House of Lords
High Streets Strategy: Business Rates
(1 day, 6 hours ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Pitkeathley of Camden Town
To ask His Majesty’s Government whether they are considering transferring liability for business rates from occupiers to property owners as part of their high streets strategy.
The Parliamentary Secretary, HM Treasury (Lord Pitt-Watson) (Lab)
Local government, property owners and occupiers can work together to improve high streets. I start by recognising that my noble friend has been at the forefront of the business improvement district movement, which the Government are keen to promote. Innovations such as the Camden Collective have provided vital incubation spaces for creative start-ups. However, the evidence suggests that shifting rates liability to landlords would be administratively cumbersome, and may disrupt funding for local services, so the Government are not considering this proposal at this time.
Lord Pitkeathley of Camden Town (Lab)
My Lords, I thank my noble friend the Minister for his reply. Having spent, as he alludes to, 20 years working with high street businesses, I know how much can be achieved when businesses and property owners work together. How will the Government’s high streets strategy encourage a stronger partnership between landlords and their tenants? Beyond the question of business rates liability, what other measures will Ministers consider to give property owners a greater stake in the success of the businesses occupying their properties?
Lord Pitt-Watson (Lab)
There is quite a long list of things to help. In the Budget alone, there is a 20% reduction for pubs and venues, 70,000 shops which will have no rates at all, and other leisure and retail outlets are frozen in real terms. There is the high streets strategy, with £210 million for the community assets programme, £125 million for derelict and vacant properties, and support for the extension of business improvement districts, including property owners outside of London being involved in the business improvement districts—I could go on. It is a broad programme to support the things that my noble friend would like to see happening.
Baroness Kramer (LD)
My Lords, with small and high street businesses under so much pressure, surely this is the time for the fundamental reform of business rates to, I suggest, a commercial landowner levy. I think we are past the point of fiddling at the margins. Do the Government recognise that a change such as this would enable hard-pressed small businesses to compete, to invest in energy improvements and to upgrade, bringing new vitality and jobs to the very heart of our communities?
Lord Pitt-Watson (Lab)
I reply to that in the same way as I did to my noble friend Lord Pitkeathley. The evidence suggests that shifting rates liability to landlords would be administratively quite cumbersome and would make it difficult for the funding of certain local services that want to go to particular types of shops and venues. That is why it is not being considered at this time.
The Earl of Clancarty (CB)
My Lords, following the question asked by the noble Baroness, Lady Kramer, does the Minister agree that, for arts organisations, which are often in a financially precarious position, it is their categorisation for business rates that urgently needs to be looked at? Does he agree with the Campaign for the Arts that regional theatres and cinemas, for example, should not be taxed at the same level as, say, an Amazon warehouse, as this ignores the value that these venues bring to community infrastructure, as much as high street businesses?
Lord Pitt-Watson (Lab)
I understand the point that the noble Earl is making. I cannot give him any assurances right now. The categorisation issues will be complicated ones. However, if there are places where he feels that there are problematic anomalies, perhaps we could talk about that, or he could write to me, and I can see whether we can do anything about it.
Lord Swire (Con)
My Lords, is it not time to accept that our high streets will never look the same again, from a combination of factors including online shopping, terrible car charges for anyone parking for more than a short time and out-of-town shopping centres? Surely the only way that we can regenerate our town centres is by encouraging younger people and families back into them, which, in turn, will engender a night-time economy and lead to a plethora of new businesses and shops. We need to think this from the start and stop fiddling around the edges.
Lord Pitt-Watson (Lab)
This is reflected in the high streets strategy. For example, the hospitality zones within the high streets strategy are making sure that we stop the conflicts that would otherwise arise between residential housing and hospitality in the same place. That is added to the rate reductions that I have talked about. The noble Lord is right that reviving the high streets may mean that there are different sorts of outlets on the high street, and that is very much at the core of the high streets strategy.
Lord Brennan of Canton (Lab)
My Lords, earlier this year, the noble Earl, Lord Clancarty, and I, along with others, went to visit the Minister’s predecessor, my noble friend Lord Livermore, to discuss the possible extension of business rates relief to recording studios in a similar way that has been granted to other cultural and creative industry facilities. Has any further thought been given to this—I noticed that it was not in the Budget this time—and will my noble friend the Minister undertake to look into it and write to those of us who are interested in the subject?
Lord Pitt-Watson (Lab)
I spent quite a lot of time trying to learn about rates, but I did not have a briefing on recording studios. I am more than happy to write to my noble friend. Perhaps he could write to me on the points that he was raising with my noble friend Lord Livermore, and I can then catch up on where that is getting up to, as I do not have an answer for him right now.
Baroness Neville-Rolfe (Con)
My Lords, this Question recognises the parlous state of many high streets, due in large part to taxes of all kinds, including national insurance contributions and business rates, and indeed the impact of the higher minimum wages and increased energy costs and parking charges. Will the Government now see sense and reduce the burden of taxes and regulation that they have imposed? We all care about our high streets.
Lord Pitt-Watson (Lab)
I can only reiterate what was in the Budget: pubs and venues have 20% off, other rates are frozen in real terms and, most specifically, 70,000 high street venues will now no longer be liable for rates. That is a very substantial incentive, I hope, for the rebuilding of high streets, together with the wider high streets strategy.
Lord Cromwell (CB)
The Minister recognises that this is an evolving situation. I am sure he also recognises that many start-ups, which he referred to earlier, start in residential properties. Is he aware that, increasingly, clauses are being inserted into residential tenancies precluding the starting of a business or making the tenant liable for any rates which arise should the business be discovered by the council?
Lord Pitt-Watson (Lab)
I say to the noble Lord that, if there are specific instances where he feels that this is problematic, I would be more than happy to address those and see whether something can be taken forward. Of course, it would be something pretty fundamental, because this is about the agreement between the tenants and the landlord, but we would want such an agreement to be focused on the reviving of our high streets.
Lord Watts (Lab)
My Lords, is it not the case that our city centres and shopping areas have been in decline for over 20 years and the previous Government did nothing about it? This Labour Government have a string of measures to regenerate our towns and cities. Should not the Opposition be ashamed of their past record?
Lord Pitt-Watson (Lab)
The answer is yes, is it not? I have talked about the rates, the £210 million for the community assets programme, and empowering the business improvement districts—did noble Lords know that they raise £185 million in voluntary rates to improve the high streets? That is fantastic. There are also the model designs for high streets, hospitality zones, and putting the high street first when thinking about new public buildings. This is a programme to revive the high street, as my noble friend says, after many years of neglect.
Chelsea FC: Releasing Funds from Sale
(1 day, 6 hours ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness D’Souza
To ask His Majesty’s Government what discussions are being held at Cabinet level about the use of funds resulting from the sale of the Chelsea Football Club to support survivors in Ukraine.
The Parliamentary Secretary, HM Treasury (Lord Pitt-Watson) (Lab)
My Lords, Ministers continue to engage across government on this issue. The Government have provided a clear legal route for the proceeds to be transferred for humanitarian purposes in Ukraine. Our priority is ensuring that they reach Ukraine as soon as possible. The door remains open for Mr Abramovich to act, but the Government are fully prepared to go to court if necessary to enforce the commitment he made when Chelsea Football Club was sold.
Baroness D’Souza (CB)
My Lords, I thank the Minister for his response. Despite what he says, even though the Government promised there would be court action in the event of non-settlement of the issue with Mr Abramovich, that court action has not taken place. I would really like the Minister to answer on that. Furthermore, the fact remains that a considerable amount of money intended to alleviate suffering in Ukraine remains in limbo. There must be other steps that the Government could take to end this four-year impasse between Abramovich and the Government on how the funds might be used. One suggestion might be to facilitate the charitable registration and work of the foundation that was established to manage the funds, which already been granted an initial government licence for distribution of aid in Ukraine.
Lord Pitt-Watson (Lab)
Let me be clear about this. On 17 December last year, the Government issued a licence creating a clear legal route for the transfer of £2.5 billion of Chelsea FC sale proceeds. Those funds have not yet been released. I imagine the noble Baroness is referring to the Foundation for the Victims of Conflict? I see she is nodding. It is for the Charity Commission to review that application. We have written to the application sponsor, Mike Penrose, and are awaiting his reply. If that charity is approved, the Government’s licence is clear that any money from the sale must go to humanitarian purposes in Ukraine. However, noble Lords will understand that because of the legal procedures that might take place, I am limited in what I should say publicly to your Lordships’ House.
Lord Shamash (Lab)
My Lords, I am sorry about my earlier enthusiasm: it was not brilliantly timed. What steps are the Government taking, along with our European partners, to arrange for the release of the £240 billion of frozen Russian assets in European and British banks to fund the Ukraine war effort?
Lord Pitt-Watson (Lab)
The Government’s support for Ukraine now amounts to £25 billion, of which £16 billion is military support. Some £4.3 billion of that was paid this year. The Russian assets remain frozen for the purposes of support to Ukraine.
Lord Bellingham (Con)
My Lords, is the Minister aware that Roman Abramovich has, through his representatives, suggested that against the £2.6 billion there is £1.4 billion in loans from offshore companies? What can he do to stop this money being set against the principal sum?
Lord Pitt-Watson (Lab)
The Government’s position is that Mr Abramovich gave a deed of undertaking when Chelsea was sold that, for the sale to take place, he would meet conditions under European law that the full sale proceeds would go to humanitarian purposes in the Ukraine. That remains the position.
Baroness Kramer (LD)
My Lords, do the Government understand that this legal warfare and paralysis is playing right into Putin’s hands by failing to deliver moneys that should be going to humanitarian causes in Ukraine because of constant delays. I am very concerned that £1.4 billion is not transferred to companies owned by Abramovich that claim they made loans to the entity and therefore have first rights. Can the Minister give us the Government’s assurance on that issue?
This is turning into Jarndyce v Jarndyce. How much is being consumed in legal fees and how much will that deplete the money that goes to the very worthy causes for which it is intended?
Lord Pitt-Watson (Lab)
As I said, the Government have laid out a clear legal route for the transfer of the money and are fully prepared to go to court if necessary to enforce the commitment that was made when Chelsea was sold. But, as the noble Baroness would expect, it would be ill advised for the Government to publicly discuss any potential litigation strategy.
Lord Ricketts (CB)
My Lords, almost three years ago in a report on Ukraine, your Lordships’ European Affairs Committee concluded that we found it incomprehensible that the Government had not yet resolved this problem. That was three years ago. Now, with the winter coming on in Ukraine and signs of European willingness to fund Ukraine faltering, surely if there is a legal route we should now drive down it. Does the Minister agree?
Lord Pitt-Watson (Lab)
We fully agree with that position, but, as I have said, it would be ill advised for the Government to publicly discuss any potential future strategy.
Baroness Neville-Rolfe (Con)
My Lords, more than four years after the sale of Chelsea Football Club, these funds remain frozen, no doubt accruing interest, while the humanitarian need in Ukraine continues to grow, as we have heard. I am keen to know why the delay is so long. Is this partly related to a tax dispute, given the huge increase in value of the club during Mr Abramovich’s tenure?
Lord Pitt-Watson (Lab)
It would be ill advised for the Government publicly to discuss potential future strategies. Possibly, the noble Baroness’s question needs to be addressed to Mr Abramovich. There is a clear legal route that has been presented to him to allow him to fulfil his deed of undertaking.
Lord Foulkes of Cumnock (Lab Co-op)
My Lords, the frozen Russian assets in the UK are well beyond the £2.5 billion of the Abramovich money. Each nation seems to be unwilling to take the initiative to unfreeze the assets, whether here, in Europe, in Canada or elsewhere, because they are worried about the reputation of their financial sector. The Canadians have now suggested an initiative in which they would lead, along with the United Kingdom, and then others would join in, so that all the frozen assets could be unfrozen together. Will the United Kingdom Government join with the Canadians in taking this initiative?
Lord Pitt-Watson (Lab)
The Government are committed to making Russia pay for the damage that it is causing in Ukraine and we will work with all international partners to consider all lawful routes to ensure that Russia does pay and that Ukraine gets the funding it needs. The UK and the wider G7 have absolutely committed to ensuring that Russian sovereign assets remain immobilised across our jurisdictions until Russia ceases its war of aggression and pays for the damage it has caused.
Lord Alton of Liverpool (CB)
My Lords, the Minister has referred to the Treasury licence and to the subsequent deed of undertaking. It would help your Lordships if he would agree to place copies of those in the Library for us to see. On the wider £185 billion of frozen Russian assets held in Belgium by Euroclear, referred to by the noble Lord, Lord Foulkes, a few moments ago, will the Government support the derisking and removal of those funds to a special purpose fund, removing Belgium and Euroclear from the crosshairs and enabling interest of around £5 billion annually to be urgently repurposed into the defence of the people of Ukraine, and indeed the defence of the wider community of Europe as well?
Lord Pitt-Watson (Lab)
I will ask my officials what can be made public in all of this. In terms of where we want to get to, I do not think there is much dispute in this House, but I do not want to be pushed to publicly discuss potential routes forward for making sure that the money that has been promised to Ukraine is given to Ukraine, and for proper purposes.
Capenhurst Facility: High-assay Low-enriched Uranium
(1 day, 6 hours ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Rooker
To ask His Majesty’s Government what progress they have made towards their target to develop High Assay Low Enriched Uranium domestic enrichment capacity at the Capenhurst facility in Cheshire; and how much of the £196 million funding has been spent to date.
The Parliamentary Under-Secretary of State, Department for Energy Security and Net Zero (Baroness Curran) (Lab)
My Lords, a resilient, secure nuclear fuel supply chain for nuclear reactors is essential to deliver energy security and to support any ambitions to grow our nuclear reactor fleet. His Majesty’s Government have committed £300 million to establish a sovereign high-assay low-enriched uranium—HALEU—capability by 2031. Urenco has been awarded £196 million of this £300 million total to deliver a first of a kind HALEU facility, which is co-funded alongside government spending. We have seen great progress to date and the project is well under way.
Lord Rooker (Lab)
I thank my noble friend for that Answer. Does she appreciate the vitality of this new process for new reactors, particularly small modular reactors? The only material available at the moment for that kind of process is from China and Russia. It looks as though the UK, and the USA, have left it a bit late. Can the Government guarantee that Urenco’s work at Capenhurst will slip into the programme for the small modular reactors, so that we can get going? It has been delay, delay, delay, and that has to stop.
Baroness Curran (Lab)
I recognise the importance of that question, and the strength that lies behind it. We very much support that urgency and the need to make sure that it is all about delivery, and recognise the connection to the small modular programme, which is something that we will emphasise. In terms of this programme, we have broken ground, completed design milestones, and are on track for 2031. Funding is being drawn down appropriately on achieving project milestones. I asked specifically how that is monitored and how we push ahead with that programme. There is confidence, and we are assured of that; there is vitality in this programme. We understand its relevance, and that we must provide this as an alternative to Russian supply. It is vital for our security, and I commit to my noble friend that I will attempt to match his enthusiasm and drive to make sure that this happens.
Lord Wigley (PC)
My Lords, will the Minister give an assurance that there are no issues arising in Capenhurst that will be allowed to delay the new SMR programme for the replacement of the Wylfa power station in Anglesey?
Baroness Curran (Lab)
I have been assured that it will not create any delays. I will make sure that I answer the specifics of that and perhaps write to the noble Lord to make sure that I give him that assurance. As I stand here, my understanding is that I can categorically give that assurance.
Earl Russell (LD)
My Lords, we strongly support this programme, and recognise that it is an important part of increasing our resilience and making sure that we are not still dependent on the Russian nuclear fuel cycle. Can the Minister confirm when start-up is likely to happen? How are the Government working with our international partners on these matters, particularly given that America is also a major supplier of this type of fuel?
Baroness Curran (Lab)
We do believe that we are on track for a start-up in 2031, and of course we work with international partners. The UK is working closely with European partners to develop a secure and resilient supply, which will play an important role in also producing medical radioisotopes. We work closely with the G7 to remain close partners in discussions on how we build supply chains free of Russian influence. I am sure noble Lords will be aware that the UK has already implemented a direct ban on Russian uranium, in May 2026. This also restricts UK persons or entities from facilitating Russian uranium supply to third countries. We have a close working partnership with the United States on nuclear policy. I attended the G20 Ministers’ meeting, and in that dimension, there was good co-operation.
Lord Ravensdale (CB)
My Lords, I declare my interest as a chief engineer working for AtkinsRéalis. Within the plutonium stockpile at Sellafield, there is something of a goldmine: £60 billion worth of an isotope called americium. The economic benefit could be much wider than that, because if we can capture the full value chain of this isotope in using it for things such as nuclear batteries and space and defence applications, we could capture even more value in a new industry for the UK. To unlock private capital and private investment, we need clear assurances from the Government and the Nuclear Decommissioning Authority that they support this programme, to allow that investment to proceed. Can the Minister say when the Government will be in a position to provide those assurances?
Baroness Curran (Lab)
I have had a discussion previously with the noble Lord about americium, and I appreciate the briefing that he has given me. The Government have supported the UK’s National Nuclear Laboratory to extract americium from the UK’s civil separated plutonium inventory at Sellafield for the European Space Agency’s ENDURE programme. We recognise the potential importance of americium for other advanced technologies, including space power systems. We are currently working with the Nuclear Decommissioning Authority to explore opportunities for collaboration with industry. I should say to the noble Lord that no decisions have been made at this stage, but discussions are ongoing, and I have a funny feeling that he will ask for those further discussions to include him, which I am happy to do.
Lord Moynihan (Con)
My Lords, I declare my interest as chair of Amey, Acteon and Buckthorn Partners. Urenco at Capenhurst is a successful project, as the Minister said, funded by the UK and Dutch Governments and two private German firms, and it aims to become the West’s first commercial HALEU plant. Will the Government now take steps to encourage the development of a domestic fuel supply chain, including decompression and fuel fabrication, to capture the significant value of this emerging market? Does this success story not prove that we do not need to acquiesce to EU rules and call on taxpayers to fund expensive EU electricity projects to have a productive working relationship with the continent in the pursuit of low-cost energy?
Baroness Curran (Lab)
I thank the noble Lord for that question—he never fails to surprise me with some of the questions that he asks. I can commit to the domestic supply chain. It is important because, as I have said before from the Dispatch Box, we want to get a double hit out of our investment: not only is it about creating that supply chain, it is about the benefits that come with the supply chain and the skills and the jobs that that will mean for Britain. I guarantee to the noble Lord that that is a vital part of this programme. It is a success story for Britain that we should be proud of and that we should focus on. On his wider point about Europe, I am always willing to work with European partners and support the electricity market of Great Britain, and will continue to do so.
Lord Spellar (Lab)
My Lords, speaking of the supply chain, I want to reference the role of Sheffield Forgemasters, which was taken over by the Government with considerable extra investment, and yet when it comes to the small modular reactors we seem to be outsourcing a lot of the forging work to the Czech Republic and South Korea.
Baroness Curran (Lab)
I do not have direct details on that specific project so I will write to the noble Lord and make sure that I can address those issues. As he will know, the Government’s SMR programme is backed by £2.6 billion across the spending review period and will create 3,000 skilled jobs onsite during peak construction and thousands more across the supply chain. The Government’s ambition is for 70% of SMR supply chain products to be British built, which is shown by over 70% of our £900 million invested into supply chain contracts going into UK-registered companies. As I say, I want this investment to work twice, once in supporting our energy security mission and once for British jobs and British business.
Lord Morse (CB)
My Lords, after that encouraging statement, I ask the Minister whether we are giving the same level of energy to capturing all the intellectual property associated with this project that we possibly can, because in the past we have often failed to do that.
Baroness Curran (Lab)
To be absolutely honest, I cannot give a guarantee about that because it is not in my briefing and I have not asked for it. I will do that and I will be encouraged to pursue that issue, given that that has been a failure in the past. I will pay great attention to that and speak to the relevant officials.
Lord Rooker (Lab)
In the last three seconds of this Question, I thank my noble friend for the positive answers that she has given. But can she convince the House that, as far as civil nuclear power in this country is concerned, there is one overall policy and not a series of silos? That is what it looks like.
