Health Bill

[2nd Allocated Day]

Further c onsideration of Bill, as amended in the Public Bill Committee

[ Relevant documents: First Report of the Health and Social Care Committee, Health Bill 2026-27, HC 219; and o ral evidence taken before the Health and Social Care Committee, on the Work of NHS England, 20 May, HC 583.]

New Clause 94

Medical devices regulationGreat Britain

“At the beginning of Part 4 of the Medicines and Medical Devices Act 2021 insert—

“Chapter A1

Medical devices regulations (Great Britain)

14A Licensing of medical devices

(1) The Secretary of State may by regulations (“medical devices regulations”)—

(a) prohibit a person from carrying out the following activities in the course of business otherwise than in accordance with a product licence—

(i) supplying medical devices;

(ii) advertising medical devices;

(b) prohibit a person from carrying out the following activities in the course of business otherwise than in accordance with a personal licence—

(i) manufacturing medical devices;

(ii) importing medical devices;

(iii) supplying medical devices by way of wholesale dealing;

(c) prohibit a person from carrying out a clinical investigation in relation to a medical device otherwise than in accordance with a personal licence.

(2) In subsection (1)(b)(ii) the reference to importing medical devices is to—

(a) importing medical devices into the United Kingdom as a result of their entry into Great Britain, or

(b) removing medical devices to Great Britain from Northern Ireland.

(3) The Secretary of State’s overarching objective in making medical devices regulations, and in exercising any functions under them, is to safeguard public health.

(4) In considering whether the exercise of a function would contribute to that objective, the Secretary of State must have regard to—

(a) the safety of medical devices;

(b) the availability of medical devices;

(c) the likelihood of the United Kingdom being seen as a favourable place in which to—

(i) carry out research relating to medical devices,

(ii) develop medical devices, or

(iii) manufacture or supply medical devices.

(5) In this Chapter—

“personal licence” means a licence, issued by the Secretary of State, authorising the licence holder to carry out an activity mentioned in subsection (1)(b) or (c) in relation to a medical device of a description specified in the licence;

“product licence” means a licence, issued by the Secretary of State, authorising the supply or advertising of a medical device of a description specified in the licence (whether by the licence holder or otherwise).

(6) Nothing in the later provisions of this Chapter limits the breadth of the power conferred by subsection (1).

14B Grant of licences

(1) Medical devices regulations may make provision about the grant of licences.

(2) The provision that may be made includes provision—

(a) requiring the Secretary of State not to grant a licence unless satisfied as to matters specified in the regulations;

(b) requiring the Secretary of State to have regard, in deciding whether to grant a licence, to matters specified in the regulations.

14C Licence conditions

(1) Medical devices regulations may make provision about licence conditions.

(2) The provision that may be made includes provision—

(a) enabling the Secretary of State to include conditions in a licence;

(b) requiring the Secretary of State to include in a licence a condition specified in the regulations;

(c) specifying conditions that, by virtue of the regulations, are to be treated as included in every licence.

(3) The provision that may be made includes provision about the variation of conditions included in a licence.

(4) Conditions may, in particular—

(a) impose requirements on the licence holder, or

(b) in the case of a product licence, impose requirements relating to the supply or advertising (by anyone) of the medical device to which the licence relates.

(5) Conditions imposing requirements on a licence holder may, in particular—

(a) require the monitoring, investigation or evaluation of the safety or performance of a medical device;

(b) require the provision of information to the Secretary of State;

(c) require the appointment by the licence holder of an individual who is resident in the United Kingdom and is authorised or required to act on the licence holder’s behalf in relation to matters of a specified description.

14D Duration of licences etc

Medical devices regulations may make provision about the duration, renewal, variation, suspension, revocation or transfer of licences.

14E Exemptions for public health purposes

(1) Medical devices regulations may authorise the Secretary of State to grant a temporary exemption from any provision of the regulations for the purposes of protecting public health.

(2) The regulations may provide for an exemption to be subject to conditions set out in the regulations or published by the Secretary of State.

14F Register of licences

Medical devices regulations may include provision for or in connection with the establishment of a public register containing information about licences.

14G Offences

(1) Medical devices regulations may create offences in relation to—

(a) a failure to comply with specified provisions of the regulations, or

(b) the provision of false or misleading information to a person for the purposes of anything required or authorised by the regulations.

(2) The regulations must provide for any such offence to be punishable—

(a) on summary conviction in England and Wales, by imprisonment for a term not exceeding the maximum term for summary offences or a fine (or both), or

(b) on summary conviction in Scotland, to imprisonment for a term not exceeding 12 months or a fine not exceeding level 5 on the standard scale (or both).

(3) In subsection (2)(a) “the maximum term for summary offences” means—

(a) if the offence is committed before the time when section 281(5) of the Criminal Justice Act 2003 comes into force, six months;

(b) if the offence is committed after that time, 51 weeks.

14H Enforcement

Medical devices regulations may confer functions on the Secretary of State or a local weights and measures authority in relation to the enforcement of the regulations.

14I Fees

(1) Medical devices regulations may make provision for the charging of fees that are payable—

(a) in connection with an application for the grant of a licence, or

(b) by the holder of a licence.

(2) Fees must not exceed an amount specified in, or determined in accordance with, the regulations.

(3) The amount, or method for determining it, may take into account the cost of exercising any functions conferred by virtue of the regulations.

(4) The regulations may confer power on the Secretary of State to waive fees.

14J Interpretation

(1) In this Chapter—

“clinical investigation” means an investigation that involves human subjects, or specimens from the human body, and is undertaken to assess the safety or performance of a medical device;

“grant” , in relation to a licence, includes vary or renew;

“licence” means a product licence or personal licence;

“manufacturing” includes assembling;

“medical devices regulations” has the meaning given by section 14A(1);

“personal licence” has the meaning given by section 14A(5);

“product licence” has the meaning given by section 14A(5);

“supplying” includes—

(a) agreeing to supply, or

(b) offering or exposing for supply.

(2) In this Chapter—

(a) a reference to doing anything in the course of business includes doing it in connection with the provision of services in pursuance of arrangements made under any legislation;

(b) a reference to the supply of a medical device by way of wholesale dealing includes the supply of it to a person who receives it for the purposes of providing services to a patient or for the purposes of supplying it to a patient.

(3) The Secretary of State may by regulations make provision as to the circumstances in which a person is to be treated, or is not to be treated, as carrying on an activity “in the course of business” for the purposes of section 14A(1).””

This introduces a new power to make regulations for the licensing of medical devices, which is intended to replace the current regulatory regime in Great Britain . — (Karin Smyth.)

Brought up, and read the First time.

16:46:00

The Minister for Secondary Care (Karin Smyth)I beg to move, That the clause be read a Second time.

Madam Deputy Speaker (Judith Cummins)With this it will be convenient to discuss the following:

Government new clause 95— Disclosure of information relating to medicines . Government new clause 98— Disclosure of information relating to medical devices . Government new clause 99— Further and consequential amendments relating to medical devices . Government new clause 100— Power to amend meaning of “medical device” . Government new clause 101— Power to restate medical devices law in Northern Ireland . New clause 9— Powers for coroners and medical examiners to report suspected health system failings — “(1) The Secretary of State must, by regulations, establish a standard mechanism for coroners and medical examiners to refer cases where they suspect failings in the provision of health care.

(2) A coroner or a medical examiner has a duty to report (a “duty to whistleblow”) using the mechanism established under subsection (1) if, in the course of their duties, they have reasonable grounds to suspect that a death or incident involved systemic failings in a health care setting.

(3) A referral under this section must be directed to any or all of the following bodies, as the coroner or medical examiner considers appropriate, based on the nature of the suspected failing—

(a) the chief officer of police for the relevant police area,

(b) the Care Quality Commission,

(c) the Department of Health and Social Care, and

(d) the Health Services Safety Investigations Body.

(4) Regulations under subsection (1) must specify—

(a) the information to be included in a referral,

(b) the timeframe within which a referral must be made following the formation of a suspicion, and

(c) guidance on the criteria for determining to which of the bodies listed in subsection (3) the referral must be directed.

(5) A disclosure made in fulfilment of the duty under subsection (2) is a protected disclosure for the purposes of Part 4A of the Employment Rights Act 1996 (protection for whistleblowing).

(6) The duties imposed by this section are in addition to, and do not affect, a senior coroner’s duty to make a report under paragraph 7 of Schedule 5 to the Coroners and Justice Act 2009 (reports on action to prevent other deaths).” This new clause requires the Secretary of State to create a standardised framework for them to formally refer suspected health system failings (including systemic issues) directly to the police, the CQC, the Department of Health and Social Care, and the HSSIB, with a duty on coroners to participate. It provides legal protection for those making such referrals. New clause 10— Duty of NHS boards to report medical malpractice — “(1) A member of the board of directors of an NHS trust or an NHS foundation trust in England must report any evidence or reports they have seen of systemic medical malpractice within the trust to— (a) the Care Quality Commission,

(b) the Department of Health and Social Care, and

(c) the Health Services Safety Investigations Body.

(2) The board of directors of an NHS trust or NHS foundation trust in England has a collective duty to—

(a) refer the trust to the Care Quality Commission, and

(b) alert the Department of Health and Social Care and the Health Services Safety Investigations Body, if staff employed by, or acting on behalf of, the trust raise concerns of systemic medical malpractice.

(3) In this section, “systemic medical malpractice” means an action or omission in the provision of health care that falls below the expected standard of care and indicates a widespread, patterned, or recurring failure within the systems, processes, or governance of the trust.” This new clause would introduce a mandatory individual duty for members of NHS and Foundation Trust boards to escalate evidence of systemic medical malpractice to the CQC, the Department of Health and Social Care, and the HSSIB. It also imposes a collective duty on the board to formally refer the trust to regulators if staff raise concerns regarding malpractice. New clause 13— Medical Disinformation — “(1) The Secretary of State must, within 6 months beginning on the day on which this Act is passed, publish a strategy on anti-vaccine and medical disinformation (“the Strategy”).

(2) The strategy must consider—

(a) support for medical professionals to build trust and engage with persons who are anti-vaccine,

(b) support for medical professionals and NHS leaders to engage with anti-vaccine councillors or officials in local authorities,

(c) investment in public messaging to combat medical disinformation, including engagement with trusted online influencers,

(d) outreach campaigns focused on communities who are sceptical about vaccinations,

(e) introducing criminal liability for those, including online influencers and politicians, who profit from medical disinformation,

(f) a new verification requirement for any social media account claiming to be a medical professional.

(3) The Secretary of State must lay a copy of this strategy before Parliament upon publication.” This new clause places a duty on the Secretary of State to publish a strategy to combat anti-vaccine and medical disinformation. New clause 14— Healthwatch funding — “(1) The Secretary of State, must within 12 months of the passing of this Act, enact a scheme to fund Healthwatch England and local Healthwatch organisations for the 2027/2028 financial year to the level estimated by the Department for Health and Social Care in 2013/14.

(2) The Secretary of State must consider uprating this funding with inflation for 2026/2027.” This new clause would ensure that Healthwatch England and local Healthwatch organisations are funded to the level estimated by the Department for Health and Social Care in 2013/14. New clause 20— Cancer Survival Research —

“(1) Within 12 months beginning on the day on which this Act is passed, the Secretary of State must by regulations establish a Cancer Survival Research Programme.

(2) Regulations under this section must—

(a) require government co-ordination and funding for research into cancers with a five-year survival rate below 20%, and

(b) establish a fellowship programme for foreign academics in cancer research. (3) Any programme established under paragraph 2(b) must make provision to waive visa fees for entry into the UK for participating academics.

(4) Regulations under this section are subject to the affirmative procedure.” This new clause would require the Secretary of State to introduce regulations requiring the government to coordinate research into cancers with the lowest survival rate. New clause 24— Strategy for provision of Minor Injuries Units and Urgent Treatment Centres in rural areas — “(1) Within six months of the passage of this Act, the Secretary of State must prepare and publish a strategy for expanding the provision of Minor Injuries Units and Urgent Treatment Centres in rural areas.

(2) The strategy under subsection (1) must be laid before both Houses of Parliament.

(3) The Secretary of State must lay a report before both Houses of Parliament on the implementation of the strategy every 12 months after the strategy has been published.” This new clause would require the Secretary of State to prepare a strategy for expanding the provision of Minor Injuries Units and Urgent Treatment Centres in rural areas and report on the implementation of the strategy annually. New clause 26— Patient safety recommendations: national oversight — “(1) The Secretary of State must establish a scheme relating to the oversight of patient safety recommendations (“the scheme”).

(2) The scheme must make provision for the monitoring and delivery of patient safety recommendations arising from—

(a) investigations,

(b) inquiries,

(c) reviews, and

(d) other patient safety bodies,

relating to patient safety.

(3) Within one year beginning on the day on which this Act is passed and every subsequent year, the Secretary of State must lay a report before Parliament on the progress of the scheme.”

New clause 27— Duty of candour and enforcement of standards of ethical conduct in DHSC — “(1) In discharging its expected standards of ethical conduct, the Department of Health and Social Care (DHSC), must, in particular—

(a) set out the steps DHSC will take to ensure that legal services provided to NHS bodies and other relevant health-related organisations are consistent with the statutory duty of candour and the principles of openness, transparency and learning following patient safety incidents,

(b) set out which oversight body is responsible for ensuring the standards set out in DHSC code of ethical conduct are adhered to and enforced,

(c) set out provisions to allow a relevant oversight body to examine, on its own initiative, suspected serious or systemic breaches of DHSC’s code of ethical conduct,

(d) set out a mechanism for ensuring that any breaches of DHSC’s code of ethical conduct are recorded and that proper data is kept and published that records the extent to which complaints have been made regarding its ethical conduct and their outcome.”

New clause 28— Review of NHS neurodiversity policy — “(1) Within six months of the passage of this Act, the Secretary of State must publish a review on—

(a) standards of NHS care for neurodiverse people,

(b) the effectiveness of current NHS trust policies regarding care for neurodiverse patients,

(c) the quality of training and guidance for frontline NHS staff in supporting neurodiverse patients, and (d) health outcomes for neurodiverse patients at NHS trusts.

(2) The review under subsection (1) must be laid before both Houses of Parliament.”

New clause 30— Review into acute stroke support services in rural areas — “(1) Within six months of the passage of this Act, the Secretary of State must publish a review of acute stroke support services in rural areas.

(2) The review under subsection (1) must include an evaluation of—

(a) decision making processes,

(b) evidence used to justify decisions,

(c) public consultation processes,

(d) health outcomes,

(e) travel times for access to services, and

(f) impact on the NHS workforces.”

New clause 41— Remit of the Human Tissue Authority — “(1) The Secretary of State must, within six months of the passing of this Act, by order under section 14(4) of the Human Tissue Act 2004, amend the remit of the Human Tissue Authority to include the regulation of funeral directors, private mortuaries, direct cremation services and other organisations which transport or hold the bodies of deceased persons for the purposes of ensuring that the carrying out of their functions is consistent with the protection of public health.

(2) The Authority must establish and maintain a register of the bodies subject to its oversight under subsection (1).

(3) The Secretary of State may by regulations make further provision regarding the establishment and operation of the register under subsection (2).

(4) Regulations made under subsection (3) are subject to the affirmative procedure.” This new clause would require the Secretary of State to extend the remit of the Human Tissue Authority to include regulation of funeral service providers to ensure their activities are consistent with the protection of public health; and to maintain a register of those bodies subject to its regulation. New clause 42— Oversight of funeral service provider premises and practices connected to the storage, preparation and movement of human remains — “(1) The Secretary of State may by regulations establish a body corporate, or confer functions on an existing public authority, ("the Regulator") to provide oversight of the premises and practices connected to the storage, preparation and movement of human remains by funeral service providers in England.

(2) The purpose of the Regulator is to ensure that the activities undertaken under subsection (1) are consistent with the protection of public health.

(3) The Regulator shall be independent in the exercise of its functions and shall not be regarded as a servant or agent of the Crown.

(4) Regulations under this section may, in particular, make provision for—

(a) a scheme for the registration of funeral service providers;

(b) the inspection of premises, vehicles and other facilities used by registered providers for the storage, preparation, care or transportation of deceased persons, or from which funeral services are arranged or conducted;

(c) the publication and enforcement of a code of practice for the funeral services sector; and

(d) the imposition of sanctions, including suspension or removal from the register, for breach of that code.

(5) Before making regulations under this section, the Secretary of State must consult—

(a) providers of funeral services; (b) such persons representing the interests of bereaved people as the Secretary of State considers appropriate; and

(c) such other persons as the Secretary of State considers appropriate.

(6) Regulations under this section are subject to the affirmative procedure.”

New clause 45— Secretary of State directions relating to early access to medicines — “(1) The Secretary of State may give directions to any of the bodies mentioned in subsection (2) about the implementation of a scheme providing early access to medicines to people with life-threatening or seriously debilitating conditions.

(2) The bodies are—

(a) integrated care board,

(b) NHS Trusts,

(c) NHS Foundation Trusts,

(d) NHS Advanced Foundation Trusts, and

(e) other health and social care bodies.” This new clause would give the Secretary of State power to direct integrated care boards, NHS Trusts, NHS Foundation Trusts, and NHS Advanced Foundation Trusts to implement a scheme to provide early access to medicines to people with life-threatening or seriously debilitating conditions. New clause 47— Review of the Early Access to Medicines Scheme — “(1) The Secretary of State must, within six months of the passing of this Act, commission a review of the regime for early and accelerated access to medicines in England and Wales.

(2) The review conducted under subsection (1) must consider—

(a) the effectiveness of the Early Access to Medicines Scheme (EAMS),

(b) the effectiveness of early access outside of the Early Access to Medicines Scheme (EAMS), and

(c) equality of access across England and Wales, with the aim of reducing geographical inequalities between different NHS trusts.

(3) The Secretary of State must lay a copy of the report and recommendations of the review before both Houses of Parliament.” This new clause would require the Secretary of State to commission a review of regime for early and accelerated access to medicines. New clause 49— National Guardian ’s Office — “(1) Within three months beginning on the day on which this Act is passed, the Secretary of State must re-establish the National Guardian's Office.

(2) The Office established under subsection (1) must—

(a) hold any responsibilities held by the National Guardian's Office as of 29 June 2026; and

(b) be operationally independent.” This new clause will re-establish the National Guardian’s Office. New clause 52— Cancer treatment: waiting times — “(1) Within six months beginning on the day on which this Act is passed, the Secretary of State must make provision for every patient to have access to cancer treatment within 62 days following referral.

(2) Provision under subsection (1) must by regulations amend the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012 to place a right in the NHS constitution for England for every patient to have access to cancer treatment within 62 days following referral.

