Sir Bernard Jenkin
MP for Harwich and North Essex · Conservative · United Kingdom
“Despite long and historic disagreements between successive UK Governments and Israel, it has remained a steadfast ally in counter-terrorist efforts to keep our people safe in this country. We are now embarked, it seems, on a full diplomatic dispute with Israel and tit-for-tat expulsions of diplomats.”
“I 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.”
“I am as keen as anybody to get on with discussing the Health Bill, but this topic is too serious an opportunity to miss, given that the hon. Member for Leeds Central and Headingley (Alex Sobel) has raised such important issues. I really commend his speech and his initiative. Everybody should read it.”
“The 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.”
“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.”
“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.”
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“I can say that with authority because it was my Select Committee that recommended HSSIB in the first place, and I also chaired the pre-legislative scrutiny Committee on the draft legislation, so how can Ministers give any authority to the Dash review, which claimed that HSSIB has expanded its remit, when it has done no such thing? Recommendation 3 proposes: “Most investigations into safety incidents should continue to be managed within provider organisations”. This really is the fundamental flaw in Dash. Recent maternity investigations conducted by trusts have highlighted the deficiency of provider-led investigations, as Ockenden and Amos have pointed out. Do the Government accept that investigations by provider organisations are inherently conflicted?”
“HSSIB is exactly equivalent to the AAIB, the marine accident investigation branch and RAIB, and was, like them, set up to conduct systemic investigations. That is why they are such effective bodies. The Health and Care Act 2022 does not limit HSSIB investigations to individual incidents. There is no reference whatsoever to “severe harm”, as Dash puts it, in the 2022 Act. It was always intended by Parliament that HSSIB should make systemic recommendations arising from the investigation of specific incidents or groups of incidents.”
“Friend the Member for Godalming and Ash (Sir Jeremy Hunt) was saying, and are not consistent or effective in identifying learning or providing accountability. Amos also says that families should have access to an independent investigation if they lose confidence in the local investigations. Without HSSIB, who will provide those independent investigations? Finding 6 accuses HSSIB of having “expanded” its “scope of work beyond the original remit…For example, HSSIB was originally established, along the lines of safety investigatory bodies in other industries, to look at specific cases or incidents of severe harm, but it has since broadened its work into making more systemic recommendations.” That is what Dash says. It is complete nonsense.”
“The new statutory HSSIB did not take on maternity and newborn safety investigations, because they were commenced without the safe space protections, so their evidence is available for legal proceedings. That is not how HSSIB operates. Since 2023, HSSIB has been conducting its own maternity investigations. Indeed, when the Amos review was established, it took on the relevant investigations from HSSIB and then relied on HSSIB for assistance with them. With sufficient resources, HSSIB could conduct all maternity investigations much more effectively than the maternity and newborn safety investigations programme. Amos reported that MNSI investigations are not trusted by families, as my right hon.”
“Can the Minister therefore point out which of HSSIB’s recommendations have been too expensive to implement? If not, where is the justification for abolishing HSSIB? Neither the NQB nor the CQC should control investigations. The AAIB cannot be prevented from making independent recommendations by the Civil Aviation Authority, the Transport Secretary or airlines themselves. Why should the NQB, which will be subject to political direction, be allowed to decide what safety recommendations should be made and what should be investigated, as Dash recommends? On page 31, Dash incorrectly states: “HSSIB was not able to retain the maternity programme because the Health and Care Act 2022 does not make provision for maternity investigations under HSSIB.” Why have the Government accepted that assertion as true? It is wrong in fact and law.”
“I thank the hon. Gentleman. Recommendation 1 in the Dash review says that the new National Quality Board should “avoid unfunded mandates being imposed on the system without due consideration”. Public inquiries have certainly made well meaning but unaffordable recommendations—I think of the Francis inquiry recommendation on blanket standards for minimum staffing—but it is wrong to see safety as a cost in opposition to other benefits. The cost of safety failures is astronomic, with NHS clinical negligence costing £3.6 billion a year, despite all the public inquiries. Effective safety management is about the cost-effective management of risk, not risk elimination at any cost. If the air accidents investigation branch did not balance costs with effective risk management, aeroplanes would not fly.”