Baroness Curran (Lab)
I congratulate my noble friend on getting in in the last three seconds there. I recognise what he has said, and that is certainly not our intention. There is now much greater coherence to our civil nuclear policy. That is something that we want to argue for and proselytise about. Particularly as I am Scottish and live in Scotland, I see that some other Governments do not understand the importance of this industry, but that is something that I will certainly be advocating, as will my colleagues across the ministerial offices. We will make the point, if it is not clear to people, that there is coherence behind this. We see it as an answer to energy security and clean energy, so we need to address that. Noble Lords should believe me that the commitment is there.
Drugs: Prohibition and Criminalisation
(1 day, 6 hours ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Jones of Moulsecoomb
To ask His Majesty’s Government, in light of the rise in deaths linked to cocaine, ketamine and synthetic cannabinoid use, what plans they have to review their policy on drug prohibition and the criminalisation of people who use drugs.
The Minister of State, Home Office (Lord Hanson of Flint) (Lab)
My Lords, drug misuse deaths in 2025 were down on those registered in the previous year. Every drug-related death, however, remains a tragedy. Drug deaths are best prevented by a combination of actions, including tackling drug supply, effective treatment and recovery support, clear societal messaging about the harms that drugs do, and a robust legislative framework to deter possession and supply.
Baroness Jones of Moulsecoomb (GP)
My Lords, I thank the noble Lord for his Answer, but I did not hear anything new in there. Until the Government do have better drug policies, knowing the number of deaths from illegal drugs is incredibly important. To do that, you need to triangulate with health data, and you need to establish whether serious violence or suicide has taken place, especially for women. What measures might the Government take to make sure that their recording of deaths is actually accurate?
Lord Hanson of Flint (Lab)
The noble Baroness raises an important point, and I hope I can assure her that the Government take that seriously. We have asked the Advisory Council on the Misuse of Drugs to look at writing four reports for us, particularly focused on women and girls. That will include the role of drugs in domestic abuse and in wider violence against women and girls. We have also set up a working group to review matters concerning the very issue she raises, which is the recording of drug-related deaths and how they are defined across all parts of the United Kingdom.
Baroness Smith of Llanfaes (PC)
My Lords, drug poisoning accounts for 37% of deaths among prison leavers in Wales. Will the Government review whether current drug criminalisation policies are helping or hindering efforts to reduce post-release overdose deaths?
Lord Hanson of Flint (Lab)
I will obviously reflect on what the noble Baroness has said, and we are always looking at what we need to do on drugs generally. This year, in fact, we have introduced a number of orders in this House which have put controls on certain drugs. Along with colleagues in the Ministry of Justice, we will look at the impact of drugs in prison, but overall, as I said to the noble Baroness, Lady Jones, drug deaths are down. That is a trend we want to continue to encourage, and one I will be working towards as Minister.
Baroness Doocey (LD)
My Lords, the director-general of the National Crime Agency has described how criminals are chemically bonding cocaine in everyday materials such as plastic and glue to evade detection. Given that the Government’s number one priority is to reduce the harm that drug does, does the Minister feel we have the right balance in the use of resources between pursuing people who have drugs for their own personal use and dismantling the ever-more sophisticated drug networks that are actually supplying the drugs?
Lord Hanson of Flint (Lab)
We have to take on the organised criminals who are supplying the drugs. In 2025-26, the National Crime Agency seized 189 tonnes of class A drugs. The quantity of illicit drugs seized at the border in 2024-25 was the largest, at 148 tonnes, recorded since 1973. So there are efforts to stop organised crime, but obviously, drug barons are looking at a whole range of methods, and the areas the noble Baroness has mentioned are extremely important. We need to keep on top of that, and that is why we have also put in some £3.4 billion over the next three years on drug and alcohol treatment as a whole, to ensure that we look at who the users of drugs are and how we can help support them.
Lord Pickles (Con)
My Lords, so far nobody has mentioned those who die as a result of drug use, particularly in road traffic accidents, but who themselves have never taken drugs in their lives. One of the great successes of the last 30 years has been the reduction in the number of people who die on the roads as a result of alcohol use. By the end of this decade, the number who die on the roads because of illicit drug use is likely to exceed the number who die because of alcohol use. There is variation from force to force in terms of the equipment used and the practices, so will the noble Lord consider getting police authorities together and getting best practice established, so that we can start to push down on drug use on the roads, as we have pushed down on drink?
Lord Hanson of Flint (Lab)
The noble Lord raises an extremely important point. He will know that some seven or eight years ago, we passed legislation in both Houses—I was then the shadow Minister in the House of Commons—on drug testing for driving, particularly for cocaine. He raises the issues of enforcement and good practice; I will take them back and reflect on them and, if I have any further information, I can reply to him. He needs to know that legislation on a cross-party basis has been passed, it will be enforced, and it is extremely important that we stop people who are under the influence of drugs driving vehicles.
Baroness Chapman of Darlington (Lab)
Will my noble friend the Minister please update the House on something we worked together on many years ago: specialist drug courts and the role they may have in reducing reoffending, particularly for people whose offending is related to their drug misuse?
Lord Hanson of Flint (Lab)
I am grateful for my noble friend’s question. The use of drug courts, and judges having ownership of individuals who go through those courts and of the treatment those individuals get, is extremely important. That is a matter for the Ministry of Justice, but it is certainly something we are encouraging. We have put in place, as we did during previous Labour Governments up to 2010, significant numbers of drug treatment orders, which focus on helping people get off drugs in the first place.
Lord Paddick (Non-Afl)
My Lords, when cannabis was reclassified from class C to class B, there was no noticeable reduction in cannabis use. But when excessive use of genetically modified cannabis was publicised as being linked to schizophrenia, the use of cannabis then reduced. Does that not say to the Government that they should be spending more on drugs education?
Lord Hanson of Flint (Lab)
It is extremely important that we send messages out throughout the whole of the age range that using drugs has potential difficulties and can cause death. It is important that we do that in schools and raise education for those involved in drug use. Going back to the noble Baroness’s question earlier, it is important that we do that when people are in prison as well, to help them leave prison in a way which improves their behaviour and gives them a better chance in life outside. Those are important issues and not ones the Government will shirk.
Lord Bailey of Paddington (Con)
My Lords, given that street-level drug dealing is one of the greatest harms perpetrated on communities across this country, what extra work could the police be doing to stop this activity, which is often dealt with as low-level crime but has a real ripple effect on the community suffering from it?
Lord Hanson of Flint (Lab)
I have to say that I agree with the noble Lord that it is not low-level crime. The front-end of drugs being dealt on the street has an upstream effect on criminal gangs who are importing drugs and doing things which cause death and harm and lack of social cohesion. One of the things we are doing is ensuring that we have better enforcement. We are putting some 10,000 extra police officers on the beat during the course of this Parliament to look at neighbourhood policing. Neighbourhood policing leads to local policing and intelligence, and I would hope it will lead to better community involvement in reducing drug use on the streets.
Lord Brooke of Alverthorpe (Lab)
My Lords, I support the Government’s whole system, but I urge the Minister to ensure that we use more resources to stem the amount of drugs now being sold online, particularly ketamine, which is being sold so cheaply. This needs to be looked at very seriously, and we need to cut back on the availability of drugs online.
Lord Hanson of Flint (Lab)
It is an important point and again, there is a whole range of mechanisms, via Ofcom, through which we can take down adverts and businesses that are involved in crime and antisocial behaviour online. My noble friend mentions ketamine, and I have to say to the House that the level of ketamine-related deaths is increasing significantly. There are always challenges, and my noble friend points to one on which we need to take sophisticated action online and offline to reduce usage and therefore help reduce the number of deaths.
Lord Davies of Gower (Con)
My Lords, does the Minister agree that, while some people seem preoccupied with talking about reparations for historic slavery, the drugs trade causes untold human misery and is one of the premier causes of slavery at all levels in the world today?
Lord Hanson of Flint (Lab)
The drugs trade is an evil trade; that is why the Government are committed to investing to ensure that we can reduce it. The 148 tonnes of illicit drugs seized at the border is the largest quantity seized since 1973. The drug barons need to know that the criminal justice agencies, the National Crime Agency and all local police forces will be after them to ensure that we hold them to account for this evil trade. I welcome the noble Lord’s support in doing that.
Railways Bill
(1 day, 6 hours ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Hendy of Richmond Hill
That the amendments for the Report stage be marshalled and considered in the following order: Clauses 1 to 11, Schedule 1, Clause 12, Schedule 2, Clauses 13 to 92, Schedule 3, Clauses 93 to 97, Schedule 4, Clauses 98 to 103, Title.
Terrorism Prevention and Investigation Measures Act 2011 (Continuation) Order 2026
(1 day, 6 hours ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Hanson of Flint
That the draft Order laid before the House on 14 September be approved.
Relevant document: 13th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 10 November.
Tobacco and Vapes Act 2026 (Display of Tobacco Products) (Consequential Amendments) Regulations 2026
(1 day, 6 hours ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Merron
That the draft Regulations laid before the House on 14 September be approved.
Relevant document:13th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 10 November.
Financial Services and Markets Act 2000 (Cryptoassets) (Miscellaneous Amendments) Regulations 2026
(1 day, 6 hours ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Pitt-Watson
That the draft Regulations laid before the House on 15 September and 12 October be approved.
Considered in Grand Committee on 10 November.
International Claims Commission for Ukraine (Immunities and Privileges) Order 2026
(1 day, 6 hours ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Antrobus
That the draft Order laid before the House on 14 September be approved.
Considered in Grand Committee on 10 November.
Youth Justice Board for England and Wales (Restoration of Powers and Responsibilities) Bill [HL]
Lord Oates (LD)
My Lords, I understand that no amendments have been set down to this Bill and that no noble Lord has indicated a wish to move a manuscript amendment or to speak in Committee. Unless, therefore, any noble Lord objects, I beg to move that the order of commitment be discharged.
Health Bill
(1 day, 6 hours ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Coffey
“Support for helping people stay and get back into workIn the National Health Service Act 2006, after section 1C insert—“1CA Duty to support people to stay and get back into workIn exercising functions in relation to the health service, the Secretary of State must have regard to the need to offer workplace health provision support to—(a) small and medium sized employers, and(b) institutions and providers within the National Health Service, considering the need to support the workforce of—(i) small and medium sized employers, and(ii) the National Health Servicein order to tackle ill health and reduce work days lost to sickness.””
Baroness Coffey (Con)
My Lords, this amendment should be pretty topical because, according to the Government, the country is facing a NEET crisis. A lot of this is driven by people with poor mental health or a lack of mental well-being. In my time as a Cabinet Minister, looking after DWP and, for a short time, health, I long felt that if the NHS had to pay for the health benefits, a lot more attention would be given to getting people better, getting people well and recognising that it should be a duty of the Secretary of State for Health and Social Care to do what they can to help people get better.
In this probing amendment, the duty is about support to help people stay in and get back into work. I have gone into particular detail about occupational therapy or occupational health—whatever the latest term is. Apparently, nowadays it can be seen as bad to use the phrase “occupational health”, because employees may feel that this is their way to being fired. That is not the intention of good occupational health, and nor is it the outcome desired with occupational therapy.
I know that small employers struggle, and it is going to get more challenging. I think there is a duty on the NHS, and the Secretary of State—by effectively taking over all the functions of the NHS—will have an absolutely key role to play. Amid all the other duties and functions they are taking on, this one should really be at the top of their agenda.
There is no special reason why all of a sudden there is this NEET crisis. When I was Secretary of State, I had the lowest-ever youth unemployment figures, both seasonally adjusted and actual, in terms of people claiming benefits and people economically not working, so I know this can be done. It takes a lot of drive and effort. During Covid we were also helped with aspects such as getting the kick-start Bill going. By the way, I commend the current Secretary of State on managing to persuade the Treasury on the latest scheme to not have additionality as something that has to be proved. I appreciate that may not always economically be right, but sometimes the bureaucracy, as I explained to the Covid inquiry, meant that very good jobs were being set aside because of a lack of clarity or a lack of understanding.
This builds a lot on what Sir Charlie Mayfield has been doing for the Government; I appreciated the recent briefing organised by the Employment Minister, Andrew Western, at which Sir Charlie spoke. It is about how we help employers in particular to make sure that it is more straightforward for people to stay in work. As we know, it is not just about getting people back into work; it is about helping them stay in work and, once they come back in, trying to make sure that they succeed. Today is not the day to get into the whole PIP discussion—it is about how health can support this.
I have long believed—and there is no particularly easy way of saying this—that actually prescribing a job could be one of the nicest things that a doctor would ever do to somebody who is unwell in one aspect or another. As we saw in jobcentres, a lot of young people are lonely and not confident, and that spirals into a different way of doing things. Quite often, work coaches would end up being like the big brother, big sister or auntie who encourages people to stop looking at their feet and look at them, and to re-engage. That is what we are seeing in quite a lot of the challenges we have. Meanwhile—and I have some sympathy with this—healthcare professionals are saying, “We don’t want to be the gateway to benefits”. Nobody is asking them particularly for that to be their principal role; what I am sure everybody would like is a healthy society and particularly a healthy young population—but there is no doubt that small and medium-sized employers need some help on how to make that happen.
Lord Singh of Solihull (Con)
My Lords, it is a great pleasure to follow the noble Baroness, Lady Coffey, and I thank her for Amendment 48. Small employers rarely have access to occupational health and the NHS, our largest employer, loses far too many working days to sickness. Her amendment is about helping people stay in work; mine is about helping young people to get there, often for the first time. I am glad that our amendments are grouped together, because they rest on the same principle. Health and work are not competing concerns but integral parts in a single life.
I speak to Amendment 279QF in my name and refer the Committee to my interests on the register. I am an NHS consultant psychiatrist, and for the last 25 years I have devoted my life to delivering early intervention in psychosis, nationally and internationally. My amendment asks the Government to commission an independent review of the therapeutic role of work in recovery from mental illness for young people. For far too long, we have treated work as an economic question, and almost never as a clinical one.
Let me begin with a paradox. When in life we are at our most physically robust, during late adolescence and early adulthood, we are at our most vulnerable psychologically. Half of all adult mental disorders begin around the age of 14 or earlier; 75% begin before the age of 25. Therefore, mental illnesses arrive just when a life is being built: exams are being sat, jobs found, relations formed and independence discovered.
Among the many serious illnesses, the most serious are psychotic disorders such as schizophrenia. They fracture your thinking, break your networks, scatter friendships and delay your education. When I began training, our approach to psychosis was gentle management of inevitable decline. However, I vividly remember a young man I met on a psychiatric round, very early in my training. We fell into a conversation. Rather randomly, he asked me whether life was worth living, almost as if it was a joke. I said, “Life is what we make of it. We can think of each day as a blank page in a diary and, within reason, we can choose what we write on it”. We parted company and I forgot all about him. Three years later, I received a letter from him. It said that he had been diagnosed with schizophrenia while a patient in that hospital. He had been told by a doctor that he would never recover. He was considering suicide. That accidental encounter with me changed his mind. He was now at university, fully well and looking forward to a future. If a few words from a stranger can provide such comfort to someone in such deep anguish, imagine what hope engendered by trained clinicians can do for those who suffer.
Early intervention in psychosis has completely changed our view of it, from pessimism about inevitable decline to optimism about intervening early. We now know that early intervention works. The earlier we intervene, the better the outcomes. England now has the best early intervention services in the world. Most young people with early psychosis now reach remission from their symptoms, but recovery is more than absence of symptoms. Your voices may have gone but you still do not have a job. You are staying in your bedroom. You have no friends and are socially isolated. You have nothing to look forward to. The young man who is no longer hearing voices has not recovered; he is simply not acutely ill any more.
This is where IPS—individual placement and support—comes in. This is an approach to vocational rehabilitation. Traditional approaches were “train, then place”. IPS says, “Place and then train”. It helps a young person quickly to find a job that is of interest and to their preference, and then supports them, along with their employer, to stay in employment. As my noble friend Lady Coffey said, employers need support for that as well. IPS does not wait for full recovery. Nobody is turned away because they still have symptoms. You may still be hearing voices or be slightly low or anxious. Added to early intervention, IPS increases employment rates from around three in 10 to around six in 10. In a randomised trial with colleagues, we went one step further; it was published in the British Journal of Psychiatry. We randomised teams into those where clinicians were given some training, along with IPS in both teams. Among the clinicians, we tackled their ambivalence about young people returning to work. Employment rates in those teams more than doubled, from 18% to 43%.
We found that the obstacle was not the illness as much as people’s ambivalence about young people with mental illness returning to work. Clinicians had told us, “Work would be stressful and would trigger a relapse” or “This young person does not have the confidence to go to work”. These fears were well intentioned but completely wrong. As I said in my maiden speech, diagnosis should never be a prophecy.
Work is not incompatible with recovery; it is an essential part of it. There is robust evidence of the benefits of work. Those who work less have poor mental health, and those who return to work see their mental health improving. Work gives a day shape, and it gives an individual an identity and a role in society. It also builds self-esteem. We assume that confidence must come before achievement, but it is the other way around. Self-esteem is not a precondition for achievement; it comes from achieving and from facing adversity—getting back to work despite having to struggle. If young people with psychosis can return to work, and work is healing, then we should be offering similar opportunities to a much larger group of young people who are suffering from depression, anxiety or neurodevelopmental conditions such as autism and ADHD. Trials of IPS in young adults with a range of mental illnesses show that it can be effective.
Let me be clear: this is not an argument about cutting benefits or using work as a stick. A young person pushed into work that they cannot yet manage may fail, and that failure will only confirm the prophecy we are trying to break. But offered with skill and at the right time, work is therapeutic. The economic case is compelling, but the case I make for this review is also clinical, moral and humane. I hope the Minister can tell the Committee whether the Government will commission such a review within 12 months, and whether she will meet the noble Baroness and me to discuss how both our amendments can find their place in the Bill. Thanks to early intervention, we no longer think of a 16 year-old with emerging psychosis as facing inevitable decline. For young people recovering from psychosis, a job is not a reward for getting well. Very often, it is part of how they get well.
Baroness Hollins (CB)
My Lords, I support both amendments in this group. The amendment tabled by the noble Baroness, Lady Coffey, draws attention to the responsibility of the NHS not only to treat illness but to help people remain healthy enough to work, and to return to work.
As a psychiatrist, I am especially concerned about the growing impact of work-related stress, anxiety and depression, and the figures are deeply troubling. A recent Policy Exchange report estimated that sickness absence in the NHS represents the equivalent of more than 80,000 employees being absent throughout the year—enough to staff 80 hospitals—at an annual cost of some £4.6 billion. In June 2025, anxiety, stress, depression and other psychiatric illnesses accounted for almost 30% of NHS sickness absences. Behind these statistics are people whose health and confidence have been damaged, colleagues struggling to cover their work and patients waiting longer for treatment. When one clinician goes off sick with burnout, colleagues must take on additional clinics. Their workloads increase, their own well-being suffers and the risk of further sickness absence grows. This is a vicious cycle. It cannot be resolved simply by encouraging people to return to work more quickly. We must ask what made them ill in the first place.
There is also a more disturbing dimension. Suicide among healthcare professionals is a serious concern, particularly in some clinical occupations. Data from the Office for National Statistics in the 10 years up to 2020 showed that there were an average of four deaths of healthcare workers by suicide every week. While we need to be cautious about interpreting occupational suicide statistics, we cannot ignore the distress experienced by staff working under sustained pressure. The NHS has a duty of care to its workforce, just as it has to its patients. Occupational health needs to be about much more than assessing fitness to work; it needs to include early psychological support, effective supervision, manageable workloads and so on. Small employers need access to similar expertise, which many cannot afford to provide independently. I hope the Government will consider how NHS occupational health services, working with other providers, might help develop accessible support for smaller businesses without diverting resources from patient care.
The therapeutic value of good work depends on the work itself being healthy. If we want the NHS to help people remain in employment, it must demonstrate what it means to be a good employer. I added my name to the amendment by the noble Lord, Lord Singh, calling for a review of
“the therapeutic role of work in health and recovery”.
Good work can give us a reason to get up in the morning. It can provide structure, purpose, friendship and the satisfaction of knowing that our contribution matters and that we have something worthwhile to give. As a psychiatrist, psychotherapist and family carer, I believe that these ordinary human experiences deserve much more attention in our discussions about mental ill-health prevention and recovery.
Baroness Bennett of Manor Castle (GP)
My Lords, I will speak very briefly to these two amendments. It is a great pleasure to follow the noble Baroness, Lady Hollins, who made some of the points that I intended to make. We really need to give people the chance to meaningfully participate and to be part of society. Good work may be one route to that, but it may not be suitable or available to everybody.