(3) The Secretary of State must establish a scheme to support NHS hospital trusts in meeting the requirement under subsection (1). (4) As part of the Scheme, the Secretary of State must expand the capacity of the Medicines and Healthcare products Regulatory Agency.

(5) The Secretary of State must make an annual statement to Parliament on progress made in meeting the requirement under subsection (1).

(6) Any statement made under subsection (5) should be made as close as reasonably practicable to 4 February.” This new clause would give patients a right under the NHS constitution to start cancer treatment within 62 days of referral and requires the Secretary of State to establish a scheme to deliver this. It also requires the Secretary of State to update the House on progress against the target on or around the time of World Cancer Day. New clause 63— Social Care — “(1) Within 3 months beginning on the day on which this Act is passed, the Secretary of State must lay before Parliament detailed proposals for reform of the social care sector.

(2) Proposals under subsection (1) must include provision for—

(a) a respite care scheme;

(b) reform of carers allowance;

(c) free personal care; and

(d) a cap on care costs.” This new clause would require the Secretary of State to lay before Parliament plans to reform the social care sector, including free personal care, a cap on care costs and that delivers for family carers. New clause 68— Report on dementia care — “(1) Within 12 months of the passage of this Act and every 12 months thereafter, the Secretary of State must publish and lay before both Houses of Parliament a report on—

(a) the provision of NHS care in relation to dementia.

(b) the provision of social care in relation to dementia.

(2) A report under subsection (1) must have regard to—

(a) any targets or standards set out in a national plan, guidance, or framework relating to dementia services, and

(b) any other information the Secretary of State considers appropriate.

(3) A report under subsection (1) must include—

(a) an assessment of variation in dementia services and outcomes between Integrated Care Board areas,

(b) information on workforce capacity, capability and training standards relevant to dementia care,

(c) information on access to ongoing post-diagnostic support services, including support for unpaid carers of dementia patients,

(d) information on continuity and coordination of care for people living with dementia, including access to a named professional responsible for coordinating support across services,

(e) outcomes and experiences for people living with dementia and unpaid carers, including crisis prevention, carer wellbeing, and experiences of joined-up care,

(f) progress on dementia prevention and risk reduction, and

(g) dementia research activity in the NHS.” This new clause would require the Secretary of State to publish an annual report on the provision of NHS care and social care in relation to dementia. New clause 72— Provision of Minor Injuries Units in Rural Areas — “(1) The Secretary of State must, within 12 months of the passing of this Act, publish and implement a strategy to improve access to minor injuries units in rural communities.

(2) The strategy under subsection (1) must include measures to— (a) expand, maintain and protect existing minor injuries units serving rural populations;

(b) ensure that integrated care boards assess local demand for urgent treatment services in rural constituencies and make provision accordingly, and

(c) promote the recruitment and retention of healthcare professionals required to staff such facilities.

(3) The Secretary of State must lay before Parliament an annual report on—

(a) the number and geographical distribution of minor injuries units in England;

(b) changes in patient access to urgent care services in rural areas; and

(c) progress made in implementing the strategy required under subsection (1).

(4) In this section, “rural constituency” means a parliamentary constituency designated as predominantly rural by the Office for National Statistics or such successor body as may be prescribed by regulations.” This new clause would require the Secretary of State to expand and safeguard minor injuries units in rural communities with the aim of improving access to urgent care, reducing pressure on major hospitals, and ensuring equitable healthcare provision regardless of geography. New clause 81— Family support duty following serious childhood diagnosis — “(1) Where a child is diagnosed with cancer or another life-threatening condition, the responsible NHS provider must, within 14 days of diagnosis, ensure that the child’s family is offered appropriate information, support and coordination services.

(2) For the purposes of subsection (1), the responsible NHS provider must offer—

(a) access to a named family support coordinator;

(b) information regarding welfare benefits, financial support and relevant public services;

(c) information regarding employment rights and workplace support available to parents and carers;

(d) signposting to appropriate mental health and psychological support services;

(e) information regarding relevant local and national charities, support organisations and peer-support services;

(f) a written family support plan setting out the support available to the family during treatment; and

(g) notification and information sharing in accordance with subsection (3).

(3) The responsible NHS provider must provide the child’s registered general practitioner and where different, the registered general practitioners of the child’s parents or primary carers, with a Family Support Summary.

(4) A Family Support Summary must include—

(a) the child’s diagnosis;

(b) the proposed treatment plan;

(c) the expected duration and intensity of treatment, where known;

(d) information regarding the potential impact of the diagnosis and treatment on parents, carers and siblings; and

(e) any recommendations regarding wellbeing support, monitoring or referral for the family unit.

(5) Following receipt of a Family Support Summary, the relevant general practice shall be encouraged to consider the wellbeing needs of parents, carers and siblings and, where appropriate, provide information, assessment, referral or signposting to suitable support services.

(6) The Secretary of State must publish guidance for NHS providers on the discharge of duties under this section. (7) In this section—

“child” means a person under the age of 16;

“family” includes parents, guardians, primary carers and siblings; and

“life-threatening condition” means a condition designated as such by the Secretary of State in guidance.” This new clause places a duty on NHS providers to offer practical information, coordination and support to families within 14 days of a child being diagnosed with cancer or another life-threatening condition. New clause 82— Parent mental health and bereavement support duty — “(1) Where a child is diagnosed with a life-threatening condition, the responsible NHS provider must ensure that the psychological wellbeing of parents, guardians, primary carers and siblings is considered as part of the child’s care pathway.

(2) Within 14 days of diagnosis, the responsible NHS provider must offer—

(a) a parental psychological wellbeing assessment;

(b) access to a designated family support practitioner, psychologist, counsellor or other appropriately qualified professional;

(c) information regarding the psychological impact of serious childhood illness, including trauma, anxiety, depression, stress and bereavement;

(d) a written Family Mental Health Support Plan;

(e) notification to the child’s registered general practitioner and, where different, the registered general practitioners of parents or primary carers.

(3) During active treatment, the responsible NHS provider must ensure that parents and primary carers are offered periodic psychological wellbeing reviews.

(4) The responsible NHS provider must offer an additional psychological wellbeing review following any—

(a) significant deterioration in the child’s condition,

(b) relapse,

(c) progression of disease,

(d) transition to palliative care, or

(e) other material change in prognosis.

(5) The responsible NHS provider must ensure that support under this section is offered proactively and must not be dependent upon a parent, guardian, carer or sibling requesting support, identifying their own need, or making a self-referral.

(6) Following the death of a child, the responsible NHS provider must—

(a) offer a bereavement wellbeing assessment to parents or primary carers;

(b) offer access to bereavement counselling, psychological support or equivalent specialist services;

(c) make proactive contact with the family within 14 days of the child’s death;

(d) offer further follow-up support at intervals specified in guidance issued by NHS England; and

(e) ensure that referral pathways are available where significant psychological distress, trauma, anxiety, depression or post-traumatic stress symptoms are identified.

(7) The responsible NHS provider must ensure that information regarding available support services is provided to siblings and that age-appropriate emotional support pathways are available where required.

(8) NHS England must publish guidance regarding—

(a) parental psychological wellbeing assessments;

(b) family mental health support following serious childhood diagnosis;

(c) bereavement support following the death of a child;

(d) support for siblings affected by serious childhood illness; (e) referral pathways into specialist mental health services; and

(f) minimum standards for proactive family mental health support.

(9) NHS England must publish and lay before Parliament an annual report on compliance with this section.

(10) In this section—

“child” means a person under the age of 16;

“family” includes parents, guardians, primary carers and siblings; and

“life-threatening condition” means a condition designated by the Secretary of State in regulations.

(11) The Secretary of State must, within three years of the commencement of this section, undertake a review of its operation and lay a report before Parliament.” This new clause would establish a statutory duty on NHS providers to identify and support the psychological wellbeing of parents, carers and siblings following the diagnosis of a life-threatening childhood condition. It would create a proactive, opt-out family mental health pathway from diagnosis through treatment and, where applicable, bereavement. New clause 83— Review of uncertain imaging findings in high-risk childhood illness — “(1) Where imaging undertaken in relation to a child with a high-risk cancer or other life-threatening condition identifies findings that are—

(a) inconclusive,

(b) indeterminate, or

(c) suspicious,

the responsible NHS provider must ensure that the findings are reviewed by a consultant clinician responsible for the child's care.

(2) Following such a review, the responsible NHS provider must ensure that the child's parent, guardian or primary carer is informed—

(a) of the nature of the uncertainty identified;

(b) whether disease progression, relapse or recurrence can be confidently excluded;

(c) what further investigations or surveillance are being considered; and

(d) the risks and benefits associated with immediate further imaging, alternative imaging modalities, or continued observation.

(3) Where disease progression or relapse cannot be confidently excluded, the responsible NHS provider must consider whether additional imaging or investigation should be undertaken within 14 days or as soon as clinically practicable, whichever is sooner.

(4) The outcome of any discussion held under subsection (2), including the views expressed by the child's parent, guardian or primary carer, must be recorded in the child's medical records.

(5) NHS England must publish guidance on the operation of this section, including circumstances in which further imaging should be considered following uncertain or indeterminate findings.” This new clause requires consultant review of uncertain imaging findings in children with designated high-risk conditions. It also aims to ensure that parents are informed of the uncertainty, the available options and the risks and benefits of those options before a decision is made. New clause 86— Compassionate access to innovative treatments — “(1) In exercising their functions in relation to the health service, the Secretary of State must by regulations make provision for compassionate access to innovative treatments, involving substances listed in Schedule 1 of the Misuse of Drugs Regulations 2001, for patients with serious or life-threatening conditions in circumstances where conventional treatments have been unsuccessful, unsuitable, or unavailable. (2) Regulations made under this section must make provision for the authorisation, supply, possession, administration and supervision of such treatments, notwithstanding any restriction imposed by or under the Misuse of Drugs Act 1971 or the Misuse of Drugs Regulations 2001, including provision for—

(a) appropriate clinical and regulatory safeguards;

(b) approval arrangements for participating clinicians, providers and pharmacies; and

(c) case-by-case decision-making having regard to clinical need, patient safety, and available evidence.

(3) For the purposes of this section, a serious or life-threatening condition is defined as a condition involving a substantial risk to life or serious impairment of health or functioning.

(4) Regulations under this section are to be made by statutory instrument subject to the affirmative procedure.” This new clause would require the Secretary of State to make provision for compassionate access to innovative treatments, involving substances listed in Schedule 1 of the Misuse of Drugs Regulations 2001, for patients with serious or life-threatening conditions in certain circumstances. New clause 87— Research into innovative treatments involving controlled substances — “(1) The Secretary of State must by regulations take steps to enable and support the development of research relating to innovative treatments, which use substances listed in Schedule 1 of the Misuse of Drugs Regulations 2001.

(2) Regulations made under this section must make provision, for—

(a) the lawful possession, supply, administration, production and importation of such substances for the purposes of clinical trials or other research activities approved in accordance with regulations made by the Secretary of State, notwithstanding any prohibition or restriction imposed by or under the Misuse of Drugs Act 1971 or the Misuse of Drugs Regulations 2001; and

(b) proportionate and timely arrangements relating to the approval, licensing and oversight of authorised research activities under this section.

(3) Provision under subsection (2) applies to—

(a) approved research bodies,

(b) authorised researchers, and

(c) participating healthcare providers,

and specified substances used for approved research purposes, and does not alter the schedule or classification of a substance.

(4) Regulations under this section are to be made by statutory instrument subject to the affirmative procedure.” This new clause would require the Secretary of State to take steps to enable and support the development of research relating to innovative treatments, which use substances listed in Schedule 1 of the Misuse of Drugs Regulations 2001. New clause 88— New Hospital Programme: publication of multi-criteria decision analysis (MCDA) reports — “(1) Within three months beginning on the date on which this Act is passed, the Secretary of State must publish the MCDA reports used to determine the prioritisation of schemes and their allocation to waves within the New Hospital Programme.

(2) The information published under subsection (1) must include—

(a) the multi-criteria decision support analysis tool used to prioritise schemes;

(b) the input data used in that analysis for each hospital in the New Hospital Programme;

(c) the scoring mechanism used in that analysis;

(d) any assessment of estate condition, including data from the NHS England Estate Return Information Collection; (e) any assessment of patient safety, service disruption or maintenance backlog;

(f) any assessment of the presence of reinforced autoclaved aerated concrete;

(g) any assessment of the risks associated with delaying individual schemes; and

(h) any review of the appropriateness of the input data or scoring mechanism by NHS England or the Department of Health and Social Care.

(3) The Secretary of State may redact information published under this section where publication would—

(a) prejudice commercial negotiations,

(b) disclose personal data, or

(c) endanger the safety or security of patients, staff or NHS premises.

(4) Where information is redacted under subsection (3), the Secretary of State must publish a statement explaining the reason for the redaction.

(5) The Secretary of State must lay the reports and information published under this section before Parliament.” This new clause requires the Secretary of State to publish the criteria, input data and scoring mechanism used to determine the prioritisation of schemes and their allocation to waves within the New Hospital Programme. Whilst the input data was obtained from publicly available sources, the MCDA reports are currently not publicly available. New clause 89— New Hospital Programme: estate failure — “(1) Within six months beginning on the date on which this Act is passed, the Secretary of State must review whether hospitals experiencing significant estate failure are being appropriately prioritised within the New Hospital Programme.

(2) For the purposes of subsection (1), “significant estate failure” includes the closure, partial closure or restricted use of hospital buildings because of structural, safety or infrastructure failures.

(3) In prioritising schemes within the New Hospital Programme, the Secretary of State must ensure that hospitals experiencing significant estate failure are treated with the same urgency as hospitals affected by reinforced autoclaved aerated concrete.

(4) The Secretary of State must publish the outcome of the review in subsection (1).” This new clause requires the Secretary of State to review whether hospitals experiencing significant estate failure are being appropriately prioritised within the New Hospital Programme, and to ensure that such hospitals are treated with the same urgency as RAAC-affected hospitals. New clause 92— Duty to report on the regulation of cosmetic surgery — “(1) Within three months of the passing of this Act, the Secretary of State must publish a report assessing the effectiveness and safety of current regulation of cosmetic surgery.

(2) The report under subsection (1) must investigate regulatory measures regarding professional checks on the providers of cosmetic surgery, including whether they—

(a) are registered medical practitioners;

(b) have completed recognised specialist surgical training; and

(c) hold Cosmetic Surgery Board Certification, or an equivalent certification, accreditation or qualification.

(3) The report must also consider the safety of current regulations of the premises where cosmetic surgery procedures are undertaken.” This new clause would require the Secretary of State to prepare a report assessing the regulation of cosmetic surgery. New clause 102— Report on impact on health of social media addiction — “(1) The Secretary of State must, within six months of the passage of this Act, commission a report on the impact on health of social media addiction.

(2) The report under subsection (1) must consider and make recommendations concerning—

(a) the mental health effects of social media addiction;

(b) the physical health effects of social media addiction; and

(c) the effects of social media addiction on demand for NHS services.

(3) The Secretary of State must lay a copy of the report with proposed actions to minimise the health harms of social media addiction before both Houses of Parliament.” This new clause would require the Secretary of State to commission a report considering the impact on health of social media addiction. New clause 103— Communication with parents of critically ill children — “(1) The Secretary of State must, within 12 months of the passing of this Act, issue guidance to integrated care boards on communication with parents of critically ill children, with particular reference to major decisions in the child’s treatment and care.

(2) Guidance issued under subsection (1) must—

(a) make provision for ensuring that parents have been fully consulted and are fully informed of decisions concerning the care or treatment of their child and the rationale behind such decisions;

(b) make provision, where potentially life-ending or life-changing decisions are to be made, to facilitate parents in accessing an independent specialist second opinion;

(c) make provision, where there is a disagreement between parents and clinicians on the care or treatment of a child, for the appointment of an independent mediator;

(d) make provision, following the advice of an independent specialist second opinion, for transfer of the child to another hospital, subject to appropriate clinical safeguards;

(e) make provision, prior to the death of a child, for family members to be given access to the child, whether in the hospital, a children’s hospice or the family home.

(3) Guidance issued under subsection (1) must have regard to Article 2 of the European Convention on Human Rights.” This new clause would require the Secretary of State to issue guidance to integrated care boards concerning their role in communicating with parents of critically ill children, and involving them in decision-making. New clause 107— Fracture liaison services: implementation framework — “(1) The Secretary of State must, within six months of the passing of this Act, publish an implementation framework for ensuring universal access to fracture liaison services in England by 2030.

(2) The framework must set out—

(a) the minimum standards expected of fracture liaison services;

(b) the steps to be taken to reduce unwarranted variation in access and quality between integrated care board areas;

(c) the respective responsibilities of integrated care boards and NHS trusts;

(d) the workforce, diagnostic, digital and data requirements necessary to support implementation; and (e) arrangements for identifying people at risk of further fragility fractures and ensuring that they receive appropriate assessment, treatment and follow-up.

(3) The Secretary of State must make a statement to Parliament each year, until 2030, setting out progress towards universal access to fracture liaison services.” This new clause would require the Secretary of State to publish an implementation framework for ensuring universal access to fracture liaison services in England by 2030. New clause 110— Rural access to child and adolescent mental health services — “(1) Each integrated care board must make arrangements to ensure that children and young people in rural areas have reasonable access to child and adolescent mental health services.

(2) In exercising its functions under subsection (1), an integrated care board must have regard to—

(a) travel distances and travel times;

(b) the availability of public transport;

(c) the availability of locally accessible community facilities; and

(d) the particular needs of children and young people who may face barriers to travelling to a centralised service.

(3) The Secretary of State must provide appropriate support to integrated care boards and local authorities to develop community-based child and adolescent mental health services in rural areas.

(4) An integrated care board and a local authority may make arrangements for the use or repurposing of vacant or underused public buildings for the provision of child and adolescent mental health services.” This new clause would improve access to CAMHS in rural areas by supporting locally delivered services and enabling vacant or underused public buildings to be repurposed for community mental health provision. New clause 111— Child and adolescent mental health workforce and service capacity — “(1) Each integrated care board must assess whether child and adolescent mental health services in its area have sufficient staffing and clinical capacity to meet the needs of children and young people.

(2) Where an assessment under subsection (1) identifies a significant shortfall, the integrated care board must prepare and implement a plan to address that shortfall.

(3) The plan must include measures to support the recruitment and retention of suitably qualified staff and, where clinically appropriate, the provision of specialist services including trauma assessment, dialectical behaviour therapy and art therapy.