“Even if HSSIB only saves a fraction of the £3.6 billion in costs of clinical negligence, it will pay for itself many fold. I do hope that Ministers will reconsider the whole issue, reflecting on the fact that none of the Royal colleges, nor any of the patient safety organisations, nor the all-party group on patient safety support this unjustifiable policy.”
“To save money, the Secretary of State should request that HSSIB conducts far more investigations into matters which he thinks are important, provided that he also provides the funding for the necessary capacity. HSSIB, for example, has conducted eight investigations into mental health suicides since 2023. Each was completed in a few weeks or months, costing a total of £850,000. In comparison, the Lampard inquiry into the Essex partnership university trust in my constituency—investigating the same problem—is expected to cost more than £5 million. Ockenden cost £14 million. This is very far from the best use of resources for conducting investigations. So I ask the Minister, why have Dash and the Government ignored the whole question of HSSIB’s value for money?”
“The Health Bill does attempt to address this by replicating the 2022 Act’s safe space provisions, but that Act also provided for disclosure in certain circumstances, which is allowed on the basis that the benefits for the safety of patients outweighs any impact on current and future investigations. But under this Bill, who will decide what protected information can be disclosed? How will the CQC give the same confidence that the safe space is not being compromised as HSSIB? Finally, Dash fails to look at the comparative cost of HSSIB investigations versus the cost of public inquiries. HSSIB at the moment only costs £6.3 million per year.”
“The recommendation also makes no reference to the statutory safe space raised by the hon. Member for Shipley (Anna Dixon) that provides for protected disclosure by patients and their families, clinicians and others in safety investigation bodies. It is a crucial safeguard, allowing people to speak. It allows for the duty of candour. I would just point out that the duty of candour does not work if it is just imposed on people. People cannot be forced to incriminate themselves. If placed under the CQC, confidence in the safe space investigations will collapse—and back we go to public inquiries.”
“Friend the Member for Godalming and Ash, is a regulator and compliance enforcer, not an investigator. How can the CQC also be an independent investigator? Dash also says that the CQC internal successor should collaborate through the NQB to agree the scope of any investigations it carries out and agree the recommendations. Dash is effectively saying that CQC investigations will be overseen by the NQB. That is a direct attack on the independence of investigations. Can the Minister explain who in future will conduct independent and unconflicted investigations into safety incidents in the NHS? For example, how would an investigation under the CQC be free to find that the CQC inspections themselves were causing unintended harm to patients, or is it back to the misery of litigation through the courts and more public inquiries?”
“I thank the hon. Lady for that intervention. Only an independent investigator can find the causes of the incident that may be part of the culture or practice of that provider, or of the system as a whole. It is like suggesting that airlines or aircraft manufacturers can protect passenger safety without the independent accountability provided by the AAIB. Of course, providers should have the capacity and capability of conducting patient safety investigations, but they must know that HSSIB can and will look at that work and will hold them to account. Recommendation 3 also says that HSSIB should continue as what it calls “a centre of excellence for investigations” in the CQC, but I am afraid that this is just a sop. The CQC, as was pointed out by my right hon.”
“I am listening very carefully to what the Minister is saying. She has engaged positively with the questions I have asked, but she has actually made the case for keeping HSSIB separate. Will she reflect on that? If the only thing she wants is for the CQC to own the recommendations, she should amend HSSIB and say, “The CQC must ensure that the recommendations are implemented.” In fact, the recommendations are directed at Ministers and bits of the health service that are answerable to her and to the Secretary of State. We should keep HSSIB separate, but by all means let us discuss how to ensure that the recommendations are implemented properly.”
