Dr Caroline Johnson
MP for Sleaford and North Hykeham · Conservative · United Kingdom
“So someone was watching to make sure he was safe, and I am so glad that was the case, but it is so very rapid, as others hon. Members have testified. There is no single test. There is no single thing we can monitor or measure that helps.”
“I want to mention group B streptococcal infection, which I have seen in paediatric practice, particularly in babies. It is a common bacteria that lives harmlessly in the gut or lower reproductive tract, but there is a risk that it can enter the bloodstream, causing neonatal sepsis when passed to newborns.”
“The Joint Committee on Vaccination and Immunisation met in July 2026 and suggested an increase in the vaccination schedule for those young people.”
“I remember sitting in this Chamber a little over two years ago—I am sure you were there too, Madam Deputy Speaker—when the then Member for South Thanet, now Lord Mackinlay, received a rare standing ovation from the House and from the Gallery as he returned to Parliament following his remarkable recovery from sepsis.”
“That was a good start, but of course, as always with medicine, there is more to do, and it was pleasing to see the previous Starmer Government build on this work by introducing the modern service framework for sepsis. We have modern service frameworks for other diseases, and it seems good to have one for sepsis specifically.”
“I remember seeing a patient whose mum had got up in the middle of the night to use the bathroom—not something she did normally, and she was not quite sure why she had on that particular night—and when she was walking back along the landing, she thought, “It’s a bit cold—I’ll just check.” She checked her son had his blankets on and was war…”
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“957.] I appreciate that it will be subject to the affirmative procedure, but we are being asked to make a decision now on something that is unfortunately very woolly. Will the Minister reassure us that she will address the following questions in the secondary legislation? Who will have permission to edit the information in the single patient record? When will they have access to it? Will it tell us who has edited it—will there be a record of who, when and where? If the record is not accurate when it is edited, how will that be addressed? How will people know that it is inaccurate, and how will it be improved?”
“Records may be kept in a particular geographical location or hospital, and if someone is away on holiday and they come in, we may not have access to their records. In paediatrics, we often give the parents of children with complex problems letters to carry that have the necessary information in them. That would not be necessary if the record were more accessible, so there are benefits to the single patient record. There are, however, a lot of questions about it. One problem is that the single patient record has not really been designed yet, so we are being asked to approve something that is a hazy vision in the distance. On 1 June, the Minister said that “although the Bill establishes the legal framework for the SPR, much of the detail will be in secondary legislation.” —[ Official Report , 1 June 2026; Vol. 786, c.”
“Clause 47 amends the existing legislation to facilitate the single patient record. We have heard about the many benefits that it may bring, for example for patients who find themselves telling the same story again and again and having to repeat themselves because caregivers cannot see the records that they need to see. That can be frustrating and sometimes very distressing for patients. I caution the Minister against saying that the single patient record will completely fix that issue, because from a clinical perspective, particularly in certain presentations, hearing the story again from the individual can be helpful for a diagnosis, but the principle is a good one, and it will make things easier for clinicians, particularly if the patient is in an area away from home.”
“I am interested in what the hon. Gentleman is saying. Does he agree that, in many ways, the NHS dataset will be one of the most valuable datasets in the world, not only to patients themselves—in terms of the value to them and their privacy—but in the ability to analyse it and perhaps understand parts of medicine that we do not understand at the moment and so improve patient care?”
“My point was that this can sometimes be beneficial. If a clinician sees a young lady who has collapsed at school, she might have fainted or had a fit. There are a lot of different potential causes, such as cardiac syncope, and lots of different potential diagnoses. A lot of the detail in making the diagnosis is in the history. The patient will probably already have been asked their story when they arrived at A&E, but it is still important for a senior clinician to ask for it again. My caution was against presuming that we can, in all cases, prevent repeated asking of questions. There would clearly be a benefit when there are particularly sensitive pieces of information, about which we need not ask two, three or four times, but we cannot stop all cases in which a patient is asked for the same story.”
“There is no detail in the Bill. As my hon. Friend the Member for Isle of Wight East said, there is nothing in the legislation requiring the computers in his local area to talk to the computers in my local area.”
“In the event that someone from Scotland comes into the hon. Gentleman’s hospital near Dover and a doctor wants to look at their healthcare record, does the hon. Gentleman envisage that the doctor will log on to their local system and see the records from Scotland, or that they will have access to the Scottish system to look at the records directly there?”