(4) In preparing the plan, an integrated care board must have regard to—

(a) the number of children and young people receiving CAMHS services;

(b) waiting times for assessment and treatment;

(c) the number and complexity of cases managed by individual staff members; and

(d) the availability of specialist clinical services.” This new clause would require integrated care boards to assess and address staffing and service capacity in CAMHS, including access to appropriate specialist services. New clause 112— Review of child and adolescent mental health services in rural areas — “(1) The Secretary of State must conduct, or arrange for the conduct of, reviews of the provision of child and adolescent mental health services in rural areas in England.

(2) Any review must consider—

(a) waiting times for assessment and treatment;

(b) access to interim support following referral;

(c) travel distances and access to public transport; (d) staffing and specialist service capacity;

(e) the availability of community-based provision; and

(f) the use of vacant or underused public buildings for the delivery of services.

(3) A review must identify areas where the provision of child and adolescent mental health services is insufficient to meet local need.

(4) The Secretary of State must publish the findings of any review and an action plan setting out measures to address any significant deficiencies identified.

(5) The first review under this section must be completed within 12 months of the passing of this Act and subsequent reviews must be completed at intervals of not more than five years.” This new clause would require a national review of CAMHS provision in rural areas, including access, waiting times, workforce capacity and the availability of community-based services. New clause 113— Radiotherapy services: access and accountability — (1) The Secretary of State must publish and maintain a national framework for improving access to radiotherapy services in England.

(2) The framework must set out nationally agreed metrics against which integrated care boards must measure and report their delivery of, and investment in, radiotherapy services.

(3) The metrics must include, but are not limited to, metrics relating to—

(a) waiting times for radiotherapy;

(b) access to radiotherapy services, including variation in radiotherapy treatment rates between integrated care board areas;

(c) the age, capability and replacement needs of radiotherapy equipment;

(d) radiotherapy capacity against assessed population need; and

(e) workforce capacity.

(4) Each integrated care board must publish an annual report on its performance against the metrics in the framework.

(5) Before publishing or revising the framework, the Secretary of State must consult persons with clinical, technical, operational and patient expertise in radiotherapy services.

(6) The Secretary of State must lay before Parliament, at least once in each financial year, a report on the implementation of the framework and any steps proposed to address underperformance or unwarranted variation.

(7) In this section, “radiotherapy services” means services involving the use of ionising radiation for the treatment of cancer.” This new clause would require the Secretary of State to publish a national framework for improving access to radiotherapy services. Integrated Care Boards would be required to report annually against national metrics on waiting times, access, equipment, capacity, workforce, investment and variation. New clause 114— Radiotherapy services: access and waiting times — “(1) Within six months of the passing of this Act, the Secretary of State must conduct and publish a review of access to radiotherapy services and waiting times for radiotherapy in England.

(2) The review must include an assessment of—

(a) variation in access to radiotherapy services between integrated care board areas;

(b) waiting times for radiotherapy services, including where radiotherapy is the first, second or subsequent cancer treatment received by a patient; and (c) the extent to which capacity, equipment, workforce or investment constraints are affecting access to radiotherapy services or waiting times for radiotherapy.

(3) In conducting the review, the Secretary of State must consult persons with clinical, technical, operational and patient expertise in radiotherapy services.

(4) The Secretary of State must lay the review before Parliament and set out any steps proposed to address identified gaps in access to radiotherapy services or waiting times for radiotherapy.

(5) In this section, “radiotherapy services” means services involving the use of ionising radiation for the treatment of cancer.” This new clause would require the Secretary of State to review access to radiotherapy services and radiotherapy waiting times. The review would examine variation between ICB areas, delays where radiotherapy is a first or subsequent treatment, and the capacity constraints affecting patient access. New clause 116— Access to medicinal cannabis for children: review and clinical trials — “(1) The Secretary of State must, within six months beginning on the day on which this Act is passed, publish a review on access to medicinal cannabis for children on the NHS.

(2) The review under subsection (1) must consider—

(a) variation between integrated care boards in the referral and prescribing of medicinal cannabis to children;

(b) the barriers preventing children from accessing medicinal cannabis through the NHS, including the number of patients who access private prescriptions as a result;

(c) the current evidence base for the clinical effectiveness of medicinal cannabis for children; and

(d) options for expanding that evidence base through clinical trials.

(3) The Secretary of State must take reasonable steps to support and facilitate clinical trials into the use of medicinal cannabis for children, with the aim of establishing a clearer evidence base to inform NHS prescribing guidance.

(4) The Secretary of State must lay a copy of the review before both Houses.” This new clause would require the Secretary of State to review inconsistencies in NHS access to medicinal cannabis for children, including the extent to which patients are forced to rely on private prescriptions, and would place a duty on the Secretary of State to support clinical trials to strengthen the evidence base for prescribing. New clause 117— Access to speech and language therapy — “(1) The Secretary of State must, within six months beginning on the day on which this Act is passed, publish a strategy for improving access to NHS speech and language therapy services in England.

(2) The strategy under subsection (1) must include—

(a) an assessment of waiting times for speech and language therapy across integrated care boards;

(b) an assessment of variation in access to speech and language therapy between different areas of England;

(c) an assessment of the speech and language therapy workforce, including current vacancy rates and future workforce need; and

(d) proposals to reduce waiting times and geographical variation in access.

(3) The Secretary of State must lay a copy of the strategy before Parliament.

(4) The Secretary of State must publish a further report reviewing progress against the strategy within eighteen months beginning on the day on which this Act is passed.” This new clause would require the Secretary of State to publish a strategy to address waiting times and geographical inequality in access to NHS speech and language therapy, and to report on progress against that strategy. New clause 123— NICE technology appraisal recommendation: accountability scheme — “(1) The Secretary of State must establish by regulations an accountability scheme relating to the implementation of NICE technology appraisal recommendations (the "scheme").

(2) Under the scheme, Health and Social Care bodies must take all reasonable steps to implement a NICE technology appraisal recommendation within three months of receiving such a recommendation.

(3) Any Health and Social Care body that fails to meet the requirement set out in subsection (2) must—

(a) publish an explanation of the reasons for the failure;

(b) specify any circumstances which have prevented implementation; and

(c) publish a plan setting out the steps it will take to implement the recommendation.

(4) Regulations under this section are subject to the affirmative procedure.”

New clause 131— Activities of religious groups in medical settings — “(1) The Secretary of State must, within six months of the passage of this Act, make regulations concerning the activities of religious groups in medical settings in England.

(2) Regulations made under subsection (1) must make provision for—

(a) clinical oversight of training provided by representatives of religious groups to healthcare professionals and students on the treatment of patients who hold religious beliefs that may influence their choice of treatment;

(b) ensuring that the contacting of any religious group on behalf of a patient, or for advice on care, is made only at the request of the patient;

(c) requiring opportunities for patients to indicate final treatment preference in the absence of religious representatives, and ensuring religious representatives cannot later verify a patient’s final treatment choice; and

(d) any other matter that the Secretary of State deems appropriate.

(3) Regulations made under this section are subject to the affirmative procedure.” This new clause would require the Secretary of State to make regulations governing the activities of religious groups in medical settings in England, to prevent medical coercion. New clause 132— Non-therapeutic male circumcision — “(1) The Secretary of State must, within six months of the passage of this Act, make regulations relating to non-therapeutic male circumcision (NTMC).

(2) Regulations made under subsection (1) must make provision for—

(a) a requirement that NTMC may only be performed by a suitably qualified healthcare professional and must be inspected by the Care Quality Commission;

(b) the inclusion of NTMC as a regulated activity under the Health and Social Care Act 2008;

(c) the creation of a statutory duty for integrated care boards to produce annual data on prevalence and complications of NTMC;

(d) a requirement that NTMC be included in the Single Patient Record; and

(e) any other matter that the Secretary of State deems appropriate. (3) Regulations under this section are subject to the affirmative procedure.” This new clause would require the Secretary of State to introduce regulation of non-therapeutic male circumcision, following several prevention of future death reports issued by coroners as a result of deaths arising from this procedure. New clause 137— Cancer outcomes — “(1) The National Health Service Act 2006 is amended as follows.

(2) After section 1GA insert— “1GB Cancer outcomes In exercising functions relating to the health service, the Secretary of State must treat objectives relating to cancer outcomes as having priority over any other objectives relating specifically to cancer.”” The Secretary of State is currently required to set cancer outcome objectives for NHS England, with those objectives taking priority over other cancer goals. The Health Bill removes this provision. This new clause would place a new duty on the Secretary of State to prioritise cancer outcomes such as survival by inserting a new section into Part 1 of the National Health Service Act 2006. New clause 138— Report on occupational health screening for fire and rescue personnel — (1) The Secretary of State must, within 12 months of the passing of this Act, publish a report on access to occupational health screening, including blood testing for biomarkers of exposure to carcinogens, for members of fire and rescue services in England.

(2) The report under subsection (1) must consider—

(a) the classification by the International Agency for Research on Cancer of occupational exposure as a firefighter as carcinogenic to humans;

(b) the current provision of occupational health screening for fire and rescue personnel by fire and rescue authorities, NHS bodies and integrated care boards;

(c) options for a national baseline entitlement to periodic health screening for fire and rescue personnel, informed by exposure risk;

(d) the resource and workforce implications of any such entitlement; and

(e) the interaction of any such entitlement with existing work by the Fire Brigades Union and the University of Central Lancashire on the UK Firefighters Cancer and Disease Registry.

(3) The Secretary of State must lay a copy of the report before Parliament.” This new clause would require the Secretary of State to report on occupational health screening, including blood testing, for fire and rescue personnel, in recognition of their elevated risk of cancer arising from occupational exposure to carcinogens. New clause 139— Duty on integrated care boards to share data with fire and rescue authorities concerning vulnerable persons — “(1) An integrated care board must take reasonable steps to share, or to facilitate the sharing of, relevant data with a fire and rescue authority for the area, or part of the area, for which the integrated care board has responsibility, for the purpose of enabling the fire and rescue authority to identify and prioritise vulnerable persons in the event of an emergency.

(2) In this section, “relevant data” means data relating to a person’s vulnerability, including but not limited to age, disability or mobility, that is necessary and proportionate for the purpose in subsection (1).

(3) Data may only be shared under this section—

(a) in accordance with the requirements of the UK GDPR and the Data Protection Act 2018; (b) subject to arrangements agreed between the integrated care board and the fire and rescue authority setting out the purpose, extent and security of the data sharing; and

(c) where a mechanism exists for a person to object to the sharing of their data under this section, save where doing so would be likely to endanger life.

(4) The Secretary of State must, within 12 months of this section coming into force, publish guidance for integrated care boards and fire and rescue authorities on the operation of this section.

(5) In this section, “fire and rescue authority” has the meaning given by section 1 of the Fire and Rescue Services Act 2004.” This new clause would place a duty on integrated care boards to share relevant data concerning vulnerable residents with fire and rescue authorities, subject to data protection safeguards, to enable fire and rescue services to identify and prioritise vulnerable people in emergencies, including fires and flooding. New clause 140— Corridor care — “(1) The Secretary of State must end the practice of corridor care in NHS hospitals within one year of the passage of this Act.

(2) If the requirement under subsection (1) is not met, the Secretary of State must commission an independent inquiry into the Government's handling of corridor care.

(3) The inquiry under subsection (2) must—

(a) investigate the effectiveness of policies, funding and guidance relating to corridor care in the Department of Health and Social Care;

(b) assess the impact on patient safety and staff morale from the continued practice of corridor care; and

(c) recommend steps the Secretary of State should take to end the practice of corridor care.

(4) The inquiry under subsection (2) should be supported by patient safety professionals from the Health Services Safety Investigations Body and the Care Quality Commission.

(5) The inquiry under subsection (2) must be published and laid before Parliament as a final report within 6 months beginning on the day on which the inquiry is established.” This new clause places a duty on the Secretary of State to end Corridor Care within 12 months, if they fail to do so they must order an independent inquiry into corridor care and the failure to eradicate the practice. New clause 141— Suspension of Advice and Guidance pending HSSIB report and mitigation plan — “(1) The Secretary of State must ensure that the operation and further rollout of Advice and Guidance services (including any targets, incentives, pathways or contractual requirements that treat Advice and Guidance as a prerequisite or preferred alternative to direct referral) are suspended until the conditions in subsection (2) are met.

(2) The conditions are that—

(a) the Health Services Safety Investigations Body (or, if its functions have already been transferred under section 63 of this Act, the Care Quality Commission exercising those functions) has laid its final report on Advice and Guidance services before Parliament, and

(b) the Secretary of State has published a written mitigation plan addressing the patient safety risks, harms and recommendations identified in that report (including any linked to patient deaths, near misses, treatment delays, resource and capacity gaps, workforce training, digital systems and incident reporting).”

New clause 142— Puberty blockers — “(1) Within three months of the passage of this Act the Secretary of State must make regulations which ensure that puberty blockers may not be prescribed, dispensed or supplied to persons under 18 years of age for the purposes of treatment related to gender dysphoria, gender incongruence or a combination of both, in the United Kingdom. (2) Regulations under this section must ensure that such drugs cannot be given out or used as part of clinical trials for the treatment of gender dysphoria, gender incongruence or a combination of both, unless that trial has specifically been approved by a resolution of both Houses of Parliament.

(3) For the purposes of this section, puberty blockers means—

(a) a “gonadotrophin-releasing hormone (“GnRH”) analogue” which means a medicinal product that consists of or contains buserelin, gonadorelin, goserelin, leuprorelin acetate, nafarelin or triptorelin, and

(b) any other drug which has the effect of suppressing or delaying puberty that the Secretary of State may by regulation appoint.” This new clause would create a requirement for the Secretary of State to make regulations which prevent puberty blockers from being prescribed to persons under 18 years of age for the purposes of treatment related to gender incongruence, or being given in clinical trials related to gender incongruence unless specifically approved by Parliament. New clause 143— Single sex facilities — “(1) The Secretary of State is required to ensure that there are single sex—

(a) changing rooms for NHS staff,

(b) toilets and washing facilities for NHS staff,

(c) wards for NHS patients, and

(d) toilets and washing facilities for NHS patients.

(2) The Secretary of State may make exemptions to the duty in subsection (1)(c) and (1)(d) where necessary for—

(a) children,

(b) intensive care units,

(c) critical care, and

(d) specialist high observation areas such as resuscitation in Accident and Emergency and the initial recovery area in theatres.” This new clause creates a requirement for the Secretary of State to ensure certain single sex facilities are made available for NHS staff and patients. It provides exemptions in certain circumstances. New clause 146— Fracture liaison services: delivery plan and annual reporting — “(1) The Secretary of State must, within 90 days of the day on which this Act is passed, publish and lay before both Houses of Parliament a delivery plan for securing universal provision of fracture liaison services across England by 2030.

(2) The plan under subsection (1) must include—

(a) a baseline assessment of current access to, and quality of, fracture liaison services in each integrated care board area, distinguishing clearly between services established before and after July 2024;

(b) annual milestones for the number of patients identified, assessed and treated through fracture liaison services, sufficient to reach the level required for universal coverage;

(c) the specific steps the Secretary of State will take to support integrated care boards to commission and sustain high-quality fracture liaison services, including any use of directions, guidance, financial incentives, capital funding or other mechanisms;

(d) workforce, diagnostic (including DEXA capacity), digital and data requirements, with associated funding assumptions;

(e) arrangements for independent monitoring and public reporting of progress against the milestones; and

(f) an estimate of the expected reduction in fragility fractures, hip fractures, associated deaths and NHS bed days, drawing on available evidence including that published by the Royal Osteoporosis Society.

(3) The Secretary of State must, within 12 months of publishing the plan under subsection (1) and every 12 months thereafter until 2030, lay before Parliament a report setting out— (a) progress against each annual milestone;

(b) the number of new fracture liaison services established and the number of patients identified in the preceding year;

(c) any revision to the milestones or timetable, with the reasons for any such revision; and

(d) action being taken to address any shortfall.

(4) In this section “fracture liaison service” means a service for the systematic identification, assessment, treatment and ongoing monitoring of people who have sustained a fragility fracture, for the purpose of reducing their risk of further fractures.” This new clause would require the Secretary of State to publish a plan to roll out fracture liaison services across England and publish reports of progress. New clause 147— Plan to manage acquired brain injury — “(1) The Secretary of State must, within 30 days of the day on which this Act is passed, publish a plan for the management of acquired brain injury across England.

(2) A plan under subsection (1) must include but shall not be limited to—

(a) proposed government actions to prevent acquired brain injuries;

(b) proposed government actions to improve acute treatment for acquired brain injuries;

(c) a statement of priorities regarding the Secretary of State’s approach for rehabilitation and long-term support for persons with acquired brain injuries across public services delivered by—

(i) the Department of Health and Social Care,

(ii) the Department for Education, and

(iii) the Ministry of Justice;

(d) proposals for data sharing between government departments, health care, and rehabilitation providers to improve patient—

(i) identification,

(ii) care, and

(iii) support;

(e) a commitment to providing 95% of people with complex needs with a personalised care plan by 2027;

(f) commitments for research into acquired brain injuries in sport;

(g) any proposed use of directions, guidance, financial assistance, incentives or other mechanisms to secure delivery of the plan’s objectives;

(h) workforce, diagnostic, digital and data requirements for implementation of the plan; and

(i) arrangements for monitoring, publishing and reporting progress against the plan.

(3) The plan under subsection (1) must be laid by the Secretary of State before both Houses of Parliament.

(4) The Secretary of State must, within 12 months of publishing a plan under subsection (1), and every 12 months thereafter until 2030, lay before Parliament a report on progress made against the proposals and commitments in the plan.” This new clause would require the Government to publish their action plan to manage acquired brain injury within 30 days of the passing of this Act. New clause 148— Radiotherapy cancer treatment services — “(1) The Secretary of State must publish and maintain a national framework for improving access to radiotherapy services in England.

(2) The framework must include nationally agreed metrics against which integrated care boards must measure and report their investment in, and delivery of, radiotherapy services.

(3) The metrics must include provisions relating to—

(a) waiting times for radiotherapy, including time to definitive treatment; (b) patient travel times to radiotherapy services, including defining an appropriate recommended travel time;

(c) the number of cancer patients receiving radiotherapy and the quality of such radiotherapy;

(d) the age, capability and replacement needs of radiotherapy equipment, including the proportion of linear accelerators that are more than 10 years old or otherwise beyond the recommended replacement age;

(e) access to modern radiotherapy techniques and technologies;

(f) radiotherapy capacity against population need and the projected increase in number of cancer patients;

(g) variation in access to radiotherapy services between integrated care board areas;

(h) provision of sustainable, flexible workforce that is equipped to harness advances in radiotherapy for patient benefit; and

(i) investment in radiotherapy services and the extent to which such investment reflects clinical need.