“Will the Secretary of State keep an open mind as to whether it is right to abolish the Health Services Safety Investigations Body, which was specifically designed to provide for a duty of candour? Clinicians would be obliged to give evidence to HSSIP; they could not refuse, and there would be criminal penalties if they did. As we have already established, the duty of candour, as conceived in the Hillsborough law, does not work, and I suspect there will be no improvement unless HSSIP is allowed to carry out completely independent investigations that have proven that they can carry the confidence of the public, patients and clinicians. Will the Secretary of State keep an open mind about keeping HSSIP?”
“The Secretary of State will have to factor that into the negotiations with the Chancellor of the Exchequer—whoever that may be—in the forthcoming spending round, and I take what he has said about the next spending round to be a very significant point.”
“Can I return to the efficiency savings that are forecast to be made? There are to be savings of £10.7 billion—£7 billion to come from resource spending and £3.7 to come from capital. Apart from some very vague headings, there is no indication in this document of where that money is going to be saved. Can the Secretary of State issue a written statement as soon as possible to set out exactly how those savings will be made? Otherwise, I have to rather agree with the Chair of the Treasury Committee, the hon. Member for Hackney South and Shoreditch (Dame Meg Hillier): we have all seen these accounting tricks before under previous Governments of both colours, and the savings are very rarely made.”
“As a consultant paediatrician, my hon. Friend will be able to give a definitive view on this matter. Some who campaign for this treatment and therapy argue that the effects of gene therapy are reversible. To what extent are they reversible? Should we be treating this as a reversible treatment? My hon. Friend has referred to permanent damage. Can we try to agree across the House at least on this matter: that gene therapy applied to children is not reversible?”
“One of the reasons why so many things go wrong in Government is that people think that they are being strategic, but actually they are just writing down a plan and forgetting about it, rather than thinking rationally. The Government response to the Liaison Committee’s report said: “Strategy in government is the coherent mobilisation of capabilities, levers, resources and partnerships towards successfully achieving public policy outcomes.” Where is the evidence of that in, for example, the Government’s policy on house building? In my constituency, there is an ambitious project to build 7,500 new homes. I am grateful to the Minister for receiving delegations making representations about that.”
“At the end of the last Parliament, the Liaison Committee, which I chaired at the time, produced a report about how Select Committees could help and enable Government to have more strategic thinking behind their policy and implementation, and we recommended a definition for strategy. In this Government’s response to the report, they said that they would adopt that definition, but I do not see any evidence that they have. These spatial strategies are, in truth, plans, not strategies. A strategy is an active process—a doing word. When someone creates a strategy, they do lots of planning, and lots of plans will go into it, but a strategy constantly evolves in the light of events and changes in circumstances.”
“I am grateful for the opportunity to say a few words. Can we first admit that the Government’s policy of building all these houses is not going terribly well, and that it is not a great success strategically? Nobody in the house building industry or in local government believes that the Government will achieve their target. I do not hold the Minister himself responsible for this confusion, but the question at the centre of my remarks is: what do we mean by the word “strategy”? I have worked on this subject during my time as a Member of Parliament. I chaired the Public Administration Committee—and then, the Public Administration and Constitutional Affairs Committee—for nearly 10 years, during which we produced a stream of reports about strategic thinking and strategy in Government.”
“I think I am within the scope of the regulations, Ms Jardine, because the amendments relate to the use of the term “strategy” in the primary legislation. I do not think I am out of order, but I will not dwell on the matter or test your patience. I have made the point.”
“I do not feel that this type of reform is reaching into the entrails of his Department, which is responsible for so much that requires strategic thinking.”
“I am making a speech, which I am entitled to do. In the case I mentioned, where there is supposedly a strategy, we seem to be planning to build a garden community without the crucial link road being in place before the house building starts. That is a big problem. Will the Minister take back to the Department the question of whether the Government agree about what “strategy” means? Are they integrating the much more agile definition of strategy into the way they operate, so that we get better public policy outcomes? That is what the whole process was intended to achieve. Incidentally, the Minister might draw on the national strategy playbook drawn up by the Cabinet Office in the first 12 months of this Government, which is apparently being implemented across Government.”
