Lewis Atkinson
MP for Sunderland Central · Labour · United Kingdom
“That will presumably be returning next July, so I want to extend an early invite to all Members and the future Member for Clacton not just to enjoy our beautiful coast but to help ensure that all rubbish from day-trippers to Roker and Seaburn is properly disposed of—in the bin.”
“Friend the Member for Tynemouth (Sir Alan Campbell), is an ardent fan of Europe, so I am sure he will join me in wishing Sunderland AFC well for the season ahead. I specifically want to mention the contribution of David Bruce, who recently departed as the club’s chief business officer.”
“Mrs Helen Smith has been teaching at St Anthony’s girls’ Catholic academy for more than 30 years, including as head of sixth form and leading the A-level politics programme.”
“I am, however, still deeply saddened—angry, even—that that grant has not been used by the council to prevent the recent closure of the Basis homeless drop-in centre, and that no alternative provision has been put in place.”
“In the last year, Sunderland has shown that it is truly a city on the up. A new hospital, library, bridge, construction skills academy, offices and housing are all open or opening soon—all secured under a Labour council—and there are investment plans in place for the Crown Works film studio, expansion of the Metro to Washington and much m…”
“Fulwell community library, which is run by a fantastic team of volunteers led by Richard Beck, provides a welcoming space for people to enjoy books and a cuppa, as I did there the other week.”
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“If so, the point at which the higher rate of tax takes effect would, in turn, increase to almost £58,000, at further cost to the Exchequer. Similarly, the additional rate of tax is currently levied on incomes above £125,000, so if the personal allowance was to rise, would that level rise proportionately too? Finally, the income tax personal allowance is aligned with the level at which people start making national insurance contributions; should that level also rise to £20,000, or would we return to a more complicated tax system in which income tax and national insurance thresholds were no longer harmonised?”
“An emergency reversal of those tax changes followed, but not before high inflation and interest rates hit the standard of living. I therefore urge our debate to be conducted in full consideration of the cost and funding of any tax policy changes. Were income tax personal allowances to rise in the way suggested by the petition, there would be several other linked tax policy choices to be made, and those choices would determine the full cost of the change. For example, would the size of the tax bands above the personal allowance be maintained? Currently, the basic rate of 20% is levied above the personal allowance and up to about £50,000 of income. Would the size of that band be maintained if the personal allowance were increased by £7,500?”
“The vast majority of those paying income tax are of working age and are not receiving the state pension. In their written response to the petitioners, the Government highlighted that making the suggested changes to the personal allowance would cost “many billions of pounds”. I am sure that the Minister will say more about that when he responds, but cost is a key element to discuss in our debate. It is Parliament’s responsibility to agree the ways and means of any policy it makes—that is, how to pay for what we decide to do. I gently suggest that the events of the last Parliament remind us how serious that responsibility is. The mini-Budget of September 2022 announced tax cuts costing around £45 billion without explaining how they would be funded, and the market reaction to that announcement left ordinary people paying the price.”
“In the 2022 autumn statement, the Chancellor at that time, the right hon. Member for Godalming and Ash (Sir Jeremy Hunt), announced that the freeze would be extended for a further two years until April 2028. Following the change of Government, the current Chancellor announced in her autumn 2024 Budget that the freeze would not be extended any further, and therefore income tax personal allowances are expected to next rise in April 2028. Although Mr Frost is a pensioner and his petition reflects a desire to boost pensioner incomes, he also believes that significantly increasing the personal tax allowance would benefit those in work, boosting incomes and reducing the need for benefits. That belief reflects the reality that less than a quarter of the 37 million income tax payers in the UK are over the age of 65.”
“It also speaks to wider and entirely understandable public frustration about living standards. In preparation for the debate, I had the pleasure of talking to Mr Alan Frost, the creator of the petition and a constituent of the hon. Member for Bridgwater (Sir Ashley Fox). Mr Frost, who is in the Gallery, explained that he has recently retired, having worked his whole life. He feels a sense of injustice that his state pension is considered as income for tax purposes, and that the tax thresholds he faces are not increasing. The events that led to that situation are as follows. In the 2021 spring Budget, the right hon. Member for Richmond and Northallerton (Rishi Sunak), who was Chancellor at the time, announced that the income tax personal allowance threshold of £12,570 would be frozen until April 2026.”