The noble Baroness said that there is a great deal of not-good work out there, and I will point to some figures that recently came out on the loss of autonomy across the entire workplace. In 1992, 62% of people said that they had a great deal of discretion over the task they conducted and how they organised their working day. In 2024, that figure was 34%—it very nearly halved. People are not getting a sense of agency and autonomy in their workplace. That is without me getting into, as the noble Baroness did, the issues of zero-hours contracts, inadequate wages, unpaid overtime, et cetera.
Having said that, Amendment 279QF has some very good elements. I particularly applaud proposed new subsection (3)(a), which states that
“the Secretary of State must consult … young people with lived experience of mental health conditions and of being out of education, employment or training, and their families and carers”—
nothing about us without us. It is crucial that it is there, but I respectfully suggest to the noble Lord, Lord Singh, that perhaps this would be better as a “good work and meaningful participation in society” amendment or something along those lines.
I am afraid that I respectfully disagree with Amendment 48 from the noble Baroness, Lady Coffey. I will be interested to hear what the Minister says about it. A basic principle of the NHS from the very start has been that healthcare is provided on the basis of need. Giving the Secretary of State a special duty to help get people back into work would take away from that basic fundamental principle. Not making it on the basis of need and seeking to use the NHS to serve the economy would be a disturbing change in principle that needs to be highlighted and questioned.
In introducing the amendment, the noble Baroness talked about prescribing a job. That terminology would be really frightening to many people. I have met people with serious mental health conditions—we know there are significant numbers of them, including people in the NEET category—who are not applying for benefits, stepping away from the system and not getting help because it is really frightening to them. We absolutely do not want them doing that with the health service. If the health service were seen as a place of fear or compulsion then that would be dangerous to their future health and well-being and, indeed, the future health and well-being of society.
Lord Mawson (CB)
My Lords, I welcome these two amendments because they encourage us to debate a very important matter—employment. I have said before that the GPs I work with would remind us that, in the very challenging communities in which they work, getting a job does more for people’s health than anything they can do as doctors. We have done lots of work in this space over the years in east London and we are now replicating that practice around the country. It is why people like me are encouraging the health service and the public sector to learn from science and business that you innovate and learn only by doing things, not by writing clever reports or academic documents at 60,000 feet. You actually have to engage.
For example, to pick up the point from the noble Baroness, Lady Bennett, we have been running for over 15 years, with Investec, a jobs and small business programme in east London. It has been enormously successful. We have built 97 businesses, or local people have, many of them with health, mental health and other complicated conditions. When you get into the granularity of all that and you watch people’s lives, you watch what happens to their children and their family when they get a job and how things actually change, it is an extraordinary thing, that journey. It is a journey, I feel, and that is why I have been challenging the direction of travel of this legislation and this Government, because I fear we are missing a serious opportunity. If it is true what Michael Marmot and some of us saying—we come to very similar numbers that 70% to 80% of the determinants of health are social and nothing to do with doctors—then we enter this space, which is really important.
I declare my interest: I am working on a 30-acre site in Surrey at the moment, with a school that has been in very difficult circumstances. In the middle of that, there is an old primary healthcare building stuck there, disconnected from the school. There is a college behind a fence over there, which is doing what the head teacher would describe as babysitting children. Is this really about employment or is it ticking boxes? You have a large piece of land where you could bring health, education and housing together in a very interesting environment. We are looking at that opportunity. There is a real opportunity there to build what this Government call a neighbourhood health centre.
I am into all that, but neighbourhood health centres in the modern world cannot be just about bringing biomedical people together in a building—a biomedical box. That is not taking seriously what this conversation is about. We need to build multidisciplinary teams. We got into employment, health and wealth seriously over the years. We have even done projects with eight year-olds on developing their business plan. It is really interesting what happens when you do that with children. It would be interesting to have the Minister’s response on this. There is an opportunity, with neighbourhood health centres, to innovate, do something seriously and pick up the strands of this discussion.
I suggest that the way we get beyond the concerns from the noble Baroness, Lady Bennett, is to create practical learning by doing cultures on the ground, because all that theoretical stuff then falls away as irrelevant. You get into people with names and addresses, you watch what happens as you bring business, entrepreneurs, health practitioners and teachers together on the ground, and you start to build multidisciplinary teams. Innovation and something rather different happens. It absolutely relates to what the noble Lord, Lord Singh, said. I have been involved, as has he, in mental health, because mental health is a really big issue in these communities. You begin to get into the detail of that and beyond the theory into practice. When you watch a young person or an adult move away from many years of dependency and drug use—much of that drug use, by the way, at great expense from the NHS—you watch them take on life and see what happens to their children and family, my goodness it is a great inspiration. My view is that that is what these neighbourhood health centres should be about is multidisciplinary teams, learning by doing and getting into the granularity of what this discussion is about.
Lord Kamall (Con)
My Lords, I am grateful to my noble friends Lady Coffey and Lord Singh of Solihull for their amendments, and, in fact, to all noble Lords who spoke. We know that ill health is an issue not only for individuals, families and the community. At the macro level, it is a principal driver of economic inactivity, with millions of people of working age not working because of long-term sickness. Recently, my noble friend Lord Howe and I met with a GP who wanted to share his experience. He said that he was told that 93% of all notes that GPs sign are sick notes, so only 7% were to return them to work. His suggestion was that maybe the GPs in those situations should be asking for a second opinion, because there is a clear imbalance going on.
For many, work provides more than an income. It offers independence, purpose, structure and social connection, and losing that connection due to ill health has wider consequences, as the noble Baroness, Lady Hollins, and the noble Lord, Lord Mawson, said. Both my noble friends said that we should think of employment not simply as a matter for the Department for Work and Pensions but as part of someone’s well-being. That was very well illustrated by the real-world example that my noble friend Lord Singh of Solihull gave from his experience as a psychiatrist.
Baroness in Waiting/Government Whip (Baroness Hyde of Bemerton) (Lab)
My Lords, I thank the noble Lord for that warm welcome.
With permission, I will address Amendments 48 and 279QF together, which look at the very important relationship between health and work. I agree with the point made by the noble Lords, Lord Mawson and Lord Singh, and the noble Baronesses, Lady Hollins, Lady Bennett and Lady Coffey—possibly all noble Lords who have contributed today—that good work, and I say that advisedly, is good for health, which is why we are already taking action to address the relationship between work and health. I agree with the noble Lord, Lord Singh, that work and health are not competing interests. I agree with the noble Lord, Lord Kamall, that the responsibility for good health does not sit just within the DHSC.
We already have programmes that bring together health and employment support around the individual, including health and growth accelerators. We are already acting at scale. This month, WorkWell began its national rollout across every ICB in England, building on pilots that have already supported around 25,000 people. Backed by up to £259 million over three years, the expanded service could support up to 250,000 people with health conditions to stay in work—this goes to the point made by the noble Baroness, Lady Coffey—or return to work. The 10-year health plan is clear on the critical role that the health system has, alongside local partners, in addressing health-related economic inactivity, especially through prevention and early intervention, which the noble Lord, Lord Singh raised.
Sir Charlie Mayfield’s independent Keep Britain Working review, published a year ago, highlighted the scale of the problem of people falling out of work for reasons of ill health and disability, including mental health conditions, and the vital role employers can play in addressing this. Further, the Government are already taking forward the development of a better model of workplace health provision through the Keep Britain Working programme. This system is intended to improve access to support for employers of all sizes, including the small and medium-sized enterprises referred to by the noble Baroness, Lady Coffey, and will be supported by a robust, recognised BSI employer standard. We are testing reforms to the fit note process so that the system works much better for patients, employers and GPs. These are aimed at moving from administrative sickness certification to a service focused on getting people the support they need to stay in work or return sustainably.
Finally, we have commissioned the recent Fonagy review and the forthcoming independent Milburn review, given the importance that the Government place on the relationship between work and health. Alongside this, given that several noble Lords mentioned young people, the Government are investing £2.5 billion by 2029 into the youth guarantee and the growth and skills levy. This investment will support young people and create up to 500,000 opportunities to learn and earn.
We do not believe that additional statutory duties or reviews are the right approach here. We are happy to offer the noble Lord, Lord Singh, the noble Baronesses, Lady Coffey and Lady Hollins, and other contributors today a meeting with the officials working on the Keep Britain Working thread. The Government are already taking significant action in the health and work space, and I hope that noble Lords are reassured that the Government recognise the importance of this issue.
Lord Mawson (CB)
My Lords, this all sounds fine in theory, but people like me are nosy—we go and have a look under the carpet at what is happening, in detail, in the machinery. Often, this machinery means well but the structures and siloed systems prevent the kinds of relationships that need to happen in the modern world.
I will illustrate this. From 2015, for many years I led the Well North programme for Duncan Selbie, which has now evolved into a national programme. It is interesting to talk to the Well Doncaster programme, which the noble Baroness, Lady Armstrong, will be pleased to hear now has 34 staff and operates across Doncaster —it is a fantastic success story and some great things are happening there. But I was talking to one of our lead colleagues there just a few weeks ago, who was saying that, in Doncaster, the Pride in Place programme is completely disconnected from this programme. I am sharing this with the Minister because there is a desperate need to get under the carpet of these practical issues, otherwise we will say all these wonderful things but—I say this from experience—very little will change.
Baroness Hyde of Bemerton (Lab)
I thank the noble Lord for those points. I recall that I did not answer substantively his point on neighbourhood health, and the further point he has raised cuts to the heart of that. I am very optimistic, as a former lead member in a local authority and now a Minister in this place, about the opportunity of neighbourhood health. It is a great moment to get away from the model of a clinical box and viewpoint and work holistically across a wide range of services. Let us continue to look under that bonnet together, because we are driving at the same aim here: improved health for all our communities, outside the silo of DHSE.
Baroness Coffey (Con)
My Lords, I am grateful to my noble friend Lord Singh of Solihull for his amendment and for the other contributions made. I respect the noble Baroness, Lady Bennett of Manor Castle, but—it will probably be the same the other way around—I do not agree with what she has asserted today. I think work is a good thing.
I am grateful to the Minister for her reply. As I expected, sadly, the Health Minister did not contribute in this debate, which somewhat sums up the situation we have within government. It is my understanding that the noble Baroness, Lady Hyde of Bemerton, is a Government Whip—I did not know that she had a policy role in the Department of Health and Social Care.
Lord Hunt of Kings Heath (Lab)
The noble Baroness is being extremely discourteous. It is the tradition in this House that, when a Bill is going through, duties of the Government Benches are shared by Ministers and Whips, and my noble friend is doing it very well.
Baroness Coffey (Con)
I am not disputing that the noble Baroness spoke very well. I am just saying what I feel it shows about this key issue. Sir Charlie Mayfield’s review is nothing new; it is great that he agreed to do it and has the clout, but it is no different from reports that came out in the last year. It is great that Alan Milburn is engaged—I hope he will bash heads together to get something really powerful done, and he has the clout to do that. I am flagging that, sadly, the Department of Health and Social Care and the NHS more broadly tend to not really get engaged. I thank the noble Baroness, Lady Hollins, for her contribution in that regard.
The NHS has a challenging time ahead with its own employees, and so does business. That is why working together will be absolutely vital.
Finally, noble Lords have talked about friendships. There is a workforce survey used by the best companies in the world: Gallup’s Q12. The most important question is question 10: “Do you have a best friend at work?” Initially, that can be quite a difficult thing to get through. Here we are on Armistice Day; people who serve their country often do so because they have their friends and comrades and the camaraderie. That matters at work too. That is why, building on what my noble friend Lord Singh of Solihull said, we need to look at this carefully. I hope the Department of Health gets far more engaged than simply the DWP programmes we have heard about today, which I still hope will continue to do well. With that, I beg leave to withdraw my amendment.
Baroness Coffey
“Promoting access to dentistry equitablyIn the National Health Service Act 2006, after section 1C insert—“1CA Duty to promote access to dentistry equitablyIn exercising functions in relation to the health service, the Secretary of State must have regard to the need to ensure provision of dentistry across England accessible to all regardless of wealth or geography.””
Baroness Coffey (Con)
My Lords, I have tabled an amendment about dentistry. With the agreement of others, I degrouped it so that we could have a short but focused debate on what is a key part of healthcare but one where access is so variable across the country that it is really struggling.
I appreciate that the Government have made some changes to the dental health contract. Three years ago, when extra UDAs—units of dental activity—were offered around the country, only one dentist in my own county of Suffolk took up the opportunity. That dentist was in Lowestoft. A couple of years ago, an adult could get added on and get routine NHS dental care at seven dentists within a mile of this place. At that time in Suffolk, you had to go about 35 miles to be able to access that if you were not already registered with a dentist. At the same time, we saw a lot of the dental providers for which people pay insurance pulling out of many rural areas. That is why I have been careful to put “access … equitably” in the amendment. Later amendments, tabled by the noble Baroness, Lady Pidgeon, refer to the “dental deserts” of which I am well aware.
I am pleased to announce some progress. In Suffolk, you now have to go only 12 miles to get to two dentists where you can see an NHS dentist. After that, it is another 23 miles to potentially see three more. Meanwhile, here in London, near the House of Lords, where no dentist is taking anybody on unless they are eligible for free dental care within a mile, you can find 14 dentists within two miles. That difference is happening not solely in Suffolk or London but right across the country.
A lack of dental provision has many significant impacts. It is not quite the same as not being able to get an operation. Things can be done in different ways, urgent care may well be available, and it does not necessarily stop people working. But it impacts their daily lives. As I said, I appreciate that the Government have done more, but I am not convinced that they have gone into the level of detail to make sure that the National Health Service is happening nationally when it comes to dentistry.
I would like to understand more from the Government on what they are doing on the measurement of access and on UDA distribution across the country. I appreciate that if you live in a rural area, you are not necessarily going to have 15 dentists within two miles of where you live. I get that. But it feels very focused on our major cities, where there is availability right now but it is very difficult to access, especially when providers are also withdrawing their private practices for people who pay insurance.
I will be interested to hear from the noble Lord, Lord Hunt of Kings Heath, about his “state of dentistry” report, which is definitely worth doing. I encourage the Government to do that even if they do not want to put it in this Bill. I am very conscious of dental deserts. With that, I beg to move.
Lord Hunt of Kings Heath (Lab)
My Lords, I have Amendment 213 in this group. What is interesting in relation to dentistry is that on the one hand we know that many people are finding it difficult to get access to NHS dentistry, but on the other hand we rarely debate dental matters in Parliament. This is a welcome opportunity to allow the Government to say some more about what they have been doing and to discuss ways in which we might see future improvements.
There is no question that since Covid there has been a sharp drop-off in the number of adults who have seen an NHS dentist in the previous two years. It was never good—it has always hovered around 50%—but, as I understand it, it has dropped to 40%. Behind that is the fact that there are areas where it is very difficult to get a dentist. We know that some people have had to go abroad, particularly where expensive treatment is concerned, because they cannot get it on the NHS. In some situations we have seen reports of people doing DIY dentistry, which, frankly, takes us back many decades.
The Government have done a lot. One must acknowledge the phased introduction of the new contract, the commitment to providing an additional 700,000 urgent and emergency NHS dental appointments each year, rolling out supervised toothbrushing programmes for children and supporting the expansion of water fluoridation schemes. These are all making a big difference and I commend the Government for them, but clearly there are some fundamental underlying issues which still need to be tackled, including workforce issues, such as whether we have the right contract to provide preventive dentistry. I agree with the BDA that the units of dental activity do not meet the modern needs of oral health in this country and we have to start to move away from that.
My amendment is about ensuring that we get, on a regular basis, an assessment of the state of dentistry services in this country, alongside a more general analysis of oral health challenges to enable us as a country and as a Parliament to have a regular update of where we are going, what the problems are and how we can solve them. This is a very long amendment, which I plead guilty to drafting, but I hope the Government will understand the principle behind it and the need for us to try to prioritise dentistry in a way that has perhaps not been done over the last few years.
Lord Patel of Bradford (Non-Afl)
My Lords, I support the aims of all three amendments in this group. At Second Reading I raised the stark health inequalities facing people living in our coastal communities, and I thank the noble Lord, Lord Hunt, and the noble Baroness, Lady Tyler, for introducing my amendments while I was not here. I particularly thank the Minister for agreeing to meet us to discuss coastal and rural health inequalities. For clarity, when I am talking about coastal communities, I normally think of small towns of 10,000, 20,000 or 50,000 people. Collectively, we are talking about 10.4 million people, which is nearly a fifth of the population.
I declare my interest as chair of the Coastal Navigators Network, a community interest company originally founded by NHS England. It brings together more than 20 coastal towns and locations to put into practice the recommendations of Sir Chris Whitty’s 2021 report, Health in Coastal Communities. Several of those areas are working to improve oral health and access to NHS dentistry through prevention, local workforce training, and community-based services. Their experience can help us understand where people are struggling to get care, and what needs to change locally.
Sir Chris Whitty’s latest report, Health in Rural Areas and Small Towns, was published just last week. It highlights a national framework for improving oral health in rural and coastal areas. This has been developed by the office of the Chief Dental Officer, working together with the Coastal Navigators Network. The work is led by Jason Wong, the Chief Dental Officer for England, and his team. Our contribution has been to bring practical experience and case studies from our coastal communities.
I was going to give two examples, but I will only give one, because one was about Lowestoft, which the noble Baroness, Lady Coffey, has already mentioned. The other example is Dorset, where the report says that only 35% of adults currently access NHS dental care, and no practices are accepting new adult NHS patients. In response, Health Sciences University, based in Bournemouth, and NHS Dorset are developing a proposed oral health institute, bringing together care, prevention and local workforce training. It is intended to support more than 30,000 clinical patient contacts a year. That is an amazing, potentially promising, answer, but they need the premises and facilities to deliver the care, and train the workforce.
The latest business case still shows a funding gap of around £10.25 million, mostly in capital funding. Without that capital investment, there is a real risk that this work will be delayed, or that the institute will not go ahead at all. The Dorset example shows why identifying unmet need must lead to practical action. Commissioning more NHS dental care will take us only so far if the facilities to provide it are not there. We need capital investment alongside commissioning, so communities can develop services and train the people who will deliver them.
The geographical problem is substantial, and perhaps the noble Baroness, Lady Pidgeon, will talk about this. A study published in the British Dental Journal in August estimated that around 2.3 million people in England live in neighbourhoods with a centre that is more than 5 kilometres from the nearest NHS dental practice. But distance is only part of the problem. Is the practice accepting NHS patients, and can someone without a car get there? For coastal communities, transport difficulties, travel costs and a shortage of NHS appointments can put all the care out of reach. That is why I welcome Amendment 213, tabled by the noble Lord, Lord Hunt, and the noble Baroness, Lady Pidgeon, with its emphasis on unmet need, workforce distribution and geographical inequalities. National and ICB averages must not hide communities where access is particularly poor.
I also welcome the focus of Amendment 216 on practical action, including emergency access, contract reform and workforce planning. There is, however, an important question about how we identify a dental desert. Amendment 216 counts practices: excellent. The British Dental Journal measures distances from one place, a home, to a dental practice. Both are useful, but we also need to know whether those practices have any NHS appointments available, and whether people can reach them.
I would welcome the Minister’s response on a couple of practical points. Will the Minister ensure that reporting shows whether people in coastal communities can actually get NHS dental appointments, and include the barriers caused by workforce shortages and difficulties with travel? Where that reporting identifies unmet need and dental deserts, how will the Government ensure that commissioning and investment follow? Will that include capital funding, where the premises and facilities are simply not there, when they are needed to provide care that is missing? Without that commitment to act, we risk describing the problem again and again, without helping people get the care that they need. More widely, will the Government use the national framework developed by the Chief Dental Officer’s team to help other rural and coastal communities facing similar problems?
Finally, I would appreciate it if the Minister could ask officials to work with the Dorset partners to explore how the proposed oral health institute can move forward so we do not lose such an invaluable option.
Lord Young of Cookham (Con)
My Lords, I shall intervene briefly in this debate on a subject on which I have interrogated the Minister from time to time. I shall make three points.
First, when I asked an Oral Question last year, 2.2 million people needed urgent dental treatment, as we have heard from the noble Lord, Lord Hunt. Since then, we have had 700,000 additional appointments, which I welcome. Can the Minister tell me whether the figure of 2.2 million needing urgent care has now been reduced?
Secondly, each year 30,000 children have rotten teeth extracted under anaesthetic. That is a terrible statistic. Has any progress been made in reducing that appalling figure?