“It is about the draft regulations, because they include the word “strategy”. The Minister cannot escape the consequences of that. The report to which I referred was a Liaison Committee report—”
“Does the Minister realise how utterly discredited the Government now look? We all understand that a majority of Members of this House want the Government to take the necessary steps to find the extra money that is necessary for defence, but it is the failure of the Prime Minister to manage his own party that is at the root of the problem. Will changing the leader make any difference?”
“Is it not clear that this escalation is a portent of what Russia intends to do as it begins to lose this war? Only a few months ago there was a general view that Russia was winning, but now it is clear that Russia is losing and it will run out of money before it can annex Ukraine. What are the Government doing to ensure that we are properly prepared to face down this escalation? It is all very well Ministers coming to this House, wringing their hands and condemning these atrocities, but what are we going to do to deter this atrocity and further Russian escalation? Will the Minister make an assessment of the St Petersburg international economic forum? It set out various scenarios for Russia in the future, some of which included the threat of nuclear weapons, so how will we deter that?”
“The regulations were laid very late, and they are being changed while they are being renegotiated with the European Union. Is this a portent of things to come, and does it not underline the need for a European Scrutiny Committee, which could look much further ahead than the Standing Orders governing my Committee allow?”
“First, I add my voice to the tributes to Sir Alex Younger, who died so young and is such a great loss to the nation. What consideration are the Government giving to re-establishing a European Scrutiny Committee? The dynamic alignment that the Government are proposing is bound to give rise to a large number of regulations coming into force in the UK. As they will have direct applicability and direct effect, they should at least be scrutinised properly. I draw the Leader of the House’s attention to the report published today by the Select Committee on Statutory Instruments, which I Chair. It gives an example—the Customs (Northern Ireland) (EU Exit) (Amendment) Regulations 2026—of how badly the Government can handle such legislation.”
“I am most grateful to the Secretary of State for giving way, and I congratulate him on his appointment. He has inherited this policy—it is not his own. I assure him that the abolition of the Health Services Safety Investigations Body is a dreadful mistake, because which other investigative function in the healthcare system is completely unconflicted in what it does? By abolishing HSSIB he is taking its functions into the CQC, which is a regulator and compliance enforcer, not an investigator, so that there is no longer any independent, unconflicted body conducting healthcare investigations. Has he consulted the royal colleges about this? I have not spoken to a single royal college that is in favour of the abolition of HSSIB.”
“It was the one place they could go to tell their story, without fear nor favour, in a safe space, and it was instructive.”
“It represents a downgrading of safety as a priority in this Government’s health policy, because HSSIB is the only organisation that can independently investigate safety incidents in the NHS and is not conflicted by any other function or role. It does not compromise any other functional role in the NHS, yet the Government have decided to get rid of it. It will not save any bureaucracy. This tiny organisation costs a few million pounds, yet it is pioneering a new system of safety management in the NHS that the NHS culturally barely understands. We forget that NHS reform is really about people and leadership, not management structures and organisational structures. HSSIB was one of the catalysts that was beginning to transform attitudes towards safety. It was a safety valve for clinicians and patients and their families.”
“I very much welcome the idealistic vision that the hon. Member for Dudley (Sonia Kumar) sets out for us, but I am afraid that it is far from what is in this Bill. Like my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), I shed no tears for the demise of NHS England; it was never an organisation independent of politics, but always looked upwards at the political leadership and did what Ministers wanted. It was created as an unnecessarily complex organisation. However, I ask myself whether reasserting the principle—unspoken in this debate—that somehow the man in Whitehall knows best is not reverting to the previous failures of the system, when we need to be looking for a much more organic and local system. I speak in this debate to lament the demise of HSSIB, as proposed in this Bill. It is a profound mistake.”
