Helen Morgan
MP for North Shropshire · Liberal Democrat · United Kingdom
“In 2022, we welcomed the first women’s health strategy, which promised to “listen more carefully to women, close gaps in care, improve research and tackle inequalities.” Those were all vital goals, but three years on, the problems remain stubbornly in place: long waits for gynaecology treatment, patchy access to services, women reporting…”
“I thank the Minister for outlining the existing statutory framework. I agree that it ought to be sufficient, but there are high-profile instances where it has not been, so I look forward to hearing more from her on Report about how the cultural change will be implemented so that further legislation is not necessary.”
“There is significant vaccine hesitancy across some ethnic minority communities and in hard-to-reach places across the country. We must do more to support doctors, nurses and the NHS to fight fiction with facts, or the long-term health of the country will suffer. That is what new clause 77 seeks to do.”
“May I associate myself with the Minister’s comments and thanks to everybody who has been involved in working on the Bill? I have also enjoyed my time on the Committee, despite the heat.”
“Some pockets of the population have been left unable to get an NHS dental appointment. The action taken so far by the Labour Government has not been good enough, but the fault for this dire situation lies solely at the door of the Conservatives. Their years of neglect have left our dentistry in a shocking condition.”
“New clause 36 would introduce a mandatory individual duty for members of NHS trust and NHS foundation trust boards to escalate evidence of systemic medical malpractice to the Care Quality Commission, the Department of Health and Social Care and the Health Services Safety Investigations Body.”
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“I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn . Clause 15 ordered to stand part of the Bill . Clause 16 Regulations about commissioning by integrated care boards”
“I add my support to amendment 52, because we do need to build confidence in the reduction of waiting lists, and more transparency around reductions would be helpful.”
“They have some of the longest waiting times for treatment and vast parts of the country are classed as radiotherapy deserts, because of lack of accessibility. Radiotherapy currently has the worst 62-day performance of all main cancer treatments, and if we are serious about ensuring that all cancer targets are met by 2029, then we need the infrastructure, people and equipment to deliver them. Cancer cases are expected to rise 30% by 2040, meaning that radiotherapy centres must be able to keep pace. Importantly, radiotherapy can also be used at an earlier stage in treatment, potentially saving lives, saving money and meeting important waiting time targets. We really ought to be leading the way on this and keeping pace with our European counterparts so that no one is left without the treatment they so desperately need.”
“I want to speak to amendment 63, tabled by my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron). As hon. Members know, he has campaigned passionately and for a long time on the provision of radiotherapy. His amendment seeks to ensure that there is sufficient and equitable access to radiotherapy. Radiotherapy is required by half of all cancer patients, and it is incredibly cost-effective, but England has fewer radiotherapy machines than comparable European countries, and thousands of people have to travel long distances and over 45 minutes for their treatment, particularly in my hon. Friend’s Cumbria constituency, as he has noted on many occasions. The Darzi review noted that radiotherapy services are on their knees.”
“I want to draw the Minister’s attention to some of the difficulties relating to cross-border healthcare in a border area. I represent an area on a border. North Shropshire has a very wiggly, for want of a better word, border with Wales, which means that some English constituents are registered with a GP surgery in Wales but receive their secondary care in England. That causes significant difficulties for them because of the lack of joined-up communication between the two Administrations. I seek assurance from the Minister that as ICBs in England will have to pay regard to people who live near the border in Wales, conversations are going on with the commissioners in Wales to ensure that that process is as smooth as possible.”
“Water resilience is very much on people’s minds this week. When a canal embankment collapsed in Whitchurch in my constituency just before Christmas, I found out that the canal network is used for drinking water, and that millions of gallons of drinking water will be being pumped over the breach every single day until it is repaired. Canal embankments are often 200 years old and largely made of sand, yet they are critical national infrastructure. Is the Minister satisfied that the Government are doing enough to retain the canal network in a safe state, not only to keep people safe but to protect our water resilience?”
“Water security is central to food security, so I would appreciate the Department outlining what those changes will mean in real terms for our farmers.”