“I beg to move, That this House has considered e-petition 702844 relating to the Income Tax Personal Allowance. It is a pleasure to serve with you in the Chair, Mr Stuart, and it is a privilege to open the debate as a member of the Petitions Committee. All colleagues from all parties will recognise the priority that the public place on improving living standards, as our conversations with constituents, polling and the facts of the matter tell us. The reality is that average disposable incomes after tax fell from 2019-20 to 2023-24 —an unprecedented and shocking situation in which people were left poorer at the end of the last Parliament than they were at the start of it. That is the key context for today’s debate, which has been triggered as a result of more than 250,000 citizens signing the petition on income tax personal allowances.”
“The IFS notes that the income level of one third of adults is already below the existing personal allowance. That group—those with the lowest incomes in society—would not benefit from the changes sought by the petition, while the greatest benefits would be received by those who are best off. That is to say, in net, such a change would be regressive, increasing inequalities of income.”
“To put those figures into context, at a minimum cost of £40 billion, the proposal would be at least as large as the tax measures proposed by the September 2022 mini-Budget, which were then quickly reversed after the economy crashed. At the higher end of the estimates—£90 billion—the cost of such a change would be around the same size as the entirety of public revenue spend on education, or two thirds of the total cost of the state pension. It is not for me, in introducing the debate, to advocate one way or another, but I urge Members contributing to speak frankly about the costs and funding of any tax changes they favour. I hope it is also useful briefly to provide some context about how individuals throughout the UK would be impacted by increases in the personal allowance.”
“The House of Commons Library estimates that it would cost more than £60 billion to increase the personal allowance to £20,000, make corresponding increases to the higher rate tax threshold, and raise the national insurance threshold to £20,000 to maintain alignment. That figure is consistent with the range of costs expected by the Institute for Fiscal Studies, which I also met in preparation for this debate. The IFS estimates that increasing the personal allowance to £20,000 would cost somewhere in the range of £40 billion to £90 billion, depending on the choices made on the related tax matters that I have outlined.”
“Of course, I join the hon. Gentleman in paying tribute to his constituent for securing this debate; 250,000 signatures is an extraordinary level of engagement in the democratic process, and that is to be applauded. I will make some points about the distribution of the benefits of income tax freezes later on in my speech. The cost of the policy requested by the petition depends on the answers to the questions I just posed. Other Members may wish to speak about how they would approach such matters, but, to aid debate, I thought it would be useful to present some indicative costs. At this point, I want to place on record my thanks to the staff of the House, including those from the Petitions Committee and the Library, for their work in helping me to access such information.”
“When I am out in Sunderland Central every week, that is the key issue that people raise with me, because for years they have been no better off and, in many cases, they are struggling to make ends meet. I get it. Putting more money in people’s pockets so they can do what they want is the public’s top priority. A key part of that is managing the public finances well. We all saw what the Liz Truss mini-Budget and unfunded half-baked tax plans did to living standards.”
“Members may also wish to know that there would also be significant geographic differences in the impact of any changes. The places with average lower levels of income—for example, Sunderland—would lose out relative to places with higher average incomes, which are disproportionately in London and the south-east. Were such tax changes funded by cutting public services, regions such as the north-east would lose out even more. I hope those matters of context will help inform the debate this afternoon. I will end where I started, with a reflection of public sentiment on living standards. As other Members have mentioned, there is undoubtedly a strength of public feeling on these matters. We have to be frank: it is our job to improve the incomes and lives of the people that we serve.”
“I thank the right hon. Lady for that intervention. Of course, it was the previous Government who harmonised the income tax thresholds for pensioners and those of working age alike, the situation having previously been different. I absolutely recognise the stress felt by pensioners around the land. That is why such a debate is difficult without wider consideration of pension incomes and in particular the maintenance of the triple lock, which is not the subject of this debate, but which strikes me as important to consider. As I was saying, there is a disparity between the potential benefits of a significant increase in the personal allowance for those with different levels of income, with those earning the most benefiting the most from such an increase.”
“No, I will make progress. The public expect us to do better than that and they expect us to do more. They want wages and pensions to go up faster than inflation, as is now starting to happen. They want to the personal allowance to rise. I pay tribute to Mr Frost again for calling for those measures, and to all those who signed the petition. We should be hugely thankful to have citizens who are engaged in our parliamentary democracy, as the 250,000 people who signed the petition are. I look forward to an interesting, and I hope informed, debate.”
“Question put and agreed to. Resolved, That this House has considered e-petition 702844 relating to the Income Tax Personal Allowance.”