“I will give the House just one example of that. The review says: “HSSIB was not able to retain the maternity programme because the Health and Care Act 2022 does not make provision for maternity investigations under HSSIB.” That is wrong. It had to give them up, because it did not have the capacity to do them.”
“All those recommendations are coming from this plethora of public inquiries that Secretaries of State keep setting up. Surely we want to replace the public inquiry system with something much more effective, as we did for rail accidents. After the Ladbroke Grove rail crash, we replaced public inquiries with the rail accident investigation branch in the Department for Transport. There has not been a public inquiry into a rail accident since the Ladbroke Grove inquiry, because we have the rail accident investigation branch. There has not been a public inquiry into an aviation accident since 1972, because we have the air accidents investigation branch. Why can we not have the same principle for safety in healthcare, instead of this ridiculous Dash review, which is full of falsehoods and misleading statements?”
“Well, no, and the abolition of HSSIB is an example of that. It was the one organisation that could independently hold any part of the system to account. If its functions are transferred to the CQC, those functions will be compromised in their independence —and they are explicitly intended to be compromised. The Government set great store by the Dash review, but it is a flawed and dishonest document that misleads the public by what it says. The Dash review is not about patient safety. It puts far more emphasis on quality. It elides quality and safety, which are not the same thing, even if many people believe them to be so. That concern is reflected by the fact that there are too many recommendations flying around and too many resources being diverted to recommendations that the NHS does not want to implement.”
“I am most grateful to the hon. Gentleman for raising the HSSIB question. The Dash review accused HSSIB of exceeding its remit. That is completely wrong in law, and it was always intended to look at systemic problems across the system. The new investigation function in the CQC will not be able to do that, because it will not be independent.”
“Is the House right to understand that the Government believe that the economy has grown significantly less—measurably less—as a result of leaving the EU, and that this is one of the purposes behind the reset? [Hon. Members: “Yes!”] I hear Government Members saying yes. Could the Government then set that out, with all the evidence and arguments proving the case? Looking at the evidence, the British economy grew at about the same rate as France and Germany when we were in the EU and, since we left, we have been growing at about the same rate as France and Germany; in fact, this year, the British economy is growing faster than Germany’s. Where is the evidence that Brexit was economically damaging? Will the Minister publish a proper statement on that?”
“I am most grateful to the hon. Gentleman, whom I know as a friend across the House, as we have worked together positively on many things. I served on the Privileges Committee that studied the Boris case and reached a conclusion upon it. If the hon. Gentleman wants to help the Prime Minister, I would be rather wary, if I were him, about drawing parallels between Boris Johnson and the present Prime Minister.”
“May I just point out that the developed vetting process has always been highly protected because otherwise it would not work? People would not give information to the developed vetting process if they thought that any detail of it was likely to be disclosed, or even if they thought that the result—the assessment of low, medium or high risk—was likely to be exposed. That is why the previous Labour Government wrote section 3 into the Constitutional Reform and Governance Act 2010: in order to prohibit that disclosure. If the Prime Minister is saying that developed vetting information will now be available to Ministers on a routine basis, would he not be undermining the very process upon which we depend for our national security?”
“Will the Prime Minister remind some of his colleagues that the United States is a democracy and an ally, and Iran is an odious regime that could have ended the war this weekend had it agreed to give up its ambitions for nuclear weapons and to cease supporting its proxy terrorist organisations around the middle east? Would it not be helpful if the Prime Minister criticised the Iran regime a bit more, rather than supporting his colleagues in criticising the United States?”
“It requires a very concerted act of leadership, alongside diligence and consistency, as well as making sure that those who do not want to make that change are eased out of their positions and that there are no promotions for those people who do not respect and demonstrate the changed attitudes and behaviours that are required. This is a big ask, and does not often happen in the public service.”