“The clause says that information could be made available “to people involved in the provision to patients of health care or social care anywhere in the British Islands”. That implies that the English system will be used to share information with people outside England—in the Isle of Man, the Channel Islands, Scotland, Wales or Northern Ireland—but it does not imply that those areas will necessarily have the same systems to share information with us.”
“Now if the CQC makes a request, it goes to the Secretary of State, and whether it is agreed to is then somewhat more optional. Will the Minister say why she needs to change that power?”
“I have a couple of questions. In lots of ways the provisions derive from clause 1 and the abolition of NHS England. Schedule 7 refers to operating a system in the interests of the health service, which is not the same as operating it in the interests of the patients. Does the Minister have any comments on that? The Nuffield Trust has pointed out that schedule 7 would not pass over to the Secretary of State NHSE’s duty to report to Parliament. Is that because the Minister thinks that duty is duplicated elsewhere and is therefore not necessary? Under the previous legislation, the Care Quality Commission was slightly stronger and could make a mandatory request that NHS England establish a system, and NHS England had to comply with that unless it related to an existing exception.”
“He said: “The Government have never committed to doubling medical school places.” —[ Official Report, 27 April 2026; Vol. 784, c. 3MC.] Given what was said by so many Ministers before the election, and by the former Secretary of State at the Dispatch Box, how can that be accurate? I raised this issue with the Minister for Secondary Care, the hon. Member for Bristol South (Karin Smyth), in the Health Bill Committee last week, but there has still been no response. How can I establish whether that is still Government policy?”
“On a point of order, Madam Deputy Speaker. On 15 October 2024, the former Secretary of State for Health and Social Care, the right hon. Member for Ilford North (Wes Streeting), said: “This Government are committed, as we were in opposition, to doubling the number of medical school places.” —[ Official Report , 15 October 2024; Vol. 754, c. 683.] On 22 April 2026, in a Westminster Hall debate, the current Minister for Care, the hon. Member for Aberafan Maesteg (Stephen Kinnock), said: “Yes, it is still our intention to double the number of medical school places.” —[ Official Report, 22 April 2026; Vol. 784, c. 134WH.] However, on 27 April, some five days later, the Minister for Care issued a somewhat bizarre ministerial correction.”
“If they do not, Parliament will have scrutiny of the bureaucracy being removed but not of the bureaucracy that the Government replace it with. As the Minister once said: “Local taxpayers deserve to know how their money is being spent.” —[ Official Report, 13 June 2023; Vol. 734, c. 122WH.]”
“Can the Minister remind me and the Committee of other areas in which local democracy will be able to input into ICB planning once these planning documents are no longer required? Under the Government’s strategic commissioning framework, ICBs have to develop population health improvement plans. Essex ICB published a document that is 148 pages long, with a particular focus on inequality. Is the Minister concerned about the length of some of the plans, the time it takes to produce them and the amount of bureaucracy involved, or does she think this is an improvement? What is the key objective in delivering these plans? Do the Government plan to introduce population health improvement plans through legislation?”
“For example, the Joint Forward Plan covered the integration of services, which the Better Care Fund plan also considers, as does the Joint Local Health and Wellbeing Strategy.” It goes on to note that duplication delivers an administrative burden, as staff “complete parallel planning returns and fulfil competing data requests,” so that is a positive aspect of the clause. Will the Minister please address the following points? Section 14Z52 contains specific requirements to address the particular needs of young people and of victims of abuse. Where do they fall now? The NHS has a large maintenance backlog. What is the new mechanism for transparency of capital prioritisation decisions between the ICBs and the trusts?”
“It must explain how it has discharged its duties under other specified sections of the Act, review the extent to which it has exercised its functions in accordance with the forward plan and its capital resource use plan, review the extent to which it has exercised its functions consistently with NHS England’s views, and review steps it has taken to implement any joint local health and wellbeing strategy. The report must include details of expenditure and be given to NHS England by a specified date and then published. In essence, the clause deletes sections 14Z52 to 14Z57. In some respects, it is legislative plumbing, to remove plans that are no longer necessary. The Government’s impact assessment notes that “there is some duplication across planning documents.”