“I will be brief. I thank all hon. Members for their contributions. A debate on tax policy can be somewhat dry, but it is important to remember, as hon. Members on both sides of the House have reflected, that there are personal stories and circumstances behind all the signatories to this petition and the emails in our mailboxes. People are struggling to make ends meet and trying to do the best for their families and raise their standard of living. It is important to remember that. On behalf of the Petitions Committee, I thank the Minister for his response to the debate and all the Members who attended. I particularly thank Mr Frost for instigating the petition and all the petitioners who signed it. We have had a short but important debate this afternoon on the nub of the key economic policy debates facing the country.”
“Sunderland is a music city, and key to that are our great grassroots venues such as the Bunker, Independent and Pop Recs. But venues like those across the country operate on a financially precarious basis. Will the Minister update the House on how he will monitor the implementation of the voluntary levy on arena and stadium gigs, so that it can rapidly provide financial support to venues like those in my constituency?”
“On Saturday night, the Israeli Government announced the approval of an expanded road network in the E1 corridor of the west bank with the stated aim of supporting the development of illegal Israeli settlements in the area. That area is critical to the territorial integrity of a future Palestinian state. Previously, unified international pressure has restrained the Israeli Government, so can the Foreign Secretary say how the Government are working with their allies to exert maximum influence on Israel in this matter?”
“I declare an interest as a member of the NHS pension scheme. Can the Minister confirm that this issue arose only because the previous Government carried out their NHS pension reforms in a way that was found to be age discriminatory? More widely, does she agree that giving NHS staff the terms and conditions and the reward and recognition that they deserve also requires prompt action each year on agreeing the NHS pay award, which the Conservative party routinely failed to do when in Government?”
“Since then, we have moved to a more diffuse system that is not at the centre of Government but commissioned by each council individually through the public health grant. The provider landscape has fragmented. Whereas NHS treatment services used to be the norm, now there is a significant pattern of commissioning—in some cases there is competitive tendering every few years. That has not helped to tackle this issue with the urgency it needs. I look forward to hearing from the Minister. I do not think legislation is required to improve treatment. This issue requires clear political will and focus, and I hope we will hear a lot more of that from the Government today and in the coming months.”
“Treatment, particularly for opiate use, must focus on substitution therapies. It was disappointing that in the last decade ideology against opiate-substitution treatment trumped the evidence base for it. There are people who could still be alive today if it were not for that ideology. The scale of the treatment gap is significant. In Sunderland, in my constituency, adult mortality from drug causes is about twice the average in England, but around 60% of opiate and crack users are not in treatment today. That must change, and I look forward to hearing the Minister’s response on that. Under the last Labour Government, the policy and health landscape was rather different. As well as the policy urgency, there were clear national levers to pull, with a primary one being the National Treatment Agency for Substance Misuse.”
“I know a little bit about that, because it was the privilege of my NHS career to manage NHS drug treatment services in the north-east of England for three years when that strategy and system were in place. A harm-reduction approach was key to treatment, as other colleagues have said. Drug deaths are horrific, and so are the wider harms, including the impact on crime. The amount of acquisitive crime in this country that is driven by addiction is really significant. The Government are focused rightly on tackling crime as well as wider health themes. This is an intervention that meets a lot of the Government’s missions. The harms around children are also significant. Many children are taken into care as a result of parental drug use. A prevention approach would reduce costs for the state by ensuring appropriate drug treatment.”
“It is a pleasure to serve under you, Dr Murrison. I pay tribute to the hon. Member for Strangford (Jim Shannon) for securing this debate. As colleagues have said, 5,448 drug-related deaths in England and Wales is truly a public health crisis, and we need a response that meets the urgency of that crisis. When the last Labour Government came into power, we were approaching 2,000 drug-related deaths a year, and that was considered serious enough at the time to implement a new national drug strategy, with funding, and to set up a national treatment agency to provide evidence-based treatment. That was at almost 2,000 deaths a year. The effect of that intervention was that drug-related deaths, which had been inexorably rising for a decade or more, levelled out and stopped rising. Thousands of lives were saved and improved.”
“This will clearly be a specialist service. It is a new service. At high levels of NHS England and equivalent bodies, there is significant expertise and practice in commissioning specialised services. The importance of the commencement period, which I hope we will discuss later today, is that engagement around the exact service specification will be drawn up in just the same way that it would be for a new cancer treatment or a treatment for a rare disease. It is right that the time will be taken to engage on that. Fundamentally, services have to be commissioned. Some suggest that this will be a free-for-all, that anyone can provide this service and that anyone can be paid for it, but that idea is nonsense. There is no obligation for the Secretary of State to reimburse anyone who decides they want to provide this service.”
