Karin Smyth
MP for Bristol South · Labour · United Kingdom
“It is a pleasure to serve under your chairship, Ms Lewell. I thank the hon. Member for Chippenham (Sarah Gibson) for securing this debate and for her well-informed and considered set of proposals about a contract of which I am aware. I will try to address most of her points.”
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“In addition, we are developing a modern service framework for palliative and end-of-life care, which will be a clinically led, evidence-based framework to support sustained improvement in outcomes for patients and carers, including identifying, measuring and reducing health inequalities, and reducing unwarranted variation in access, exper…”
House of Commons28 October 2026Contains Parliamentary information licensed under the Open Parliament Licence v3.0Source ↗
“That is why this Government are taking action to reduce unwarranted variation, cut waits and improve access to high-quality community services. That is where we want to get to.”
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“I will come on to some of that, because it is also tied up with the Health Bill and the things that we are proposing to do for the future. The hon. Lady also touched on one of my favourite subjects: the accountability of local health systems.”
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“Lady said, now we need to make sure that what was promised is delivered. That is what we all want to see for the people of her community and across the wider ICB. I want to be clear on our general expectations of community services: they are really vital to the left shift, particularly in rural areas.”
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“Lady is saying from her position in Chippenham, and that may be different from other positions—it is a large geographic area. That is one of the issues that we need to get right.”
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“The ICB assures me that it remains committed to engaging openly with those communities, with MPs and with Healthwatch throughout the delivery and development of those community services.”
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“I recognise the concerns about delays, callbacks and referrals across the teams, and about getting people through the single point of access. Single points of access have been worked on for many years under many different contracts. Generally, they should do what they say on the tin and actually help people move forward, so HCRG does need to make its work. I understand that, as a result of some of the issues that have been raised, the ICB is increasing its oversight, bringing together the provider and the system to support improvement. It is really important that that work also brings together patients, carers, the local community, staff and other stakeholders as it develops.”
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“That is why this Government are taking action to reduce unwarranted variation, cut waits and improve access to high-quality community services. That is where we want to get to. Moving on to HCRG Care Group’s performance, as we know, it has taken on the contract to bring together more than 130 community health and care services across the ICB area. It is a large-scale “transformation” programme, as it is called. Since the contract was awarded, the ICB has obviously had to work very closely with it. The ICB is responsible for managing the contract, and I met it in advance of this debate to hear from it as well. As I understand it, the ICB has arrangements in place—the hon. Lady alluded to how many there are—to oversee quality, safety and performance across all those commissioned services, and performance is regularly monitored.”
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“For the first time, we have set a target for systems to reduce long waits for community health services: by 2028-29, at least 80% of activity delivered by community health services should take place within 18 weeks, bringing community health services in line with targets for elective care. We have also published guidance outlining the core components of community health services for children, young people and adults that ICBs should provide. That guidance is hugely important for many of the issues that the hon. Member for Chippenham has raised today. We know that there is variation in the services available across the country, and that people are waiting too long to access community health services.”
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“Lady said, now we need to make sure that what was promised is delivered. That is what we all want to see for the people of her community and across the wider ICB. I want to be clear on our general expectations of community services: they are really vital to the left shift, particularly in rural areas. A wide range of services is delivered under that umbrella—from district nurses to services provided by allied health professionals, such as physiotherapy and occupational therapy—for adults and children where they live, in local communities. They also provide really good local jobs. Those services are vital to supporting our ambitions for neighbourhood health, which is why we set out clear ambitions for them in our medium-term planning framework.”
House of Commons28 October 2026Contains Parliamentary information licensed under the Open Parliament Licence v3.0Source ↗
“It is a pleasure to serve under your chairship, Ms Lewell. I thank the hon. Member for Chippenham (Sarah Gibson) for securing this debate and for her well-informed and considered set of proposals about a contract of which I am aware. I will try to address most of her points. The contract was signed just after the general election, but it was on my radar before then, partly as a local MP. As I think the hon. Lady said, there are staff here today, and I am conscious that this remains a concern for staff and some of the trade unions—not least because my hon. Friend the Member for Swindon North (Will Stone) has kept it on my radar. I am absolutely aware of the genesis of the process by which this contract came forward, and I want to make sure that people know that. I will not rehearse it, however; we are where we are now. As I think the hon.”