“Section 14Z56 sets out that an ICB and its partner trusts must prepare a joint capital resource use plan before the start of each financial year, and that the period may be determined by direction from the Secretary of State. Section 14Z57 sets out that an ICB and its partner trusts may revise the joint capital resource use plan, but if it is revised significantly, it must be published and given to the list of specified authorities. Section 14Z58 sets out that an ICB must produce an annual report on how it has discharged its functions.”
“The plan must also cover steps that will be taken to implement the local health and wellbeing strategy, the particular needs of young people, and the particular needs of victims of abuse. ICBs and their partner trusts must publish the plan and give it to a set of specified authorities, and NHS England may give directions for that. Section 14Z54 sets out that an ICB and its partner trusts must consult people when developing such plans and that health and wellbeing boards must be involved. Section 14Z55 sets out that the relevant health and wellbeing board may give an opinion, and that when it does so, it must provide it to the ICB and its partner trusts.”
“As the Minister said, the clause removes the need for ICBs and their partner trusts to produce a joint forward plan. The existing legislation requires ICBs and their partner trusts to prepare a plan setting out how they propose to exercise their functions over five years, which is reviewed and/or revised each financial year. Joint forward plans address objectives in the Government mandate regarding the ambitions in the NHS long-term plan and planning guidance. Section 14Z52 of the 2006 Act sets out that an ICB and its partner trusts have to prepare such a plan before the start of each financial year and specifies what the plan must give regard to, including the ICB’s discharge of its duties—general duties and financial duties—under other sections of the Act.”
“We have a very confusing pattern emerging, which may require further reorganisation of ICBs to line them up, with a further cost down the line.”
“Overall, it is regrettable that local government does not have the direct feed into ICBs that the design of those integrated care partnerships provided. Whether or not I agree, I can follow the theory or principle behind making the area covered more local, in line with the strategic authority. However, if the Government wanted to do that, I do not understand why they did not decide the mayoral areas first. At the moment, we do not know where the mayors will be, and where they are now is not where the ICBs are. The Government have decided to cut ICB budgets and force mergers before they have decided where the mayoral authorities will be in some cases. Even where there are mayoral authorities already, the Government have not mandated that the ICBs be coherent with them, and, therefore, in many cases, they are not.”
“Clearly, there will be a cost incurred by the abolition of the process, but there will also be an opportunity cost to services if ICBs and commissioners are not working together in the provision of social care as effectively as they were before. That will cost people in social care, and it will cost people in healthcare. As recognised by the impact assessment that the Government have produced themselves, there is a risk of reduced focus on the wider determinants of health at system level. Committee members on both sides of the House have already stressed the impact that other health determinants can have on the health service and social care, and we have previously considered amendments to that effect.”
“As Conservatives, we believe that streamlining bureaucracy is sensible, and I am sure that this is a well-intentioned reform. However, a survey conducted by the NHS Alliance in November indicated that a quarter of integrated care system leaders are likely to keep the integrated care partnerships anyway on a non-statutory basis, and 40% plan to fold them into health and wellbeing boards and working partnerships with the authorities. It is not really a ringing endorsement of the policy if a sizeable number of people intend to keep it anyway. Like many other elements of the Bill, these changes are uncosted—if we read the impact assessment, it says “N/A” for the cost.”
“Clearly, that would now apply only to guidance issued by the Secretary of the State, because NHS England is also being abolished. An integrated care partnership must publish its integrated care strategy and give it to each local authority and partner ICB. Integrated care partnerships must reconsider and, where necessary, revise the strategy each time they receive a new needs assessment. Clause 23 deletes section 116(5A) of the Local Government and Public Involvement in Health Act 2007. That subsection required the local authorities to give a copy of the needs assessments to the ICBs, which is of course no longer necessary because they are being abolished. Clause 23 also deletes sections 116ZA and 116ZB of the same Act, which established ICBs and defined integrated care strategies respectively.”
“Section 116ZA of the 2007 Act requires ICBs and local authorities whose areas coincide or overlap to create integrated care partnerships, which consist of a member appointed by the ICB, one from each responsible local authority and any other members that they choose to add; to some extent, they can determine their own procedures. Section 116ZB of the 2007 Act requires ICBs to prepare an integrated care strategy “setting out how the assessed needs in relation to its area are to be met by the exercise of functions of…the integrated care board…NHS England, or…the responsible local authorities”. When developing that integrated care strategy, the integrated care partnerships must have regard to NHS England’s mandate and any guidance issued by the Secretary of State.”