“I thank the Home Secretary for her statement, and for the way in which she is promoting learning rather than blaming, because that is the best way to get the change we need. I also thank her for her robust response to the shadow Home Secretary, my right hon. Friend the Member for Croydon South (Chris Philp), about the point he raised, and for the point she is now making about the requirement for a cultural shift. Can she take a close interest in this? Not many leaders in many organisations understand that it means changing the attitudes and behaviours of individuals in their organisations—it is not just about setting a policy.”
“Why have they blocked a water purifier and even medical supplies? They have blocked a fast boat that would provide emergency evacuation, so these people are more at risk as a result of the Government. Is that the Government’s policy, after all the wrongs that have been done to the Chagossians?”
“I congratulate the Minister on so valiantly trying to explain the inexplicable and reconcile the irreconcilable. I do not want to detain the House by quoting the whole Monty Python dead parrot sketch, but this is now an ex-treaty; it is no more; it has shuffled off its mortal coil. Coming back to the Chagossians, why can the Government not just honour what the Court has decided about the right of return? Why are they now trying to frustrate the survival and safety of the Chagossians who have returned, taken there by my good friend and former Conservative MP Adam Holloway, who has organised the expedition despite the Government? Why are the Government now mounting operations and sending police officers and customs operators to frustrate the process of safety equipment going to the expedition to support the Chagossians?”
“That is not going to bother President Putin one jot, and he will carry on doing exactly what he is doing until we are prepared to escalate this and show that we are prepared to deter what he is doing to our country.”
“Can we be absolutely clear from this statement, which I very much commend for its candour and bluntness, that these two GUGI submarines have now left UK waters? They were carrying out hostile acts in UK waters, and I cannot believe that many people in the MOD are happy with the limp-wristed response of the rest of the Government to this episode. Has the ambassador been summoned for a public dressing down? Have we expelled any Russian diplomats in retaliation? Are we making it clear to our Russian adversaries that if they mess in our territorial waters, we will demand their immediate surrender, and that they should surface and be escorted to a British port or we will open fire, or at least fire a warning shot? Just saying, “We see you,” is not going to be enough.”
“May I inform the Minister that the previous Conservative Government listened to the people of Essex, and the MPs and county and district councillors for Essex, and cancelled any plans for LGR? That is because county government in Essex predates the Norman conquest. It is more embedded in our history than almost anything else, except perhaps our churches and ancient buildings. Nobody in Tendring district or Colchester city wants to live in an amorphous area called “North East Essex”. What is more, people there know that this upheaval and reorganisation will cost public services, inflict damage on continuity and push up council taxes—and it is good for us, because we will simply blame this wretched gerrymandering Labour Government.”
“I draw my hon. Friend’s attention and the attention of the House to the other fundamental structural flaw in the method the Government have adopted for planning defence: the aspiration after 2029 is only an aspiration. The Treasury has agreed to no spending line in its own forecasts and figures beyond 2029, and yet the defence investment plan is a 10-year plan. How can the Treasury agree to a 10-year plan when it has not agreed to any funding for defence after 2029? It is just an aspiration.”
“I share the respect of my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith) for the Minister and his experience, but the two statements from the Leader of the Opposition that he read out are not incompatible. The fact is that we would not have joined in the military action that the Americans and the Israelis initiated, but it is undeniable that the war has now come to us. What does he think is happening in London? Did he not hear the deputy chief of the Metropolitan police on the radio this morning talking about the rising Iranian threat that is now domestic in our own capital? This war has come to us. As Leon Trotsky said, Madam Deputy Speaker, “You may not be interested in war, but war is interested in you.””
“This is aimed at reshaping the societal, economic and informational environment, at undermining people’s faith in democracy and democratic values, and at destroying the faith of our voters in our democratic system. The question now is: what are we doing to fight back? Well, what are we doing? I know that in bits of Government, many small parts of the Government are at war. There are some wonderful people in the Ministry of Defence who are sweating the night hours to do things that are of crucial importance.”