“On top of that, several farmers in the area have reported being unable to reach their milk buyer for information about pricing, meaning that they are unable to plan ahead. Farmers suffer time and again for their lack of power in the supply chain. Will the Government outline the action they will take to bolster the role and effectiveness of the Groceries Code Adjudicator and to enshrine its golden rules in law so that producers are properly protected, as recommended by the EFRA Committee and the Batters review? Farmers in my constituency are particularly concerned about the proposed changes to water abstraction licences due in 2028, which could have a huge impact on the viability of many farms in my area.”
“I thank the hon. Member for North Northumberland (David Smith) for securing this debate. I am the vice-chair of the APPG on food security. Agriculture makes up 20% of businesses in North Shropshire, with well over 1,000 agricultural holdings, so it is a huge part of our local economy. In the short time I have, I will focus on two issues. For the roughly 130 dairy farmers in North Shropshire the huge pressures of climate change, increased input costs, rising energy and fertiliser prices, and hostile trade deals have come at a time when milk prices are simply not keeping up with the cost of production, as we have heard. One farmer in Market Drayton reports being down £25,000 a month on his milk price, while a family farming in Maesbrook told me that they have been selling off livestock just to keep their heads above water.”
“It would be nonsensical for the Government not to take a strategy forward. Will the Secretary of State pledge to implement every single one of the Nottingham report’s essential actions, and to work with us to deliver the essential investment we need to make Britain a safe place to have a baby, and end this shocking cycle of failure? Anger is not enough. Mothers, doctors and midwives are sick of seeing review after review and being met with stasis, with the same failures repeated over and over again. This must be the moment we say, “Enough.””
“Review after review has led to 748 recommendations since 2015, but birth injury and mortality rates have continued to rise. These reviews all reveal similar issues: unsafe staffing levels, lessons not learned, issues not escalated, insufficient training, and women’s concerns ignored. Four years ago, after the Shrewsbury review, we found that over 200 babies had died unnecessarily in Shropshire, yet things have got worse. Donna Ockenden’s Nottingham report reveals new and extremely distressing revelations about serious failures to protect the dignity of the deceased in after-death care, something that must be addressed through proper regulation. Liberal Democrats have put forward a maternity rescue package that would guarantee one-to-one midwifery care and introduce a national maternity commissioner to oversee vital improvements.”
“May I start by acknowledging the hon. Member for Sherwood Forest (Michelle Welsh), Donna Ockenden and the Secretary of State for the statement and for their hard work? I thank the Secretary of State for the actions that he has proposed so far, which I think are the first tangible actions we have heard in this place. I must also acknowledge the incredible courage and resilience of the Nottingham families who have been instrumental in bringing about this review. No one can imagine the pain that they have gone through. I am distressed and angry to be stood here once again speaking about babies who should not have lost their lives, mothers who should not have lost their lives and trauma that families should not have experienced.”
“Before the general election, I was the Liberal Democrat housing spokesperson, and one thing that came up regularly was how important housing is, and not just for obvious physical conditions—mouldy houses can cause breathing issues. Temporary accommodation is devastating for the long-term health outcomes of the people who are placed in it. Does the Minister agree that working with MHCLG to improve housing—particularly social housing—is critical to achieving the Government’s objective?”
“One of the challenges of recruiting staff in Shropshire relates to exactly that point: some areas of the health service are perhaps less exciting to work in than others. Ensuring that innovation is driven across every NHS site and every region will help us understand the recruitment and retention problems that have plagued some of the country’s more rural areas.”
“In ophthalmology, private providers do thousands of cataract operations very efficiently, but the less exciting and more critical work of preventing people from going blind, which is done in NHS hospitals, is under threat because so many people want to work in easy and profitable areas. I am concerned that that will occur in more areas of the NHS if the Bill allows more privatisation. Although I do not have an ideological problem with the NHS contracting out to private providers—that has worked well to bring down elective waiting lists, for example—the provisions to protect the mix are important. I am not sure that amendment 53 really moves us forward; it just requires the Secretary of State to consider who benefits from the change in mix.”