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“The ICB is currently undertaking a review of the services following concerns raised, and will continue to monitor the impact of those changes to ensure that safe and effective care is maintained. Again, that is absolutely the direction of travel in that we want to see those services change and improve.”
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“I will come on to some of that, because it is also tied up with the Health Bill and the things that we are proposing to do for the future. The hon. Lady also touched on one of my favourite subjects: the accountability of local health systems. The hospital at home services are also important—as it says on the tin—to keep people out of hospital when they do not need to be there and to support early discharge. They remain an important part of the community services offer across Bath and North East Somerset, Swindon and Wiltshire ICB. There have been changes to the service provision and I am assured by the ICB that there are no plans to reduce capacity or withdraw the hospital at home service—I am sure that the hon. Lady will correct me if that is wrong.”
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“Lady asked two questions about comparable data. If anyone has not read the transformation and opportunity packs that I sent all MPs last year about their local systems, I recommend that they do that. I will continue to get information on their local systems to them. The hon. Lady probably knows that we cannot compare like for like, but she should have that information; we are getting it on stream. I am happy to write to her with details of what is or might be made available. The hon. Lady asked about the CQC. As she knows, it is an independent regulator, but I will ensure we write to her about it. I thank her and other Members who contributed to the debate. Question put and agreed to.”
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“In addition, we are developing a modern service framework for palliative and end-of-life care, which will be a clinically led, evidence-based framework to support sustained improvement in outcomes for patients and carers, including identifying, measuring and reducing health inequalities, and reducing unwarranted variation in access, experience and outcomes. We continue to work hard to strengthen community care services and shift care closer to home. As the hon. Lady said, what was promised to her population and the wider ICB area must be delivered. All too often, community health services do not get the attention that they deserve, and staff on the ground do not get the recognition that they deserve. This debate has raised some important questions about how we hold organisations delivering and commissioning services to account. The hon.”
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“Patients approaching the end of life and those important to them—their closest friends and family—should absolutely receive compassionate, dignified and personalised care in an appropriate environment. That is why the Government are committed to improving access to high-quality palliative and end-of-life care, and to shifting more care from hospitals into the community and, where appropriate, the home. NHS England requires ICBs to commission appropriate palliative and end-of-life care to meet the needs of their local populations. To support ICBs in that duty, NHS England has published statutory guidance and service specifications.”
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“We have the strategic commissioning framework setting out what effective strategic commissioning looks like, and the strategic commissioning development programme provides targeted support to strengthen those capabilities in local systems. We recognise that there is variability across the country. To be clear: ICBs are responsible for assuring the quality, effectiveness and value of the services that they commission, while NHS England oversees the performance of ICBs through the oversight framework, including consideration of how effectively they discharge those commissioning responsibilities. Finally, we have heard about issues with palliative and end-of-life care.”
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“Another thing that we have changed since coming into power is that from 2026-27 every ICB will be placed in a delivery segment based on national performance measures. That will help to identify when greater support, scrutiny or intervention is needed at the national level. That will be complemented by an annual assessment of how effectively each ICB is discharging its statutory functions. Where performance is falling short, oversight can be increased and support can be targeted at the areas of challenge and, where necessary, formal intervention powers are available. That brings ICBs into line with other providers. At the same time we are strengthening ICBs’ commissioning capability, partly through the Health Bill.”