“Friend the Member for Banbury said that the state must oversee and regulate the service, and I entirely agree. Commissioning powers sitting with the Secretary of State will ensure that that is the case. The hon. Member for Richmond Park said that the issue is who is commissioning. Again, we are clear that the only person doing any commissioning will be the Secretary of State, potentially delegating this to NHS structures at the time. The NHS and the Secretary of State are not unused to commissioning highly specialised, sensitive services in this way. Indeed, I would be amazed if the Minister and my hon. Friend the Member for Spen Valley do not confirm that the Government were involved in the drafting of this new clause to ensure that it is equivalent to the other powers that the Secretary of State has.”
“It is a pleasure to serve under you this this morning, Ms McVey. I rise in support of new clause 36, which sets out an entirely workable, appropriate and safe set of provisions for the Secretary of State to ensure that these services are provided across England, as well as appropriate powers for Wales, although I am far from being an expert on those matters. The new clause would convey powers to the Secretary of State to commission services free at the point of use, in a way that is entirely analogous to the commissioning of other health services that are provided, as we know, by a range of providers. I came to this place having been an NHS manager for nearly 20 years, and I feel that the debate has sometimes slightly confused elements of commissioning, provision and the way in which the NHS commissions and manages services. My hon.”
“It is inconsistent for Members to argue that we should maximise continuity of care and have the best safeguards around coercion and capacity by having someone who has known the individual for a long time, while also arguing that the Secretary of State should not be permitted to commission that individual’s GP to play any role. I challenge opponents on that matter.”
“No, it will not, in the same way that G4S does not suddenly appear and provide treatment through a new cancer service that the Secretary of State decides to commission under specialist powers. I am afraid that some opponents of the Bill are trying to scaremonger about potential provision as a way of altering the way people voted on Second Reading. A number of amendments clearly deal with whether potential providers should be public sector, voluntary or, indeed, private organisations. I emphasise that the overwhelming majority of GP services in this country are private contractors.”
“Indeed, clause 8(6)(d) requires that they must not be “a partner or colleague in the same practice or clinical team as the coordinating doctor”, so although some are suggesting, perhaps in a positive sense, that there should be one, entirely separate organisation that does all this, that would not meet those requirements. There are those who are trying to instil a fear of one large organisation being set up to take someone from start to finish, but that is not possible under the Bill as drafted.”
“I hope to help the hon. Gentleman with the points I am about to make. What I would say to begin with is that we have talked throughout this Committee about using an opt-in model. There is this idea that everyone will be doing this, but we have rightly set out requirements for specialised training and so on. There will clearly be individual doctors in the NHS, and so on, who decide that they want to provide these services, and specialisms and appropriate regulation will accordingly be developed as part of that. The other thing I would highlight is that the current drafting explicitly requires a range of provision. The second doctor must be independent.”
“Member for East Wiltshire, there are some hospices and end-of-life providers who have made it known that, if this law passes, they may wish to explore whether they will provide such services. Equally, others will not. This goes back to the conscience debate that we had last week. There will be no obligation, so a hospice in one part of the country may well say, “Yes, we wish to provide this service as an option to our patients,” whereas a hospice in another part of the country might say, “We do not.” We need to get past this metropolitan mindset, whereby ll the providers are within easy travelling distance from each other.”
“No, I do not agree with the hon. Member, and I will tell her why. The reality is that the shape of the health provider landscape is different in different parts of the country. For example, in Wolverhampton, there has been a significant amount of vertical integration, such that in many cases GP services are part of the NHS provider trust. Therefore, those amendments that would prohibit any public body from participating would explicitly prohibit GPs in Wolverhampton from that provision. Elsewhere, some hospices—a small number—are provided directly by the NHS. Given the history of the hospice sector in the UK, there is clearly a strong voluntary and charitable element of that provision, which is entirely right, but that varies in different parts of the country. To return to the point made by the hon.”
“The right hon. Gentleman is entirely right. These powers need to provide for that patient-centric nature, in a service that is explicitly commissioned by the Secretary of State, which will vary in different parts of the country, and not just in the provision landscape. The services provided in rural North Northumberland will, by their nature, probably be different from those provided in London, and that is entirely appropriate.”