“It is a pleasure to serve with you in the Chair, Sir Roger. I have concerns similar to those of the shadow Minister about clause 10. Proposed new section 12E allows Ministers to vary the proportion of activity by provider, and I am interested in the rationale behind that. The powers to retain the provider mix were put in place because of concerns that the NHS would be privatised by the back door, so the requirement to maintain the mix is there for a reason. As we heard earlier when discussing ophthalmology, there are risks to using private provision for certain NHS activities, as there can be unintended consequences—a bit like the deregulation of buses.”
“The hon. Gentleman outlines an unintended consequence of the NHS contracting out to private providers. There are ways to get the pricing of those services right, but the clause could introduce that unintended consequence. Why is this proposal included in the Bill, and what does the Minister see it being used for? Is there a risk that a future Government might use it to bring much more privatisation into the NHS? The general public consensus is that that would be a bad thing. What safeguards can she put in place to ensure that does not happen?”
“How can we be sure that that will actually happen on the ground, and that ICBs, hospital trusts and other health trusts will have the opportunity to flex their local muscle and ensure that services are best shaped for the local population? The NHS Alliance has called for an operationally independent regulatory function in DHSC to oversee NHS organisations, or for an independent panel to make appointments. Will the Minister consider such practical changes to ensure that political capture is not an unintended consequence of the Bill?”
“If we imagine for a moment that an incoming Government decided that they did not approve of diversity on an NHS board, for example, and replaced an executive with their own candidate, that would be a horrifying situation. I think we would all agree on that. It would be useful to include safeguards now and set a precedent that such action would not be acceptable under this Bill. Notwithstanding the fact that a future Government could come along and change that, they would have to be transparent about their reasons for doing so. The former Health Secretary, the right hon. Member for Ilford North, claimed that he was taking powers back into DHSC in order to give them away to the system, but this Bill has a lot on taking those powers and very little on giving them to the system.”
“We have discussed the reality that current Parliaments cannot bind future ones, and I take that point on board. However, current Parliaments do set precedents and establish the legal frameworks within which future Governments initially operate until they change the law. With the potential for more extreme Governments, there is a risk of discrimination and political considerations entering what should be clinical decision making—for example, decisions on whether to place a trust into special measures or what services are offered, such as sexual health, IVF, outreach to migrant communities and so on. We are concerned not about the current Secretary of State, or indeed the shadow Secretary of State, but about the risk of those sweeping powers being placed in the hands of an extreme Government.”
“NHS leaders argued that this would mitigate the risk of direct political control of the service and pointed out that the 10 regional strategic health authorities had played a useful role in running the service efficiently before the creation of NHSE. That proposal was rejected by Ministers, and it is not entirely clear why. I am interested to hear the Minister’s view on that. It is now being reported that a fresh attempt is being made to argue that regional teams should be hosted by an NHS organisation—probably an ICB—to protect their employment terms and, as staff would remain public rather than civil servants, provide some brake on political control. Can the Minister shed any light on all this? Does she recognise the importance of maintaining operational freedom in NHS decision making?”
“I mentioned in Committee last Thursday that the Liberal Democrats are worried about the risk in the Bill of political capture and the Secretary of State’s ability to meddle in day-to-day operations. As I am sure the Minister is aware, speaking at the NHS ConfedExpo this month, Sir Jim Mackey, the chief executive officer of NHS England, warned that the Bill may give Ministers too much control and that there has to be operational freedom; otherwise we will grind to a halt. I want to probe the process by which we got to this point. Originally, there was discussion about whether the seven NHS regional teams should become independent arm’s length bodies to mitigate such a risk.”
“I could not agree more with the Minister that when there is an obvious failure, either in a local system or in a trust, we would hope that the Secretary of State will intervene. She will know from our experience in Shropshire that, when a system is failing or underperforming, that intervention is welcome. But the Bill gives the Secretary of State power to intervene even when things are going well, which is quite an extension of power. Will the Minister comment on that?”
“Schools in North Shropshire received an average of £6,460 a head last year, compared with a national average of around £7,910. Outcomes at GCSE and key stage 4 are consistently lower than the national average. Will the Secretary of State meet me to discuss what resources can be put in place to improve outcomes for children in North Shropshire?”