“When preparing the assessment, the local authority and its partner ICB must “co-operate with one another…have regard to any guidance issued by the Secretary of State…involve the Local Healthwatch organisation”, and involve local people and the relevant district councils. I note that later in the Bill we will also come to the abolition of Healthwatch. Section 116 of the 2007 Act has been modified by the Health and Social Care Act 2012 and the Health and Care Act 2022 to ensure that references match the current NHS structure. For instance, in 2008 there were primary care trusts, rather than ICBs.”
“In essence, the clause abolishes integrated care partnerships and strategies, which are where ICBs come together with local authorities to discuss how they can make their services more integrated. We know that many of the challenges facing the NHS are caused by difficulties in social care provision and some of the difficulties in social care provision are caused by issues with health provision, and that if those commissioning services in those two areas work together, we can see an improvement in both. The Local Government and Public Involvement in Health Act 2007 made changes to local government structures and enhanced public involvement in health services. Section 116 requires local authorities to produce joint strategic needs assessments for the local authority and its partner ICB.”
“We have the local authority tasked with delivering social care, which may be led by one political party; the mayor directing the ICB, who may be of a different political party; and the Secretary of State who can also direct the ICB, who may again be of a different political persuasion. How does it work if they disagree? Does the mayor actually have authority, given that the Secretary of State can override them anyway? How does the Minister see that working in practice? It feels like some people will be in power without responsibility and others will have responsibility without the power to exercise it.”
“My hon. Friend is, as ever, correct. The mayors are also not all responsible for health and social care—the local authorities are, in most cases. There could therefore be a mayor directing proceedings with the ICB who is a political opponent of those actually democratically elected to look after social care. ICBs are supposed to be apolitical commissioners accountable to the Secretary of State, but now, instead of working with social care directors, they will work with an elected mayor instead. I can see a positive to that in terms of democratic accountability, but what happens if they all disagree? There is some incoherence about who is in charge.”
“The consultant will then review that referral and decide whether they think it is clinically appropriate to see the patient, whether a different specialty may be more appropriate, or whether they can give advice or make suggestions about treatment that could be given in primary care instead. When a patient is given an appointment in secondary care, it essentially means that the GP has decided that they clinically need it, and the consultant has decided that they clinically need it too. If the Government want a diversion rate of at least 25% by March 2027 for at least 10 high volume specialties, are they suggesting that patients who the GP and consultant agree clinically need an appointment should not get one? If so, why?”
“In March 2026, the Government produced a neighbourhood health framework policy paper, which identified the goal of reducing non-elective admissions for those with severe frailty. Given that goal, why are the Government not on track to deliver the fracture liaison service improvements that they promised? The policy paper also commits to what it calls “a diversion rate of at least 25% by March 2027 for at least 10 high volume specialties”. What is a “diversion rate”? It essentially requires more GP referrals to be rejected, so let us be clear about what that means. When someone, either hon. Members or constituents, goes to see their GP, they are referred to a consultant for care; I should declare an interest as a consultant in the NHS.”
“What mechanisms does the Minister envisage there being for local people—local patients—to contribute to the neighbourhood health plans? A local Healthwatch currently contributes to the equivalent, the joint local health and wellbeing strategy, as a way of ensuring that it captures patient and community voices. How will that be done otherwise? Some 80% of the Government’s new neighbourhood health centres that will deliver these plans are expected to be funded through public-private partnerships. Does the Minister have any comments on that, particularly in the light of the expensive private finance initiative that the last Labour Government entered into and left us stuck with?”
“I would appreciate it if the Minister could talk about that. As has been said, Sir Andrew Dilnot told the Committee that “we cannot really address many of the fundamental problems facing the NHS if we do not sort out social care.” –– [ Official Report, Health Public Bill Committee, 16 June 2026; c. 84, Q131.] The Government have asked Baroness Casey to review social care, but they have developed this measure in the meantime. Is that because they have been talking to her and know that it is the sort of thing that she will recommend—or are they putting the cart before the horse, as my hon. Friend the Member for Farnham and Bordon suggested? Later in the Committee’s considerations, we will come to Healthwatch, its benefits and the concerns that I and, I am sure, many other Committee members have about its abolition.”
