal is greater than individuals voting with their feet. Choice can reduce geographical disparities in access. It allows patients to leapfrog underperforming local providers and access the same standard of care available to those in other areas.
As in many other policy areas, when Government give people the freedom to choose, we tend to end up with better outcomes across the board. Notwithstanding those points, I am concerned that the clause is not sufficiently robust, because, when put under the microscope, it has a weak legal threshold. It requires the Secretary of State to promote the involvement of patients and to act with a view to enabling patients to make choices, but what does that look like in practice? If a patient—or a set of patients represented by a charity—identifies that choice is not being offered in one particular area, what is their legal recourse? A view refers to a person’s thoughts, not to a specific obligation. If we are to legislate, the measure needs to have teeth, or it is just a statement of someone’s job, as we said earlier. Unless there are breakthroughs in mind-reading technology, how would we prove that the Secretary of State did not think about patient choice while closing a hospital, downgrading the NHS app or squeezing out a specific type of provider?
Members cannot legislate just for today’s Government; they legislate for future Governments who may interpret legal duties in different ways. The amendment, therefore, would strengthen the patient choice duty in the clause from a general aspiration into a specific and enforceable right to choose between providers for out-of-hospital services. Integrated care boards would have a legal duty to offer patients a meaningful choice of at least two providers from their area and, where relevant, in neighbouring areas. The latter part is important for those located in rural areas and for those with uncommon conditions.
My amendment would prohibit ICBs from limiting patient choice of provider based on commercial interest or organisational type. That would safeguard against ideologically motivated directions, which can undermine patient choice. The Minister is a sensible person, but some of her detractors, and future Ministers, may not be. They may view choice and private sector provision as part of a grand conspiracy. We cannot provide them with the tools to undermine many years of progress. For that reason, I hope that Members will support the amendment. I look forward to hearing the Minister’s choice.
Clause 5 ordered to stand part of the Bill.
Clause 6
Promoting innovation
In February, the shadow Secretary of State, my right hon. Friend the Member for Daventry (Stuart Andrew), and I met the scientist Professor Hanna and his team at Imperial College. It was a fascinating visit; Professor Hanna is looking at a breath test for pancreatic cancer. Outcomes for pancreatic cancer and other cancers of the upper GI tract are very poor, but he discovered that, before the cancer is detectable in any other form, volatile organic compounds are present in the breath. He has developed a machine that an individual can breathe into that will detect those compounds in order to detect the cancer early and potentially treat it. It is estimated that that will improve the pancreatic cancer survival rate threefold, although from a low base, from 7% to 21%. That will make a huge difference.
It is exciting how widespread that could become. If people travel to the continent, in particular to France, they have to carry a breathalyser, which costs just a few pounds, in their car. Professor Hanna is talking about how his technology, once it has been proven, could be developed on that scale so if someone was concerned about their symptoms, they could go to their GP or pharmacy and procure a breathalyser test to reassure themselves or to acquire a referral.
Innovation has the potential to save lives, which is very impressive. In a technological form, many people, including me, wear watches that tell them what their heart rate is and that monitor their exercise. There is so much available now that was not before, so we need to encourage innovation because it will improve our healthcare and survival rates.
Members will have seen many reports about the productivity challenges facing the NHS. In sectors like manufacturing and software, new technologies allow organisations to significantly increase their output per worker, but that is difficult in healthcare: nurses can make use of new equipment and better techniques, but taking care of a human will always remain labour-intensive. Breakthroughs like robotic assisted surgery are impressive, but not necessarily frequent. The NHS has to offer increasing salaries to attract workers from other sectors, even if productivity is growing more slowly than in other parts of the economy. That is why innovation is so important: it is one of the ways that the health service can improve outcomes and productivity at the same time.
Currently, NHS England has a legal duty to promote innovation. That is set out in section 13K of the NHS Act 2006, which was it was inserted by the Health and Social Care Act 2012. As the Government are abolishing NHS England, that duty will disappear. The Government have chosen for clause 6 of the new legislation to place the duty on the Secretary of State instead. If innovation is encouraged and supported across the health service, it can unlock better outcomes and higher productivity, which is good for the Government, taxpayers and patients.
I want first to refer to a rather puzzling provision in clause 6:
“The Secretary of State may make payments as prizes to promote innovation in the provision of health services in England.”