The third point, which is related to the second one, was also touched on by the noble Lord, Lord Hunt: progress with fluoridation. I asked the Minister about this last year and she said:
“On water fluoridation, as the noble Lord said, an extra 1.6 million people across the north-east will benefit from a water fluoridation scheme following quite a lengthy process and that will start in 2027-28”.—[Official Report, 19/3/25; col. 1228.]
Why is there such a lengthy process? And are any other areas following up this very welcome initiative in the north-east? I look forward to the Minister’s reply.
Baroness Finlay of Llandaff (CB)
My Lords, the noble Lord, Lord Young, has highlighted the problem specifically for children. I shall expand on that slightly, because this is a major public health problem. Prevention is essential. Children who have had their teeth extracted may do fine if they are fit and well, but there is another group of children who are already ill, who may have a malignancy or may be on chemotherapy, or who have learning difficulties. There is a need for even more prevention measures for those children because, at every stage where they get tooth decay, their risks of things such as septicaemia and so on go up.
It is also a public health issue. In schools, children are now being taught to brush their teeth, which is excellent. The fluoridation programme is to be commended, and some of us would like to see it rolled out even faster. However, the other area is fizzy drinks, sweets, babies being given sugary dummy things to suck, and so on. Children are being brought up to have tooth decay, sometimes from the age when they are weaned.
These are all big public health initiatives, but the health service is being left to pick up the tab. I found it rather worrying that the cost of these decay-linked dental extractions in young people is over £50 million a year. This is not insignificant, and it really needs to be tackled.
Baroness Bennett of Manor Castle (GP)
My Lords, I will speak very briefly. I begin with an apology to the British Dental Association, because I told it I had signed Amendments 213 and 216 but then found the email stuck in my outbox this morning.
I shall make just two points. First, the arguments for action, at least in those two amendments, have already been powerfully made, even though we have not yet heard from the noble Baroness, Lady Pidgeon. I had a meeting with my honourable friend Adrian Ramsay in the other place with a great organisation, the beautifully named Toothless in Suffolk, which is now Toothless in England. It is great to see people getting out, campaigning and doing politics, but they should not have to campaign to get basic dental services. To pick up on the figure mentioned by the noble Lord, Lord Hunt, six in 10 adults have not seen an NHS dentist in the last 10 years.
Secondly, following on from the point that has just been made about children’s health, we also need to consider dentistry at the other, older end of life. There is increasing evidence of the effects of a systemic inflammatory burden on heart disease and diabetes, and there is very good evidence that it makes managing blood sugar more difficult. There are increasing links to pneumonia, exacerbation of COPD, and, potentially, joint inflammation and Alzheimer’s. We tend to think of dentistry as being one thing and health another, but actually we need to join all this up and see dentistry as requiring the same focus and attention—as part of the whole general health of our society, rather than as a separate thing.
Lord Lansley (Con)
My Lords, I want to intervene in this debate to talk about dentistry, particularly for the reasons set out by the noble Lord, Lord Hunt of Kings Heath. We do not debate dentistry much, and insofar as this Bill is not changing but simply restating the commissioning obligations of the NHS, we should take the opportunity to say, as we will in a number of other respects as we go through the Bill, that there is room for reform. That reform may not necessarily require primary legislative change, but that does not mean we should not take the opportunity to make those points.
To follow up on what noble Lord, Lord Hunt of Kings Heath, said about the need to move on from units of dental activity being the basis, my noble friend Lord Howe and I fully agreed with that thought 15 years ago. That was why we entered into the now tedious process of trialling, piloting and then prototyping how a new dental contract would work. Its purpose would be to pay practices on a capitation basis, with a focus on preventive work and the maintenance of good oral health, rather than remuneration by reference to units of dental activity and what is regarded as the treatment treadmill on which dentists had worked. Notwithstanding the Government’s view in 2023 that these prototypes were a failure, the principles remain right. Therefore, we should say to the Government: do not let it drop.
First, the capitation was based essentially on existing populations, and the whole point of the system would be to establish the initial oral health status of a given population to a degree of granularity that enables it to be a serious measure of what needs to be done. That would be really important, taking the point made by the noble Lord, Lord Patel of Bradford, in places where there are serious deficiencies in present oral health status. It would allow us better to modulate dental resources to the places where the need is greatest. The first thing is therefore to get that capitation—that basis—right, and there is going to have to be an initial investment to establish the oral health status of the population in relation to dental practices before we start down the process of remunerating practices for the work they have to do.
Secondly, the structure of payment to dental practices needs to move away from treatment towards prevention and the maintenance of the oral health of the population. Once we have a good measure at the start, we can assess how well practices are doing. That means that we have to introduce for dentists a quality and outcomes framework with similar incentive effects to the framework for GP practices; it should adopt a similar approach. In addition, we must be clear that the purpose of this is to maintain and increase good oral health, and therefore to reduce the number of treatments. Indeed, the prototypes of the new dental contract took various forms, but it did lead to a significant reduction in the number of treatments. However, because the incentives were not aligned properly, dental practices were not then incentivised to increase access. The whole point is to reduce the number of treatments and to increase patient access to NHS dentistry.
We should aim to arrive in the long run at a point where not only children but most adults assume that they can access NHS dentistry. We will have to be open to combining NHS entitlements in the maintenance of good oral health with the ability to use private dental care.
Finally, the Treasury had a hand in all this, and some 10%—or in some cases maybe more—of the patient income did not materialise in these prototypes because the patients were not paying for the treatments. We received about £860 million a year by way of dental charging, and losing £100 million or thereabouts was not something the Treasury was very keen on. But that just means we should have dental charging that is not linked to treatments. The logic says that if we are aiming for a dental contract which prioritises access, good oral health and preventive work, then so should the charging regime; all these incentives have to be aligned.
I hope that, notwithstanding the unhappy experiences that many would say the dental contract reform process has suffered up to now, we do not give up. We should go back to it. We should look at it and say we have learnt a lot. That means that we have to go back into this process, reasserting the principles and aligning the incentives with those principles.
Lord Kakkar (CB)
My Lords, I support Amendment 213 in the name of the noble Lord, Lord Hunt of Kings Heath, and the noble Baroness, Lady Pidgeon. I wonder whether the Minister might comment on the fact that while chronic gum disease in itself is a bad thing, resulting from a lack of access to primary dental services, it is associated with a profound impact on systemic health and, in particular, chronic diseases such as cardiovascular disease. Those with gum disease are at far higher risk of heart attacks, stroke and narrowing of the blood vessels—atherosclerosis.
In establishing the principles and the mechanism for the delivery of a regular state of NHS dentistry report, with the capacity now to federate across different datasets in the NHS, we would have the opportunity to start understanding the relationship between the failure to provide primary dental services and the prevalence of other chronic diseases, in particular cardiovascular diseases. That might well help further improve the mapping of services and local investment not only in dental services but in services for other, potentially fatal diseases.
I wonder whether the Minister and indeed the department have considered how this report might be the stimulus for bringing together other datasets and understanding the impact of the failure in dentistry provision on the broader health of the nation.
Baroness Pidgeon (LD)
My Lords, we have had a really good debate on this group of amendments. My Amendment 216 addresses one of the most persistent inequalities in our healthcare system: the growing number of communities that simply cannot access an NHS dentist. For too many people, finding an NHS dental appointment has become an impossible task, with entire areas effectively becoming dental deserts. Other amendments in this group are very much in the same place.
Amendment 216 would require the Secretary of State to establish a scheme specifically designed to tackle that problem, ensuring that integrated care boards can guarantee emergency access to NHS dentistry and provide free dental check-ups to children, mothers within one year of having given birth, pregnant women and low-income households. The amendment recognises the current state of access to NHS dentistry across the country, and that preventive care is better for patients and more cost-effective for the NHS than treating advanced dental disease later.
However, my amendment would go further by recognising the critical importance of dental health for patients facing serious medical treatment and guaranteeing dental appointments for those about to start chemotherapy or undergo transplant procedures. It would help ensure that necessary treatment was not delayed because of untreated dental problems and would support those patients at a time of great need.
In this debate, we have heard of how dentists are remunerated. My amendment would require the publication of a reformed dental contract before the scheme was introduced, because the current contractual arrangements have contributed significantly to the workforce shortages and access problems that we see today.
My amendment is practical and targeted at ending dental deserts, improving access to dental care and ensuring that NHS dentistry is once again available to the people who depend on it. The noble Lord, Lord Patel, and the noble Baroness, Lady Coffey, have given clear examples of the different needs of coastal and rural communities and the importance of access to transport for access to services, which too often gets forgotten in these debates.
The amendment from the noble Lord, Lord Hunt, to which I have added my name, would ensure the publication of an important, regular report on the state of NHS dentistry and a debate in Parliament, which would keep a focus on this issue. There is so much going on in the health space that this can easily get lost, which in some ways has led to the situation we are in today.
We mentioned children in our debate. More than for any other reason, children attend A&E because of tooth decay. That is extraordinary. We can talk, and we have talked, about how we are tackling the issue—we have programmes teaching children how to brush their teeth properly—but what are we doing in nurseries and other early care settings? Only 10 years or so ago, my son was in nursery. That nursery had an NHS dentist who came in every six months and did check-ups with the children, and you got a note sent home. Why are we not looking at some of that preventive work? This report would allow the wider debate that we have started today, as well as discussion of some of the other important points and links to other health issues. I hope the Minister will respond positively and pick up the issue of that regular report.
Lord Mawson (CB)
My Lords, I support the amendment from the noble Lord, Lord Hunt. I will share a practical experience. In Tower Hamlets, a large proportion of the residents are Bengali and eat betel nut, which produces all the symptoms and serious health impacts that the noble Lord, Lord Kakkar, has well described. I have previously mentioned the street we rebuilt following some very difficult health circumstances. We ended up building a health centre, a school, 600 homes, and now a primary school, and we joined it all up with a multidisciplinary team. When you bring the headteacher, the GP, the pharmacist and the housing practitioners together, you start to learn things about the community in which you are based, and we began to discover this serious health implication among the Bengali community.
Because we had a very good working relationship with Queen Mary University, which is up the road and which became a partner in this development, there was an opportunity to bring a dental school, with a brilliant professor of dentistry, on to the street. We could then connect it to the pharmacy, the school and the science programme—which we have been running for 14 years with Professor Brian Cox—and create a whole joined-up situation that would not only improve the dental health of people but, if we connected it properly into the school, might well produce more dentists. It would mean that, instead of the health centre being overwhelmed by these issues, the dentists could start to deal with patients and the detail of all this. My point is that, if we began to think of neighbourhood health centres not as a box but as a street and a campus, and of the connections between these things, it would begin to throw up interesting innovations and solutions to issues that arise particularly in places such as Tower Hamlets, which are very much to do with dentistry.
I have to say that this was one of our health failures, because all that was coming together; everyone was in favour of it, and the professor of dental health was brilliant, but it sadly fell because of the politics going on in the medical school. I am illustrating it because, if we create a culture on the ground in neighbourhoods and build the relationships, these kinds of innovations around these very serious issues, which deal with the very serious medical conditions that the noble Lord, Lord Kakkar, rightly described, can start to happen.
Lord Evans of Rainow (Con)
My Lords, perhaps I may start by warmly welcoming the noble Baroness to the Dispatch Box. We wish her well.
This has been a valuable debate on an issue that affects millions of people across the country. While the amendments before us take different approaches, they are united by a common concern that access to NHS dentistry remains increasingly difficult to secure. I particularly wish to speak in support of the amendment in the name of my noble friend Lady Coffey. At its heart lies a simple but important principle: access to dentistry should not depend on where a person lives or what they can afford. Few would disagree that oral health is an integral part of overall health, yet for too many patients access to NHS dental services has become a postcode lottery.
The duty proposed by my noble friend would place equity at the centre of decision-making. That is a principle which this House has supported on many other occasions in many other areas of healthcare. It is surely no less important when it comes to dentistry.
The amendment from the noble Lord, Lord Hunt, and the noble Baroness, Lady Pidgeon, also raises an important issue. One frustration for Parliament and for the public is that discussions about NHS dentistry are too often conducted in the absence of clear, comprehensive and consistent information. Regular reporting on workforce pressures, access, inequalities and unmet need would provide a valuable evidence base against which future progress could be measured and Governments held to account.
The amendment from the noble Baroness, Lady Pidgeon, addresses perhaps the most visible manifestation of the current problem: so-called dental deserts. Finding an NHS dentist has become extraordinarily difficult, if not impossible, in many parts of the country. Today, three in five adults are not accessing NHS dentistry. That is not a marginal problem; it is a challenge affecting communities across the kingdom. We now have areas of the country where fewer than four in 10 adults have seen an NHS dentist in the past two years. That should concern us all. It speaks not merely of pressures within the service but to growing inequalities in access to care.
Patients are travelling significant distances for routine treatment; being forced into the private sector, despite financial pressures; or presenting at GP surgeries, walk-in centres and A&E departments because they have nowhere else to turn. These are symptoms of a system that, despite the dedication and professionalism of the dental workforce, is struggling to meet public demand.
Improving NHS dentistry requires more than warm words. Good oral health is not a luxury; it affects children’s development, educational attainment and well-being. It affects people’s ability to work, to communicate with confidence and to maintain their dignity. Increasingly, we understand its connection to wider physical health and quality of life. At a time when we are rightly focused on prevention, reducing health inequalities and delivering care closer to home, dentistry must be part of that conversation. We cannot continue to accept a situation in which access to NHS dental services depends so heavily on geography, workforce shortages or the ability to pay. These amendments offer thoughtful and constructive ways of advancing that object.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I am very pleased to respond to this group, following on from these Benches from my noble friend Lady Hyde, who I am delighted to be working with on this Bill. I am very glad that she made her debut on group 1 today. We look forward to hearing more.
I am in absolutely no doubt of the challenge when it comes to dental services and dentistry. I am also deeply conscious of the situation that we started from. I will refer to some of the points about improvements and the need for further improvements, but let me turn first predominantly to the amendments before us.
On Amendment 49 from the noble Baroness, Lady Coffey, I understand the good intention behind this amendment but do not believe that it is necessary, because under Section 1 of the National Health Service Act 2006, the Secretary of State will continue to have a duty to promote a comprehensive health service in England and that includes NHS dental services.
In addition, Clause 4 strengthens the statutory framework by amending the Secretary of State’s existing duties so that they must have regard to the need to reduce inequalities in access to health services across England. As the noble Lord, Lord Patel of Bradford, rightly said, that includes coastal communities as well as others. The duty that I referred to provides a clear statutory basis for considering geographical and other inequalities in access. A dentistry-specific duty would therefore duplicate the deliberately broader framework that the Bill establishes.
I can reassure the noble Baronesses, Lady Coffey and Lady Pidgeon—because the comments that I am about to make also relate to Amendment 216 in the name of the noble Baroness, Lady Pidgeon—that we are taking practical action to tackle dental deserts. I was grateful for the comments of the noble Lord, Lord Patel of Bradford, who made the point that the definition of a dental desert is rather more complex than just miles, or indeed numbers, and that is indeed the case. The practical actions that we are taking include introducing a package of reforms to address some of the most pressing issues that dentists and dental teams have been experiencing, and therefore the knock-on effect to patients. These reforms prioritise those with the greatest need and shift care away from clinically unnecessary check-ups.
On the matter of addressing dental deserts, we have, supported by some £11 million, brought in some 50 additional dental school places on top of the existing 809. It is interesting to note that the University of Porstmouth and the University of East Anglia are where these will be provided; we are going to train more dentists in the areas that need more dentists. As we know, throughout the medical professions, when you train in an area you are more likely to stay. I add that all NHS regions now have a dental school. We also have the golden hello recruitment incentive scheme, with payments to dentists of £20,000 to work for three years in areas that need them the most. As of July this year, 159 dentists had started working in the areas that needed their services the most.
Referring back to Amendment 216 in the name of the noble Baroness, Lady Pidgeon, I make the point to a number of the comments made that since July 2024 we have sought to rebuild NHS dentistry while being in no doubt of the challenge. In 2025-26, just under 3 million additional NHS treatments were delivered compared with the previous year, and around half of those benefited children. I very much share the concerns that noble Lords have described. It is totally unacceptable that the primary reason for emergency care for children is their very poor dental health. Children’s access now exceeds pre-pandemic levels, more adults are being seen and more dentists practise in the NHS, if we compare it with 2019-20.
I absolutely agree with the noble Baronesses, Lady Finlay and Lady Pidgeon, and other noble Lords, about the key role of prevention. That is exactly why, as the noble Baroness, Lady Finlay, said, we have brought in a toothbrushing scheme for young children, as well as fluoridation. We are seeking to tackle—if noble Lords will forgive the pun—the root causes. I cannot think of another word, but perhaps noble Lords will enjoy that anyway. It is important that we prevent as well as treat, for sure.
I turn to Amendment 213, tabled by noble friend Lord Hunt. We agree that transparency and accountability are essential to a properly functioning NHS dental system. However, the amendment risks duplicating existing arrangements. For example, the annual dental statistics help to identify problems and inform policy development, and I know that nobody present would wish to divert resources away from patient services. The whole focus of the Bill is on increasing Ministers’ accountability to Parliament, so I have no doubt of that happening.
I will pick up on some of the other points that were made, in more general terms. The noble Baroness, Lady Coffey, the noble Lord, Lord Lansley, and my noble friend Lord Hunt spoke about the dental contract and expressed concerns about the focus on units of dental activity, which I understand. I agree that reforming the dental contract is a key lever, and that is why we are working with the British Dental Association and other representative bodies to do just that. In addition to that contract, we are looking at how we can better use technology and boost the number of NHS dentists, as well as all the other areas that I have spoken to.
The noble Lord, Lord Patel of Bradford, asked about funding. I can confirm that the dental budget is worth around £4 billion, net of patient charges. The Government want to ensure that the ring-fenced dental budget is spent on the patients who need it most, and we need to maximise treatments for taxpayers’ money. I am pleased to say that we reduced the NHS dentistry underspend, which was standing at £392 million in 2023-24, to £36 million in 2024-25. That will make a major change to the provision of dental services. On the question from the noble Lord, Lord Patel, about the dental framework being developed by the Chief Dental Officer, I will be pleased to write with more detail on that.
I will pick up a few points in response to the noble Lord, Lord Young; where I cannot do so at the moment, I will be pleased to write to him. As I have mentioned, 4 million urgent appointments were delivered in 2025-26; that is 8.4% more than in 2024-25, and more than in any previous year under the current contract. We have now required high street dentists to deliver a minimum amount of urgent treatment as part of their contract. On the point about fluoridation, which the noble Baroness, Lady Finlay, also spoke to in terms of prevention, we are investing £136 million over five years to maintain existing schemes across England and fund the expansion to which the noble Lord referred across the north-east of England. Some 6 million people are already benefiting from fluoridated water, and this latest intervention is expected to reach an additional 1.6 million, to reduce tooth decay and inequalities in dental health.
The noble Lord, Lord Kakkar, talked about bringing together datasets to understand the impact of dentistry on broader health, which is a point I take. I will be pleased to look into that and write to him.
Lord Patel of Bradford (Non-Afl)
I thank the Minister very much for that detailed response. When she writes to noble Lords, can she specifically pick up the issue of capital funding? Lots of the places that I am looking at have a population with enough people to have complex problems, but not big enough to have infrastructure. We really struggle without some capital investment. As the noble Lord, Lord Lansley, said, we need some capital funds to set up some of these physical services to actually do the workforce training.
Baroness Merron (Lab)
Yes, I will be very pleased to include reference to that. I would probably use the word more broadly—the infrastructure that is necessary to support the dental activity—but I take the point and I will do my best to assist.
Baroness Coffey (Con)
My Lords, I thank the Minister for her comprehensive response. There is something in what she said about a dental team. Many noble Lords have talked about children. Dental therapists are unsung heroes and heroines who are perfectly qualified to undertake a lot of the work that has been mentioned today, particularly when dealing with children. The challenge is that too many dentists will not allow dental therapists to practise. I have asked them for reasons why, and there are certain things they cannot and are not allowed to do with NHS paperwork. Dentists also talk about liability, in terms of insurance.
We need to open this up much more widely. I encourage the Minister to speak to the Minister for Health Innovation, who I believe is responsible for dentistry, to see what more could be done. Too many children’s teeth, never mind older people’s, are just being ruined when they do not need to be. It does not need to be a dentist who goes into a nursery to look at these things; there are perfectly well-qualified people who can undertake that.