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“Lady is saying from her position in Chippenham, and that may be different from other positions—it is a large geographic area. That is one of the issues that we need to get right. We are working closely on it in the Health Bill, where we are devolving responsibility and accountability for commissioning and providing services at a local level. That is the right thing to do. We also need to get right the link to neighbourhoods and place through local authorities while strengthening health and wellbeing boards. That is the direction of travel in the Bill and what we are currently trying to make happen. ICBs are held to account nationally for delivering for patients. The oversight framework provides a transparent approach for assessing performance.”
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“Industrial relations are also important. We cannot run a health and care service without good staff who are well supported, nor without maintaining good industrial relations at a local level. That is a matter primarily for the group, its employers and recognised trade unions. The ICB needs to continue to monitor that and go through those established processes for doing so. It needs to keep working with them and we certainly support that at a national level. On the wider issues about supporting ICB performance, I sympathise. I have spoken many times in Opposition and Government about the frustrations of local Members of Parliament in understanding the very fragmented system left under the Lansley reforms. I appreciate what the hon.”
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“Once safe staffing is secure, there will be a short period of time to stand up rotas and put services in place. I have had assurances that, during that period, the trust will get in touch with every mother and give them the chance to change their birth plans to Barnstaple, should they want to do so.”
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“The question is how we attract the best talent to our rural and coastal communities, and show them that Barnstaple and other similar places are among the best in the country to build a life. I want to thank partners that are working with the trust on recruitment, including the Royal College of Obstetricians and Gynaecologists. The trust is also exploring hiring international candidates, but ultimately we want the unit to have enough staff to provide a safe service that is sustainable—another point that has been well made today—even if a doctor is unwell or otherwise on leave. Every week, the chief medical officer at the trust conducts an assessment to see whether the unit is ready to reopen its doors. Every two weeks, the trust updates key stakeholders on the status of the unit.”
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“The trust has set the following three tests before the unit can reopen: first, there must be 24/7 consultant and registrar cover in place through an on-call rota; secondly, three quarters of those staff must be employed full time; and thirdly, new staff must have gone through employment checks, onboarding and induction. Today I can update the House that the outlook on safe staffing was more positive last week, but unfortunately some recruitment has fallen through since then. The trust is still seeking the additional clinical staff that they must have to provide a safe service. As hon. Member for North Devon knows, the issue is not that the roles are not funded. They are generously funded, and the trust has even gone so far as to offer salary top-ups, but the roles remain unfilled.”
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“Member for Honiton and Sidmouth (Richard Foord), expectant mothers are travelling all the way to Exeter or Bristol, and the current situation is not sustainable. I have given birth very healthily three times, and I am grateful for the care that I had. I had to travel only a short distance down the road and, frankly, that was enough, so I empathise deeply with women who have to endure long journeys. I will not rehearse the recent history that led us to this point, because I know the House is well acquainted with that. As the hon. Member for North Devon knows, the responsible Minister is the noble Baroness Merron, but I will do everything I can to take this opportunity to update him and the House on where we are, and follow up in writing on any specific questions, if necessary.”
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“Friend the Secretary of State has chosen to prioritise maternity, and why the work of the national maternity and neonatal taskforce is so important. In particular, the new modern service framework will define the standards needed to deliver care across the country, whether in large inner-city areas or small rural places. I know the hon. Member for North Devon understands that the North Devon maternity unit was closed for a good reason: the trust could not provide a service that it knew was unsafe. It is really important that we all bear that in mind as we discuss this issue. We must support good, sound clinical assessment, particularly in this area. However, it is unacceptable that, as we have heard from the hon.”
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“I thank the hon. and gallant Member for North Devon (Ian Roome) for raising this very important matter. He calls attention not just to his own constituency but, as we have heard from others, to a broader issue that we face, particularly in our rural and coastal communities. I want to stress that the Government are clear that all women have the right to receive the same high-quality, safe and compassionate care, wherever they have their babies. We need to ensure, and mums need to know, that services are there for them when they need them, including at the time they go into labour. I thank the hon. Member for North East Fife (Wendy Chamberlain) for sharing the experiences of her constituents Kristie and Tammy today, and I agree that we need to bear such experiences in mind. That is why my right hon.”