(4) Each integrated care board must publish an annual report on its performance against the metrics in the framework.

(5) Before publishing or revising the framework, the Secretary of State must consult persons with clinical, technical, operational and patient expertise in radiotherapy which the Secretary of State considers appropriate.

(6) The Secretary of State must lay before Parliament, at least once in each financial year, a report on the implementation of the framework.” This new clause would require the Secretary of State to publish and maintain a national framework for improving access to radiotherapy services in England. New clause 149— Modern Service Framework for Respiratory Disease – prioritisation and reporting — “(1) Within 12 months of the day on which this Act is passed, the Secretary of State must—

(a) publish a statement setting out the criteria and process by which the National Quality Board will assess proposals for future Modern Service Frameworks (including respiratory disease), and

(b) lay before both Houses of Parliament a report on the prioritisation of respiratory disease for a Modern Service Framework.

(2) The report under subsection (1)(b) must include—

(a) an assessment of the current burden of respiratory disease in England including—

(i) emergency admissions,

(ii) variation by integrated care board area,

(iii) outcomes;

(b) the evidence of potential for rapid and significant improvements in quality of care and productivity that a respiratory Modern Service Framework could deliver;

(c) the status of existing work on respiratory pathways including for—

(i) pulmonary fibrosis,

(ii) pulmonary rehabilitation,

(iii) diagnostics,

(iv) early detection and lung cancer screening,

(v) supported self-management,

(vi) access to medicines;

(d) the expected timetable for any decision by the National Quality Board on whether to prioritise a respiratory Modern Service Framework; and

(e) interim actions the Secretary of State and NHS England are taking to reduce unwarranted variation and emergency admissions attributable to respiratory disease pending any such decision. (3) If the National Quality Board decides not to prioritise a respiratory Modern Service Framework within 18 months of the day on which this Act is passed, the Secretary of State must, within three months of that decision, publish and lay before Parliament an alternative national plan for improving respiratory care that addresses the matters set out in subsection (2)(a) to (c) and (e).

(4) The Secretary of State must publish an updated report under subsection (1)(b), or a progress report against any respiratory Modern Service Framework or alternative plan, at intervals of not more than three years.

(5) In preparing any report or plan under this section the Secretary of State must consult clinicians with expertise in respiratory medicine, organisations representing people with respiratory disease, integrated care boards, and NHS providers of respiratory services.”

New clause 150— Modern Service Framework for Musculoskeletal Care – prioritisation and reporting — “(1) Within 12 months of the day on which this Act is passed, the Secretary of State must—

(a) publish a statement setting out the criteria and process by which the National Quality Board will assess proposals for future Modern Service Frameworks (including musculoskeletal conditions), and

(b) lay before both Houses of Parliament a report on the prioritisation of musculoskeletal care for a Modern Service Framework.

(2) The report under subsection (1)(b) must include—

(a) an assessment of the current burden of musculoskeletal conditions in England including—

(i) waiting times,

(ii) emergency admissions or unplanned care,

(iii) variation by integrated care board area,

(iv) impact on work and economic inactivity,

(v) outcomes,

(b) the evidence of potential for rapid and significant improvements in quality of care and productivity that a musculoskeletal Modern Service Framework could deliver;

(c) the status of existing national programmes including—

(i) the Getting It Right First Time (GIRFT) MSK Community Delivery Programme;

(ii) any related elective recovery or neighbourhood health initiatives,

(d) the expected timetable for any decision by the National Quality Board on whether to prioritise a musculoskeletal Modern Service Framework; and

(e) interim actions the Secretary of State and NHS England are taking to reduce unwarranted variation, waiting times and the impact of musculoskeletal conditions on patients and the wider economy pending any such decision.

(3) If the National Quality Board decides not to prioritise a musculoskeletal Modern Service Framework within 18 months of the day on which this Act is passed, the Secretary of State must, within three months of that decision, publish and lay before Parliament an alternative national plan for improving musculoskeletal care that addresses the matters set out in subsection (2)(a) to (c) and (e).

(4) The Secretary of State must publish an updated report under subsection (1)(b), or a progress report against any musculoskeletal Modern Service Framework or alternative plan, at intervals of not more than three years.

(5) In preparing any report or plan under this section the Secretary of State must consult clinicians with expertise in musculoskeletal medicine and related professions, organisations representing people with musculoskeletal conditions, integrated care boards, and NHS providers of musculoskeletal services.” New clause 151— Patient safety recommendations: Government response — “(1) This section applies where the Secretary of State commissions a review or a report into a patient safety issue.

(2) The Secretary of State must—

(a) decide within six months whether they are going to implement each recommendation of the review;

(b) publish a response to each recommendation with a statement indicating whether each recommendation will be implemented; and

(c) publish a timeline for implementation of recommendations which will be implemented.” This new clause requires the Secretary of State to respond to patient safety recommendations. New clause 159— Mental health waiting time standards and reporting — “(1) The National Health Service Act 2006 is amended as follows.

(2) Section 12F (expected mental health spending) is amended as follows—

(a) in subsection (1), after paragraph (a) insert—

“(aa) stating the Secretary of State's expectations for that year regarding performance against the waiting time standards published under section 12FA;”;

(b) in subsection (1), after paragraph (aa) insert—

“(ab) stating the Secretary of State's expectations for that year regarding the relationship between performance against those waiting time standards and expenditure on mental health services, and”;

(c) for subsection (1)(b) substitute—

“(b) explaining the reasons for the expectations stated under paragraphs (a), (aa) and (ab).”.

(3) After section 12F insert— “12FA Mental health waiting time standards (1) The Secretary of State must adopt target national waiting time standards covering mental health services, including community and urgent care.

(2) In determining standards under subsection (1) the Secretary of State must have regard to advice from the Chief Medical Officer about the standards necessary to ensure safe and effective mental health care.

(3) The Secretary of State must publish waiting time standards under this section within 12 months beginning on the day on which this Act is passed.

(4) The Secretary of State may make regulations under section 14Z45A to give effect to the waiting time standards published under this section.”” The new clause would require the Secretary of State to adopt and publish waiting time standards for mental services having regard to advice from the Chief Medical Officer. It would expand the Secretary of State’s existing annual reporting duties to parliament to include reporting the NHS performance in meeting the NHS waiting times standards. New clause 161— Report into the availability and quality of data relating to dementia care — “(1) The Secretary of State must publish a report on the availability and quality of data relating to dementia care within 12 months of the passing of this Act.

(2) The report must include an action plan to address gaps in dementia data across prevalence, the health and social care interface, the dementia care pathway, experience of care, and workforce.

(3) The action plan must, in particular, address the absence of key performance measures, including but not limited to—

(a) waiting times to assessment and diagnosis; (b) non-medication related interventions; and

(c) care and treatment outcomes.”

Amendment 82, in clause 62, page 45, line 37, at end insert—

“(8B) Provision under (8A) about the period within which a recommendation is to be complied with must—

(a) only apply to individual recommendations in the case of exceptional circumstances,

(b) follow a process aligned with NICE's health technology evaluation procedures,

(c) be subject to engagement from industry stakeholders.”

Amendment 106, page 45, line 37, at end insert—

“(8B) Regulations under subsection (8) must include provision about the period within which NICE guideline NG206 on myalgic encephalomyelitis (ME) must be complied with.

(8C) The Secretary of State must publish an annual statement on compliance with NICE guideline NG206, including the extent to which integrated care boards and relevant NHS bodies have implemented recommendations relating to ME specialist services and severe or very severe ME.” This amendment would require that a period must be set within which the NICE guideline NG206 on ME must be complied with by ICBs and other health bodies. Furthermore, the Secretary of State must publish an annual statement on compliance with NICE guideline NG206 across the NHS in England. Amendment 1, page 45, line 39, leave out clause 63.

Amendment 2, page 46, line 3, leave out clause 64.

Amendment 3, page 46, line 39, leave out clause 65.

Amendment 4, page 47, line 36, leave out clause 66.

Amendment 7, page 48, line 15, leave out clause 68. This amendment removes the clause abolishing Healthwatch England. Amendment 5, page 48, line 18, leave out clause 69.

Government amendments 65 and 66.

Amendment 6, page 52, line 34, leave out clause 75.

Government amendments 67 to 69.

Amendment 89, in clause 80, page 54, line 36, at end insert—

“(3A) The Secretary of State may not make regulations under subsection (3) commencing section (1) until the condition in subsection (3B) has been met.

(3B) The condition is that the Secretary of State has published an impact assessment in respect of the abolition of NHS England that complies with subsection (3C) (a "qualifying impact assessment").

(3C) A qualifying impact assessment must include—

(a) a quantified estimate, expressed in monetary terms, of the total transition costs of abolishing NHS England, including in particular—

(i) redundancy costs;

(ii) the costs of integrating data, digital and information technology systems;

(iii) the costs of reorganising and rehousing staff and functions; and

(iv) productivity losses during the transition period;

(b) a quantified estimate, expressed in monetary terms, of the ongoing annual costs of the restructured Department of Health and Social Care following the abolition of NHS England, including any costs falling on integrated care boards as a result of the transfer of functions to them; (c) a quantified estimate, expressed in monetary terms, of the estimated annual savings arising from the abolition, including savings from the elimination of duplicated corporate functions and reduced administrative costs;

(d) a quantified estimate, expressed in monetary terms, of the net present value of the abolition, being the difference between the total costs under paragraphs (a) and (b) and the total benefits under paragraph (c) over a period of not less than ten years;

(e) a statement of the key assumptions underlying the estimates in paragraphs (a) to (d) and an assessment of the sensitivity of those estimates to changes in those assumptions;

(f) an assessment of the risks to the delivery of the anticipated benefits, including the risk of disruption to NHS functions during the transition period; and

(g) a statement of the methodology used to produce the estimates, including any data sources relied upon.

(3D) Before publishing a qualifying impact assessment, the Secretary of State must submit it for independent scrutiny to the Regulatory Policy Committee (or any successor body) and must publish the Committee's opinion on the assessment alongside it.

(3E) The Secretary of State must lay the qualifying impact assessment and the Committee's opinion before both Houses of Parliament.

(3F) Regulations to commence section (1) are to be made by statutory instrument and may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.

(3G) A draft instrument under subsection (3F) may not be laid unless at least 60 sitting days have elapsed since the qualifying impact assessment was laid under subsection (3E).” This amendment requires the Secretary of State to publish, and submit to independent scrutiny, an impact assessment on the abolition of NHS England, containing quantified cost and benefit figures, before making regulations to abolish the body. Amendment 90, page 54, line 36, at end insert—

“(3A) The Secretary of State may not make regulations under subsection (3) commencing section (1) until the condition in subsection (3B) is met.

(3B) The Secretary of State must publish a plan setting out how health services provided by or under arrangements made by NHS bodies are to work alongside and be integrated with the social care system in England (the "health and social care integration plan").

(3C) Before preparing the health and social care integration plan, the Secretary of State must have regard to—

(a) the recommendations made by the Independent Commission on Adult Social Care (or any successor body undertaking that Commission's work) in any report published by the Commission; and

(b) the need to reflect any recommendations of the Independent Commission on Adult Social Care in the plan which are relevant to the interface between health services and adult social care.

(3D) The health and social care integration plan must include—

(a) a description of the structural and operational arrangements for joint working between NHS bodies and local authority social care services following the abolition of NHS England;

(b) proposals for how the transfer of NHS England's functions to the Secretary of State will affect the coordination of health and social care commissioning, including commissioning of services for people with complex needs spanning health and social care; (c) arrangements for reducing delayed discharges from hospital attributable to the absence of suitable social care provision;

(d) proposals for how the funding flows between the NHS and the social care system, including NHS Continuing Healthcare, will be managed following the abolition;

(e) the workforce implications for the health and social care sectors arising from the abolition of NHS England and the steps to be taken to address them; and

(f) a timetable for implementing the arrangements described in the plan.

(3E) The Secretary of State must lay the health and social care integration plan before both Houses of Parliament.

(3F) Regulations to commence section (1) must be subject to the affirmative procedure.

(3G) A draft instrument under subsection (3F) may not be laid before either House of Parliament until at least 60 sitting days after the health and social care integration plan has been laid under subsection (3E).

(3H) In this section—

“NHS body” has the same meaning as in the National Health Service Act 2006;

“social care system” means the system for the provision of care and support under the Care Act 2014 and services provided by local authorities in the exercise of their functions relating to adult social care.” This amendment requires the Secretary of State to publish and lay before Parliament a plan setting out how health services will work alongside the social care system following the abolition of NHS England before using their powers for its abolition. The plan must address joint commissioning, funding flows (including NHS Continuing Healthcare), delayed hospital discharges, and workforce. Amendment 25, page 112, line 18, leave out schedule 9.

Amendment 12, in schedule 9, page 130, line 16, at end insert—

“(2A) After paragraph 6(8) insert—

“(9) A committee of the Commission is to be appointed in accordance with regulations.

(10) The purpose of the committee is to oversee the health services safety investigation functions formerly conducted by HSSIB, transferred to the Care Quality Commission under the Health Act 2026.

(11) The committee is to be operationally independent from the Care Quality Commission.

(12) The committee is to consist of a chair appointed by the Secretary of State, and not less than six and not more than twelve other members appointed by the chair.

(13) A majority of the members of the committee must not be members of the Care Quality Commission.

(14) So far as is reasonably practicable, the persons appointed to the committee must include persons with knowledge or experience relevant to the discharge of functions under this paragraph.”” This amendment would ensure that oversight of HSSIB’s functions would remain operationally independent of the Care Quality Commission (CQC) following the transfer of its functions to the CQC. Amendment 8, page 134, line 20, leave out schedule 10. This amendment removes the schedule abolishing Healthwatch England. Amendment 9, page 136, line 1, leave out schedule 11. This amendment removes the schedule abolishing Local Healthwatch organisations. Amendment 78, schedule 11, page 137, line 2, at end insert—

“(2A) In making arrangements under subsection (2), an integrated care board must have regard to the need to facilitate participation by persons who may experience barriers to engagement, including persons with long-term, complex or fluctuating health conditions.” This amendment would require an integrated care board, in making arrangements for gathering patient views, to have regard to the need to facilitate participation by persons who may experience barriers to engagement, including persons with long-term, complex or fluctuating health conditions. Government amendment 72.

Amendment 100, in schedule 12, page 155, line 5, at end insert—

“(10) An order under this section that establishes, varies the area of, abolishes or merges an integrated care board may not be made unless a draft of the order has been laid before, and approved by a resolution of, each House of Parliament.”

Amendment 33, in schedule 12, page 156, line 28, at end insert—

“(c) must publish any evidence the Secretary of State has received in respect of the impact of the proposal.”

Government amendments 73 to 75.

Karin SmythI know that many hon. Members want to talk about the provisions in the Bill covering many important issues. I will therefore speak briefly about two Government amendments relating to medical device licensing and information sharing.

I will first address new clause 94 regarding medical devices licensing, and consequential amendments new clauses 99 to 101 regarding medical devices disclosure. These amendments are about ensuring that Great Britain’s medical devices regulatory framework remains fit for the future. As we know, medical technology is evolving rapidly, particularly in areas such as software and artificial intelligence, while our current framework was designed for a very different technological landscape. This set of amendments establishes the statutory foundation for a future medical device licensing regime, applying to Great Britain only. EU medical devices legislation will continue to apply in Northern Ireland.

Such a regime would require medical devices to be licensed and certain persons operating within the supply chain to hold a licence. By placing the detail in the regulations, the amendment allows us to work with patients, healthcare professionals and the medical device sector to create a regulatory framework that protects patients, supports innovation and strengthens the UK’s life sciences sector.

Jim Allister (North Antrim) (TUV)In the aftermath of the Windsor framework and the damage done to intra-UK trade, section 45B of the United Kingdom Internal Market Act 2020 was passed, which was said to promise that there would be no further export procedures that could impact adversely on trade from Northern Ireland to Great Britain. Yet, in new clause 94, we have such constraints in the imposition of a licensing programme, whereby to bring—I will not say “export”, as it is an internal market—a medical device from Northern Ireland to Great Britain, a licence is needed by the recipient. How is that compatible with section 45B of the United Kingdom Internal Market Act?

Karin SmythAs the hon. and learned Gentleman knows—we have spent many long hours in this place discussing the arrangements with regard to our leaving the European Union—there are different regulations, as a result of Brexit, between Great Britain and Northern Ireland. As is currently the case, due to the Windsor framework, that results in Northern Ireland following the EU device regulations. This has been discussed with the Northern Ireland and Windsor framework taskforce in the Cabinet Office, and we are content that the provisions are right, given the framework’s application. I know and understand the point that the hon. and learned Gentleman makes, and I am sure that he will pursue it with the Government in other areas.

New clauses 95 and 98 update and clarify the Secretary of State’s information-sharing powers for medicines and medical devices. They provide a clearer legal framework for the Medicines and Healthcare products Regulatory Agency to share information with UK health systems, organisations and trusted international partners. The current legislative framework does not always provide the MHRA with the powers or clarity it needs to share information quickly and effectively, and this creates barriers to collaboration, including with the NHS. The new clauses will address these challenges, providing a clear statutory basis for information sharing.

There is currently no explicit statutory domestic information-sharing power for medicines, whereas there is for medical devices. The new clauses bring information-sharing powers about medicines in line with those for medical devices and updates the list of statutory purposes for which the MHRA may share information. Importantly, these reforms do not weaken existing safeguards. Patient information will not be shared internationally without consent, and domestic protections under the Data Protection Act 2018 and the UK General Data Protection Regulation remain unchanged. These new clauses and amendments will act in the interests of patients, and I commend them to the House.

Sir Bernard Jenkin (Harwich and North Essex) (Con)Will the Minister give way?

Madam Deputy Speaker (Judith Cummins)I think the Minister has finished her remarks.

Dr Caroline Johnson (Sleaford and North Hykeham) (Con)As is now routine, I declare an interest as an NHS consultant paediatrician, a member of the British Medical Association and a member of the Royal College of Paediatrics and Child Health. Yesterday the Government voted not to introduce a backstop to decide on the Hughes report. I submitted a written question that also had a deadline of last night to ask when they were going to respond, and they have not answered that either. Taking their time about something is one thing, but for the Government to completely ignore victims, refusing to give an answer and refusing to provide a backstop or a deadline, is frankly shameful.

Patient safety is really important, and one key element to improving it is striking a good balance between accountability and blame. If we do not hold people accountable for their actions, they may not be as careful, but if they feel that their superiors are looking to find fault, they will be defensive and may cover things up. That makes it hard to get to the root cause and prevent mistakes from happening again. The Health Services Safety Investigations Body, or HSSIB, was set up with this problem in mind. Like the Air Accidents Investigation Branch, it has a safe space. This means that people are not held legally responsible for what they reveal to that team. They can then get to the bottom of why things are going wrong and find system errors. People come forward because they know and trust that HSSIB is independent, but this Labour Government want to change that.