“On the other point that some hon. Members have made about regulation, I remind the Committee that any provider will be regulated not only under this Act, but by the Care Quality Commission, in entirely uniform manner. I am therefore confused by the points made by opponents of the Bill. Some have said there should be no provision of this by the NHS or any public body, some say there should be no provision by charities—including, presumably, local hospices, should they make that decision—while others say there should be no provision by local GP practices to provide continuity of care. Perhaps those different points reflect different ideologies within the Committee that are deeper than this issue, but they perhaps also reflect the fact that opponents of the Bill simply do not want this service to be provided at all.”
“The hon. Gentleman is providing a masterclass in scaremongering. I know he needs Labour votes to switch before Third Reading, but this service must be explicitly commissioned by the Secretary of State, and it is inconceivable that they would commission that in the way that the hon. Gentleman describes. The co-ordinating doctor is of course one person, and they would be involved in the first assessment and the provision of assistance. Whether that is a doctor employed by the NHS or somebody else, it can only be one individual, but there are the other safeguards we have talked about, such as the panel, which the hon. Gentleman has spoken against. It is absolutely appropriate that the Secretary of State has the powers and the duty to commission the service, and that they will do so from range of providers, reflecting the differences.”
“Just because he does not wish to have the option for himself, he does not believe that there should be free-at-the-point-of-use provision on the NHS for anyone else. I will take Bevan back to this side of the Committee Room. He said: “The essence of a satisfactory health service is that the rich and the poor are treated alike, that poverty is not a disability and that wealth is not advantaged”. At the moment, at the end of life, wealth clearly is advantaged. Those who are wealthy and are able to go to Switzerland do have choice at the end of life. Dignity and independence and autonomy should not be based on ability to pay. That is why we need to pass this Bill; that is why the powers to commission in new clause 36 are entirely appropriate and necessary; that is why I support it.”
“No, I am going to finish this point. The hon. Member for East Wiltshire did a good job of reading a Bevan quotation before—although I do not advise him to seek Labour party selection with such gravitas in his voice. However, I think he is the heir not to Bevan, but to Bernard Braine, the Member for South East Essex, who said in the 1967 debate on the David Steel abortion Bill: “The idea has been spread around that it will be available on the National Health Service.” In reference to the waiting lists, Braine went on to ask: “Are our consultant gynaecologists going to make that list longer by making beds available to those who want abortions?” —[ Official Report , 13 July 1967; Vol. 750, c. 1382.] That is the tradition of objection that the hon. Member for East Wiltshire is in.”
“Throughout that time, the annual reporting requirement of the commissioner, who will undoubtedly have been appointed in advance, will kick in. I also draw the Committee’s attention to new clause 35, tabled by my hon. Friend the Member for Penistone and Stocksbridge, which speaks to some of the concerns raised by my hon. Friend the Member for Bexleyheath and Crayford. I strongly support the new clause, and the establishment of a disability advisory board to report annually on the effect on disabled people of not just the Act but the implementation. Picking up any concerns or views about its effect on people with disabilities would happen in a timely manner under new clause 35.”
“It is a pleasure to serve under your chairmanship, Sir Roger. I will be brief. I am in favour of retaining the Bill as it stands. The key thing is the interplay between this clause and clause 42, on commencement. I would have been minded to support changes to the reporting period had the Bill been commencing within two years, as clause 42 as drafted sets out, but my hon. Friend the Member for Spen Valley has tabled an amendment that will change the backstop of the commencement period to four years. The timescales set out in this clause are from the day on which the Bill is passed. It makes no sense to carry out a formal review of the operation of the legislation before the services have come into being. We will have a four-year timetable, potentially, for the backstop of the commencement.”
“That is exactly right. For those reasons, I think we need to retain the full five-year review period. As my hon. Friend the Member for Rother Valley outlined, the review of the Act by the Secretary of State will be in addition to the annual reporting from the commissioner and, if we accept new clause 35, in addition to annual reports from the disability advisory board. Clearly, over the course of multiple amendments, we will have strengthened the reporting requirements both in advance of and post implementation.”
“Friend the Member for Bexleyheath and Crayford makes good points around the earlier assessment of palliative care; I do not think that is something that divides the Committee. There have been amendments tabled by many Members over the course of the Committee that have sought to improve and strengthen palliative care as part of a holistic package at the end of life. I wonder if that is something that I could work on with my hon. Friend on Report, even if it is not possible to agree to new clause 28 tonight.”