I will likely return to the issue of dentistry on Report, but, with that, I beg leave to withdraw my amendment.
Baroness Coffey
“Promoting access to ambulance services equitablyIn the National Health Service Act 2006, after section 1C insert—“1CA Duty to promote access to ambulance services equitablyIn exercising functions in relation to the health service, the Secretary of State must have regard to the need to ensure provision of ambulance services across England accessible to all regardless of wealth or geography.””
Baroness Coffey (Con)
My Lords, we have got a Holy Trinity now. We have dealt with how we encourage people to get into and stay in work, we have talked about dentistry, and now we are going to talk about more things to do with urgent care.
This amendment is about promoting equitable access to ambulance services. I feel passionately about this: it was something I dedicated a lot of my time to as an MP, trying to improve access at local level. It was when I learned about how often, on a regional basis, we would see actual manipulation of where ambulances were placed in order to make sure targets were hit—but it did not mean that patients were served well.
There are a number of issues in regard to ambulances, and I pay tribute to many first responders. In the statistics, recorded nationally, a volunteer responder turning up is the same as having a paramedic arrive. In the East of England Ambulance Service, which had started to show improvement but is now really struggling —again—ambulances are quite regularly sent without any qualified paramedics in them.
I come back to the point that this situation can be very serious. Quite often, outside our major cities, for example in the east of England, if you have a stroke or a serious heart issue, you have to go to Cambridge for the best treatment. Stuff has happened along the way to try to make sure that you can stop en route, in places such as Ipswich and Norwich, in order to get something along the way. A stroke is something that causes the greatest harm, in terms of people having a good quality of life later. Of course, having a wide range of first responders across the country is a very useful way to help people who have had either a cardiac arrest or a heart attack, to keep them alive. But the difference in your quality of life depends on how quickly you get treatment when you have had a stroke; it is a real life changer.
One of the things I am conscious of is that we have many rural areas around the country. Something more needs to be done to help rural communities. It also happens to be the case—particularly thinking of coastal areas—that a lot of tourists rely on emergency services when they are on holiday. That is not taken into account in some of the funding measures, as far as I am aware.
I am pleased that we have seen an increase in the number of paramedics, but, reflecting on the point referred to earlier by the noble Baroness, Lady Hollins, on clinical staff in the NHS, it is paramedics who have the highest sickness rates. I think it is more than double —perhaps even treble—how often an average hospital doctor or consultant sadly ends up being off ill. It is not the Cinderella of the NHS, but it is certainly a part of the service that has been forced into mergers over the years, and there is huge reluctance among NHS leaders to break them apart in a way that would perhaps help patients. Indeed, we are effectively seeing many more mergers happening around England, which is going to be a real struggle, particularly for rural communities.
I am grateful to the Minister for sending the letter today about what will be happening. ICBs are taking on dentistry as part of their statutory duties, but there was no reference to what would be happening with ambulance services. I know it is common practice that one ICB tends to do the commissioning on behalf of all ICBs in that area, because they are currently constrained by the fact that they do not have any choice in where they get their ambulance service. I am not suggesting that we go for some free-market approach. We need a sensible, well-connected way of dealing with these emergencies. It would be useful to hear what the Secretary of State’s plans are for the next phase of NHS provision across the country.
I share the concerns, reflected in other amendments in this group, about people suffering corridor care. I look forward to trying to better understand the amendment from the noble Baroness, Lady Pidgeon, regarding 12-hour admissions to A&E. It has become terrible how patients are not being seen, especially when that can be a matter of life and death. I hope that we will have some further useful discussions on this important blue-light service and recognise the contributions made by paramedics and community first responders right across our country. I beg to move.
Lord Scriven (LD)
I know the noble Baroness likes to be absolutely correct. She said that the highest rate of NHS staff sickness was among ambulance paramedics. It is actually ambulance support staff, which does not include paramedics. I am sure she would like to correct the record.
Baroness Coffey (Con)
I am grateful to the noble Lord for doing that. That is not in the information that I have, but I completely accept what he has said. It is unusual in the NHS that the average number of sickness days lost to non-clinical staff is more than double that to clinical staff, but I completely understand the noble Lord’s point.
Lord Patel of Bradford (Non-Afl)
My Lords, Amendment 72, in my name, addresses a straightforward concern: patients being made to wait for assessment or treatment because of an administrative or financial rule when clinically appropriate care could be provided sooner. My amendment would prohibit minimum waiting times imposed across the NHS in England for administrative, financial or capacity-management reasons. It would apply to both commissioners and providers, including through contracts and activity plans. It would protect clinical decisions about when an assessment, investigation or treatment should take place. A patient may need to wait for a clinical reason, but they should not be made to wait because a commissioner has imposed a minimum waiting period to manage budgets or activity.
That is already happening. An investigation published by the British Medical Journal on 9 September found that nearly half of England’s integrated care boards had introduced some form of minimum waiting time. It reported minimum waits of 16 weeks for routine procedures in Shropshire, Telford and Wrekin, and West Yorkshire, and for cataract treatment in south-east London. Can the Minister confirm whether these policies remain in place and whether the Government consider them acceptable when clinically appropriate care can be provided sooner?
The situation is even starker for ADHD and autism assessments. For example, published information from West Yorkshire’s ICB confirms a minimum wait of two years from referral for assessments with independent providers. The ICB says that this is intended to make waiting times fairer and to manage financial pressures, but the central question remains: why require someone to wait two years if an appropriate assessment could be provided sooner? An assessment can help someone understand their difficulties and get appropriate support. A two-year delay can have consequences for their education, employment and family life.
The ICB allows urgent assessments where certain specified clinical criteria are met. Those urgent exceptions are important, but what happens when the criteria are so restrictive that they exclude patients whom clinicians believe are at serious risk? I present this point from a practical perspective. I heard only last week about a concern in another ICB area. Clinicians there identify patients whom they believe are at risk of serious harm, including self-harm and suicide, yet those patients appear to fall outside that ICB’s tightly drawn criteria for urgent assessment. When clinicians raised these concerns, the responses reported include directing patients to NHS 111 and suggesting that referrals could be returned to their GP if the provider is concerned about managing the clinical risks while they wait. Of course, NHS 111 and GPs have important roles in helping patients access urgent support, but that does not answer the clinicians’ concern that these patients need an earlier specialist assessment.
This concerns the restrictions on funded activity rather than a fixed minimum wait time, but it raises a serious question: are urgent criteria being drawn around the available budget rather than the clinical needs of the patient? Surely there must be a prompt clinical review and a clear, funded route to appropriate care for patients whose clinicians identify serious risk, even when they fall outside the ICB’s specified categories.
I recognise that commissioners face very difficult financial choices, but making patients wait when appropriate care is available does not remove their need for care. Their condition may worsen and they may need more help from other services while they wait. I have three concerns about policies that impose these minimum waits: harm to patients, fairness and transparency.
First, on harm to patients, someone waiting for a hip replacement, cataract surgery or diagnostic test may be living with pain, unable to work or drive, or losing their independence. Their life does not go on hold because a waiting time clock has started. If their condition worsens, they may need more help from their GP, social care or emergency services. Meanwhile, capacity that could have been used to treat them sooner may grow unused. How is that a sensible use of NHS resources? In responding to the BMJ investigation, the Royal College of Surgeons warned about deliberately delaying patients who are ready for treatment. The Royal College of General Practitioners also questioned blanket minimum waits while patients could be treated sooner.
Secondly, on fairness, access to care should depend on clinical need, yet a patient in one ICB area may be required to wait at least 16 weeks while someone with the same needs in a neighbouring ICB area faces no such rule. Surely that is the definition of a postcode lottery. What does “patient choice” mean if someone chooses an appropriate provider who could see them sooner but a commissioning rule prevents it?
Thirdly, there is transparency. In Written Answers to Dr Luke Evans MP on 22 June, the Government said there was
“no formal national policy supporting minimum waits”,
but they confirmed that the NHS standard contract allowed local commissioners to set what they called “activity planning assumptions”. Whatever the label we use, if a contractual rule stops a patient receiving care sooner, its effect must surely be open to scrutiny. Yet the Government also said that NHS England did not collect information on which ICBs impose minimum waits, which services were affected or their impact. How can the Government judge these policies without that information? Patients should know why they are waiting and be able to challenge a rule that unnecessarily delays their care.
Baroness Finlay of Llandaff (CB)
My Lords, I shall address Amendments 219 and 229, tabled by the noble Baroness, Lady Pidgeon. I have already had a brief discussion with her, because I would have liked to have signed Amendment 229, except for a bit of the wording. She is absolutely right that corridor care is one of the scandals of our time. In fact, it was on the news at lunchtime today, with patients being filmed in corridors still. We also still have social care problems arriving in emergency departments. These are people who really need to be looked after; they cannot just be sent out.
One thing about emergency departments is that people arrive, attend and then, after they are assessed, there is a decision about whether they are to be admitted. There is a clear line in the way that the figures are collected. That becomes important because roughly 25% of the people who attend are actually admitted. We have to be really careful that there is no gaming around these figures, which can happen by managers if targets are put in that become difficult to reach for one reason or another.
There are terribly long trolley waits at the moment. In each of the past three years, over half a million patients have been waiting on trolleys. As we touched on at Oral Questions yesterday, the flow through hospitals is a problem, with very high bed occupancies. We have far fewer beds in our NHS than the average across the EU—we have below half of that average. Also, the countries that have lower bed numbers often have other services in place. For example, in the Netherlands, the numbers of beds in hospitals are not that high but it has the discipline of nursing home medicine, with a large number of beds and staff trained to a very high level.
One problem that we face is the flow through hospitals —in, through and out of them. In simply addressing the front door, we are not addressing the problem properly, because there are a number of patients who are deemed to be medically fit for discharge but remain in hospital. That number is estimated at nearly 13,000 patients a day, which is huge. These patients are deemed to have been medically optimised but no longer need to remain in the hospital.
The design of our emergency departments does not help in relation to corridor care or other care. I had the privilege of spending some time in Groningen in the north of the Netherlands and was astounded at its emergency department, which was superbly laid out. There were two direct resus rooms from the ambulance bay, fully equipped so that they could be turned into emergency operating theatres for very major trauma, with CT scanners in them. They had moved from the open front door, which we have, to being able to move major trauma and other problems straight into much more appropriate environments than we have been providing.
I commend the Government for taking on the problem of modernisation, but I hope that we look at the whole issue of patient experience and patient flow and recognise that, unless we do something about our emergency departments, the more than 90% of staff who feel that they cannot cope in the longer term will be on their knees and we will have more problems going forward.
Baroness Pidgeon (LD)
My Amendment 219 addresses the deeply concerning and increasingly common practice of corridor care. No patient should be left receiving treatment, assessment or prolonged care in a corridor simply because there is nowhere else for them to go. A friend of mine only a couple of weekends ago showed me a picture of a relative in hospital, who was in a corridor. This is absolutely unacceptable. As we heard from the noble Baroness, Lady Finlay, it was on the news again today. Corridor care undermines patient dignity, compromises privacy, increases clinical risk and places additional strain on hard-working NHS staff who are trying to deliver safe care in environments that were never designed for that purpose.
We all recognise the immense pressures our hospitals are facing, from rising demand to workforce shortages and delayed discharge, but corridor care must never become normalised, as I fear it has, as an acceptable feature of our health service. Dr Ian Higginson, president of the Royal College of Emergency Medicine, has described corridor care as
“dangerous, undignified, and a source of national shame”.
Survey data published by the royal college only on 20 July shows that 61% of clinical leads in England said that their trusts did not even capture corridor care accurately, with many saying that patients who were on chairs and in waiting rooms waiting for admission were not counted towards their corridor care figure.
There is significant variation in reporting between hospitals and emergency departments. Consultants are concerned about patients who wait on chairs in waiting rooms, off-the-clock assessment units and the repurposing of space as “non-corridor” places, where they put chairs so that patients can wait and not be counted. I have even been told of somebody being sat on a chair in a cupboard because that would not count towards corridor care figures. This is also not counting patients waiting in ambulances or on corridors on the way into departments. It is simply unacceptable. This amendment would help shine a light on the true scale of the problem and support genuine efforts to ensure that patients are treated in appropriate clinical settings with the dignity, safety and respect that every person deserves when they turn up to their hospital in their time of need. We need this to lead to the end of this practice.
My Amendment 229 seeks to address another visible symptom of the pressures that our National Health Service faces: the growing difficulty in securing timely admission from accident and emergency departments into appropriate hospital beds. When patients have been assessed and a clinical decision has been made that they require admission, prolonged waits in A&E not only are frustrating but can lead to poorer outcomes, increased risk to patient safety and greater distress for patients and their families. These delays also contribute to serious overcrowding in emergency departments, making it harder for clinicians to deliver care to all those who come through their doors. While we know that the causes are complex—bed capacity, workforce shortages, which we talked about earlier, and the difficulty of discharging medically fit patients into the community and social care settings, as we heard from the noble Baroness, Lady Finlay—we should be clear that long waits for admission are just not acceptable.
This amendment would provide greater transparency and accountability and help ensure that the health system focuses on reducing delays and delivering the safe, timely and dignified care that patients have every right to receive. Putting this right in the NHS constitution would focus efforts and make sure that we address this serious issue. We do not want patients avoiding A&E because they fear endless hours of waiting. We know that is happening; we hear about it. Sorting out admissions and ending corridor care would transform the patient experience and, most importantly, patient outcomes.
The amendment tabled by the noble Lord, Lord Patel of Bradford, on prohibiting minimum waiting times is important. We discussed this in a group only last week. We need to see waiting times minimised and patients receive the diagnostics and treatment that they need in a timely manner—one that is led clinically rather than by budget rationing, which we see too often today. The amendment from the noble Baroness, Lady Coffey, talks about ambulance services. I commend the recent work by the Public Services Committee, which looked at the response and reaction between ambulance services and emergency departments, but it only scratched the surface of that issue. A lot more could be done with that workforce and those teams to ensure that patients get to the right door for further clinical care. I look forward to the Minister’s response to this important group, as this is really on the minds of the public today.
Earl Howe (Con)
My Lords, I shall speak only briefly on this group of amendments, not because I am in any way lukewarm about their content—quite the opposite—but for the practical reason that, as a Committee, we are being urged to make faster progress, bearing in mind the number of debating hours allocated to us. Let me say how impressed I was by the speeches from the noble Baroness, Lady Finlay of Llandaff, and the noble Lord, Lord Patel of Bradford. I hope the Minister will take their very powerful points back to officials in the department. I also agree fully with all that the noble Baroness, Lady Pidgeon, said about the unacceptability of corridor care.
I will make a couple of points on my noble friend Lady Coffey’s amendment on equitably available ambulance services. This is a tremendously important issue. As she will remember, I had to grapple with it as a Health Minister, not least as regards services in her then constituency. It is sadly the case that the category 1 response target of seven minutes has not been met nationally since April 2021. The Government have made big investments in emergency response services since coming to office; that is excellent, but since July 2024 the dial on category 1 and category 2 response times has not moved appreciably, if at all. That is not meant as a criticism but simply as another indication of how difficult a challenge this is.
Baroness Merron (Lab)
My Lords, I am most grateful to noble Lords for their contributions. Indeed, we all share a determination to ensure that patients receive safe, timely care in the right place. I am grateful to the noble Earl, Lord Howe, for his brevity; I will also seek to focus on amendments, and I hope noble Lords will appreciate that the reason for that is so we can deal with the content of the Bill.
Amendment 50 in the name of the noble Baroness, Lady Coffey, raises the important issue of rural access to ambulance services. I confirm that ICBs already have a statutory duty to meet the needs of their local population and to have regard to the need to reduce health inequalities, with respect to both ability to access health services and outcomes. I can assure your Lordships’ Committee that the funding that ICBs receive for commissioning ambulance services is based on factors such as age and deprivation and is adjusted to reduce health inequalities. To the point on rural areas, this includes adjustments for longer emergency ambulance journeys. We have heard some statistics, but I confirm that the category 2 mean ambulance response time is, as of July of this year, three minutes and 35 seconds faster than in July 2024. That is not the end of the story; I am simply indicating progress that is being made. I recognise, as always, the challenge of the situation that we are dealing with.
On Amendment 229, tabled by the noble Baroness, Lady Pidgeon, I certainly share her determination to reduce long waits in A&E. Trusts are already expected year on year to improve four-hour performance and to reduce waits of 12 hours or more from arrival. There is no complacency about what we have to do to improve performance, which is why the Secretary of State recently announced £140 million of investment in urgent and emergency care schemes across England, including urgent treatment centres, same-day emergency care, emergency department upgrades and additional ambulance capacity.
We are also taking action across the urgent and emergency care pathway to reduce excessive waits and to improve patient safety and flow through hospitals, which the noble Baroness, Lady Finlay, spoke to. I assure your Lordships’ Committee that this will continue following the abolition of NHS England. It is our view that a legal time limit in itself would not address the underlying pressures on capacity and patient flow that contribute to long waits, and establishing a new statutory scheme would risk distracting from the crucial work that is already under way.
On Amendment 219, also tabled by the noble Baroness, Lady Pidgeon, I could not agree more that corridor care must not—not even should not, but must not—be normalised. I am reiterating some of the points that I made in a recent Oral Question, which I believe was from the noble Baroness, on this very important point. Our priority is sustained action to address the causes by improving patient flow and discharge, expanding urgent care capacity and supporting the most challenged hospitals. We have introduced a consistent national definition and reporting arrangements, and we have improved transparency and enabled support to be focused where it is most needed.
The Secretary of State has also asked NHS England to bring forward urgent plans aimed at eliminating corridor care for children. I can say that one in six trusts consistently reported no corridor care across their emergency departments or the wider hospital over the summer. I particularly make the point about the summer because of the extreme pressure due to the weather—not something we usually say, but we are increasingly seeing it. The pressures were immense, and that was their report to us.
The noble Baroness, Lady Finlay, made the strongest case for exactly what we are doing with the neighbourhood health service, which is about moving the focus from hospital to community. I spoke earlier this week in the Chamber about the movement of savings accruing from timely discharge that can be directed to neighbourhood health. We are trialling that, because it is a very clear and practical way to make the move that the noble Baroness rightly identifies.
Baroness Pidgeon (LD)
My Lords, may I tease something out that the Minister was saying about corridor care? She quickly moved on to another thing, and I wanted to come back in.
Yes, this is similar to a discussion we had only last week or the week before in answer to a Question I had tabled, but two-thirds of medics working in emergency departments are saying that their trusts are not accurately reporting the data on corridor care. The Minister keeps saying that we have this new definition or whatever; it was decades ago that I worked in the NHS, but we had a way to make sure that people were not counted as being on a trolley: you took the wheels off and it became a bed. Trusts are very creative at finding ways around to meet their definitions. If two-thirds of those surveyed by the Royal College of Emergency Medicine are reporting that their trusts are not accurately calculating this, what are the Government doing to try to get under the data, to make sure that the Minister and the department are getting accurate data to be able to deal with this serious problem?
Baroness Merron (Lab)
I feel quite sure that the noble Baroness herself never did such a thing.
Baroness Merron (Lab)
I take very seriously the point that the noble Baroness made. I am sure it is already being looked into, but I will personally make sure that that is the case.
On corridor care and children, one example of the practical action taken is our recent announcement that the NHS is rolling out a standardised system to spot when a child’s health is deteriorating, so that early warning signs are caught earlier and there is faster action. The paediatric early warning system will be introduced in all emergency departments by the end of 2027-28, with an ambition to also roll this out in ambulance and community settings in the future. This is broader than just corridor care, but I know that that is a particular concern, as I said, when it comes to children. I cannot confirm often enough that we remain committed to fully eliminating corridor care before the end of this Parliament.
Finally, on Amendment 72, in the name of the noble Lord, Lord Patel of Bradford, I can give the reassurance that there is no national policy supporting blanket minimum waits. Indeed, patient safety always comes first. If a commissioner puts capacity measures in place, urgent referrals must be excluded, minimum waits must not be set above 18 weeks and providers must continue to triage patients according to clinical priority.
At the start of the year, it is important and expected that commissioners plan to balance service delivery with their yearly budgets while prioritising patient safety and clinical need. I remind your Lordships’ House that it is due to our approach to financial planning that the NHS stayed in line with its budget in 2025-26 while also cutting waiting lists by over 250,000 between July 2024 and August 2026. Removing the use of tools to support planning could drive unplanned activity and overspending, which would of course undesirably divert resources from other patients.