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“The Barnstaple maternity unit will reopen. I cannot give the hon. Member for North Devon a guarantee from this Dispatch Box of the date when that will happen, because it will depend on securing safe staffing. That is the problem that everybody needs to focus on, and this Government are focused on doing that with the local system. We will do everything we can to help the hon. and gallant Gentleman get those services back on track on behalf of his constituents. Question put and agreed to.”
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“However, the broader systemic issues they face, particularly in staffing, must be addressed in our upcoming workforce plan, and I do agree that retention is a key part of that. Ministers have made it clear to the NHS that we must do everything possible to help reopen North Devon maternity services. NHS England, the ICB and the regional team in the south-west are working with the trust to resolve these issues as soon as possible. As I have said, my right hon. Friend the Secretary of State has rightly made maternity a national priority for this Government. She is chairing the national maternity and neonatal taskforce to drive forward reforms, and to deliver systemic and sustained improvement across maternity and neonatal care, including in relation to the failings exposed in the south-west of England in recent months.”
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“Last year I visited North Devon district hospital, as part of my remit in overlooking the new hospitals programme, to see how it is using the £30 million the Government have made available to support the rebuild of the 50-year-old staff accommodation block and invest in MRI scanners. We are committed to those services in Barnstaple, and it is important for all hon. Members’ constituents to be clear about that. Our 10-year health plan, produced last year, clearly set out the issues for rural and coastal communities, which the right hon. and learned Member for Torridge and Tavistock (Sir Geoffrey Cox) noted. We particularly highlighted those communities in the 10-year health plan because we recognise that they have specific needs and do not benefit from a one-size-fits-all approach.”
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“There is a dedicated helpline for women to discuss their birth plans, a maternity triage line for urgent help, special appointments to talk about travel costs and accommodation, free taxis for women who do not have their own transport and are advised by the triage line to go to hospital, and mental health support. These are good and sensible steps, but it is still unacceptable for women to have to travel for two hours while they are in labour. Trusts in our rural and coastal communities do face systemic pressures, because they have fewer births and because it can be hard for the local NHS to recruit.”
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“Yes, of course, and that is what the trust does. I would gently urge all hon. Members to work very closely with the entire trust on these issues to solve these problems. It is absolutely right that the trust is working with MPs. It is reviewing its decision on a weekly basis, and it is important that it communicates openly and transparently with all its partners when those decisions happen. I am always very clear that Members of Parliament speak on behalf of their constituents and can be helpful in communicating those messages, because we want to make this work. In the meantime, the trust continues to offer a range of maternity services, and it has taken steps to help the women covered by its duty of care.”
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“I absolutely endorse your comments about our colleague, Mr Speaker. I know that my hon. Friend and many other colleagues are deeply concerned about the issues at Northern Care Alliance. As of June this year, the trust has been placed under the highest level of regional oversight and support from NHS England. It is imperative that rapid movements are made, governance systems are strengthened and that every patient receives the standard of care that they deserve.”
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“My hon. Friend makes an excellent point about the importance of intermediate care, which is a key component of supporting patients into discharge to recover outside of hospitals. Community beds play an important role, but we are clear that home-based intermediate care also needs support, particularly for frail people, through neighbourhood health. That should be the default pathway, and we will continue to work with the system to make that happen.”
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“I am, of course, happy to meet my hon. Friend to discuss that issue further. I am clear that all changes to services should be based on clear evidence that they deliver better outcomes for his constituents and people across the country. He is absolutely right that we want to extend care closer to home. As I said, the default is to get more care into people’s homes, and I am happy to discuss that further with him.”
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“The hon. Lady is right that we absolutely want to get more care closer to people’s homes and into people’s homes. We want to support frail people in their homes before they even get into hospital. I am working with the integrated care board to make sure that all that happens. I am happy to discuss that further with her.”