The Health Bill will abolish HSSIB and transfer all its functions to the Care Quality Commission—the body responsible for regulating health and social care. This is the same CQC that, according to Ministers, is not fit for purpose. Why are the Government doing this? Ministers cite a review by Dr Penny Dash that said that the patient safety landscape was “cluttered” and “fragmented”, but too many different organisations are producing too many recommendations. That report was narrow in scope, and the clutter is not caused by HSSIB. In recent years, 30 public inquiries produced 1,400 recommendations, but HSSIB produced just 56.

The Government have suggested that moving HSSIB into the CQC can improve the quality of care and safety, but it is not clear how. People come forward to HSSIB precisely because it is a safe space, and this Government are removing the confidence in that safe space. For the new set-up to work, frontline workers will need to believe that the new unit in the CQC is independent, despite the law making it clear that it is not. The Government’s impact assessment says that the national quality board will provide clear direction to the new investigations unit, but the national quality board is tied to the NHS, so how does that square with the new unit staying independent? The impact assessment also says that the vast majority of investigations are expected to be directed by the Health Secretary. How can we be sure that the new unit will have the power and resources to look at things that might be politically difficult for the Government? How will the people in charge of the CQC balance the responsibility of investigating with the responsibility of maintaining that safe space?

Sir Bernard JenkinOn the question of how the CQC leadership becomes conflicted, will my hon. Friend reflect on the fact that, in an Adjournment debate I held in July, the then Patient Safety Minister, the hon. Member for Birmingham Edgbaston (Preet Kaur Gill), made it clear that the person responsible for deciding what safe space information might be released would be the chief executive of the CQC? If the chief executive of the CQC is to see all that information, how would he or she not be able to use it, or be tempted to use it, when he or she inspects hospitals for the purposes of the CQC? Would the safe space not then be hopelessly conflicted, and therefore lose public confidence?

Dr JohnsonAbsolutely; my hon. Friend has obviously read my speech. What would happen if the new unit identified the CQC itself as the problem? Ministers have not provided good answers to these questions. To be honest, they cannot, because the Government cannot have their cake and eat it. Either HSSIB remains independent or it is folded into the CQC and loses its independence. The Government are either decluttering the landscape by removing an organisation or simply hiding it inside another organisation, to the detriment of both. We have tabled amendment 1 to protect HSSIB, and I urge the Government to support it in the interests of patient safety.

Stuart Andrew (Daventry) (Con)My hon. Friend is making an important point about HSSIB. We have heard time and again that frontline staff value the safety that HSSIB provides to them and the confidence they have in reporting. Given that we in this Chamber have heard some harrowing stories about maternity services around the country, does she not think it is important that we listen to the staff, and not just one individual with a different point of view?

Dr JohnsonAs always, my right hon. Friend is absolutely right.

HSSIB has recently produced a report, which it would benefit the Government to listen to. The House will be aware that the advice and guidance service provides GPs with specialist advice, which sometimes avoids referrals. However, Ministers have made it mandatory to ask for advice before certain types of referrals, and set an aim for one in four referrals to be diverted back. The Government said that they were not rationing care or meddling with waiting lists—that there was nothing to see here, and that the Opposition were spreading misinformation—but HSSIB has published an interim report linking this process to delays in patient care, including cancer diagnoses. New clause 141 asks the Government to suspend the new process until they have properly considered it.

Layla Moran (Oxford West and Abingdon) (LD)The hon. Lady may be aware that the Health and Social Care Committee has a pre-appointment hearing with the incoming chair of the CQC tomorrow morning. One question I would like to ask them hinges on the answer to another question, on which I would have loved an update from the Minister. The previous Secretary of State said that HSSIB will not be merged with the CQC until the CQC is ready, but we have never had a list from the Government as to exactly what metrics they will use to decide when that happens. That will have a bearing on what kinds of questions we ask the chair and CEO. What specifically do the Government mean by “ready”? Does the hon. Lady not see that as a problem?

Dr JohnsonI absolutely do. The Government have said that the CQC is not fit for purpose, yet they are now asking it to do things it did not do before, including not only HSSIB but event healthcare management, as the hon. Lady will be aware. It is absolutely right that the Government pause and think this one through again.

One of our other amendments concerns puberty blockers. One of the first rules of medicine is primum non nocere—first, do no harm—and yet here we have a Labour Government sponsoring a £10.6 million trial to put 226 physically healthy children as young as 11 on puberty-blocking drugs. That was said to make the former Secretary of State, the right hon. Member for Ealing North (James Murray), “uneasy”. Why was he uneasy? Perhaps because these are powerful drugs that could cause serious long-term harm, because most children get better by themselves, because we cannot reliably identify which children will persist with a trans identity and which will not, because the huge increase in girls experiencing gender dysphoria has not been adequately explained or because the Tavistock data has not yet been reviewed in the data linkage study. There are many reasons for concern, but I am aware that we are short of time.

It is difficult for a clinician to tell which children’s symptoms will self-resolve and which will not. As a result, we risk putting a large number of children on puberty blockers to assess the effects on, as the former Health Secretary put it, a

“very small subset of a very small group”. —[ Official Report , 22 June 2026; Vol. 788, c. 56.] That means the results of the investigation may be unreliable, and it could cause unnecessary harm to children, so why are the Government not ensuring that the data linkage study is, at the very least, done first?

17:00:00

The Minister will note that there was a vote on this trial at the end of the Opposition day debate in the summer, where a large number of her party abstained and three voted against. There were also votes against from many other parties. As a doctor, I appreciate that voting on a clinical trial is unusual, but let’s be clear: this is the Labour Government’s trial, it is taxpayers’ money being spent and it is young British children who we are talking about. If the Government want to run this trial and pay for it, why not bring it before the House so that parliamentarians can decide whether it is the right thing to do? We have a new Prime Minister and a new Secretary of State. The country needs to know if they are content to pay for a trial of powerful drugs on an unnecessarily large group of children, the majority of whom have self-limiting, temporary feelings of distress.

We also have an amendment regarding single-sex spaces. When the Supreme Court ruled on 16 April 2025 that the legal definition of a woman refers strictly to biological sex, many up and down the country will have wondered, “Why do we need judges to tell us that?” We are all, including in the eyes of the law, male or female. Of course, there are people who feel more comfortable presenting as the opposite sex, and I am sure the whole House would agree that trans men and trans women need protection from harm and harassment in the same way as their fellow citizens. I hope that the whole House would also agree that a woman should never be forced to get undressed in the presence of a man, and vice versa. But that is what happened to the Darlington nurses. Seven nurses were forced to share a changing room with a transgender woman, someone who is male but who presents publicly as a woman. The Supreme Court was crystal clear: the legal definition of a woman is based on biological sex, and yet these nurses were subjected to pressure and intimidation for raising concerns about getting changed in front of someone who is a man.

Rachel Taylor (North Warwickshire and Bedworth) (Lab)I thank the hon. Member for giving way and the tone in which she is conducting this debate. Would she feel more comfortable, however, if a transgender man with balding hair and a full beard, who was behaving like a man and full of testosterone, was attending a female toilet facility at night at a motorway service station? I would not feel safe, but it seems she would feel safer in that situation than she would with a trans woman getting changed in front of nurses or attending a toilet.

Dr JohnsonI am not sure why the hon. Member has reached that conclusion. I am saying that this is based on biology, and people who are trans require the same protections as people who are not—that is what I have said very clearly.

The Darlington nurses were particularly brave in bringing their case forward. The cost was £187,000 in damages after an employment tribunal ruled in favour of them. That is a victory for dignity, for women and for common sense, but it is also a significant cost of public money to an NHS trust because it decided not to follow the law. That money could have been spent on patient care. What steps is the Minister taking to ensure that this guidance is fully and properly implemented across the NHS? How will she ensure that a repeat of the Darlington nurses case does not happen again, and what guidance has been given to NHS managers on how to handle this?

The Minister for Women and Equalities did not help matters. She had the responsibility to sign off the Equality and Human Rights Commission’s draft code of practice to inform businesses, services and public bodies how to implement the Supreme Court’s guidance in law. But for over a year, the Government failed to lift a finger to enforce the law. For over a year, businesses, hospitals, service providers and public bodies were left waiting for the Government to tell them what the official guidance said. Now that it is here, we need to know how it is being implemented. How will the Minister ensure that this guidance is implemented universally in our NHS? How will the Government ensure that single-sex spaces are protected? What provision will they make for transgender individuals? What reassurance can the Minister give to women working in our NHS that they are safe? Our new clause 143 makes it clear that both staff and patients in the NHS must have access to single-sex spaces to protect their dignity and their privacy. I hope the Minister will be able to support this; I cannot see why she would not.

The Government have also decided to abolish Healthwatch and reduce the number of local Healthwatch branches. Healthwatch England has been engaging with patients since 2013, with more than 150 operating in a hub-and-spoke model, but that is about to change. Why? One reason seems to be to avoid duplication. The Government are clearly not keen on lots of Healthwatch branches doing the same thing in different areas of the country and feel that some branches may operate better than others. They say that they want to bring feedback closer to decision makers, but is that a good idea?

The Government could have chosen to improve Healthwatch as it stands. In 2023-24, more than 925,000 people used Healthwatch to get advice and information, and more than 300,000 shared their experiences to improve services. They could have increased awareness further and developed a clear feedback chain, but instead they have decided to abolish Healthwatch altogether. That is of grave concern. How can patients be expected to complain to the system about the system? The Prime Minister previously wrote: “People speak to Healthwatch because they are outside the system—they are impartial, trusted, and provide a safe space for concerns to be shared.”

On that, he was right, and I ask the Minister to accept our amendment on this subject.

We have tabled a number of other amendments, including one on fracture liaison services, one that would produce a modern service framework for musculoskeletal care and others on radiotherapy, respiratory health, brain injury and the Government’s new medical devices regulations. However, I appreciate that we are short of time, so I will just make two short comments, if I may, Madam Deputy Speaker,

First, I of course agree with the intent of the Liberal Democrats’ amendment 140, but it requires the presence of HSSIB, and since the Government seem hellbent on removing that, I do not know how the amendment would work. New clause 81, a Back-Bench amendment that has been selected by Mr Speaker, relates to another really important issue. As a paediatrician, I see the importance of what it suggests. The regulations would need to be carefully drafted for those who have a brief illness, to define life-threatening illness more clearly and to avoid duplication of work, but in principle, it is an important amendment. I commend our amendments to the House.

Madam Deputy Speaker (Judith Cummins)With the exception of Front-Bench speeches, there will be an immediate three-minute time limit.

Grahame Morris (Easington) (Lab)I am speaking today in support of new clauses 113 and 114, which stand in the name of the hon. Member for Westmorland and Lonsdale (Tim Farron) and to which I have added my name.

I say at the outset that I am in full support of this Government’s ambitions on cancer. I welcome the recent investment in radiotherapy equipment, and I sincerely want the national cancer plan, which was published in February, to succeed. But I speak as someone who worked in the health service, who is a cancer survivor and who has taken a particular interest in this issue, not least as vice chairman of the all-party parliamentary group on radiotherapy. It is in that capacity, and as a supporter of what the Government are trying to achieve, that I respectfully ask Ministers to accept one or both of these new clauses.

By way of brief explanation, new clause 113 requires the Secretary of State to publish and maintain a national framework of agreed metrics for radiotherapy, requires integrated care boards to report annually against those targets and requires a report to this House once a year. New clause 114 asks very straightforwardly for a single review of access to radiotherapy and radiotherapy waiting times to be laid before Parliament within six months.

Anna Dixon (Shipley) (Lab)Does my hon. Friend agree that the ethnic inequalities we see in cancer outcomes and access to cancer treatment such as radiotherapy should also be included in the suggested review?

Grahame MorrisThis is a huge issue that should concern everyone. I believe there is cross-party consensus on the issue of health inequalities and huge variation in access depending on which part of the country people live in. That is an absolutely valid point.

We know the international consensus is that around half of all cancer patients have an evidence-based indication for radiotherapy at some point in their treatment. We should be aware that here in the United Kingdom in 2021, the last date for which figures were available, only 35% of cancer patients received it as part of their primary treatment.

Tim Farron (Westmorland and Lonsdale) (LD)I am extremely grateful to the hon. Gentleman for the excellent points he is making. Let me add that in Lancashire and south Cumbria, only 29% of cancer patients get access to radiotherapy. He will be aware the Government’s target is that 85% of people diagnosed with cancer should be treated within 62 days, but only 41% of patients who are recommended radiotherapy get treated in those 62 days. He will also know that for every four weeks of delay in cancer treatment, there is a 10% lower chance of survival. Should the Government not accept new clause 114 to make it mandatory for people to be treated within two months so that they get the best chance of survival?

Grahame MorrisThe hon. Gentleman hits the nail on the head—that is perfectly put. I believe there is cross-party consensus that this is the way forward. Over the last 16 years that I have been a Member, along with the hon. Gentleman, I have presented the case to a whole succession of Ministers from various parties, all of whom seemed to be in agreement. We definitely have an opportunity to restore what was once a world-class cancer service and get us back to where the international benchmarks say that we should be.

As I am sure Members are aware, responsibility for commissioning radiotherapies was devolved to the integrated care boards. I can understand the logic of moving commissioning closer to local populations. The hon. Member for Westmorland and Lonsdale, who tabled the new clause, and I do not seek to undo that. However, we wish to stress to the House that radiotherapy is not an ordinary local service, and it should not be considered as one. It is delivered from a very limited number of highly specialised centres dependent on capital equipment with long replacement cycles. It relies on a small, highly skilled workforce of about 6,000 people, all of whom take years to train, all the while relying on physical infrastructure that cannot be commissioned at short notice.

Patients routinely cross integrated care board boundaries to reach these specialist centres. Many boards, entirely understandably, do not have dedicated radiotherapy expertise in house. In August 2023, 70% of integrated care boards had no named person responsible for ensuring sufficient radiotherapy treatment capacity at all. I am willing to work with Ministers to seek a resolution with the solutions that we propose.

Madam Deputy Speaker (Judith Cummins)I call the Liberal Democrat spokesperson.

Helen Morgan (North Shropshire) (LD)Yesterday, I highlighted our concerns about the implications of quick-fix, top-down reorganisation for the sovereignty of the NHS and the interests of patients. In a system that already spends too much time and money reacting to failure, rather than planning for success, patient safety is already under threat. Rather than addressing those failings, this Bill is at risk of making a bonfire of patient safety. Our amendments would reverse the gutting of safety mechanisms from the NHS, all of which have been painstakingly introduced after far too many scandals.

Amendments 8 and 9 would restore Healthwatch England and local Healthwatch organisations, while new clause 14 would restore Healthwatch funding after 10 years of cuts to its service. Given that Healthwatch was originally established as a response to the devastating Mid Staffordshire scandal, its abolition would be a step backwards, showing that lessons have not been learned. An independent patient voice is essential to shape local services and highlight where they are not working well, and folding it into existing NHS structures risks destroying the trust that exists precisely because of its independence.

Edward Morello (West Dorset) (LD)Will my hon. Friend give way?

Helen MorganI am not going to give way, because there are many colleagues who wish to speak and there is very limited time. I hope my hon. Friend will forgive me.

Another vital body for safeguarding and investigating patient safety is the Health Services Safety Investigations Body, which again functions well because of the trust NHS professionals have in its independence and objectivity. Both would be lost under the proposal to roll it into the CQC. Our amendment 12 would ensure that HSSIB’s functions remain operationally independent of the CQC, so that the NHS is not left to mark its own homework. Together, these amendments are designed so that patients are protected from another Mid Staffordshire, another Shrewsbury and Telford, another Nottingham, another East Kent or another Morecambe Bay. Rash decision making must not be allowed to put patients at risk.

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We would also go further than protecting existing patient safety measures and significantly strengthen whistleblowing routes through new clauses 9 and 10, which would create standard mechanisms for whistleblowing by coroners and hospital boards, new powers to report wrongdoing, and new requirements on managers and the Department of Health and Social Care to whistleblow where there are concerns about systemic medical malpractice or failure.

However, keeping patients safe goes beyond just blowing the whistle. My hon. Friend the Member for Epsom and Ewell (Helen Maguire) has tabled new clause 52 to give patients a right to start cancer treatment within 62 days of referral, with a scheme to deliver this. Liberal Democrat research earlier this year found that 80% of trusts failed to meet that 62-day target, with nearly 1,000 patients waiting over six months for treatment. People are suffering and dying because of these failures—it just is not safe.

The egregious patient safety failure that I will focus on today, though, is the corridor care crisis. The latest release of monthly corridor care statistics revealed the worst summer on record for A&E waits, with well over 300,000 waits of 12 hours or more in June and July. Nearly 100,000 people were treated in hospital corridors in July. After 2025 saw the worst level of 12-hour trolley waits in A&E ever recorded, this summer’s corridor care statistics show an ever-worsening trend.

The human reality of those numbers is that patients are left to deteriorate for hours in corridors, potentially without food or water, and staff are pushed to breaking point. One nurse described the conditions as akin to “torture”, with a 2025 survey from the Royal College of Physicians finding that 78% of physicians had provided care in a temporary space. The Royal College of Emergency Medicine’s recent “Safe to Care” campaign reveals the huge strain that this type of care puts on staff, with 96% of emergency department staff surveyed reporting that they had experienced violence or aggression as a result. That is totally unacceptable.

In a response to a written parliamentary question I asked in June, the Department of Health and Social Care revealed that it had not undertaken any assessment of the impact of A&E waiting times on excess deaths. Given that the Royal College of Emergency Medicine’s June report estimated that well over 15,000 excess deaths occurred in 2025 in connection with long waits, this lack of investigation by the Department is devastating for patient safety. Inaction on corridor care is costing lives in the thousands every year; it is incumbent on the Government to act now and act fast to put an end to this crisis. I have therefore tabled new clause 140, which would require the Government to end corridor care in NHS hospitals within one year and to launch an independent inquiry into corridor care, including into Government policy, if that is not achieved.

Many of the protections and organisations being abolished or weakened in this Bill were introduced following scandals during the Prime Minister’s tenure as Health Secretary. He promised lasting change and to listen, and previously opposed the removal of Healthwatch, but he is now due to oversee a big backward step in patient safety.