On the points made by the noble Lord, Lord Patel, about autism and ADHD assessment, expectations have already been set out for ICBs and providers to reduce those long waits and to improve experience, quality and productivity in ADHD services over the next three years. We are moving to a needs-led support model that means earlier access to information and support and appropriate interventions that are individually based, without and before a diagnosis.
On the question about ICBs imposing minimum waits and whether we will publish which ICBs are doing this, there are no plans to publish this information. The data is held locally and that is right, because these are decisions for local areas. To restate what I said before, commissioning decisions are for ICBs to make.
Lord Scriven (LD)
The Minister just made a very important point. Can she clarify? Is she saying that there is a requirement for ICBs to statutorily report that they have implemented a minimum wait standard, or not?
Baroness Merron (Lab)
The question from Lord Patel was about whether there were plans to publish this information, and I was explaining that there are no plans and the reasons why.
Lord Patel of Bradford (Non-Afl)
Going back to the analogy of taking the wheels off the beds, it feels as if ICBs have certain budgets they want to spend on certain things and they are creating criteria that exclude vulnerable people. This is really important. All I am asking is, are the Government not looking at the more than 50% of ICBs that have put in minimum waiting times without assessments? If they are not assessing that information or looking at the data, how do they know what ICBs are up to? It is not about publishing it—okay, I suggested that we should publish it; it is about examining what these ICBs are doing and what the potential dangers are. I heard the conversation that said, “These are our criteria”. While our clinicians are saying that these people are at risk of suicide, they are saying, “These are our criteria”.
Baroness Merron (Lab)
I am glad that the noble Lord understands the reason why the Government are not seeking to publish, which was the question I was being asked about. For me, this is a question about the accountability of ICBs, currently held accountable by NHS England. But the whole purpose of the Bill is to improve the quality of accountability after the abolition of NHS England.
Lord Patel of Bradford (Non-Afl)
I just have one last point, and I am conscious that people have said that we do not want to take this too far. Will the Minister reflect on the issue and the principle that somebody who requires treatment or assessment should not have to wait for purely financial or administrative reasons, even though there is a clinical need?
Baroness Merron (Lab)
I have already made reference to what the priorities are: need and patient safety. I assure the noble Lord that I reflect on everything noble Lords say, and I certainly believe that I have already given that assurance.
Baroness Coffey (Con)
My Lords, this group of amendments has been informative, as have noble Lords’ contributions. I think that the noble Lord, Lord Patel of Bradford, may be referring to situations where a minimum is being deployed for people who have expressed their view that they would like to use an independent provider to tackle the issues, and I think that something is not quite right there. But we also have to be realistic. NHS England and all the trusts have to live within their means and not every area can be bailed out, as continues to happen at the Nottingham University Hospitals Trust and the Liverpool University Hospitals NHS Foundation Trust, which is in the recently published figures.
Obviously, whether it is about an ambulance or going to an urgent treatment centre or SDEC, I am conscious that the philosophy in the NHS up until fairly recently was that it was very proud that it had far fewer beds per person on average compared to other parts of Europe, on the basis that people would often get their operation, be dealt with and go home safely that same day. Thus, the thinking was that not quite so many beds were needed.
I welcome the reference to Sir Chris Whitty’s report, particularly in the context of rural communities. But without further ado, I beg leave to withdraw my amendment.
Baroness Hayman
“Duties as to climate change etcIn the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert—“1CD Duties as to climate change etc(1) In exercising functions in relation to the health service, the Secretary of State must have regard to the need to—(a) contribute towards compliance with—(i) section 1 of the Climate Change Act 2008 (UK net zero emissions target), and(ii) section 5 of the Environment Act 2021 (environmental targets: effects), and(b) adapt to any current or predicted impacts of climate change identified in the most recent report under section 56 of the Climate Change Act 2008.(2) The Secretary of State may publish guidance about the discharge of— (a) the duty imposed on the Secretary of State by subsection (1) of this section;(b) the duty imposed on integrated care boards by section 14Z44 (duties as to climate change etc);(c) the duty imposed on NHS trusts by section 26B (duties in relation to climate change etc);(d) the duty imposed on NHS foundation trusts by section 63B (duties in relation to climate change etc).(3) In discharging their duty under section 14Z44, integrated care boards must have regard to guidance published under subsection (2). (4) In discharging the duty under subsection (1), the Secretary of State must have regard to guidance published under subsection (2).””
Baroness Hayman (CB)
My Lords, I am grateful for the support for my Amendment 52 from the noble Baronesses, Lady Sheehan and Lady Ritchie of Downpatrick, and the noble Lord, Lord Crisp. I shall listen with interest to the debate on, and particularly the Minister’s response to, Amendment 248, tabled by the noble Baroness, Lady Boycott, which is a very practical way forward.
I did not take part in Second Reading on the Bill. Actually, I had a self-denying ordinance. I decided, having had my first involvement with the NHS in 1980, having seen so many reorganisations and, I am afraid, having become a little jaundiced about the effectiveness of those reorganisations in transforming patient care rather than changing administrative structures, that I would not say anything. My mother always said that if you cannot say something nice, do not say anything at all. However, here I am, and I am here because of the recent history of legislation on the NHS, in particular, the NHS Health and Care Act 2022.
I was involved in the debate on issues relating to climate in that Bill. After cross-party pressure on the issue, the Conservative Government of the time tabled amendments which became part of the Act, and which are mirrored in Amendment 52 in my name today. They were described thus by the then Minister, the noble Baroness, Lady Penn:
“They place a duty on NHS trusts, foundation trusts, ICBs and NHS England to have regard to the Government’s key ambitions on climate change and the natural environment in everything they do. This could mean preparing thousands of NHS buildings to adapt to climate impacts, protecting and enhancing biodiversity across 25 million square metres of trust estate, or decarbonising the millions of kilowatts of energy used by trusts every year”.—[Official Report, 1/3/22; col. 729.]
That, of course, saves money for the trusts involved. The amendments were warmly welcomed by the then Opposition, with the noble Baroness, Lady Wheeler, saying:
“I thank the Minister and welcome these government amendments in response to the key concerns raised in Committee about the crucial importance of including the NHS’s duties on climate change and working towards net-zero emissions in the Bill”.—[Official Report, 1/3/22; col. 733.]
My amendments, which mirror those amendments, are trying to maintain the status quo. They are essentially Conservative in the sense that it was a Conservative Government who introduced them.
Therefore, I ask the Minister to help me understand why, when NHS England’s functions transfer to the Secretary of State along with responsibilities to consider the impacts of climate change on our health services and public health and the significant role the NHS has to play in helping the UK to meet its national climate and environmental targets and to provide leadership—we saw that at COP 28 in Glasgow, with other countries’ health services actually responding—the Bill before us omits the NHSE’s statutory duty to publish guidance on what it regards as the best way for ICBs and the organisation itself to meet those duties and how it is fulfilling them, along with an established framework for reporting details of progress on reducing emissions in its annual report and accounts. There is no in-kind replacement for these requirements on the Health Secretary, meaning that without legislative change and amendments of this sort, there will be no obligation on DHSC to continue driving progress, specifically on the health service’s carbon emissions reduction work.
Ministers may say that they will have powers to issue fresh guidance if they choose to, but whether it is issued and how robust its contents are will be contingent on the priorities of the Government of the day, and we have an example before us of how those can change. That outcome does not bring the same level of certainty or direction that the NHS needs to maintain regular accountability and long-term national momentum towards its targets. I hope that the Government will not try to argue that, because the Climate Change Act 2008 applies to all government departments, this amendment is unnecessary. It is clear that the powers that were put in the 2022 Act are much more specific to the NHS and the health system and essentially provide accountability and transparency. The NHS itself says that the duties supported the health service’s own ambition to become the world’s first health system to embed net zero in legislation. The 2022 Act requires commissioners and providers of NHS services specifically to address the UK net-zero emissions target and environmental targets and to adapt to any current or predicted impacts of climate change identified within the Climate Change Act 2008. We saw quite a few of those this summer and quite a few of the effects on the health service.
The Bill before us does not require the Health Secretary, when making decisions about the NHS, to consider how the organisation is contributing to carbon targets, to regularly report on its performance or to prepare it for the climate risks it faces. That is what we risk losing if we do not amend the Bill. I know the Government are trying to clear provisions and responsibilities out of the way and do not want to put extra bureaucratic requirements on the NHS, but my amendment recognises this. Because it is already in the 2022 Act, it does not widen the requirements in any way. It is simply trying to restore the status of the existing duties. The need to co-ordinate and steer responses to climate change and nature loss at the national level ought not to be treated as unnecessary paperwork. These duties have been quietly working as intended in the face of rising climate challenges. NHSE appears to have been getting on with them and setting emissions reductions targets that now have a statutory basis. It reports that direct emissions were reduced by 14% in the years 2020-25 and that the NHS is on track to meet its 2032 and 2040 goals.
Within the last four years, the evidence points to climate change increasingly becoming a major challenge for health and health services. The Parliamentarians’ Guide to Health and Climate Change, developed by Peers for the Planet—in which I declare a past interest—and the Wellcome Trust is insightful reading and shows why climate change is already a UK public health issue. A number of organisations, such as the Wellcome Trust and the UK Health Alliance on Climate Change, have expressed concerns that failing to replace these obligations once NHSE functions are transferred to the Secretary of State will mean that there is no obligation for Ministers to report annually on progress towards NHS net-zero commitments, to publish sustainability guidance or to account to Parliament for this work. This will leave future transparency and oversight reliant to an unacceptably large degree on ministerial discretion, and it will undermine co-ordination of national objectives. I hope the Minister will be able to tell us how, if these duties for the DHSC are not replaced, we can ensure that our national health services have appropriate regard to the challenges of climate change. I beg to move.
Baroness Boycott (CB)
I will speak to Amendment 248, but first I want to say that that was a terrific introduction by the noble Baroness, Lady Hayman, who is such a long-term, amazing campaigner for climate change. I would be horrifically surprised if the Minister does not reply completely in the affirmative towards this amendment, because, especially following the summer we have had, I do not see how anyone could continue to have their head in the sand about this risk. Climate change is not a hypothetical threat. There were 2,877 health-related deaths in May and June alone in the heatwaves—and this is not going to get better. This is not a one-off thing. In the climate emergency film there is a memorable line which says, “This is the best weather you are going to get in your lifetime”. That is truly scary. It may not happen next year, but it sure as hell will happen within the next two or three years.
The effects of this heat are not spread evenly over the population. It affects vulnerable people, children, the elderly, people living with chronic conditions, those in poor-quality housing and pregnant women. The noble Baroness, Lady Hayman, mentioned our work with the Wellcome Trust. I am vice-chair of Peers for the Planet. We have examined the effects of heat on pregnancy and maternal health, and it is not about being somewhere super-hot, which is what I have always thought. It is about being somewhere where your normal temperature condition changes. You are just as vulnerable if you are in Bristol as if you are in a field in southern India. It is about temperature change rather than extremes of temperature. It is important that we understand that, because that is going to hurt us. The climate and environmental impacts are also adding strain, as we have heard, to a service under pressure. The NHS said that this summer’s heatwaves piled pressure on its services and the NHS showed that A&E bore the brunt. We have just heard the amendments from the noble Baroness, Lady Coffey, and the other amendments about the emergency services. This is just going to make it worse.
Heat-related A&E attendances already account for 6% of average daily total attendances across the UK on extreme heat days, and the impact is estimated to cost £538 million a year. This cost could rise by 144% by the 2030s. That is almost tomorrow, really, when you come to thinking about putting a new building together. It is welcome that the NHS trusts will retain their current “have regards” to climate change, but we really need to do more. We are not ramping up enough. The climate itself is not standing still. The Climate Change Committee warned that our health service remains chronically underprepared to deal with the risks, and there remains a lack of resilience for the physical NHS estate to cope with extreme weather.
Lord Crisp (CB)
My Lords, I am delighted to have put my name to both amendments, and to have heard them argued for so powerfully and cogently by my noble friends Lady Hayman and Lady Boycott. I want to emphasise one or two points, and add one slightly new point, because so much has been covered very quickly.
It seem odd that, in this year of all years, we decide to get rid of a power that used to be there, to reduce the emphasis on climate change and not to make it clear that the duties of NHS England need to be transferred in their detail. This was the point that my noble friend Lady Hayman was making. It is not just the general point that the Secretary of State has a responsibility as part of government policy to ensure that climate change is tackled; the detail of it needs to be there. Requiring NHS institutions to create and publish detailed resilience plans—the sort of plans that you can recognise in practical detail—would not only be useful for them but, frankly, give the public confidence, because there is a public confidence issue here.
I will not emphasise the Wellcome report on climate change. I hope that noble Lords and the Minister have had a chance to look at a report that is specifically focused on climate change and health. As I recall—sorry, this sounds like an advert—it has nine chapters that detail the impact from the latest research that is available globally. It is a powerful report; I declare an interest.
The NHS is interesting in this regard, because the NHS is both affected by climate change and a cause of it, and between them these two amendments deal with that. When I was chief executive of the NHS, there was some extraordinary figure that something like 3% or 5% of traffic in London was caused by the NHS and by people going back and forth to appointments. There is a lot on that side in terms of the impact on the climate from what the NHS does. A lot has been done in the last 20 years, but there is more to do.
The second amendment, proposed by my noble friend Lady Boycott, is about helping the NHS to be resilient. This is the big point that I want to emphasise. It was in my noble friend’s speech, but I would like to make it even clearer: many people in your Lordships’ Chamber have been involved with the NHS, and I guess we all know that everything in the NHS is a priority to someone. That is why it is so difficult to deal with, and one has to think of it in that way—but there are some overarching priorities. Frankly, this is an overarching priority. It is not about a discrete issue; it is about something that is going to affect all the services we have talked about earlier today, and other services as well. I hope that the Government are going to give this a high priority in their future thinking. I suspect that the public expect them to do so, and one can only imagine the consequences if the NHS does not get this right. I hope the Minister will accept these amendments. As my noble friend Lady Boycott said, the case is compelling and we are looking for an affirmative.
Baroness Bennett of Manor Castle (GP)
My Lords, it is a pleasure to take part on this group and to utterly applaud the three speeches we have already heard. I have not signed any of these amendments, because I wanted to leave space for others. Speaking as an old newspaper editor, “Green signs amendment about climate and environment” is a bit like “Dog bites man”, so I wanted to ensure that we had the maximum impact from other signatures. We have already heard the case made powerfully for this, but I want to make a couple of additional points and to follow on from what the noble Lord, Lord Crisp, said about priorities.
I have encountered many individuals in the NHS who are doing spectacular work in reducing the NHS’s carbon emissions. The Minister is not currently in her place, but I will say to another Minister that I encourage her to visit County Durham and Darlington NHS Foundation Trust, where tremendous work is being done, particularly on reducing the impact of acute care. Sometimes with acute care there is a feeling that we have to do the emergency stuff and we cannot do anything here. Actually, what we have seen is that in looking at where the use of intravenous drugs can be reduced and tablets used instead, clinical outcomes are improved and the amount of plastic use is significantly reduced. When you really start to look at what you are doing and how you can do it better, you can improve both clinical and environmental outcomes. That is just one example that I happen to know about.
It is important that the people who are doing this know that they have support from the centre and that this is an NHS priority, because they are putting time, energy and attention into this. Unless we see support from the centre by saying that this is a priority, it is hard for them to get the resources and support they need to make change happen. We know that any large organisation has a large sense of inertia, and delivering change needs support right through the organisation. As the noble Lord, Lord Crisp, said, the climate emergency is a health emergency as well, and there are so many ways in which these two factors interact.
On the amendment from the noble Baroness, Lady Boycott, looking at resilience to climate and environmental degradation risks, I want to cross-reference it to the joint intelligence chiefs’ report on the impact of environmental degradation on our food security. Are we thinking about the food security of the NHS? We have to be able to feed the patients, but there is also a great deal of feeding of staff that has to happen in the NHS. How much have NHS institutions looked at how secure their food supply is? That is something that the joint intelligence chiefs, not known as radical green activists, have said is really an issue. I note in passing that we still have not seen the publication of that full report, which is very disappointing.
There is another issue that I think everyone is very aware of after this summer. I note that my honourable friend in the other place, Hannah Spencer, has a Private Member’s Bill about working conditions and having a maximum working temperature, which, whatever that might be, has been exceeded in many of our NHS institutions over the past summer. We have seen staff collapsing as a result of the heat in their workspace. That has to be considered unacceptable, but what is it doing to patients if staff are collapsing from heat?
Baroness Coffey (Con)
My Lords, this is another interesting group. I want to follow on from the initial amendment from the noble Baroness, Lady Hayman. I have more of an interest in thinking of the Environment Act and the targets there and reducing waste. This is a story about how much single-use plastic is used in the NHS.
I spent a month in hospital a few years ago and, for me to have a shower every day, a nurse used to get a bin bag or two and then strap them around my arm, basically because I could not get water on a particular cannula. I was a bit surprised by that, because you could just buy from Amazon a whole bunch of sleeves that can be dried and reused. I am sure there is some clinical reason that they could cite—I was struggling to find out why—just because I was in hospital. I did exactly what I have just mentioned when I went into recuperation at home. Instead of just thinking about straws or plastic cups, the NHS has a real opportunity to do a lot more thinking about what it uses, what needs to be thrown away and what could go back to somewhere else. I am not suggesting that people reuse syringes and the like, but the NHS could think more carefully, instead of this single-use culture.
Building on that, the amendment tabled by the noble Baroness, Lady Boycott, is also highly relevant. I am very conscious that we did not make much progress in getting hospitals built, sadly. Some of this was, frankly, due to an argument going on between local hospitals, the NHS, the Treasury and so on about what was going to be built. The purpose of moving to a modular basis of building is to have something that is scalable and that should be a lot more resilient in the future. The reason I mention that is that we still have the challenge of hospitals that have a RAAC risk and the unfortunate delay in their construction being replaced. I think there are five around the country—it so happens that three of them are in East Anglia—that will not now be happening until, I think, 2033.
One of the simpler things that we can learn from the continent, where we have seen extreme weather—indeed, we have been experiencing it more regularly ourselves—is design, thinking about heat, as has been mentioned. Indeed, that month I spent in hospital happened to be during a particularly hot summer, and I bought my own fan so I could try to keep cool. It was regularly removed because it had not gone through the electricity checking system and therefore obviously had a dodgy plug that was going to blow up the entire hospital. There are areas like that where intelligent design, thinking through not only the use of materials but the design of hospitals in future, is going to be vital.
I appreciate that this is not just about hospitals. Quite rightly, noble Lords have referred to what is happening in terms of quality of housing. This Bill can play a role in trying to get embedded, right across the country in our NHS settings but also at home, that real change and transition. Whether it is about having more shutters, making that much easier to operate and, if you have them at scale, much cheaper to deploy, or whether it is about thinking carefully about design and whether every NHS building has to be BREEAM Excellent —my personal view is the answer to that is no—it would certainly reduce a lot of cost. By and large, BREEAM Excellent tends to prefer air conditioning to aspects of simpler design. I am very pro air conditioning, but that does not mean it is needed quite everywhere.
Lord Hunt of Kings Heath (Lab)
To follow on from the noble Baroness, Lady Coffey, we should acknowledge that the NHS has done an awful lot in its environmental and climate change policies, and we should pay tribute to the people who have led that. One of their problems is that some proposals—maybe to do with heating or lighting—that will not only reduce carbon usage but reduce costs long term need some up-front investment, but we still do not seem to have found a way to allow for the NHS to borrow against a fund for it to be repaid over the years ahead. I hope that we might think about this, particularly in relation to sustainability and climate change.
I was looking at advice issued by the CQC in the light of the 2022 legislation that the noble Baroness quoted from. It says:
“Trusts and ICBs meet this new duty”—
that was placed in the 2022 Act—
“through the delivery of their localised Green Plans. Every trust and ICB in the country now has a board-level lead for net zero and sustainability”.
Perhaps my noble friend the Minister might want to write to me about whether, despite the changes in legislation, that responsibility still lies with local NHS services. Will the CQC guidance still stand post the passage of the Bill?