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“As the hon. Gentleman knows, the situation deteriorated massively under the 14 years of Conservative government. He is well aware of the fragmentation of all our services. He knows how the system was fragmented and what happened under those reforms. He knows that is why we are trying to change it. He is absolutely right, though, that people being in beds in hospitals or in parts of the system where they should not be is not good for their health or their outcomes. That is why it is part of our three shifts, and that is fundamentally why the Prime Minister is very clear that we will raise social care up the agenda and ensure that people are treated more in their homes and in community services where they live. I welcome his support for our shift to neighbourhood care and to better care closer to home.”
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“I thank Audrina for the great work that she is doing, supported by the campaign. Food in hospitals is really important, and we would be very happy to meet Audrina. Well done to her.”
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“My hon. Friend raises an excellent point about the state that these buildings were left in by the Conservative party, as Lord Darzi’s report made clear. We are investing unprecedented amounts in capital and giving greater certainty, and I would be happy to meet my hon. Friend to discuss the proposal from Ipswich. It is up to local systems to come forward with plans, but I would be happy to discuss that further with my hon. Friend.”
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“My hon. Friend is absolutely right that it is the responsibility of the commissioners to look holistically at the provision of services. We want more services closer to home, using technology, care in people’s homes and so on, but she is quite right to highlight this issue. I know that she will continue campaigning on it, and I hope everyone has listened to her, so that people can come together to help her constituents.”
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“I am glad the hon. Gentleman found that correspondence helpful. As he knows, I am keen to discuss the new hospital programme and its progress with all Members. I am sure that discussions about the renal service at Hinchingbrooke continue to take place locally, and that those involved will continue to work together. I know that the hon. Gentleman will keep in touch about the progress of the discussions on behalf of his constituents, and I am happy to talk to him about the issue.”
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“I appreciate my hon. Friend’s concern on behalf of her constituents. We are moving the system governing hospitals such as Blackpool away from deficit funding so that it becomes well governed and managed, in line with fair shares allocation, and I shall be happy to discuss that further with my hon. Friend.”
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“I have met the hon. Member for Torbay (Steve Darling) to discuss this matter. Obviously, money has been allocated. We are well aware of the hospital’s position, and it is also part of the programme. I shall be happy to provide further information if the hon. Lady is not clear about the allocations that have been made.”
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“I pay tribute to my hon. Friend the Member for Watford (Matt Turmaine) and others for their campaigning in that part of north-west London and elsewhere. The movement of services is now firmly part of the programme, and the people of Watford will have the services that they deserve. Discussions are continuing, and I shall be happy to update the House on the final decision as soon as possible.”
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“I recently met the hon. Member, and as he knows, we are absolutely committed to working with the local system to do that. I absolutely commit to updating him as soon as possible if he is not aware of where we are on that. I will get something back to him very quickly.”
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“I am always keen to discuss and visit places in Dorset with my hon. Friend. I am happy to look, with him, at the integrated care board’s overall plan for the provision of all those services.”
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“I am aware of the issues around the hon. Gentleman’s local hospital; I have worked with him closely as part of the new hospital programme as well. It is up to local systems to decide on the clinical pathways across the whole patch. Those decisions must be clinically led, and there must be consultation with local people. I am very happy to keep an eye on that, and to talk with him in the future.”
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“That is quite controversial; some people do not like what they call league tables, but I think it is important that people can see that.”
House of Commons14 October 2026Contains Parliamentary information licensed under the Open Parliament Licence v3.0Source ↗
“To be clear, I regularly meet teams and Members of Parliament in my role. I want to share how some of that operational oversight works. I will highlight two major areas. One is the oversight framework, which provides a clear and consistent assessment of every NHS organisation. In her expertise, the hon. Member for Sleaford and North Hykeham recognised that there are many ways to judge performance, but the new framework looks at what matters most to patients and taxpayers: waiting times, quality of care, use of staff and money, and leadership capability in order to have good-quality patient care. They cannot be separated in my view. I have made sure that it is transparent for the public and Members of Parliament.”