“However, if local authorities and partner ICBs have to give regard to what the centre is doing when developing neighbourhood health plans, to what extent does the Minister envisage that being directed? Local authorities and partner ICBs giving regard to the centre could mean there being a very loose requirement from the centre to provide for the local population, and then they get on with it; it could also be very prescriptive—my right hon. Friend the Member for Godalming and Ash (Sir Jeremy Hunt) has talked about the pros and cons of having targets—with a whole litany of targets in the plans. Whether that squares with the Government’s claim to be devolving power, or whether it strikes as a centralising power, depends on how that is done and to what extent the Secretary of State plans to direct it.”
“Section 116B of the 2007 Act places a duty on local authorities and partner ICBs to have regard to various strategies when exercising their function, specifically, a joint strategic needs assessment, an integrated care strategy and a joint local health and wellbeing strategy. NHS England also has regard to these when providing healthcare for a specific area. Clause 24 changes the JLHWS to a neighbourhood health plan. In many ways, that aligns with the shift in the Government’s 10-year health plan from hospital to community. As they have described it, more care in the neighbourhood will allow hospitals to focus on the more specialist care that may be needed, so more people can be cared for closer to home, which seems a reasonable aim.”
“Clause 24 puts neighbourhood health plans on a statutory basis. Currently, section 116A of the Local Government and Public Involvement in Health Act 2007 requires local authorities and partner ICBs to prepare a joint local health and wellbeing strategy once they have received their integrated care strategy. Essentially, that means that the ICBs and local authorities produce their overall strategy, then it devolves down, and then the joint health and wellbeing strategy looks at how it will be delivered. The local authority and its partners must give regard to the integrated care strategy, the NHS England mandate and any guidance issued by the Secretary of State. The strategy must be published and local people and the local Healthwatch must be involved in its development.”
“New clause 70 talks about a certain range of primary care providers being consulted by the ICB. Can the hon. Member clarify whether it is his intention for all providers of those services in a defined area to be consulted, or would it be a representative selection? If it is the latter, how would they be chosen?”
“Will the Minister explain why she thinks that is important, and in what situation she thinks that power would be used? Finally, will she say whether the financial directors of NHS trusts have been consulted about these changes? If so, what was their feedback? Clause 26 tidies up relevant provisions in two pieces of legislation, as the Minister has described.”
“The Secretary of State may also give directions about specified periods in which accounts are to be prepared. Will the Minister explain why those provisions are felt to be necessary? There will be suspicion among some more cynical people that the power to specify periods could be used to be more flattering for the Government, or that methods and principles could be used to change the perception of the position. Can the Minister give an example of where she thinks such periods would be useful, and also say why she thinks it is necessary to enable the Secretary of State to give directions about methods and principles, and form and content, in a way that is not done at the moment? The exception for charitable trusts of which the NHS is a trustee is being removed.”
“As has been said, clause 25 specifies how NHS trusts should handle their accounting. Paragraph 11A of schedule 4 to the NHS Act 2006 sets out the current obligations, which are that the trust must keep proper accounts, that the Secretary of State may give directions about how the accounts are held, and that the accounts must be prepared annually, may be examined by the Comptroller and Auditor General, and must be submitted to NHS England. Clause 25 replaces paragraph 11A entirely. Under the new provisions, the reporting goes to the Secretary of State, instead of NHS England—which seems sensible, because the Government are abolishing NHS England—and the Secretary of State may give directions about “methods and principles”, as well as the “form and content”.”
“That will clearly be within his gift if he becomes Prime Minister, but for individuals who work in one location to be asked to move to another is disruptive to their family and social lives, and involves significant relocation costs. If people are moved in the way that clause 28 describes, particularly by transfer, what choice will they have? What will happen to their pension, salary and other terms and conditions, and will they have a choice of location or not?”
“Remuneration of the special health authority chairman and staff can be determined by the Secretary of State, with the approval of the Treasury. Does the Minister foresee an upper limit to those sorts of salaries? People will essentially be able to transfer from one special health authority to another, or to an ICB—or be placed at the disposal of another special health authority, an ICB, a local authority or the Secretary of State. Will the Minister talk about the location, pension and salary of those individuals? We heard yesterday that the future Prime Minister, the right hon. Member for Makerfield (Andy Burnham), may want to move a whole load of civil servants from London up to Manchester.”