Finally, I am aware that Mr Speaker is provisionally minded to select the official Opposition’s new clauses 142 and 143 for separate decision, so I will briefly outline my concerns about them. New clause 142 seeks to politicise a drug trial in a way that is unprecedented and inappropriate. Drug trials must be protected by objective ethical and medical safeguards, and it is vital that they are undertaken in a way that follows a rigorous, accepted and predictable scientific process that prioritises the safety of patients. Baroness Cass has outlined her concerns about the misinformation surrounding this trial in her letter to all MPs, which was sent before the summer recess—I strongly recommend that all MPs read that letter. Allowing politicians to override objective ethical and medical safeguards would be a dangerous precedent to set, particularly in a world where vaccine deniers and anti-science fantasists have a clear route to getting their hands on the levers of power. As always, we stand firm in believing in an evidence-based approach, and argue strongly against the risks of political capture when we should be led by the science.

Liberal Democrat policy on single-sex spaces requires that everyone who needs access to a single-sex space can have it safely and feel comfortable and secure, while ensuring that nobody faces discrimination on the basis of their being trans. The Opposition’s new clause 143 is very poorly drafted and would create chaos and confusion within the NHS by applying requirements to spaces such as pop-up flu jab clinics, blood donation sessions in the community and potentially even care delivered in a private residence in a way that is clearly unworkable and would damage delivery of care. Therefore, I am also unable to support that new clause.

Given their haste in tabling the amendments to retain Healthwatch, I am disappointed that the official Opposition are not using this opportunity to push for a vote on that critical issue instead. I urge the Government to accept the amendments tabled in my name and those of my Liberal Democrat colleagues to protect patient safety if they, unlike the official Opposition, are serious about building a health service that works for staff and delivers for patients.

I have enjoyed working with the Minister here in the Chamber, in Committee and on a one-to-one basis, and I am sure that she has the best of intentions. I hope that she has listened to our genuine concerns about patient safety during the last two days, and will consider our amendments further in the other place. Otherwise, the Liberal Democrats will continue to fight for significant improvements for patient safety as the Bill progresses to the House of Lords.

Liz Twist (Blaydon and Consett) (Lab)I welcome the Bill, and was pleased to be a member of the Bill Committee. I also welcome the Government’s new clauses, about which the Minister has spoken today.

New clause 159, to which I have added my name, seeks to address a long-standing legislative omission in our health service. I thank my hon. Friend the Member for Sunderland Central (Lewis Atkinson) for tabling it. For over a decade since the Health and Social Care Act 2012, Parliament has recognised the principle of parity of esteem between physical and mental health, but without statutory accountability that parity has remained an aspiration rather than a clinical reality.

The scale of the problem is clear. NHS data shows that 1.87 million adults and more than 576,000 children and young people currently hold open referrals for mental health services. While the Government set clear targets to reduce physical healthcare waiting lists, mental health services are excluded from these core constitutional ambitions, and the division has severe consequences. A survey conducted by Rethink Mental Illness found that 83% of patients experienced a deterioration in their mental health while waiting for support, and that nearly a third of those whose health worsened attempted suicide.

New clause 159 would require the Secretary of State to publish national waiting time standards for mental health services within 12 months of the Bill passing into law. The fact is that what is measured is addressed, so we need to give the same attention to mental health that we rightly give to physical health measures. These standards, which cover both community and urgent care, must be developed in consultation with the chief medical officer. Crucially, the new clause mandates the Secretary of State to report performance against those waiting times, alongside mental health expenditure, to Parliament every year. That will ensure that the funding that we allocate in the House is linked transparently to patient outcomes. If we do not measure waiting times we cannot manage them, and patients will continue to be left until they are in crisis before they receive support. It is time that we started to pay the same attention to mental health as we do to physical health, so that we can really achieve parity of esteem.

The Government have set out a welcome and ambitious path to rebuild our NHS, and achieving true parity of esteem is central to that mission. I urge the Minister to look closely at new clause 159 as a constructive measure.

Dame Caroline Dinenage (Gosport) (Con)I will speak about new clause 41, which stands in my name.

We put enormous, unquestioning trust in those who care for the bodies of our loved ones when they die. However, in this Chamber six months ago, I told a former Health Minister, the hon. Member for Glasgow South West (Dr Ahmed), about Elkin and Bell, the Gosport funeral directors who left 46 bodies decaying in an unrefrigerated room. One of them, an elderly gentleman whose family had already paid for his cremation, was left decomposing for 36 days. I said then that the funeral sector was nothing better than a lawless wild west with no mandatory qualifications to practise, no accreditation for professionals, no licensing of businesses, no inspection of premises, and no law to fall back on when things go wrong. It was only persistence and ingenuity on the part of Hampshire constabulary that saw Elkin and Bell brought to justice. The Minister at the time told me that a decision on regulation would come in the Government’s full answer to the Fuller inquiry, and we are still awaiting.

Since then, matters have worsened. In July, Robert Bush, a funeral director in Hull, was sentenced to 20 years in prison after pleading guilty to 67 charges for bodies left decomposing in squalor. Forty-six grieving families had been reunited with the wrong ashes, but the real horror is that these will not be isolated cases. Under the law as it stands today, almost anyone can set themselves up as a funeral director.

Amanda Martin (Portsmouth North) (Lab)I thank the hon. Lady for her work in this area in the neighbouring constituency. The vast majority of funeral directors operate with integrity, compassion and professionalism. Does she agree that, as reputable businesses, they are crying out for robust regulation?

Dame Caroline DinenageI genuinely could not agree more. This is not at attack on the profession. The vast majority of funeral directors do their job with extraordinary skill, great care and huge professional integrity. It is precisely because of the trust that grieving families place in them every single day that we cannot allow a rogue minority to drag the reputation of the whole sector through the mud.

In a written statement on 1 September, the Government said they intended that proposals for regulation would be forthcoming, but they set out no timetable, and detailed plans were promised only “in due course”. Families have already waited years and cannot be expected to wait indefinitely. New clause 41 would require the Secretary of State, within six months of the Bill passing, to extend the remit of the Human Tissue Authority beyond hospital mortuaries, which it currently covers, to funeral directors, private mortuaries, direct cremation services and any other organisation that transports or holds the bodies of the deceased.

Stuart AndrewDoes my hon. Friend agree that Donna Ockenden’s report into what happened in Nottingham, particularly the harrowing stories of the mortuary issues there, adds to the case that she is making?

Dame Caroline DinenageI pay tribute to my right hon. Friend for the fantastic work that he did as shadow Secretary of State for Health and Social Care, and he is absolutely right. We really need the full response to the Fuller report in order to implement not only changes to mortuaries, but all the other amendments that it recommended.

New clause 41 would place a duty on the Human Tissue Authority to establish and maintain a register of every business brought within its oversight, with how that register operates set by regulation, so that for the first time a grieving family could check, before they hand over the body of a loved one, whether the business in front of them is properly overseen. I recognise that the hon. Member for Leeds South West and Morley (Mark Sewards) has tabled new clause 42 on a new, bespoke freestanding regulator. Both new clauses would fix the same issue, and either will do.

The key thing is that this is a moment for the Government to seize, not resist. Ministers have already said that, in principle, they agree with what new clause 41 would require of them. Every trade body agrees. Every family who has been failed agrees. Every Member from across the House who signed our letter agrees. It feels like the Government agree, so I ask the Minister to tell the House exactly when a statutory scheme will be brought forward by the Department of Health and Social Care, and to set out the timetable for implementation.

None of us is comfortable dwelling on our own mortality, which is exactly why the funeral sector has gone on for so long without proper scrutiny. It is a truism—we hear it all the time—that funerals are for the living; they are for families to say goodbye to their loved ones with dignity. They should be able to grieve without the added horror of questioning whether the body they buried was the right one, or whether the ashes they scattered belonged to the right person. Robert Bush’s sentencing should be the last time that this House has to debate such a gruesome case, but it will not be unless the Government push ahead to close this regulatory black hole.

Chris Hinchliff (North East Hertfordshire) (Lab)I am sure that many Members from across the House are aware of the campaign in memory of Hugh Menai-Davis, the son of my constituents Ceri and Frances who tragically passed away at the age of just six. As part of that campaign, the amendments that I have tabled to the Bill are designed to support families at the most difficult time imaginable.

Our national health service and welfare state have changed and evolved over almost a century, and we should always keep a close watch on how faithfully they remain connected to their founding principles. Support “from the cradle to the grave” should not a dusty slogan; it must be a constant aspiration. Wherever gaps or shortcoming are identified, we must address them.

It should concern us all that support for parents of seriously ill children is one such gap. When a child becomes seriously ill, the NHS mobilises around the child, quite rightly, but parents must mobilise around everything else—getting to work and hospital appointments, looking after other children, managing existing caring responsibilities, and somehow keeping on top of bills, rent or mortgages that do not stop when a child becomes ill. When all of this takes place alongside the fear that their child may die, the pressure on families is near impossible to bear.

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Too often our systems see a patient, a parent, an employee, a sibling or a pupil, but rarely a family, and we need our NHS to see the full picture. There is a clear gap in our safety net when parents of seriously ill children are left without the co-ordinated financial, practical and emotional support they need. The message from those with lived experience is that, in these scenarios, parents find themselves passed from pillar to post, endlessly repeating the devastating reality they are living through, which compounds their trauma. The stress and complexity this adds to the burden that parents and carers already face when caring for a seriously ill child contributes to longer-term health impacts for families in a way that we cannot ignore. A linked record cohort study of more than 35,000 mothers found high incidences of depression, cardiovascular disease and death among mothers of children with life-limiting conditions.

New clause 81 proposes a single named co-ordinator bringing together information on financial support, employment rights for parents and carers, and signposting to relevant charities and support as part of a written plan for the family. This would cut away repetitive bureaucracy and mean that parents are no longer left to their own devices in trying to figure out a way through the challenges their families face in these situations. It is a simple duty, but one that could make a massive difference. At one of the most difficult times imaginable in a family’s life, it would ensure that they are no longer simply left to navigate an overwhelming and unfamiliar system alone. Childhood illness is traumatic enough. We should do everything we can to stop it.

Madam Deputy Speaker (Caroline Nokes)Order.

Clive Jones (Wokingham) (LD)I would like to speak to new clause 137. Cancer Research UK estimates that, in the six months since the national cancer plan was published, over 168,000 people were diagnosed with cancer in England. The number of those diagnosed is at a record high and this is projected to continue. Almost one in two of us will get cancer in our lifetime, and no one in this country is untouched by the disease. I welcome the Government’s ambition to improve cancer outcomes in the national cancer plan. Alongside my amendment to the Health Bill, my current private Member’s Bill seeks to guarantee that the Government make progress towards delivering these targets and are held to account by Parliament on that.

Over the past five decades, cancer survival has more than doubled because of lifesaving research, earlier detection and cutting-edge treatments. However, in the last decade progress has slowed, and the 10-year cancer survival index was better in the early 2000s than in the 2010s, so we are in danger of going backwards. The national cancer plan commits to meeting cancer waiting times targets by the end of this Parliament. The previous Government failed to do that, and I really hope that this Government will manage it. It is also important that these targets are met, alongside a full range of commitments in the plan.

The Health and Care Act 2022 required the Secretary of State to include cancer outcome objectives in the annual mandate set by the Secretary of State for NHS England, and those outcome objectives explicitly took priority over other cancer objectives. I have tabled this amendment because the current Health Bill abolishes that mandate, including the previous statutory requirement for cancer outcome objectives to be prioritised over other cancer objectives, and a similar duty has not been replicated elsewhere in the Bill.

With the removal of the statutory requirement to prioritise cancer outcomes over other cancer objectives in the health system, there is a very real concern that progress on cancer outcomes risks being deprioritised amid the competing priorities of a Department facing many external pressures. I am therefore seeking assurances from the Minister that, despite the disruption of the ongoing merger and the removal of the cancer outcomes clause, progress on delivering the transformation laid out in the national cancer plan will be delivered, and that it remains a priority for the new Prime Minister and the new Secretary of State. I ask the Minister to guarantee that the capacity needed to drive forward this essential work on cancer is protected.

Madam Deputy SpeakerOrder. I call Kate Osborne.

Kate Osborne (Jarrow and Gateshead East) (Lab)If I may begin on a personal note, just three weeks ago I had a second operation on my back, and I wish to put on record my sincere thanks to the staff who cared for me, from the clinicians who treated me to everyone involved in my care and recovery. [Hon. Members: “Hear, hear.]

Too often our access to healthcare depends on our postcode. That postcode lottery is stark in a number of areas, but nowhere more so than with IVF. As chair of the APPG on fertility, I have raised this issue repeatedly with Ministers. I again invite Ministers to attend our fertility roundtable tomorrow and to commit to ensuring that every ICB follows, at the very least, the NICE guidelines on access to IVF and fertility treatment.

We must strengthen the role of voluntary, community and social enterprise organisations in neighbourhood health planning and NHS commissioning. Voluntary organisations understand the barriers to care for hard-to-reach communities and often have trusted relationships with communities that statutory services struggle to reach. We see that particularly clearly in HIV and AIDS provision. Voluntary organisations have been fundamental to the UK’s response for decades, through prevention, testing, peer support, tackling stigma and supporting people living with HIV. I am extremely grateful to the National AIDS Trust for working with me on the new clauses, and I thank Ministers for their constructive engagement. Members of the LGBT+ community must have trust in healthcare providers, and community groups bridge that gap when needed.

New clauses 142 and 143 would actively harm vitally needed healthcare. The provision in new clause 142 has already been rejected in Committee, and we see it for what it is: an opportunity to attack some of the most vulnerable in our society. Access to much-needed healthcare has already been paused in the UK, and if access to treatment for gender dysphoria is now to be dependent upon additional research, the pathways trial must go ahead without further delay.

The provisions in new clause 143 were also rejected in Committee and are another attempt to vilify. The amendment fails to recognise the framework already in place to ensure that single-sex services are provided where they meet the requirements of the Equality Act. Neither the code nor the Supreme Court judgment mandate the provision of single-sex facilities. Providers must still consider whether the service falls within an exception within the Equality Act, whether single-sex provision is proportionate, what the impact might be on trans people, and what mitigation might be necessary.

I welcome the 10-year health plan. We have made great strides in repairing the damage done to our NHS—

Madam Deputy Speaker (Caroline Nokes)Order. I call Sir Bernard Jenkin.

Sir Bernard JenkinI would very much have liked to have discussed the medical devices questions arising from the Bill. The Minister made an incredibly short speech about that important matter. It is quite clear that these provisions are part of the covert dynamic alignment with the EU and the covert rejoin agenda being pursued by the Government. It raises all sorts of constitutional questions, but those are not for today.

I will concentrate on HSSIB. I rise to support amendments 1 to 4, which would remove the abolition of HSSIB from the Bill. The Government have singularly failed to make the case for removing this crucial safety investigation function. It did not exist until recently, and now they want to scrub it out. I suspect that is because too many people in the health system do not like being held to account by an independent investigative body.

Karin Smythindicated dissent .

Sir Bernard JenkinThe Minister shakes her head, but she is yet to give a good reason as to why this measure is in the Bill.

When we had an Adjournment debate in July with the then Minister for patient safety, the hon. Member for Birmingham Edgbaston (Preet Kaur Gill), she could not answer the question of who would conduct independent safety investigations in the NHS after the abolition of HSSIB. She said that safety investigations would be conducted by the Care Quality Commission, but she could not actually claim that they would be independent; as my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) demonstrated, they would not be.

If, as it seems, it is intended that safety investigations should be carried out by the CQC unaffected by the transfer, why make the transfer at all? How much is this transfer going to cost? I asked the Minister, in a letter I sent her after the debate in July, to give us the information on how much the transfer of all this would cost. Nothing has arrived. I never had a reply to the letter. Of course, the Government have changed the Minister and the new Minister for patient safety, the right hon. Member for Kingston upon Hull North and Cottingham (Dame Diana Johnson), is not in the House today. I rather suspect that she is more sympathetic to this argument than the Minister sitting on the Front Bench today.

In our earlier exchanges we discovered and once again exposed how the safe space will be brutally compromised by the fact that it will be housed in a regulator with, inevitably, other ulterior motives. The chief executive of the CQC is wantonly conflicted in terms of looking after the safe space, so he cannot be the one left in charge of that function.

The real point here is that we are missing the opportunity to save so much money. Governments keep having public inquiries. The EPUT—Essex Partnership University NHS Foundation Trust—public inquiry, affecting my constituency, cost in its first year £5 million, and in its second year it is costing another £5 million. The whole budget for HSSIB was only £6.3 million a year, yet it does scores of investigations, not just one inquiry. The Ockenden inquiry cost £14 million. If we could save just a fraction of the cost of medical negligence, which is £3.6 billion a year, HSSIB would pay for itself.

Jeff Smith (Manchester Withington) (Lab)Clauses 5 and 6 place duties on the Secretary of State to promote patient involvement, patient choice and innovation. My new clauses 86 and 87 would apply those principles to psychedelic-assisted therapy treatments involving schedule 1 controlled substances.

I have been pleased to be a trustee of the charity Drug Science, which has allowed me to talk to researchers who are looking at therapeutic treatments using what are called psychedelic drugs. Around the world there is growing evidence of the successful treatment of post-traumatic stress disorder, trauma, mental health issues and end-of-life distress using these drugs. For some patients they are absolutely revelatory. They change lives for the better and can relieve the burden of those conditions on the wider health service.

Researchers tell me, however, that the barriers the current system puts in place really restrict research. Research involving schedule 1 controlled substances generally requires a Home Office licence, and the bureaucracy and inertia in the system adds delay, cost and an administrative burden to the extent that research grants are being lost because of delays.

The issue has already been considered. In 2023 the Home Affairs Committee recommended urgently moving psychedelic drugs to schedule 2 in order to facilitate research. Later that year, the Advisory Council on the Misuse of Drugs recommended that research using schedule 1 drugs in universities and hospitals should be exempt from the Home Office domestic licencing requirement and should instead operate under schedule 2 controls. In 2025 the Government accepted the ACMD recommendations in principle. There is supposed to be a pilot of a proposed extension to test operational feasibility, but that has not happened. The Government said the policy work was under way and that further plans would be published in due course, but without a timetable for implementation. My new clause 86 would make it happen. Other jurisdictions are ahead of us on this issue. The US Department of Defence and the US Department of Veterans Affairs are already funding clinical trials for military personnel and veterans. New clause 87 concerns compassionate access to treatment. International research has identified potential in some treatment-resistant psychiatric conditions and end-of-life distress. There is international precedent. The 2022 Canadian special access programme has allowed clinicians to request restricted drugs, including psilocybin and MDMA, to treat those conditions. We can learn from those experiences.

Finally, I am grateful to the Minister for meeting me to discuss these issues, and for her agreement on the principle of enabling the clinical research of these drugs and her commitment to get back to me to outline how the Government will take them further.