An explanation of what is meant by “prizes” might assist not only the Committee but the public more widely. It is a rather odd word and does not sit hugely comfortably with the serious issue of promoting innovation in the NHS and healthcare in this country. It rather more conjures up the idea of a lottery or a game show. Are these payments to be unlimited? What are they for? Where is the pot of money? We know something of the way in which the Secretary of State may make those payments, because the clause sets out that they may “establish a committee” to give advice about dishing out prizes and that they may pay money to those people who sit on the committee to help the Secretary of State decide who deserves a prize and who does not.
At a time when the Government and the Minister talk about efficiencies and saving money and when excellent organisations such as Healthwatch, which delivers its work for a surprisingly limited amount of money, are to disappear, it is rather remarkable to see these provisions without greater context, although I do wonder what context would suggest that a prize is a useful way of promoting innovation. Are there to be any restrictions in the way the prize money is spent? Are there any categories in which a person or organisation falls within the potential pool of prize winners and any categories where they do not? For example, could a prize winner be an individual? Does the Minister envisage money being paid to individuals? Perhaps more likely, could a non-NHS organisation, like a GP practice—notwithstanding the fact that they are very important for delivering NHS services—win a prize? If a GP practice were to benefit from prize money, if indeed they could, would there be any restriction on how that money is spent? Might there be a giving of prize money with one hand and the taking of money with another, which would make the prize simply a cut in some sort of other payment and nothing more than a gimmick? If not—if prize money is to be genuinely additional money—is that actually the best way of distributing money? When an organisation—take again the example of a GP practice, or set of practices, or primary care network—demonstrates innovation, that innovation may have led to more efficient use of the money it already has. Is it therefore sensible
to give it yet more money, or will it maybe lead to an oversupply of payments in one area and a dearth of supply in others?Of course, innovation, and the environment that leads to innovation, does tend to thrive in a competitive environment, but I have some concerns without further context about whether incentivising competition through prize money is the way to go. Certainly, if we asked the great British public the straightforward question, “What is the best way to achieve greater innovation in healthcare?”, it would take them a long time to say, “Set up a committee and pay those committee members to advise the Secretary of State on dishing out prizes to those who show innovation.” I suspect we would have to go a long way to find a member of the public who came up with that idea, and it would probably take just as long to find someone to back the idea without further explanation, but perhaps we will get some clarity when the Minister speaks.
Turning to amendment 58, there is consensus that innovation is a good thing and that the Department and the Secretary of State should promote it. The advantage of the amendment is that it provides more detail on what innovation means and how it should be targeted, promoted and delivered.
For example, the amendment would require that the Secretary of State must
“take steps to ensure the timely adoption and spread of clinically effective innovations”.
The NHS can be excellent at innovating, but the adoption and take-up of those innovations across the health service can be frustratingly slow. Indeed, there are numerous examples where it does not happen at all. Expressly referencing the taking of steps to ensure the spread and adoption of effective innovations is a strong, meaningful and necessary amendment.
The amendment would also require that the Secretary of State must
“identify and seek to remove barriers to the uptake of innovation”.
Sometimes, the reason why innovation does not spread is not lethargy, apathy or neglect, but because there are various structures within the NHS and procurement and regulatory barriers that, although not set up or designed to restrict innovation, nevertheless have a tendency to do that. The focus of the amendment is on identifying and seeking to remove such barriers to allow that uptake of innovation.
I note that the amendment mentions “cultural barriers to change”. In my previous career working for a national health charity, part of my role was to roll out specialist nursing services, working in partnership with NHS organisations and others operating in the health and social care space. We embedded new practices that might be described as innovation. In fact, a lot of it was not overly innovative in thought or practice, but it was innovative for certain corners of the country where those practices were not happening.
For example, on the adoption of electronic record-keeping systems, certain trusts used a number of them that did not speak to each other. There was a cultural barrier—if by culture, we mean work culture—in that some NHS trusts were very good at embedding and adopting an electronic patient record system that was uniform across the trust, or, where more than one system was operating, the systems were interoperable
and spoke to each other. In other NHS trusts, there was a cultural issue of wanting to leave teams alone and not disrupt their working practices, even if the imposition of a new system would have delivered efficiency and better patient outcomes.Clause 6 ordered to stand part of the Bill.
Clause 7
Education and training
The Chair adjourned the Committee without Question put (Standing Order No. 88).
Adjourned till this day at Two o’clock.