“Member for Ilford North (Wes Streeting), to pause the Pathways clinical trial while concerns raised by the MHRA were thoroughly addressed. Will the Secretary of State confirm whether the MHRA has confirmed that the concerns that led to the withdrawal of the trial have been substantially addressed, and how many children are expected to take part in the trial now that its parameters have been altered?”
“We agree that treatment should first be based on talking therapies, so that patients are given the space and support that they need, but it is crucial that young people can start those therapies as a matter of urgency, not after years of delay. Decisions about these young patients’ futures should be made in an informed way, with expert clinicians and based on the best possible evidence, which the NHS must build up safely and effectively. We support prioritising clinical evidence, so that patients’ interests are put at the heart of decision making in all areas of healthcare. Guidance and decisions around puberty blockers must be led by experts and clinical evidence, and not influenced by ideological opinion. That is why we supported the decision of the former Secretary of State, the right hon.”
“I thank the Secretary of State for advance sight of his statement. The Liberal Democrats have long highlighted the need for better access to specialist healthcare for children and young people struggling with gender identity. The closure of the Tavistock clinic and its inadequate rating by the Care Quality Commission demonstrated that urgent change was needed. Young people struggling with gender identity face serious challenges. They have been badly let down for years by low care standards and extremely long waiting lists. On top of that, they have to contend with a toxic public debate, which comes at a huge cost to their wellbeing at a particularly vulnerable stage in their life. The average three-year wait for a young person to see a specialist can be extremely harmful at such a vulnerable age.”
“Tackling health inequalities is the priority of everybody in this Room, and we need to ensure that we have an efficient structure in place to ensure that it happens.”
“We have had eight Health Secretaries in the past 10 years. After all that swapping and changing, how can the Minister ensure a degree of continuity when the new Secretary of State takes over? One benefit of quangos is continuity over a long time, divorced from the political turmoil of Westminster. We must be clear about how distractions will be avoided in the new structure. Finally, we heard in evidence on Tuesday that the new structure feels like a centralisation of power in Whitehall, when what is needed is more power devolved down to local level so that local services can be shaped to reflect the demographics that they serve and to address the important point of health inequality. Will the Minister explain why she is confident that measures to ensure local accountability and local shaping of services will be able to go ahead?”
“We found reorganisation hugely distracting; it took away from our ability to do our day jobs well. Then, within a couple of years, a lot of the equivalent roles were re-hired and we were back to square one. It is critical that the Government avoid that scenario in this big reorganisation of the NHS. I hope that the Minister can provide reassurance that it has been well thought through and that we will not find ourselves, two or three years down the line, with similar numbers of people replicating the roles that exist currently, following a huge distraction that resulted in no improvement in patient outcome or experience. My questions are fairly limited. Does the Minister know, at this point, what the impact the reorganisation has had on the system and how much it has cost in secondary impacts?”
“At this stage, as we start to consider the legislation, it would be helpful to have clarity on who will be in charge of the NHS and how the layers below will be organised. We have also heard that hours of staff time, leadership focus and money have been directed away from frontline services. In the oral evidence session, Sarah Woolnough of the King’s Fund and Jon Restell of the Managers in Partnership union suggested that that has been distracting and that, in any body, a significant reorganisation has an opportunity cost. In my previous life, I was an accountant at Centrica plc—one of those back-office checkers everybody wants to get rid of, but who turns out to be quite important in providing the information that enables the business to run smoothly.”
“It has taken a long time even for the Treasury to agree on the funding of the redundancy bill. We have found out that redundancy costs of £800 million will be taken out of the future operating costs of the NHS. I hope that the Minister will describe how that will be delivered to ensure that the costs do not detract from patient care on the frontline. There is still some uncertainty about the new structures within the DHSC and NHSE reorganisation. We have heard that the previously announced plan for three top-level roles—a permanent secretary, a chief medical officer and an NHS chief executive officer—might be changed, and that there is a proposal to merge the permanent secretary and NHS CEO roles.”