Anna Sabine (Frome and East Somerset) (LD)I will speak to new clauses 116 and 117, which I have tabled.

Clover Carkeet, from my constituency, is a delightful seven-year-old girl who has suffered from intractable epilepsy since she was 12 weeks old. Clover’s seizures could be controlled only by huge doses of steroids, leaving her very unwell, until her parents secured a private prescription for medical cannabis, reducing her seizures by 95%. Medical cannabis is legal and can be bought privately under NHS supervision, but it is not routinely available on the NHS. As a result, families are faced with an impossible choice: fund thousands of pounds a month to pay privately, or watch their child suffer while relying on the treatments available through the NHS. Why are parents being made to make that choice? Colleagues across the House, including the hon. Member for Gower (Tonia Antoniazzi), have long campaigned on the issue and support new clause 116, which calls on the Secretary of State to assess the availability of medical cannabis on the NHS for children. I hope the Government will support this new clause too.

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On new clause 117, in June, thyroid surgery left me with vocal cord paralysis, as Members can particularly hear today. This has given me a real and unwelcome insight into the challenges faced by people who experience voice loss. According to the Lary Project, around 30% of adults will experience voice loss at some point in their life. Speech and language therapists could often resolve these issues entirely, but access to therapy is determined by a postcode lottery.

I was fortunate to get NHS speech therapy this summer, but not everyone is. That is why new clause 117, backed by the Royal College of Speech and Language Therapists, calls on the Secretary of State to publish a strategy tackling waiting times and unequal access to speech and language therapy. To do this job, we all rely on our voices, so I urge the House to support new clause 117.

Madam Deputy Speaker (Caroline Nokes)That brings us to the Front Bench. I call the Minister.

Karin SmythWe have genuinely had a wide-ranging and thoughtful debate, and I want to try to address all the points that have been raised. I think there is broad agreement across the House on the goals that we are seeking to achieve with the Bill: safer care, better outcomes and a stronger voice for patients. Every patient deserves safe and high-quality care, every community deserves to have its voice heard, and everyone should be able to access the care they need, when they need it. The question before us is how best to deliver those ambitions.

In general, we do not believe that the current landscape works, and that better outcomes are always achieved through new reporting requirements, additional layers of statutory process or more bureaucracy. Instead, we are committed to devolving responsibility and to empowering leaders in the NHS, while also holding them directly accountable, so that the NHS is focused on delivery and improving care.

I will begin with Healthwatch. I think there is broad consensus that we want to see patient voices heard strongly at every level of the healthcare system—it is something that all MPs feel strongly about, dealing with constituents as we do. Hearing the patient and user voice results in better decisions in a system that is designed around them—a system that is better able to correct when things go wrong.

Our ambition is to ensure that insight and experience from patients, service users and communities is part of commissioning and service planning decisions, rather than being held at arm’s length and outsourced. Our ambition is that this is done effectively everywhere. It is about strengthening the power of patients’ voices inside the NHS, where decisions are taken, not silencing criticism of those decisions. Within our approach, integrated care boards and local authorities will be expected to engage with people in their areas and will have a statutory duty to obtain their views.

That is a core part of the new strategic role of ICBs, and it involves transparency about what people have told the system, what the system has done in response and how learning is shared across partners. ICBs will be held to account if they do not demonstrate those elements. However, we have heard the strength of feeling in this place and in Committee, and as the Bill moves to the other place, I can commit to working closely with colleagues across this House and in the other place in order to review these provisions and ensure that our approach sufficiently empowers and devolves to local populations. We all want to ensure that the changes deliver for patients and service users, building public trust and ensuring that their voice is embedded in the care they receive.

Adrian Ramsay (Waveney Valley) (Green)The CEO of Healthwatch Norfolk said today:

“To cease the statutory functions of Healthwatch without a suitable alternative in place…is to risk another major failing in patient safety and scrutiny of the health system.”

Did the Minister’s remarks just now suggest that the Government may be reviewing the plans to scrap Healthwatch?

Karin SmythIt will not be a surprise to the hon. Gentleman that I do not agree with his proposition, although I commend the work that many people have done in Healthwatch. We want to work with people in the other place to make sure that this is the right way forward.

I am sorry that we do not have more time to debate HSSIB, because it requires more discussion, although we had a good debate in Committee. We have heard many discussions today. I have met the hon. Member for Harwich and North Essex (Sir Bernard Jenkin), and I hear what he is saying; I will ensure that he gets a response to his letter from the new Minister for Patient Safety—asap, as they say.

It is an issue that we need to get absolutely right. We all know, from our experience with patients and families, about the importance of creating a culture in which concerns can be raised without fear and lessons are learned effectively. The Government fully agree with those objectives. Our view is that patient safety, in line with the Dash review, is best served by clear lines of accountability, effective independent scrutiny, and a relentless focus on learning and improvement. We are therefore transferring HSSIB’s functions to the CQC to ensure that learning from investigations can more readily inform improvement activity across the system.

We recognise the importance of ensuring that the investigation arm has the autonomy to investigate the qualifying incidents that it deems appropriate free from interference, and I can give the House the assurance that we will work with the executive of HSSIB and the CQC to ensure that their operating model upholds this operational independence.

In response to the Chair of the Health Committee, who is not in her place, let me say that there is obviously no one single metric by which to judge the suitability of the CQC. It is usual in the Department’s oversight of arm’s length bodies and independent regulators to look at things like stable leadership, IT capability, governance and operational effectiveness. This is something I am sure the Select Committee can help with.

Sir Bernard JenkinWill the Minister give way?

Karin SmythI apologise, but I am going to press on. There is a lot to get through.

We are committed to tackling health inequalities wherever they arise. There are strong duties on both ICBs and the Secretary of State to tackle these inequalities, and we remain firmly committed to doing so. We continue to drive forward improvement plans including the national cancer plan and the mental health strategy, which will transform mental health care into a system that responds and intervenes early, reduces waiting times for support, and ultimately supports people to participate fully in education. I note in particular that the Government are already making record investment in mental health. All ICBs are expected to meet the mental health investment standard over the next three years, and all are forecast to meet it for 2026-27.

We are also committed to delivering the national cancer plan and focused on driving improvements, including on diagnostic capacity, which is key to addressing waiting times and tackling variation in access to better treatment, as we have heard today from my hon. Friends the Members for Easington (Grahame Morris), whose work in this area I commend, and for Blaydon and Consett (Liz Twist).

Freddie van Mierlo (Henley and Thame) (LD)Will the Minister give way?

Karin SmythI am going to press on a little bit, if I may.

I remind the House that we are doing this within the existing legal structures, and that our approach is not to put in place additional duties and layers of detail and specificity in primary legislation. I think we should avoid the temptation to create separate statutory obligations for each condition or patient group, particularly in an age where people are living longer and very often with more than one health condition. Instead, we should commit ourselves to tackling inequalities for everyone, everywhere.

We have again heard from the Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), about corridor care. The Government have been consistently clear that corridor care is not an acceptable standard of care and should not be normalised, and it is our intention to reduce and ultimately eradicate it. I think it is worth reminding the House that corridor care does not occur everywhere; some places have made huge steps to avoid it, and we want to share that learning. I particularly commend Barnsley foundation trust, South Warwickshire foundation trust and the Dudley group foundation trust, where there have been zero incidents in the last reporting. We must recognise that corridor care is one of the most visible and distressing symptoms of systemic pressures across the urgent and emergency care pathway, and our focus is on taking action now to tackle those underlying pressures.

We are improving patient flow, strengthening discharge arrangements, investing in urgent and emergency care services, and providing targeted support to the systems and trusts facing the greatest challenges from corridor care, so that improvements can be delivered where they are needed most. To ensure that we can understand where these challenges are, we have already introduced a national definition of corridor care, and strengthened reporting and oversight arrangements.

Deirdre Costigan (Ealing Southall) (Lab)I thank the Minister for giving way and wish her a happy birthday, too. The NHS trust in north-west London was recently found to be one of the most improved in London in terms of reducing waiting lists. Does she agree that all the changes that she is bringing in through the Bill, including those discussed today, will help us to bring down those waiting lists even further and address the issues with corridor care that she has outlined?

Karin SmythI thank my hon. Friend for her best wishes and commend the work that she and many other Members are doing directly with their trusts to understand the impact of the work that we are doing to bring down those waiting lists and improve access for patients. As I have said, corridor care is a sign of systemic failure in the system and is unacceptable. I think we have all witnessed it in our local trusts, but it is coming down in places, and we want to continue to see it eradicated.

I pay tribute to my hon. Friend the Member for North East Hertfordshire (Chris Hinchliff) for his championing of the families of children suffering from life-threatening illnesses. I know that Members on both sides of the House recognise the profound impact that receiving a diagnosis of a life-threatening condition has on a child and their family. It is vital that all these families feel supported, informed and cared for, and I wholeheartedly recognise that the support that they are offered now is often not proactive or joined up, with the onus, as he said, being on families to navigate the system and seek support themselves. With that in mind, the Government commissioned a report on the mental health impacts of life-threatening childhood illness on families, named in the memory of Hugh Menai-Davis. I pay tribute to Hugh’s parents for their campaigning and offer them my deepest condolences.

The report process is progressing well, and I can commit to the report being published in this Parliament, with a full Government response issued within three months of publication. For too long, children’s health has not been a priority, which is why my right hon. Friend the Secretary of State for Health and Social Care has directed the Department to make maternal and child health central to its work. We know that a child’s health has ramifications for the wellbeing of the whole family, and there must be better solutions to join up support for parents of unwell children.

The new cross-Government mental health strategy will also address how we better support parents and families, and the Government intend to work closely with parents, families and campaigners to identify workable solutions and make available more proactive support.

I turn now to the Opposition amendments, starting with new clause 142, in the name of the Opposition spokesperson, the hon. Member for Sleaford and North Hykeham (Dr Johnson).

Rachel TaylorWill the Minister give way?

Karin SmythI will carry on.

As the hon. Member for Sleaford and North Hykeham knows well, provisions are already in place to appropriately control access to puberty-suppressing hormones for children and young people presenting with gender incongruence or dysphoria. Children and young people with gender incongruence deserve evidence-based care. The Cass review recommended a clinical trial to provide high-quality comparative evidence on the potential benefits and risks of the medicines. That is now under way.

I agree with the comments from the hon. Member for North Shropshire, but I have to disagree with the view of the hon. Member for Sleaford and North Hykeham that, uniquely, access to these types of medicines must be subject to the scrutiny and approval of Parliament. I think that, as a clinician, she understands that.

I would also like to address new clause 143. As the hon. Member for Sleaford and North Hykeham knows, the EHRC’s updated code of practice for services, public functions and associations commenced on 5 August. It provides guidance on how sex-based distinctions in the Equality Act can be applied, including in the NHS. This new clause is unnecessary. This legislation is the law and the law is clear. The NHS will obviously follow the law. New guidance has been drafted and will be published imminently. For the record, I am due next week to meet the Darlington nurses who she spoke for. I agree that they were brave; they should not have had to go through what they went through.

I want to address new clauses 41 and 42 on funeral regulation in the name of the hon. Member for Gosport (Dame Caroline Dinenage), who spoke powerfully on behalf of the whole House; I commend the work that she has done. My hon. Friend the Member for Kingston upon Hull West and Haltemprice (Emma Hardy) has spoken to me in great detail about this issue, as has my hon. Friend the Member for Leeds South West and Morley (Mark Sewards).

The Government were appalled by the offences committed by Robert Bush and the profound harm caused to bereaved families. Every deceased person must be treated with care, respect and dignity. We are undertaking urgent work to develop comprehensive proposals, including formal regulation of the funeral sector to drive out rogue operators and strengthen protection for bereaved families. As the hon. Member for Gosport said, operators that work well will also want to see this. We will begin sharing proposals shortly, and I am very happy to include hon. Members in the discussions.

Mark Sewards (Leeds South West and Morley) (Lab)Does the Minister accept that the Prime Minister said in July that the sector needed to be regulated and that this continues to be a priority for his Government?

Karin SmythAbsolutely, and I am committed to working with my hon. Friend and many other hon. Members across the House.

I was pleased to meet my hon. Friend the Member for Manchester Withington (Jeff Smith) to discuss his amendments concerning medicines. I hope that I reassured him—from his speech, I think that I did—that the Government do support well-designed research into innovative treatments using controlled drugs, where this is conducted safely and appropriately. We also understand the complexities involved, including the need to minimise the risk of harm and misuse. That is why we are working across government to consider how to implement the recommendations from the Advisory Council on the Misuse of Drugs to reduce barriers to research with schedule 1 controlled drugs. I committed to write to my hon. Friend to set that out further; I will do.

A number of hon. Members tabled amendments on issues with their local infrastructure. We have already published the capital plan and improved long-term capital planning to improve local infrastructure.

I think that I have addressed most things—

Rachel TaylorWill my hon. Friend give way?

Karin SmythI am so sorry; I will to talk to my hon. Friend later. The debate has been wide ranging. If there are things that I have missed, I commit to getting back to hon. Members. I know that my noble Friend Baroness Merron is committed to working co-operatively with all Members as the Bill proceeds through the other House.

18:00:00

Debate interrupted (Programme Order, 7 September ).

The Deputy Speaker put forthwith the Question already proposed from the Chair (Standing Order No. 83E), That the clause be read a Second time.

Question agreed to.

New clause 94 accordingly read a Second time, and added to the Bill.

The Deputy Speaker then put forthwith the Questions necessary for the disposal of the business to be concluded at that time (Standing Order No. 83E).

New Clause 95

Disclosure of information relating to medicines

“(1) The Medicines and Medical Devices Act 2021 is amended as follows.

(2) In the heading of Chapter 2 of Part 2 omit “International agreements:”.

(3) In section 8 (disclosure of information in accordance with international agreements)—

(a) in the heading omit “in accordance with international agreements”;

(b) for subsections (2) and (3) substitute—

“(2) The relevant authority may disclose such information—

(a) for the purposes of enabling or facilitating the exercise by a public authority of any of its functions,

(b) for the purposes of enabling or facilitating the carrying out by a person of an activity relating to human medicines,

(c) for the purposes of giving effect to an international agreement or arrangement (and the disclosure that may be made for this purpose includes disclosure to a person outside the United Kingdom),

(d) for the purposes of civil proceedings or the prevention, investigation, detection or prosecution of criminal offences, or

(e) for the purposes of warning members of the public about matters in relation to human medicines.

(3) The relevant authority may not disclose patient information in reliance on subsection (2)(c) without the consent of the person to whom the information relates.

(3A) The relevant authority may not disclose commercially sensitive information in reliance on subsection (2) unless the relevant authority considers that the disclosure is appropriate, having taken into account the public interest as well as the interests of any person to whom the commercially sensitive information relates.

(3B) In considering whether the disclosure of commercially sensitive information in reliance on subsection (2) is appropriate the overarching objective of the relevant authority must be to safeguard public health (taking into account the safety and availability of human medicines) where that is relevant to the disclosure in question.

(3C) Where information to which this section applies is disclosed to a person in reliance on subsection (2)(a), (b), (c) or (d), the person may not use or further disclose the information except—

(a) with the agreement of the relevant authority and for a purpose mentioned in subsection (2), or

(b) in accordance with an enactment or order of a court or tribunal.”;

(c) in subsection (4), for “subsections (5) and” substitute “subsection”;

(d) omit subsection (5);

(e) in subsection (6)—

(i) omit the “or” at the end of paragraph (a);

(ii) at the end of paragraph (b) insert

“, or

(c) contravenes any obligation or restriction created or arising by or under the Windsor Framework, whether or not an obligation or restriction to which section 7A(2) of the European Union (Withdrawal) Act 2018 applies.”;

(f) in subsection (8)—

(i) omit the definition of “relevant person”;

(ii) at the appropriate place insert—

““Windsor Framework” has the meaning given by section 20(1) of the European Union (Withdrawal) Act 2018.”” —(Karin Smyth.)

This creates a general information-sharing gateway for the Secretary of State and Department of Health in Northern Ireland in respect of information about human medicines. At the moment the statutory gateway is limited to disclosures made in accordance with international agreements.

Brought up, and added to the Bill.

New Clause 98

disclosure of information relating to medical devices

“(1) Section 39 of the Medicines and Medical Devices Act 2021 (disclosure of information relating to medical devices) is amended as follows.

(2) For subsections (2) to (7) substitute—

“(2) The Secretary of State may disclose such information—

(a) for the purposes of enabling or facilitating the exercise by a public authority of any of its functions,

(b) for the purposes of enabling or facilitating the carrying out by a person of an activity relating to medical devices,

(c) for the purposes of giving effect to an international agreement or arrangement (and the disclosure that may be made for this purpose includes disclosure to a person outside the United Kingdom),

(d) for the purposes of civil proceedings or the prevention, investigation, detection or prosecution of criminal offences, or

(e) for the purposes of warning members of the public about matters in relation to a medical device.

(3) The Secretary of State may not disclose patient information in reliance on subsection (2)(c) without the consent of the person to whom the information relates.

(4) The Secretary of State may not disclose commercially sensitive information in reliance on subsection (2) unless the Secretary of State considers that the disclosure is appropriate, having taken into account the public interest as well as the interests of any person to whom the commercially sensitive information relates.

(5) In considering whether the disclosure of commercially sensitive information in reliance on subsection (2) is appropriate the overarching objective of the Secretary of State must be to safeguard public health (taking into account the safety and availability of medical devices) where that is relevant to the disclosure in question.”

(3) In subsection (8)—

(a) in the words before paragraph (a), for “subsection (3) or (4)” substitute “ subsection (2)(a), (b), (c) or (d)”;

(b) in paragraph (a), for “subsection (3) or (4)” substitute “subsection (2)”.

(4) In subsection (10)(c), for “the Protocol on Ireland/Northern Ireland in the EU withdrawal agreement” substitute “the Windsor Framework (as defined by section 20(1) of the European Union (Withdrawal) Act 2018)”.

(5) In subsection (12)—

(a) omit the definition of “relevant person”;

(b) at the appropriate place insert—

““Windsor Framework” has the meaning given by section 20(1) of the European Union (Withdrawal) Act 2018.””— (Karin Smyth.)

This expands the purposes for which information about medical devices may be shared by the Secretary of State .

Brought up, and added to the Bill.

New Clause 99

Further and consequential amendments relating to medical devices

“(1) The Medicines and Medical Devices Act 2021 is amended as follows.

(2) Omit Chapter 1 of Part 4 (medical devices - regulations: general).

(3) The repeal of Chapter 1 of Part 4 of the Medicines and Medical Devices Act 2021 by subsection (2) does not affect any regulations made under section 15(1) of that Act before its repeal in so far as they extend to Northern Ireland.