“I rise to speak in support of new clause 40. Given the implementation period that we are talking about, the repeated and routine reporting to Parliament on progress is essential, especially for those who want to see this Bill implemented safely and properly. Nevertheless, there are people—some of whom have joined us in the Public Gallery in recent weeks—for whom that needs to be done with deliberate speed, but without any compromise on the safety and thoroughness of implementation. New clause 40 achieves that, and I commend it. In a different world there would have been a way of us compositing new clause 28 with new clause 40, and I regret that the two are not compatible. My hon.”
“I understand somewhat where the hon. Member for East Wiltshire is coming from, but as a fundamental matter, people have to be paid for time worked. I feel that an interpretation of his amendment is that people would not be able to be paid for time worked. This is not about performance-related pay, as he suggests in that continuation of his—I suggest—scaremongering theme from before, but about remuneration for time worked. For example, if someone is referred for an additional capacity assessment, it is right that the person doing the assessment is paid for their time worked, not as an incentive, but as a normal payment for time worked. I think that the amendment is poorly drafted and not workable. I will therefore vote no.”
“The hon. Member is making an interesting point, particularly in relation to the commissioning of the service. In the NHS, we generally commission on a block basis and a fee-per-activity basis. I can entirely see that that block basis would be appropriate for this commission, and I am happy to work with him on Report to make that the case. That is not what this amendment says, though. It talks about payment for individual doctors, which gets into the issue of people being fairly paid for their time, which he referenced. I invite him to collaborate on the commissioning arrangements on Report, rather than pressing this amendment.”
“Although I await the Minister’s comments, I do not think it is possible to support new clause 9 in its current form, for the reasons that the hon. Gentleman lays out. We have set out that there will potentially be a small number of doctors providing these services. A GP—not a member of the public—would need to know where to direct their patient. I cannot see how, other than by having some form of electronic directory or email correspondence, it would be possible for such people to become available. I am not able to vote for the new clause at this stage, but I will put it on my notepad of things on which I am keen to work with colleagues on Report, perhaps by learning the lessons from the surrogacy advice and taking advice from Minister.”
“I have great sympathy with the intent behind the amendment, and I would like us to get it into a workable form. The hon. Member for Reigate may wish to confirm this, but there is a similar offence in the Surrogacy Arrangements Act 1985—the advertising of surrogacy arrangements is an offence. The important difference in the Surrogacy Act is that there are some further caveats beyond those in the draft amendment— for example, to ensure that there is not inadvertent creation of offences of the type that the hon. Member for Solihull West and Shirley mentioned. The Surrogacy Act sets out that resulting prosecutions would be carried out only with the approval of the Director of Public Prosecutions, to ensure that such safeguards were in place.”
“Amendment 481 would insert a new subsection (3)(a) into clause 23, which suggests that an employer has the power to veto an employee doing an act on their time. That is moot: it is not necessary. In the healthcare environments in which I have worked, a doctor may practise elsewhere, doing their own thing, but while they are employed in a certain NHS trust to do an NHS service, they cannot suddenly decide to do something else.”
“I reassure Members that I think it entirely appropriate for hospices or other providers of palliative care to consider whether they want to participate, should the Bill become law. I imagine we will get to a situation in which some will and some will not, which is absolutely appropriate. Particularly in end-of-life cases, a patient will make a choice on the back of that. I am aware that some end-of-life care providers in my area are actively considering whether this is something that they will do; I am equally aware that there are others that think it is not for them. We heard in evidence that in Australia some providers of palliative care provide integrated, holistic care in which it is one of a number of options, whereas other providers do not.”
“Healthcare organisations up and down the land now make decisions about what is appropriate for them to deliver, based on skills, expertise and demand and whether they think they are well placed to provide care. I agree with the hon. Member for Reigate, but it does not follow that the amendments are required to enforce that principle. As I understand it, because it is permissible, every organisation and every individual practising healthcare professional will be able to say, “On my own bat, I’m not going to participate in this, regardless of what my employer believes,” not least because of clinical governance and regulation. There is already a strong body of healthcare regulation around the acts and services that are provided. It is currently overseen by the Care Quality Commission. We do not need to reinvent that regime.”
“On organisations providing assistance, I want to reset things with a common-sense approach to how it will work in practice. The hon. Member for Reigate made the point that hospices should be under no obligation as organisations to provide specific services. I agree. The powers set out under clause 32 for the Secretary of State to make arrangements for the provision of these services, which we will come on to debate at some point, will operate as they do elsewhere across the health service. An NHS organisation or another organisation will say, “This is the set of services that we provide as an organisation.” I see nothing in this Bill that will compel them to do anything other than that.”