“That may not seem like a huge risk considering who the current Secretary of State and shadow Secretary of State are, but given the febrile political atmosphere that we are working in, it seems a poor time to give a Secretary of State sweeping operational powers over the detailed functioning of the NHS, with few checks and balances. I will speak about the most concerning elements and make the argument in greater detail when we debate cause 11. As the hon. Member for Sleaford and North Hykeham said, the former Health Secretary, the right hon. Member for Ilford North, said that top-down reorganisation of the NHS was the last thing he wanted to do, and yet that is where we find ourselves today. It feels as if the plan has been pulled together very quickly, and that it has been complex to turn into a piece of workable legislation.”
“The Liberal Democrats broadly support the abolition of NHS England. As constituency MPs and users of the NHS, we see a huge amount of duplication and unnecessary bureaucracy as our local health organisations try to navigate the processes of securing capital investment, for example. Reducing duplication between the Department and NHS England is clearly welcome if done well, but we have concerns about the way in which that is being undertaken. We think that this centralising process, under which the Secretary of State takes on more powers, risks political capture.”
“Yes, we need confidentiality, but I was not convinced by what I heard then—that we needed a completely separate organisation that was duplicating the work of others.”
“In terms of safe space, clearly, confidentiality is important. Confidentiality is important right across the board; staff need to feel able to report within NHS organisations and to the CQC where they have concerns. I have to say that I was concerned in that Health Committee session to hear an example given by Jeremy Hunt, who said that if a midwife is concerned about quality of care in their maternity unit, they need to be able to go somewhere and report that, and to know that HSSIB would not tell anyone else about it. I looked at Duncan, our chief nursing officer, who was there with me, and we were shocked to hear that. How can that possibly be right? We need to have a mechanism whereby if there are concerns about quality of care, they are properly investigated, and mechanisms to deal with those problems and improve services.”
“Q Good morning, Dr Dash. Since hearing the evidence that was given to the Health and Social Care Committee, have you reflected on the concerns that the driver of confidence in HSSIB is its operational independence? What concerns do you have that it will lose that perception of independence and its safe space approach to learning when something goes wrong? Dr Dash: The CQC is an independent regulatory body as well. The hope and expectation is that we have a high-calibre, independent regulatory body that is the prime regulatory body for looking at how well health and care services are delivered and, as well as observing how well they are currently performing, is able to carry out specific, focused investigations when it spots systematic problems across the healthcare system, or indeed when particular problems are identified.”
“When I was speaking to people, I found some fantastic examples of different healthwatch organisations across the country, but that is not at all consistent and they are often too far removed from what is actually happening in terms of day-to-day services to have a significant impact on improving patient experience.”
“They all have considerable teams of people who are doing that—speaking to different members of society and conducting usually frequent events to get input and hear what people are looking for from their health and care services. When they are looking to design particular services, whether mental health services or children’s services, they go much deeper into that and speak to specific groups, often involving the providers as well. Those mechanisms are already embedded within ICBs, but we need to continue to ensure that they do those as well as they can.”
“They need to get way better at collecting patient experience, they need to understand it from different groups, wards and medical teams, and they need to be playing that back. Ideally, that should be part of everyone’s appraisals: “Here’s the sort of feedback that we’ve had. Here’s what we’ve heard. Here’s how we’re acting on that.” We need to put that in the places where healthcare is delivered, and that is in those provider organisations. The ICBs have a different role, which is to commission healthcare services in order to improve health and ensure high-quality care, and it is their responsibility to speak to communities.”
“Q I should have declared that I am a member of the patient safety APPG. Let me turn to similar concerns about Healthwatch and its independence. If it is absorbed within ICBs locally or within the Department of Health at a national level, do you have concerns that those organisations will essentially be marking their own homework rather than listening to impartially collected evidence about patient experience? Dr Dash : I will talk first about providers and then about the commissioners, the payers, the ICBs. We absolutely should expect all providers—GP practices, community trusts, hospital trusts—to see patient experience as a crucial part of their role and not to outsource it to someone else; it has to be a crucial part of what they do.”
“Our concern is that, while the narrative is about a straight transfer, empowering local systems and earned autonomy, the legislation pulls a lot of power back to the Secretary of State, and you cannot legislate for how a future Secretary of State may enact those powers.”