(4) In section 21 (compliance notices)—

(a) in subsection (1) omit “involved in marketing or supplying a medical device”;

(b) in subsection (1A)(a), for “15” substitute “14A(1)”;

(c) for subsection (5) substitute—

“(5) Where—

(a) there is a failure to comply with a medical devices provision as it extends to Northern Ireland, and

(b) the person mentioned in subsection (1) is a manufacturer for the purposes of any provision in the EU Medical Devices Regulations,

a notice under subsection (2) may be served on the manufacturer or on another person who has been designated by the manufacturer to act as their representative (or both).

(5A) Nothing in subsection (5) limits the circumstances in which a notice can otherwise be given to a person by giving it to someone on their behalf.”

(5) In section 34 (recovery of expenses of enforcement), in subsection (1)(a), before paragraph (i) insert—

“(ai) regulations under section 14A(1),”.

(6) In section 42 of the Medicines and Medical Devices Act 2021 (interpretation of Part 4), in subsection (2) omit the definition of “manufacturer”.

(7) For section 43 substitute—

“43 Power to make consequential etc provision

(1) Regulations under this Act may make consequential provision.

(2) The Secretary of State may by regulations—

(a) make provision that—

(i) is consequential on regulations under section 14A(1) (medical devices regulations in Great Britain), and

(ii) extends to Northern Ireland;

(b) make provision that—

(i) is consequential on regulations under section 14K(1) (power to restate medical devices law in Northern Ireland), and

(ii) extends to England and Wales or Scotland.

(3) The provision that may be made by regulations under section 14A(1) by virtue of subsection (1) of this section, or by regulations under subsection (2)(b) of this section, includes provision amending—

(a) an Act (including this Act),

(b) an Act of the Scottish Parliament, or

(c) an Act of Senedd Cymru.

(4) The provision that may be made by regulations under section 14K(1) by virtue of subsection (1) of this section, or by regulations under subsection (2)(a) of this section, includes provision amending—

(a) an Act (including this Act), or

(b) Northern Ireland legislation.

(5) Regulations under this Act may—

(a) make supplementary, incidental, transitional, transitory or saving provision;

(b) make different provision for different purposes;

(c) make different provision for different areas;

(d) make provision for all cases to which the power applies or for those cases subject to specified exceptions or for any specified cases or descriptions of case.

(6) This section does not apply in relation to—

(a) regulations under sections 50 or 51 (commencement and transitional provision);

(b) regulations under paragraph 9 of Schedule 2 (supplementary provision about civil sanctions).”

(8) In section 45 (consultation), in subsection (3)—

(a) for “15(1)” substitute “14A(1)”;

(b) for “15” substitute “14A(4)”.

(9) In section 47 (regulations: procedure), for subsection (3C) (inserted by section 73 of this Act) substitute—

“(3C) Regulations under Part 4—

(a) are subject to the negative procedure if they contain only provision made in reliance on paragraph 9 of Schedule 2 (supplementary provision about civil sanctions);

(b) are subject to the draft affirmative procedure if they are not within paragraph (a).

(3D) Regulations under Part 5—

(a) are subject to the negative procedure if they do not contain provision made in reliance on section 43(3) or (4);

(b) are subject to the draft affirmative procedure if they are not within paragraph (a).”

(10) Omit Part 6 (duty to report on operation of medicines and medical devices legislation within 5 years of passing of Act).

(11) In Schedule 2 (medical devices: civil sanctions)—

(a) in paragraph 1(1), before paragraph (a) insert—

“(za) regulations under section 14A(1),”;

(b) in paragraph 4(1)(a), before sub-paragraph (i) insert—

“(ai) regulations under section 14A(1),”;

(c) in paragraph 5(1)(a), before sub-paragraph (i) insert—

“(ai) regulations under section 14A(1),”;

(d) in paragraph 13(1), in paragraph (a), after “under” insert “regulations under section 14A(1),””— (Karin Smyth.)

Brought up, and added to the Bill.

New Clause 100

Power to amend meaning of “medical device”

“In section 42 of the Medicines and Medical Devices Act 2021 (interpretation of Part 4), after subsection (2) insert—

“(3) The Secretary of State may by regulations make provision about the meaning of “medical device” in this Part (including by amending this section).””— (Karin Smyth .)

Brought up, and added to the Bill.

New Clause 101

Power to restate medical devices law in Northern Ireland

“After section 14J of the Medicines and Medical Devices Act 2021 (inserted by section (Medical devices regulation: Great Britain) of this Act) insert—

“Chapter A2

Power to restate law in Northern Ireland

14K Power to restate law in Northern Ireland

(1) The Secretary of State may by regulations restate, to any extent, the Northern Ireland medical devices legislation.

(2) In this section, “the Northern Ireland medical devices legislation” means—

(a) regulations under section 15(1) (before its repeal by section (Medical devices regulation: Great Britain) of the Health Act 2026),

(b) the Medical Devices Regulations 2002 (S.I. 2002/618),

(c) the Medical Devices (Northern Ireland Protocol) Regulations 2021, and

(d) the EU Medical Devices Regulations.

(3) A restatement may use words or concepts that are different from those used in the law being restated.

(4) A restatement may make any change which the Secretary of State considers appropriate for one or more of the following purposes—

(a) resolving ambiguities;

(b) removing doubts or anomalies;

(c) facilitating improvement in the clarity or accessibility of the law (including by omitting anything which is legally unnecessary).

(5) The provision that may be made by the regulations may be made by modifying any enactment.””— (Karin Smyth.)

This confers a regulation-making power to restate the legislation about medical devices in Northern Ireland. For Great Britain, the existing law will be replaced by the new licensing regulations. This power allows the law for Northern Ireland to be restated (with minor changes of the kind often found in consolidation Acts).

Brought up, and added to the Bill.

New Clause 140

Corridor care

“(1) The Secretary of State must end the practice of corridor care in NHS hospitals within one year of the passage of this Act.

(2) If the requirement under subsection (1) is not met, the Secretary of State must commission an independent inquiry into the Government's handling of corridor care.

(3) The inquiry under subsection (2) must—

(a) investigate the effectiveness of policies, funding and guidance relating to corridor care in the Department of Health and Social Care;

(b) assess the impact on patient safety and staff morale from the continued practice of corridor care; and

(c) recommend steps the Secretary of State should take to end the practice of corridor care.

(4) The inquiry under subsection (2) should be supported by patient safety professionals from the Health Services Safety Investigations Body and the Care Quality Commission.

(5) The inquiry under subsection (2) must be published and laid before Parliament as a final report within 6 months beginning on the day on which the inquiry is established.”— (Helen Morgan.)

This new clause places a duty on the Secretary of State to end Corridor Care within 12 months, if they fail to do so they must order an independent inquiry into corridor care and the failure to eradicate the practice.

Brought up.

Question put, That the clause be added to the Bill.

68|18:01|79|300| The House divided: | Question accordingly negatived. ||0|0

New Clause 142

Puberty blockers

“(1) Within three months of the passage of this Act the Secretary of State must make regulations which ensure that puberty blockers may not be prescribed, dispensed or supplied to persons under 18 years of age for the purposes of treatment related to gender dysphoria, gender incongruence or a combination of both, in the United Kingdom.

(2) Regulations under this section must ensure that such drugs cannot be given out or used as part of clinical trials for the treatment of gender dysphoria, gender incongruence or a combination of both, unless that trial has specifically been approved by a resolution of both Houses of Parliament.

(3) For the purposes of this section, puberty blockers means—

(a) a ‘gonadotrophin-releasing hormone (“GnRH”) analogue’ which means a medicinal product that consists of or contains buserelin, gonadorelin, goserelin, leuprorelin acetate, nafarelin or triptorelin, and

(b) any other drug which has the effect of suppressing or delaying puberty that the Secretary of State may by regulation appoint.”— (Dr Caroline Johnson .)

This new clause would create a requirement for the Secretary of State to make regulations which prevent puberty blockers from being prescribed to persons under 18 years of age for the purposes of treatment related to gender incongruence, or being given in clinical trials related to gender incongruence unless specifically approved by Parliament.

Brought up.

Question put, That the clause be added to the Bill.

69|18:15|108|357| The House divided: | Question accordingly negatived. ||0|0

New Clause 143

Single sex facilities

“(1) The Secretary of State is required to ensure that there are single sex—

(a) changing rooms for NHS staff,

(b) toilets and washing facilities for NHS staff,

(c) wards for NHS patients, and

(d) toilets and washing facilities for NHS patients.

(2) The Secretary of State may make exemptions to the duty in subsection (1)(c) and (1)(d) where necessary for—

(a) children,

(b) intensive care units,

(c) critical care, and

(d) specialist high observation areas such as resuscitation in Accident and Emergency and the initial recovery area in theatres.”— (Dr Johnson .)

This new clause creates a requirement for the Secretary of State to ensure certain single sex facilities are made available for NHS staff and patients. It provides exemptions in certain circumstances.

Brought up.

Question put, That the clause be added to the Bill.

70|18:28|106|302| The House divided: | Question accordingly negatived. ||0|0

Clause 63

Transfer of HSSIB’s functions to CQC

Amendment proposed1, page 45, line 39, leave out clause 63— (Dr Caroline Johnson.)

Question put, That the amendment be made.

71|18:39|162|297| The House divided: | Question accordingly negatived. ||0|0

Clause 70

Regulationsreference to agreements and standards

Amendment made65, page 49, line 1, leave out from “supply),” to end of line 7 and insert—“for subsection (2), substitute—

“(2) The provision that may be made in reliance on subsection (1)(a) includes provision that—

(a) refers to international agreements, including such agreements as they have effect from time to time;

(b) refers to international standards, including such standards as they have effect from time to time;

(c) refers to United Kingdom standards that are specified in a list published by the Secretary of State from time to time.””— (Karin Smyth.)

This amendment standardises the provisions enabling the Secretary of State to make regulations referring to international standards and agreements (already in section 16(2) of the Medicines and Medical Devices Act 2021), and United Kingdom standards (inserted by this Bill).

Clause 72

Consultation about medicines and medical devices regulations

Amendment made66, page 50, line 2, leave out “or 4” and insert “4 or 5”.— (Karin Smyth.)

This is consequential on NC99 and ensures that regulations under new section 43(2) of the Medicines and Medical Devices Act 2021 are subject to the consultation requirements imposed by new section 45(1ZA) (which is inserted by clause 72).

Clause 79

Extent

Amendments made67, page 54, line 19, at end insert—

“(ea) section 61 (sections 56 to 60: interpretation);”.

This is a technical amendment which ensures that the interpretation provisions in clause 61 relied on by clauses 56, 58 and 59 will have the same extent as those clauses.

Amendment 68, page 54, line 23, leave out “Section 71 extends” and insert

“Sections 71 and (Medical devices regulation: Great Britain) extend”.

This is consequential on NC94.

Amendment 69, page 54, line 23, at end insert—

“(3A) Section (Power to restate medical devices law in Northern Ireland) extends to Northern Ireland only.”— (Karin Smyth.)

This is consequential on NC101.

Schedule 12

Minor and consequential amendments

Amendments made72, page 150, line 15, at end insert—

“Mental Capacity Act 2005

91A In Schedule AA1 to the Mental Capacity Act 2005 (deprivation of liberty: authorisation of arrangements enabling care and treatment) (as inserted by section 1 of the Mental Capacity (Amendment) Act 2019), for paragraph 8, substitute—

“8 In paragraph 6(1)(d) “NHS continuing healthcare” has the meaning given by section 12(10) of the Care Act 2014.””

See the explanatory statement to amendment 73.

Amendment 73, page 191, line 36, at end insert—

“328A In section 12 (further provision about assessments), for subsection (10) substitute—

“(10) “NHS continuing healthcare” has the meaning given by regulations.””

This amendment and amendments 74 and 72 are consequential on the repeal by clause 16 of section 6E of the National Health Service Act 2006 and accompanying regulations. Existing regulations contain a definition of “NHS continuing healthcare” which this would replace with a power to define the term in regulations.

Amendment 74, page 192, line 7, at end insert—

“329A In section 52 (supplementary provision about provider failure), for subsection (10) substitute—

“(10) “NHS continuing healthcare” has the meaning given by section 12(10).””

See the explanatory statement to amendment 73.

Amendment 75, page 197, line 26, at end insert—

“Access to Medical Treatments (Innovation) Act 2016

369A (1) Section 2 of the Access to Medical Treatments (Innovation) Act 2016 (database of

innovative treatments) is amended as follows.

(2) In subsection (1) for “Health and Social Care Information Centre (“the HSCIC”)” substitute “Secretary of State”.

(3) In subsection (3)(a) in the words before sub-paragraph (i), for “HSCIC” substitute “Secretary of State”.

(4) In subsection (4)(a) and (b) for “HSCIC” substitute “Secretary of State”.

(5) Omit subsection (6).”— (Karin Smyth.)

This is a consequential amendment to section 2 of the Access to Medical Treatments (Innovation) Act 2016, which would replace references to the Health and Social Care Information Centre with references to the Secretary of State, and remove a requirement for the Secretary of State to consult with the Centre before making regulations.

Third Reading

18:51:00

The Secretary of State for Health and Social Care (Yvette Cooper)I beg to move, That the Bill be now read the Third time.

Let me thank all those who have been involved in bringing this Bill to this point, including all those involved in Committee. I thank the parliamentary staff, the departmental staff and the legal staff, and the Members on both sides of the House, who have debated so many different issues during the passage of the Bill. In particular, I pay huge thanks to the Minister for Secondary Care, my hon. Friend the Member for Bristol South (Karin Smyth), who has not only chaperoned this Bill through every stage from beginning to end—with some different Health Secretaries along the way—but has done today’s Report stage on her birthday; I wish her a hugely happy birthday.

I am grateful to everybody for their engagement, including those who, as well as debating the issues covered by the Bill, have taken the opportunity of these debates to raise so many issues that are so important to patient care right across the country, and to the improvements we need to make to patient and family care. I include in those thanks the parents of little Hugh Menai-Davis, who were in the House today.

Members in all parts of the House have been raising issues from special educational needs and disabilities to funeral regulation and health inequalities, and it is important that our NHS and health systems continue to improve.

Jim Dickson (Dartford) (Lab)I thank the Secretary of State very much for giving way, because I know time is short. She is talking about the various issues that have come up while the Bill has been debated. One of them is the most common cause of death in the UK: dementia. An amendment that I tabled with the Alzheimer’s Society suggested that we bring the data on dementia, which is scattered right across the health system at the moment, into a single place to drive progress on early diagnosis and treatment. Does she agree that that is an important priority for the Government?

Yvette CooperMy hon. Friend is exactly right to raise this vital issue. So many of us will have families and constituents who are affected by dementia. We are committed to introducing a dementia tsar as part of our response to Louise Casey’s commission, and we will be looking at data issues and evidence as part of that. As this legislation completes its passage through this House, I thank my predecessor Health Secretaries for the work that they have done in bringing down waiting lists, improving treatment and getting more appointments than ever before. There are thousands more doctors, nurses, midwives and mental health workers in place than ever before, and we thank our national health service staff across the country. They also recognised that we inherited a system that was still badly held back by the failed 2012 Lansley reforms, including the huge administrative issue and unaccountable bureaucracy, with lots of duplication, poor communication and no proper accountability. This legislation is about strengthening democratic accountability and the focus on patient care. To be clear, I pay tribute to the work done by many people across NHS England—including in particular the recent work of the current chief executive, Jim Mackey, to substantially improve patient care and to reduce that duplication—but the systems and structures have been holding people back. That is why we have brought this reform forward, part of which will not just end the wasteful duplication, but ensure that our NHS system is better able to deliver.

I will update the House and the NHS shortly on the future operating arrangements. Let me say now that that means returning to some of the arrangements that applied before 2012, when we had strong national NHS leadership, but with much greater partnership and accountability and far less duplication than we have today. I have been frank with both the Department and NHS England that the focus needs to be on patients.

We are making some further reforms in response to the discussions in this House. I have made a commitment that we will bring forward amendments in the House of Lords to establish England’s first statutory maternity commissioner, implementing the Amos review’s recommendation, but also directly reflecting the work and determination of my hon. Friend the Member for Sherwood Forest (Michelle Welsh), the Government’s national maternity adviser. I thank her for the work that she has done. We have also amended the Bill to ensure that local government is represented on ICBs. That was raised by the Select Committee. I am also clear that we need to ensure that patients’ voices are properly embedded in decision making. Members have all debated the importance of the single patient record to improve care.

It is great to be back at this Dispatch Box as a Health Minister, 24 years since I last spoke at the Dispatch Box as a Health Minister. I am surprised by how little has changed in many ways, but one thing that has not changed, but which is so immensely important to all of us, is the dedication of NHS staff and the people who work right across the country to support patients and communities. This Bill is about helping them to ensure they can do their jobs in the most effective way. I commend this Bill to the House.

18:56:00

Damian Hinds (East Hampshire) (Con)I welcome the Secretary of State back, as it were, to the Department. As we debate Third Reading of the Bill, she is the third Secretary of State for this Bill. It was about 40 minutes after First Reading that the right hon. Member for Ilford North (Wes Streeting) resigned. I wonder which bit he had just spotted. We wish the Secretary of State well, though, and not only because of her East Hampshire heritage. There will be times when we disagree entirely, and there will be times when we find commonality, but at all times it is our job to scrutinise the Government in the interests of the public and on behalf of the dedicated professionals and other staff in these most vital of sectors.

It is also my first opportunity to pay tribute to my predecessor in this role, my right hon. Friend the Member for Daventry (Stuart Andrew). He took on that responsibility in the very finest traditions of this House. He had and has respect and admiration across the House, and I know his approach was much appreciated by so many working in and in support of health and social care.

This has been a big Bill, and I thank the Public Bill Committee for all the work they did. In particular, I thank my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), my hon. Friend the Member for Farnham and Bordon (Gregory Stafford), who was the Whip and is now a shadow Minister, and everybody on that Committee. We will not divide on Third Reading, because there are important things in this Bill that we support. However, there is a great deal of concern about a huge IT project with no detail behind it as yet. It should put a shiver down any incoming Minister’s back when they hear that they have been bequeathed a large public sector IT transformation project.

The Government are taking oversight out and putting that inside the body that is meant to oversee things, removing patient voice and, most of all, doing an enormous top-down reorganisation of the NHS. There have already been 10 of those since 1974. If the answer to the NHS’s problems was a top-down reorganisation, perhaps one of the previous ones would have worked. Whatever the outcome, and whatever this legislation ends up being, I know that the other place will be scrutinising it closely. We will scrutinise its implementation and what difference it actually makes in the end for patients. Question put and agreed to. Bill accordingly read the Third time and passed.