Baroness Pidgeon (LD)
My Lords, I am grateful to the noble Baronesses, Lady Hayman and Lady Boycott, and all noble Lords who have put their names to these amendments, including my noble friend Lady Sheehan.
The central question is straightforward: as the Bill proposes changes to the organisation of the health service, how do we ensure that its responsibilities for climate change, environmental protection and—from all that—patient safety are strengthened rather than simply diminished and reduced?
We absolutely support Amendment 52. As the noble Baroness, Lady Hayman, has clearly set out, in 2022 the House established climate and environmental duties for NHS England integrated care boards and trusts but not for the Secretary of State. As functions move into the department, responsibilities for this must not disappear. The amendment is modest; it talks about “have regard” to the duty. It would not prevent the Minister balancing competing priorities but would make sure climate change was absolutely on the agenda.
Can the Minister explain who will report progress to Parliament once NHS England’s annual reporting responsibilities are lost? How will Parliament be able to scrutinise this in future? Just because there is an organisational change—and we see that a lot in the NHS—it should not then lead to a huge accountability gap and a potential reduction in work in this area.
We also support Amendment 248 and its requirement for each NHS trust and foundation trust to publish an assessment of climate risks to its premises, workforce and services, together with plans to address them. This is a practical and proportionate requirement; we should not wait until wards are overheating or hospitals flood before asking whether there was a plan and doing something about it. Adaptation is about patient safety, as we have heard, and, given the extreme weather that we are now living through, it is essential. It is about resilience, as the noble Lord, Lord Crisp, said.
The final point made by the noble Lord, Lord Hunt, was important: this is about investing to save in terms of tackling sustainability issues. That is spot on. Years ago, there was an “invest to save” fund. We need to look at that if we are going to be able to make savings in the future to invest in the capital works that are needed. I hope the Minister will be able to respond positively to this group.
Earl Howe (Con)
My Lords, again, if the Committee will forgive me, I will speak only briefly. I start by expressing my support for the remarks made by the noble Baroness, Lady Hayman, in speaking to her Amendment 52. It seems impossible to argue that the Secretary of State for Health and Social Care should be exempt from a duty to be mindful of the climate change agenda in everything they do, especially as we remember that the Secretary of State for Health and Social Care presides over an organisation with a very large carbon footprint. It was very much with that in view that Section 9 of the Health and Care Act 2022 included duties on NHS England to have regard, in the exercise of its functions, to the Climate Change Act 2008. Therefore, the noble Baroness was entirely right that the duties that apply currently to NHS England in this area should now logically apply to the Secretary of State.
Having said that, I would be surprised if the Minister did not respond by saying that the first part of Amendment 52 is unnecessary, for the very dull reason that Section 15 of the Climate Change Act 2008 already places a duty on “the Secretary of State”, in exercising his or her functions, to have regard to
“the need for UK domestic action on climate change”;
the section spells out what that means in practice. It has long been drummed into me that an Act of Parliament conferring duties on “the Secretary of State” should be read in law as applying to any Secretary of State. That is a very legalistic point, and I do not think that it constitutes a sufficient reason for the Minister to resist this amendment, for all the reasons set out so well by the noble Lord, Lord Crisp.
Personally, I feel the need for something declaratory and specific in this area. The duty to issue detailed guidance seems a very definite omission from the Bill. As we heard the Minister say in response to the previous group of amendments, climate change is becoming a highly relevant factor for ICBs and trusts in the planning of service delivery. As the noble Baroness, Lady Boycott, was right to emphasise, it is equally relevant in the public health context and to the design of buildings, including hospitals. With all that in mind, I hope that the Minister will feel able to give the noble Baroness’s amendment a positive response.
Baroness Hyde of Bemerton (Lab)
My Lords, I thank all noble Lords who took part in the debate on this important group of amendments. I will address Amendments 52 and 248 together.
I turn first to Amendment 52, tabled by the noble Baroness, Lady Hayman. The Government remain committed to tackling climate change and ensuring that the NHS continues to play its part. I agree with the noble Lord, Lord Crisp, that this is an overarching priority. However, we do not believe that this amendment is necessary. I am indeed going to say that the climate change target and environmental targets referred to in the amendment already apply to the Secretary of State through the Climate Change Act and the Environment Act. The 10-year health plan was clear that we will continue to support the NHS’s climate ambitions. The reforms in this Bill do not remove or weaken that commitment.
The amendment also provides for guidance on the discharge of climate duties. However, the Bill already enables the Secretary of State to issue such guidance to integrated care boards, alongside transferring NHS England’s existing guidance powers for NHS trusts and foundation trusts to the Secretary of State. Importantly, integrated care boards, NHS trusts and foundation trusts will retain their existing statutory climate duties. We will continue to support the aims of the NHS’s climate ambitions in a way that improves delivery of care, returns savings to front-line services and drives wider economic growth. I say to the noble Baronesses, Lady Coffey and Lady Bennett, that I look forward to debating in full the use of single-use plastics in the NHS in the group of amendments on medicines and medical devices beginning with Amendment 111, but I will not pre-empt a fulsome discussion of that by delving into that content here, so we can all look forward to that.
I turn to Amendment 248, in the name of the noble Baroness, Lady Boycott. NHS trusts and foundation trusts have to consider the need to adapt to the current and predicted impacts of climate change. All trusts and foundation trusts are already required to have green plans in place. In reply to the noble Baroness’s point about how we will ensure that this happens, following the abolition of NHS England, the Secretary of State will issue guidance to support the system in discharging their duties, building on the existing Green Plan Guidance published by NHS England. There are statutory guidance-making powers in the NHS Act 2006 for ICBs, trusts and foundation trusts, under which the Secretary of State expects to issue guidance to support that system in discharging its duties.
As many noble Lords raised, including the noble Baroness, Lady Hayman, we know that the impacts of climate change are already being felt across the NHS, including disruption from heat in particular, flooding and other types of extreme weather. That is why the 10-year capital plan committed to renew that focus on climate resilience. We have strengthened adaptation planning with green plans to prepare for severe weather events and improve climate resilience of local sites and services, and plan to conduct an adverse weather emergency response exercise in every NHS region by 2030, so strengthening that whole system preparedness for extreme heat through UKHSA-led planning, co-ordinated alerts and mandatory local response arrangements across the NHS.
All trusts are required to have adverse weather plans to ensure service continuity during major events, such as heatwaves. Beyond planning for acute incidents, trusts also undertake climate change risk assessments to identify and reduce overheating risks and their potential impacts. There is already, therefore, a clear framework for trusts to plan and respond to climate risks. I humbly suggest that the Government do not have their head in the sand but that our focus should be on delivering against these existing duties and plans. The 10-year health plan also committed to supporting the NHS’s existing net-zero targets and climate objectives as set out in Delivering a “Net Zero” National Health Service, published in 2020. I am sure noble Lords are aware that, since the publication of that strategy, NHS carbon footprint emissions have indeed fallen by 17%.
To address the point raised by the noble Lord, Lord Hunt, I have covered some of the local duties points. The CQC guidance will remain, but I will write in full laying that out. On the point from the noble Baroness, Lady Pidgeon, about how this will be reported to Parliament, information on annual NHS emissions will continue to be published in the DHSC’s annual report and accounts, which are also laid before Parliament annually. That will ensure that Parliament continues to receive that regular information on the NHS’s progress towards those environmental objectives. I hope that this reassures noble Lords that the Government recognise the importance and, as many noble Lords have raised, ongoing salience of this issue.
Baroness Bennett of Manor Castle (GP)
I think this was probably before the noble Baroness came into the House, so I will not ask her whether she remembers the Financial Services and Markets Bill, on which we had a very similar debate. The Government eventually made a concession that was introduced directly into the Bill and did not say that we had to rely on the overarching Environment Act, et cetera. Will she have a look at the debate on the Financial Services and Market Bill, in particular Third Reading, when the Government explained why they had given way on that Bill?
Baroness Hyde of Bemerton (Lab)
I believe I was in the House; it was after the King’s Speech. I will absolutely go away and review that debate and take it back.
Baroness Coffey (Con)
I have just looked at the other amendments and can find “plastic” referred to only in terms of infant feeding material, so I just wanted to get a sense of which amendment we are talking about. I did not quite catch which one the Minister referred to.
Baroness Hyde of Bemerton (Lab)
There is a group of amendments beginning with Amendment 111, which includes an amendment with a reference to single-use plastic. It is grouped in the medicines and medical devices section. I believe it was de-grouped; it was originally in this group and now is in the group beginning with Amendment 111. I know nothing will stop noble Lords discussing the things they want to in that group, irrespective of the content of the amendments.
Baroness Hayman (CB)
My Lords, I am extremely grateful to everyone who has taken part in the debate, perhaps particularly to the noble Baroness, Lady Coffey, because she quite rightly pointed out that the amendment deals with Environment Act duties as well as the climate change ones, and that is extremely important.
I was very grateful for the support, generally for—I think it was the noble Earl, Lord Howe, who said it—the declaratory nature of what is needed in this Bill. There is a very powerful case to say that there are gaps between the previous legislation and what we have now. There will be some very interesting governance arrangements within the NHS; we have been talking about new special health authorities, for example. There are lots of different ways in which we have to make sure that we are secure in having an overarching commitment.
On the essentially legalistic position which I think the Government are taking on this, the noble Baroness, Lady Bennett, is quite right to cite the Financial Services and Markets Bill. The Chancellor did not say then, “The Chancellor has a responsibility under the Climate Change Act, so you cannot put anything in at all”. The Minister was here for that Bill, but she was not here for a couple of other examples I could put forward to her. It would be very helpful if Ministers were willing to continue to discuss how we can bring this to a resolution, because I am encouraged by the amount of support for the current amendment around the Committee. I beg leave to withdraw the amendment.
Lord Tarassenko
“Duty as to UK suppliers and sovereign capabilityIn the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert—“1CD Duty as to UK suppliers and sovereign capability(1) The Secretary of State must take into account the matters mentioned in subsection (2)—(a) in setting the award criteria for a relevant contract under section 23 of the Procurement Act 2023, so far as those matters relate to the subject matter of the contract, and(b) in having regard, under section 12(1)(a) of that Act, to the importance of delivering value for money in connection with the award of a relevant contract.(2) The matters are—(a) the extent to which the data, control and support of the system concerned will remain within the jurisdiction of the United Kingdom,(b) the risks to the security and resilience of the health service arising from any respect in which they will not, including the risk that access to NHS patient data could be compelled under the law of a country or territory outside the United Kingdom, and(c) so far as consistent with the international obligations of the United Kingdom, the contribution of the contract to developing and maintaining capability within the United Kingdom to design, deliver and support technology and information systems which handle NHS patient data.(3) Subsections (4) and (5) apply to a material relevant contract under which—(a) the data, control or support of the system concerned will not remain wholly within the jurisdiction of the United Kingdom, or(b) the supplier, or any subcontractor with access to NHS patient data, is subject to the law of a country or territory outside the United Kingdom under which access to such data could be compelled,(a “jurisdiction-risk contract”).(4) Before entering into a jurisdiction-risk contract, the Secretary of State must consult—(a) the National Cyber Security Centre,(b) persons representing the interests of patients, and(c) trade unions representing health service staff,on the proposed contract, and must, before, or as soon as reasonably practicable after, entering into the contract, lay before Parliament a report on that consultation.(5) As soon as reasonably practicable after entering into a jurisdiction-risk contract, the Secretary of State must lay before Parliament a statement setting out—(a) the reasons for the award, including how the matters in subsection (2) were taken into account, and(b) whether the Government is taking, or is planning to take, steps to develop or support long-term domestic alternatives to the systems provided under the contract. (6) The Secretary of State must, at least once in every period of 12 months, lay before Parliament a report setting out—(a) the number and total value of relevant contracts entered into during that period, the proportion of each awarded to UK suppliers, and the number and total value of jurisdiction-risk contracts entered into during that period; and (b) how the award of those contracts has contributed to the objectives of any NHS Digital Sovereignty Strategy published under section (NHS Digital Sovereignty Strategy) of the Health Act 2026 (NHS Digital Sovereignty Strategy).(7) A report or statement under this section may omit information the publication of which would be reasonably likely to prejudice national security or the commercial interests of any person, but must state that information has been omitted.(8) This section is without prejudice to the national security exemption under paragraph 25 of Schedule 2 to the Procurement Act 2023.(9) In this section—“material relevant contract” means a relevant contract with an estimated value, determined in accordance with Schedule 3 to the Procurement Act 2023, of more than the threshold amount that applies under Schedule 1 to that Act to a contract of that kind awarded by a central government authority, including a contract awarded under a framework and a renewal or extension of a relevant contract;“NHS patient data” means patient information (within the meaning given in section 250E(7)) relating to persons who have received health care or social care in England;“relevant contract” means a contract entered into by the Secretary of State for the provision of technology or information systems which—(a) form part of the single patient record, or hold or process patient information for its purposes, or(b) are provided for use across the health service in England as national systems and hold, process or provide access to NHS patient data;“the single patient record” means the system for making patient information available referred to in section 250E(1), whether or not established by regulations under that section;“UK supplier” means a company incorporated in the United Kingdom which either has no parent undertaking or each of whose parent undertakings (within the meaning of section 1162 of the Companies Act 2006) is incorporated, and has its head office, in the United Kingdom.””Member's explanatory statement
This new clause would require procurement of the single patient record and national systems handling NHS patient data to weigh UK jurisdiction over data, control and support, and UK capability, with consultation and statements to Parliament for higher-value contracts outside UK jurisdiction, and an annual report on the UK share.
Lord Tarassenko (CB)
My Lords, I shall also speak to Amendments 171 and 289, all in my name and that of the noble Baroness, Lady Kidron, who I thank for her support. I remind the Committee of my interests: I hold an honorary contract with Oxford University Hospitals NHS Foundation Trust, which is in the process of being renewed, and I am a director of LIO Health, a UK company which contracts with mental health NHS trusts.
The NHS holds health data no other country can match, namely longitudinal records for the whole population of England: primary care data, electronic patient records—EPRs—in hospitals and patient outcomes in multiple national registries. The single patient record, SPR, has the potential to bring primary care and secondary care records together for the first time and, in time, to link them to outcome data. That is a national asset of extraordinary value, not only for direct care but for research that will improve patient outcomes. It provides a unique opportunity for the UK companies that could build the systems which hold and process the SPR data.
The Government have told us that the SPR will indeed be delivered through contracts with multiple suppliers, with no single supplier dominating. Those contracts will be awarded over the next two years. These amendments ask a simple question: which companies are likely to win these contracts? Today, the US company Epic supplies the EPR in close to 20 NHS acute trusts. This year alone, four trusts in Somerset and Dorset have signed a £222 million 10-year contract with Epic, and Lewisham and Greenwich a £52 million contract. In general practice, EMIS, a company founded in Leeds, was sold to United Health in 2023 for £1.2 billion, and then on to another American company, a private equity firm, TPG, this year, so a large share of our GP records now sits with a US-owned supplier.
UK capability, although patchy, is still there. TPP, still UK-owned, supplies SystmOne across general practice and community services. Nervecentre, a British company founded in 2010, now has some 15 trusts committed to its cloud-native EPR, including a 10-year, £53-million contract with Liverpool University Hospitals, signed this spring. As I said at Second Reading, Kynos, a FTSE-250 company, won the contract in open competition to build UK Biobank’s output-checking system. UK companies can win and do win when procurement gives them a fair chance.
The contracts awarded for the single patient record in the next two years will typically run for 10 years and will define the health software market until the mid-2030s, the end of the NHS 10-year plan. If UK companies do not win a significant proportion of these contracts, the gap between US and UK suppliers will not stay where it is now. It will widen with every contract award, as revenue, engineering talent and know-how about NHS data build up on one side of the Atlantic. In 10 years’ time, that gap will be insurmountable. We will have lost the ability to build and support the core digital infrastructure of our own health service, and we will not get it back; the window to act is now.
Amendment 53 makes sure that UK jurisdiction and UK capability are taken into account when they matter: at the point of contract award. It requires the Secretary of State to take three matters into account when setting award criteria under Section 23 of the Procurement Act 2023 and when weighing value for money under Section 12(1)(a) for contracts for the single patient record and for national systems handling NHS patient data: first, the extent to which the data control and support of the system will remain within UK jurisdiction; secondly, the risk to the security and resilience of the NHS where they do not, including the risk that access to NHS patient data could be compelled under the law of another country, the US CLOUD Act being the obvious example; and, thirdly, consistent with our international obligations, the contribution the contract makes to building and maintaining UK capability.
Value for money is not simply the lowest price of a contract term. It must include the cost of dependency, the cost of exit and the value of the capability we keep. For larger contracts where data control or support will not remain entirely in the UK, the Secretary of State must consult the National Cyber Security Centre, patient representatives and NHS trade unions, and lay a Statement before Parliament explaining the award and whether domestic alternatives will be developed. Every year, the Secretary of State must report the number and total value of the contracts and the proportion awarded to UK suppliers, defined as UK companies with no foreign parent.
Amendment 53 deals with individual contracts and Amendment 171 provides a strategy. It requires the Secretary of State within 12 months of Royal Assent to publish an NHS digital sovereignty strategy. That strategy must cover four topics: first, treating NHS patient data as a sovereign data asset, including where it is stored and from where it may be accessed; secondly, assessing the risks across hardware, software, supply chains, and procurement, including reliance on foreign technology; thirdly, building domestic capability, including options to prioritise UK technologies; and, finally, research access to pseudonymised data in a way that keeps public trust. A sovereign data asset held in the UK under UK control with the benefits flowing back to the NHS is the best guarantee of that trust.
For research access, the NHS digital sovereignty strategy must set out the hierarchy: UK universities, medical research charities and the NHS itself, including the NIHR, will come first; UK suppliers second; and everyone else third. The strategy must also address how the NHS will share in the value created, with returns reinvested in the health service. Data must be accessed only within a trusted research environment in the UK, with outputs checked before release. Amendment 289 would bring both new clauses into force on Royal Assent, when the 12-month clock for the strategy would start, and the procurement duty in Amendment 53 would apply to the SPR contracts now being prepared.
All the amendments in this group share one concern: who controls the digital foundations of the NHS? I look forward to hearing from the noble Lords who have tabled them.
I support Amendment 277, from the noble Baroness, Lady Neville-Rolfe, which would require the Secretary of State to report on how NHS procurement supports patient care, value for money, resilient supply chains and economic activity in the UK. I also support Amendment 160, from the noble Lord, Lord Clement-Jones, which would require the Secretary of State to establish through regulations a governance framework for NHS IT and data contracts.
Several amendments in this group are concerned specifically with the Palantir contract for the NHS federated data platform. After the Secretary of State’s appearance in front of the Commons Health and Social Care Committee last week, when she refused to be drawn on whether the Palantir contract would be extended, I look forward to hearing what the Minister might have to say about the topic. I have two questions that I hope the Minister will answer in full. First, how will the value-for-money assessment of the SPR contracts take account of UK jurisdiction and resilience? Secondly, will the Government commit to publishing an NHS digital sovereignty strategy, whether or not they accept the wording of Amendment 171? After all, last week the Secretary of State said:
“We want … sovereignty. That has to include sovereignty for UK data”.
This country has world-class health data science and a health tech sector that should be given the opportunity to grow. The single patient record contracts are the biggest opportunity that the sector will see in the next 10 years. We must not spend the next decade buying back our own capability at a premium. I beg to move.
Lord Clement-Jones (LD)
My Lords, it is a pleasure to follow the noble Lord, Lord Tarassenko. I will speak to Amendments 144, 147, 158 to 160, and 172E in my name, and I give our strong support to Amendment 53 on the digital sovereignty package, spoken to so convincingly by the noble Lord, Lord Tarassenko. We are very much singing from the same hymn sheet on these Benches.
I was unable to take part at Second Reading, but, over the years, as the noble Lord, Lord Kamall, will know from his time as a Minister, I have taken a strong interest in the access to, use and destination of NHS data for all purposes. Digital technology and data analytics hold transformative potential for our NHS, but technology is as effective only as the governance that underpins it, and health data platforms can succeed only if they command absolute public and clinical trust. If the NHS hands over its core data architecture to closed, proprietary vendors without retaining public ownership of software connectors or enforcing open API standards or clear parliamentary oversight, we risk locking our health service into perpetual vendor dependency.