“Q Good morning. Sarah, the Bill transfers a lot of NHSE’s powers to the Secretary of State. Do you have any concerns about the additional powers conferred upon the Secretary of State? Does that go too far? Sarah Woolnough: There are probably two concerns in a couple of different areas: appointments and the power of direction, which is very broad. We think it would be helpful to probe the detail and understand the intention a little more to see whether the legislation could do with amendment. There is more general point. If the narrative is that this is a straight transfer, of course, you cannot legislate for culture and how those powers will be used.”
“I worry about the capacity of ICBs to deliver once that is cut, particularly given the headcount and budget reductions in ICBs generally. Local authorities are probably more experienced in doing direct community engagement and more confident about their ability to pick up the responsibilities. Indeed, I suspect that many of them will continue to commission some sort of external support to help them do this, but their budgets will be restricted. They will get only half the money for healthwatch, so that will be a concern.”
“That sort of insight will be lost entirely under the current structure, unless we build in a requirement for ICBs and local authorities to share the intelligence that they are hearing and to work collaboratively to understand patient and care user experience. That then raises the question, “Why are we splitting them?” If they have to work closely together to comment on the worst experiences of care, I do not understand the rationale for splitting them. In terms of preparedness, I said earlier that ICBs will not have any additional resource for doing this. They have their own engagement teams at the moment, but even those that have been doing this very well have been leaning on their healthwatch for many years to help them engage with seldom-heard communities and build additional capacity.”
“Q Jacob, how prepared are ICBs and local authorities to take on the healthwatch functions? Is there a concern that splitting the local healthwatch function will lead to a lack of joined-up focus on health and on the social care element that resides with local authorities? Jacob Lant: I will pick up the second part of the question first. The majority of the worst experiences of care—the worst incidents, where people feel most lost—tend to be in the gaps between services. Hospital discharge is a really good example of where the transfer between the NHS and social care services does not always work in the best interests of patients.”
“We have to code things to be able to respond to our contract, so we have to be good at that. Things fall down when information comes from other providers, which we have no control of. That would be an area of real concern—that such information would be part of our property and our jurisdiction. I guess it is about the detail of how that record will be structured. If it is a brand-new thing and we all feed into it, that is very different from all the data coming to the current healthcare record that we hold. I think the detail is not there yet to enable us to describe who should be the data controller, but certainly I do not think that any practice manager would want to control data generated by someone other than themselves.”
“That legal obligation of a data controller looms large for them, whereas it does not loom as large for large NHS organisations—although, technically, the impact is as hard. I do not mind who controls the data; what we need to do is to find a way to enable that data to be shared safely and with a belief that it is done for patient benefit. I do not think it matters whether GPs maintain data control, with something else happening to support them, or whether it is taken away from them; it is about how we enable that to happen. But I do think that general practice struggles more with resilience. Kay Keane: I think that is true, in that we are generalists, not experts in a lot of areas. Certainly, we can be very good data controllers of our own data—the stuff that we produce, and that we write and code about our patients.”
“Q Can I also ask about the single patient record? We have heard concern from GPs about their role in being the data controller and what that might mean when data is shared beyond their initial remit. What do you think is most desirable: for the GP to remain the data controller, or for that role to sit elsewhere? Dr Dickson: I am not a general practitioner. The key thing for data control and data sharing is the trust that patients have in us to share and to hold their data in a way that is beneficial for them as individuals, and potentially sometimes beneficial for the population, but not to share it for what you might call retail use. One issue with data control is that most general practices are small businesses with a small number of staff working flat out.”
“Q Do you think anything else should be on the face of the Bill to give us clarity so that that GP concern is mitigated? Kay Keane: The patients need to understand exactly who has access to that record and exactly who is feeding into it. There is a huge amount of trust between a patient and a GP, and a patient and a healthcare professional in a general practice, and we do not want that trust to be diminished so that the patient stops telling us the things that are worrying them—the whole story. We want them to continue their trust, but if they think that information is spreading further and further across the system, we might lose some of it.”