“The clause modifies paragraph 3(12)(a) of schedule 6, so that directions may be given about placing the services of officers at the disposal of the special health authority and, newly, the Secretary of State or an ICB, but not NHS England. As the Minister said, the clause also modifies paragraph 13 of schedule 6, so that a special health authority can be required by regulations to pass information to integrated care boards, which is a new power, but no longer to NHS England. NHS England is to be abolished, so it is sensible to say that staff can no longer be placed there—that seems an entirely reasonable exercise—but the legislation providing for special health authorities essentially contains open-ended spending power.”
“Paragraph 13 states: “Provision may be made by regulations with respect to the recording of information by a Special Health Authority, and the furnishing of information by a Special Health Authority to the Secretary of State, another Special Health Authority”, or NHS England. Clause 28 modifies that paragraph such that regulations can now provide for the transfer of an officer to an ICB—that is a new power—as well as a special health authority and a local health authority, but no longer to NHS England because NHS England is being abolished. Regulations can now provide for an officer’s services to be placed at the disposal of the ICB and the Secretary of State, which is a new power, as well as the special health authority or local authority, but no longer NHS England.”
“Clause 28 enables the Secretary of State to make regulations for the transfer of staff from one special health authority to another, or to an ICB. Paragraph 3(8) of schedule 6 to the National Health Service Act 2006 states: “Regulations may provide for the transfer of officers from one Special Health Authority to another”, or to NHS England, “and for arrangements under which the services of an officer…are placed at the disposal of another Special Health Authority”, or NHS England, or a local authority. Paragraph 3(12)(a) states that the Secretary of State may give directions “to place the services of any of its officers at the disposal of another Special Health Authority”, or NHS England.”
“For example, the National Treatment Agency for Substance Misuse became part of Public Health England in 2013, and the NHS Institute for Innovation and Improvement was closed in the same year. The functions of the National Patient Safety Agency went to the NHS Commissioning Board Special Health Authority, later known as NHS England, in 2012 and then to NHS Improvement in 2016. Widening the scope could leave us with more quangos than are necessary. Which specific functions do the Government plan to move into special health authorities under this widened power? Have the Government just decided that they need this power and are increasing the scope because they are abolishing NHS England without a proper plan? Is this power just to cover themselves in the event that, as they start to make a plan, they find out they need it?”
“There are plenty of other nationally delivered services, and although the Government have suggested that some services, such as screening, will become localised as part of the Bill, some things will remain national. Can the Minister give some examples of what the new provision will be used for? I can see there is provision for flexibility, but the special health authorities would require setting up, and there are set-up costs and costs associated with branding and those sorts of things. How does the Minister envisage those costs being provided for, and when will it be necessary for the Government to use them rather than just using the Department? Special health authorities have been created, reconfigured and shelved many times.”
“Special health authorities are, in essence, specialist health authorities set up by the Secretary of State, usually to provide an England-wide service of some form. Examples include NHS Blood and Transplant, and the NHS Business Services Authority, which provides NHS pensions—I should declare that I have an NHS pension—admin for prescription exemptions and other such business-type functions. We also have NHS Resolution, which deals with clinical negligence claims, and the NHS Counter Fraud Authority. In principle, special health authorities are useful in some cases, but they are effectively a form of quango. Can the Minister explain when she thinks the Government might want to set up a special health authority, rather than using a department within the DHSC to deliver the same thing?”
“Could the Minister be clear if a foundation trust wanted a nurse and a midwife, perhaps because they had a specific issue with the midwifery area, or a medical practitioner and a registered dentist, could they have both? The Minister suggested that an exemption would be ambulance care, but there are medical practitioners, consultants, with expertise in out of hospital care. Does the Minister feel their expertise is not useful in some way? I will speak to amendment 36 once it is moved. On clause 30 stand part, that clause removes the requirement for NHS England to consult prospective members or governors of a prospective foundation trust before its authorisation. Getting a new foundation trust without NHS England because it has been abolished is a consequence of earlier clauses that we have already voted on.”
“Many NHS inquiries have reported back that frontline concerns did not reach the highest tiers of leadership. The Government are now closing an independent channel for sounding the alarm. Will the Minister comment on that? I welcome Government amendment 19 because the idea that you need medical expertise on the board of a trust that delivers medical care seems to me fairly obvious, because otherwise you will get decisions that are not grounded in medical knowledge. I do recognise what the Minister says about it was not having been her intention to demote the voice of clinicians, but that was the effect. This amendment will go some way to correcting that, by having an executive director who is registered medical practitioner or a dentist, and another who is a registered nurse or midwife.”