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“As we bring the two bodies together, it is important to maintain the distinction between running large trusts and running the system as a whole, with operational performance oversight. It is a skilled job. It is hard to run a big trust. It requires good clinical and operational managers, and good leadership and knowledge. The complete separation of the Department and Ministers from NHS England meant that the oversight and what we could see in our constituencies as Members of Parliament was not linked up under the previous Government. That is one thing that will improve. As the hon. Member for Sleaford and North Hykeham (Dr Johnson) just said, of course Ministers will not be micromanaging. It is a skilled job. The complete separation that removed oversight from local trusts has been a dysfunction of the system over the last decade.”
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“Let us be clear for patients and members of the public who are paying attention and for all our constituents: this Government will not accept poor performance, and we are determined to accelerate the recovery, particularly in the most challenged trusts. I will just clarify some of the rules. Everyone knows that NHS England is an arm’s length body. That was a decision taken a number of years ago by my good friends the Liberal Democrats and the Conservatives when we were in opposition. The Health Bill, which is progressing through the House of Lords, changes that arrangement to put the NHS together with the Department of Health and Social Care. The Bill was not opposed in principle by any political party, because we all know that the arrangement has not worked.”
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“Friend the Member for Ipswich (Jack Abbott) for hosting his trust in the way he has and seeing an improvement in his constituency, as he outlined, with mental health being considered as well as acute services. The Liberal Democrat spokesperson, the hon. Member for North Shropshire (Helen Morgan), spoke about her work in supporting her local trust and seeing those improvements. It can and does happen. Many of the trusts that have been discussed today have faced problems built up over many years. In fact, I remember some of them from being a manager in the health service over the past 20 years or so. There is rarely one cause or a quick fix. There are varying problems, whether they be workforce shortages, poor estates, weak leadership, organisational change or rising demand, and some of those can reinforce one another.”
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“Thank you. It is a pleasure to serve under your chairmanship, Mr Stuart. I want to try to get back to most colleagues. I thank the hon. Member for Chelmsford (Marie Goldman) for securing this debate, and all Members who have spoken about the experiences of patients, because this is absolutely about the experiences of patients, families and the NHS staff in all our constituencies. When an NHS trust underperforms, however we define it, the effects are very real. Patients wait longer, staff work without the stability and support they need, and public money is not used as effectively as it should be. Since becoming a Minister, I have made it clear that I think Members of Parliament should be part of conversations with local trusts. I commend my hon.”
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“There is more to do, but we want practical, safer and more timely care, and stronger organisations. I am pleased to have had the opportunity to debate this issue today. It is important for MPs to be part of the discussion. We want to improve all trusts, but we are focusing on those with long-term issues, sometimes having been affected for decades. The people in those areas deserve better, and we are determined to make sure they get it.”
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“The purpose is to remove barriers to improvement, provide the right expertise and hold boards and NHS leaders to account for results. The Government will continue to work with NHS England. I am committed to keeping Parliament informed of significant developments. We will judge our approach by its effect on patients and staff, not by the creation of more processes. The oversight framework and the intensive recovery programme provide a clear route from identifying the risk to taking targeted action. There is much more to do. It can only be done in local circumstances with co-operation and transparency, including working with Members of Parliament. Where we hear examples of trust chief executives not doing that, I am prepared to call it out. It is not acceptable.”
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“She highlighted a terrible case, and I will make sure that she has a meeting with the Minister to go through how that can be supported on behalf of her constituents. I know that she will work closely to make sure that they are served better. We are seeing early improvements through the IRP, but we need to demonstrate progress through safer care, better operation and financial performance. We have clear milestones and credible plans for stronger organisations. Support nationally is time-limited but proportionate, because trusts ultimately have to stand on their feet. Intensive oversight is not about naming and shaming. Staff in challenged trusts are working in exceptionally difficult circumstances. As we need to encourage people to work there, we must show them that it can be better.”
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