In speaking to these amendments, I am building directly on the outstanding work of my Liberal Democrat colleagues in the Commons. I pay tribute to my honourable friend Martin Wrigley, who led the charge on vendor lock-in; my honourable friend Helen Morgan, who tabled a new clause on a sovereign health data trust; and my honourable friend Dr Danny Chambers, who tabled a new clause establishing the framework for an NHS digital sovereignty strategy.
On these Benches, we believe three principles should apply: NHS patient data is a sovereign public asset, exactly in the way that the noble Lord, Lord Tarassenko, described; data infrastructure must adhere to open, FAIR—findable, accessible, interoperable and reuseable—standards; and commercial suppliers must operate under strict public benefit conditions, with the NHS retaining full legal ownership of software interfaces and data pipelines.
Baroness Bennett of Manor Castle (GP)
My Lords, it is a great pleasure to follow two of your Lordships’ House’s real experts in this area, and I look forward to hearing from a third shortly. To extend the metaphor of the noble Lord, Lord Clement-Jones, we are singing from the same hymn sheet, but just different parts. That is what this group of amendments is doing.
I will start with my Amendments 168, 169 and 172B, and I will deal with Amendment 268 at the end, which is somewhat different. These three amendments address different parts of the same problem. Who has access to NHS patient data? Who controls the infrastructure holding that data? Should the NHS should continue to rely on Palantir to provide that infrastructure?
I will start with the principle behind all three: NHS patient data belongs to a public health service under public control. It should not be accessible to commercial companies simply because the NHS has entered into a contract with them to provide the technology. The Government will no doubt say that patient data remains under NHS control and that Palantir acts as a data processor and cannot use the information for its own commercial purposes. Those are important contractual assurances, but they do not, as the other amendments in this group highlight, answer the issues that are raised. There is a difference between owning the data and having control over the systems through which that data is accessed, processed and managed. There is also a difference between a contractual promise and having the practical ability to guarantee that sensitive information remains beyond the reach of commercial contractors. In fact, we know that that is exactly what is happening.
NHS England has confirmed that three Palantir engineers have administrative-level access to the national data integration tenant, part of the federated data platform. A further 12 Palantir engineers have had more limited project-specific access for particular data sets and tasks. Now, this is not an allegation that Palantir employees are routinely browsing individual patient records, but administrative-level access to a system holding identifiable patient information is a serious responsibility. It raises huge questions about the boundary between public control and commercial access. I note that the National Data Guardian herself has questioned this. She said that the information about external contractors having access to identifiable patient data appeared to be inconsistent with the data protection impact assessment she had previously reviewed and she sought clarification from NHS England on this.
Amendment 168 addresses this directly. It would stop commercial entities and their employees, officers and subcontractors from accessing identifiable NHS patient data. That includes not just direct access to patient records but administrative and privileged access to databases, as well as access through software, support, maintenance and testing. We need this because we cannot allow the distinction between accessing patient records and administering the systems that contain them to become a loophole in the protection of confidential information. Commercial suppliers can still provide technical services. The amendment does not prevent the NHS from buying software or obtaining technical support, but it requires those services to be delivered using anonymised records. The NHS should be able to benefit from technical expertise without giving commercial companies access to identifiable patient information.
We come to the specific issue of Palantir, which is covered by both amendments. Palantir, as has already been alluded to, is not an ordinary technology supplier with no wider controversies. Its work with the Israeli military has drawn serious criticism from human rights organisations, including Amnesty International, which has documented the company’s links to Israel’s military activities in Gaza. It is also important to look at the ownership and the philosophy of this company. In March, Alex Karp said he believes AI will shift power away from
“highly educated, often female voters who vote mostly Democrat”
and towards working-class men.
I asked the Library to have a look at the ownership and control structures of Palantir. I thank it for its very detailed research, to which I am not going to subject noble Lords in detail. The key point is that Alex Karp, to whom I have just referred, co-founder Stephen Cohen, and chairman Peter Thiel have between them 49.99% of voting power because of the stock structure of the company. I note that the major institutional shareholders are Vanguard Group and BlackRock, Inc. They are not known for being companies that stand up for human rights, the rule of law or the public good. They have very distinct financial interests.
In particular, the company’s chairman, Peter Thiel, is known for his controversial views. At the Oxford Union in 2023, he said that the NHS makes people ill and should be privatised. I note also, in a broader context, that he is on the record as framing politics as an existential struggle against the Antichrist. Mr Thiel has named possible suspects for the Antichrist, including Representative Alexandria Ocasio-Cortez, Greta Thunberg and people who are critics of artificial intelligence. Now, that is quite disturbing. I would also note the fact that he was asked, in a video available online under the headline “Peter Thiel and the Antichrist”, whether he preferred the human race to endure. The interviewer said:
“You’re hesitating”.
Peter Thiel said:
“Well, I don’t know. I would … There are so many questions around this”.
The interviewer repeated:
“Should the human race survive?”
After 18 seconds, Mr Thiel said, “Yes”.
I have some questions to put to the Minister within the framework of the fact that the UN guiding principles on business and human rights make it clear that businesses have a responsibility to respect human rights. Have the Government properly considered those responsibilities when awarding and continuing this contract? Have they assessed Palantir’s links to breaches in international human rights law? Will the Government explain what human rights due diligence was undertaken?
I will jump to Amendment 172B. I stress that it does not say that we have to switch off Palantir immediately. It is a proposal for a transition away from Palantir, with patient care and data security protected throughout. The Government may point to the benefits that they say the federated data platform is already delivering. Of course, better use of data can help hospitals to manage waiting lists and make better use of resources, but none of that requires the NHS to surrender its control.
Lord Austin of Dudley (Non-Afl)
My Lords, I will speak to Amendment 279A in my name and comment on the potential impact of the amendments tabled by the noble Baroness, Lady Bennett of Manor Castle.
My amendment would require the Secretary of State to report annually to Parliament on NHS and social care procurement of medical devices, consumables and services in England, assessing its performance against the objectives in Section 12(1) of the Procurement Act 2023, and would confine the report to those objectives. Noble Lords scrutinised the Act carefully, including the objectives that authorities must have regard to when carrying out procurement: delivering value for money; maximising public benefit; sharing information so that suppliers and others can understand procurement policies and decisions; and acting, and being seen to act, with integrity. Those duties are already established in law. My amendment would provide Parliament with a focused, regular account of how they are being applied in an area of considerable importance to patients and taxpayers.
In the NHS, as we heard earlier, value for money cannot simply mean the lowest purchase price. An MRI scanner that costs less to buy may prove more expensive over its working life through maintenance, breakdowns or additional training requirements. Reliability and clinical effectiveness matter, as do the consequences for patients when equipment is unavailable. An annual report would help Parliament to examine whether those considerations are being weighed properly. The Act does not require each objective to receive equal weight in every procurement, so the report should explain how they have been applied in practice.
Proposed new subsection (2) would keep the report focused on those established objectives; other applicable legal duties would continue to apply. Proposed new subsection (3) would exclude procurement still governed by the previous regulations under the transitional arrangements. The reporting arrangements should be proportionate, drawing wherever possible on information already collected. I hope the Minister can explain how the department intends to account to Parliament for the application of these objectives, and whether the Government would consider the focused annual reporting duty proposed in this amendment.
Amendment 172B raises serious legal and procedural problems. In singling out one company, it raises the question of whether it would make this Bill a hybrid Bill. It also risks breaching the United Kingdom’s obligations under the WTO Agreement on Government Procurement. The Ministerial Code expressly requires Ministers to comply with international law and treaty obligations. Will the Minister explain how this amendment could be implemented consistently with those duties? Your Lordships’ House spent many hours scrutinising the Procurement Act; this was serious work to protect public money, secure good services and ensure that suppliers are treated fairly. This amendment could completely undermine that work.
The amendment singles out one company by name, even though many tech companies provide services to the NHS. It seeks to end its contract at the first opportunity and exclude it from the replacement. It asks us to substitute a subjective political judgment for the outcome of a competition in which bids were assessed against objective published criteria. If its supporters believe that different standards should apply, they should explain what those standards are and apply them consistently; they should not ask Parliament to settle the outcome for one company in advance. What opportunity would the company have to demonstrate that it could meet the requirements? It would have none. However effective its technology and however competitive its price, the amendment would already have decided the answer. That is an extraordinary approach to spending public money. The precedent would extend well beyond this contract. We should be particularly careful about singling out a supplier by a political test that no elected body has defined.
Why should a company spend time and money competing for a public contract if the published rules can be set aside after it has won? The risks are clear: there would be fewer companies willing to bid, weaker competition and higher prices for taxpayers. While politicians argued about which suppliers they approved of, public services would wait longer for the technology they needed. If there is evidence that a supplier threatens national security, there are statutory powers for dealing with that. Serious allegations should be examined against the evidence, through the proper processes. Patients and taxpayers are entitled to ask what they would gain from this proposal. Would it mean shorter waits, safer care or lower costs? What would replacing the system cost? How would services be protected during the change? Where is the evidence that this amendment would deliver better care or better value?
We have already seen the consequences of the dispute over technology procurement. This is a different subject, but the principles still apply. When the Met was facing substantial financial pressures, the commissioner wanted to use technology to reduce administrative work and protect front-line services. He also said that it could help the police catch people who threaten the public
“at a pace that simply isn’t possible without”
the enabling technology. Yet the proposed contract was blocked and the commissioner warned that between 500 and 700 officers and staff posts delivering services to Londoners could be affected, which would make the city and its residents less safe. The mayor’s office said its concerns were about procurement and value for money. Those questions deserve proper examination, of course, but why were Londoners originally told suppliers should
“share the values of our city”?
Procurement requires evidence and a proper assessment of the consequences. It cannot become a test of whether politicians approve of a company’s so-called values. The same principle applies to the NHS. I think this amendment is a political boycott dressed up as procurement policy. It seeks to exclude a company from serving the NHS because of its relationship with Israel—but Israel, as the only liberal democracy in the Middle East, is deeply integrated into the world’s technology and medical industries. Major companies operate there, invest there and work with Israeli institutions. Palantir is one of many tech firms working in Israel. Perhaps its offence is that it is not embarrassed about it. Oracle came second in the bid process for the federated data platform; it has supplied software to the Israeli military. IBM came third; it has contracted to build data centres for the Israeli military. Microsoft has supplied the Israeli military with cloud technology. Nobody complains about Parliament using Microsoft Word and Outlook to conduct our business. If every corporate association is now a test of political purity and individual politicians’ values, there will be much more boycotting to be done in future.
This amendment singles out one company. It offers no consistent standard against which every supplier would be judged. Doing business with Israel should not disqualify a company from serving the NHS. Contracts should be awarded in line with the rules and on the basis of whether they can fulfil the contract, the quality of their work and value for money—open, free and fair competition which increases quality and reduces costs to the taxpayer.
The standards for technology in our health service should be demanding. Suppliers must demonstrate that their systems work, protect patient information and provide value for money. They must show how their technology helps doctors and nurses deliver better patient care. Every supplier should face those tests, because patients should come first. A patient waiting for cancer treatment gains nothing from a political boycott. If technology can help bring an operation forward, we should establish whether it works and can be used safely. Procurement decisions must not be turned into an instrument of somebody else’s foreign policy. If a system can help get someone treated sooner, I want the NHS to be able to use it. There should be fair rules, applied consistently, with patients and taxpayers coming first. Those are the principles that I ask the Minister to uphold.
Baroness Kidron (CB)
My Lords, I will speak to Amendments 53, 171 and 289 in the name of my noble friend Lord Tarassenko, and Amendment 160 in the name of the noble Lord, Lord Clement-Jones, all of which I added my name to. I have my own amendment on NHS data as a sovereign data asset in a later group, which is remarkably poor organising on my part, but it does give the Minister two shots at saying we are right.
The primary difference between the amendments in this group and those in the later group is that these amendments focus largely on the use of NHS data by companies contracted and procured to provide services to the NHS, rather than primarily on how the benefits from technology trained on NHS data are retained in the UK. However, both sets of amendments cover the key elements and, whichever approach is finally taken, determining who has access to UK health data, and on what terms, is an extremely urgent issue.
During debates on the Data (Use and Access) Bill last year, I tabled an amendment on sovereign data assets, of which the NHS’s data was a key example but not the only one. At the heart of that debate, which I urge officials to look at, was a warning that has become only more urgent. The speed at which the Government are giving access to our data is swifter than the plans they have to protect its financial or societal value. We are nearly two years on and there is still no published strategy or government policy to maintain British control over valuable data assets. We do not have a clear plan for how our data or the systems that host it will be resilient to foreign interference. We do not have a clear strategy for building technological capability within the NHS for its data or ensuring that all the healthcare and economic value that comes from our data will indeed come back to the UK as a benefit.
Amendment 53 offers a road map for the conditions for access to NHS contracts, with a focus on control of data, building sovereign capability for data handling and reducing the dependencies and risks from foreign firms. This is not government data; it is data held in trust for the British public and they are being poorly served.
Amendment 160 looks at how contracts are awarded and ownership of the architecture that supplies services to the NHS. It singles out the way in which free or low-cost services are used to gain access, create dependency and result in vendor lock-in, which a number of noble Lords have already described well.
Amendments 171 and 289 would require the Secretary of State to publish a digital sovereignty strategy for the NHS, including control of systems that host data, control over the data itself, avoiding vendor lock-in and capitalising on our data to build technological capability and commercial value. It is an exhaustive checklist, but it mirrors those issues I laid in the Data (Use and Access) Bill and the Cyber Security and Resilience Bill, and in the debate on digital sovereignty in July. It also aligns with multiple recommendations by committees of both Houses, including—I will try to say this very quickly—the Commons Science, Innovation and Technology Committee’s report, Rewiring the State; the Commons BIST Committee’s report, Investing in the UK Economy, the Joint Committee on the National Security Strategy’s report on undersea cables; and the Lords Science and Technology Committee’s inquiry into financing and scaling UK science and technology. The Lords committee also has an open inquiry on innovation in the NHS and personalised medicine. How many times do we have to make the same recommendation? This is a flashing warning light.
Baroness Hyde of Bemerton (Lab)
My Lords, as agreed by the usual channels, we need to move to consider dinner-break business. While unusual, I therefore propose that the debate on this amendment be adjourned and that we return to it after dinner.
Mobile Phones in Schools
(1 day, 6 hours ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Cash (Con)
My Lords, I thank the Minister for the Statement, which we on these Benches wholeheartedly welcome. The statutory guidance for schools is to be updated, so that from September 2027 schools must act to ensure that
“children cannot have unsecured mobile phones in their blazer or bag throughout the school day”.
The road to get here may have been somewhat longer and more tortured by late nights in Division Lobbies than desired by the majority in this House, but it is always to be celebrated when we achieve consensus in the end.
I would like to take a moment to pay tribute to my noble friend Lady Barran, who led on this issue in your Lordships’ House, despite the then Secretary of State, the right honourable Bridget Phillipson, calling a phone ban a “headline-grabbing gimmick”. In June last year, my noble friend tabled an amendment to the Children’s Wellbeing and Schools Bill to ask for exactly what has now been announced. In February, this House agreed to that by 178 votes to 140. The noble Baronesses, Lady Kidron and Lady Cass, and the noble Lord, Lord Hampton, put their names to it. Peers across the House voted for it. In the other place, my right honourable friend Laura Trott pressed the case at every stage. I put on the record my thanks to them all.
It is such a positive change of heart for the benefit of children that I find myself in joyous agreement with the Secretary of State, Lucy Powell—a line you may not always hear me utter—who said yesterday:
“Children should not be using smartphones at any point during the school day, full stop”.
Amen. But the stronger guidance will not apply until September 2027, so pupils taking GCSEs this year will still have the grade-lowering distraction of their phones. Can the Minister please tell us why on earth the guidance cannot take effect more urgently?
While I of course welcome the Government’s consultation into independent safety certification for educational technology, the Statement is completely silent on the real issue: there is insufficient evidence to prove that educational technology improves educational outcomes at all, and growing, serious evidence to indicate the very opposite, that it can be a real detriment to learning. The evidence and the warnings are here now, yet the Statement is silent on the need to reduce time spent on screens in classrooms, and on the known damage of edtech already. Even on the Labour Benches in the other place, the concerns were being cited. The Minister, Josh MacAlister, warned that
“where technology has been left to let rip”
in other countries, it
“has displaced books, reading, writing”.—[Official Report, Commons, 10/11/26; col. 61.]
The Labour MP Alistair Strathern told the House that generative AI threatens to harm
“children’s learning in the same way that smartphones did”.—[Official Report, Commons, 10/11/26; col. 63.]
Be under no illusions that children having access to screens in any context in schools is going to facilitate both. In September, the OECD reported that pupils who use AI for tasks such as summarising texts score lower in science on average. A study of almost 1,000 secondary pupils found that those who practised maths with a chatbot scored 17% lower when they were tested without it.
The neuroscientist Dr Jared Cooney Horvath, whose book The Digital Delusion is essential reading on this subject and has just been published in the UK, told the United States Senate in January that this is the first modern generation to score lower than its parents on core cognitive skills. His review of almost 400 meta-analyses found that pupils read with less understanding on screens than on paper, and that the effect of edtech on disadvantaged pupils is the greatest of all. He reported that pupils on classroom devices can be off task, though they appear to be on their screens, for up to 38 minutes in every hour. Having teachers in my family, I know exactly how challenging that is, because they talk about it. Sweden has already reversed course and is spending heavily to put printed books back in its classrooms.
According to Dr Horvath’s analysis of PISA data for England since 2012, which is available on his Substack, independent schools, which sharply and more rapidly increased their use of classroom technology, found that their pupils’ results fell back, including once background is taken into account. State schools used far less technology, and their pupils’ results rose. I know the Minister shares my concern and real desire to see all our pupils do their very best and achieve their potential, and I know she will take seriously this mounting body of evidence that we must put the brakes on the use of edtech. But at the moment the department is going ahead with developing AI tutors for up to 450,000 disadvantaged pupils, the very children who most need a good teacher in front of them. The certification scheme announced yesterday has no timetable, and the department says it has no power to require schools to use it. As proposed, it would test safety but leave out whether a product actually helps children to learn.
On phones, this House gave warnings and the Government took two years to act. On edtech and AI, the warnings are being given here tonight, on the record. Will the Minister confirm that the AI tutoring programme will go no further than the Education Endowment Foundation trials until those trials report, and that certification will be compulsory and will test learning as well as safety? Will the Minister meet Peers from all Benches in this House who have raised these concerns before the consultation closes, so that this time we can get more quickly to the right answer for British children?
Lord Mohammed of Tinsley (LD)
My Lords, I welcome the Government’s announcement and, in particular, their recognition that schools must be places where children can concentrate, learn and develop relationships without the constant distraction of mobile phones.
However, I hope the Minister will forgive me for pointing out that the Government have taken rather a long time to arrive at this position. It was rightly pointed out that it was the Opposition Benches in your Lordships’ House who consistently pressed for schools to become phone-free environments. I notice that the noble Baroness, Lady Barran, is in her place. We spent many a time meeting with parents, head teachers and other campaigners.
During the passage of the Children’s Wellbeing and Schools Act, we pushed the Government to put their guidance on a statutory footing, despite their initial reluctance. We argued that the voluntary guidance was insufficient and that head teachers needed clarity and consistency, and I am pleased that the Government have finally recognised the strength of that argument.
The stats presented underline why further action is necessary. Only 16% of secondary school pupils say that mobile phone rules are followed all the time. More strikingly, where schools operate a “not seen, not heard” policy, only 20% of school leaders report consistent compliance, compared with 74% where phones are collected. That is compelling evidence that the existing approach is not working.
However, announcing stronger guidance is one thing; giving schools the resources to implement it is quite another. The Government have suggested that schools can choose between collecting phones, secure lockers or lockable pouches—but these approaches all have financial and practical implications. The Education Committee has highlighted that purchasing pouches alone can cost a secondary school around £20,000. We all know that school budgets are under enormous pressure, and we cannot expect head teachers to absorb yet another unfunded responsibility. Can the Minister therefore explain why the Government are not providing dedicated funding to support schools with implementation? Will they commit to ensuring that no school is disadvantaged because it cannot afford the necessary equipment?
Secondly, I welcome the Government’s recognition that exemptions and reasonable adjustments will be necessary for children with medical and special educational needs and disabilities. For some children, a mobile phone is not simply a distraction; it is an essential tool for managing a medical condition, communicating or accessing support. I am also particularly concerned about young carers, who may need to check on a sick, disabled or vulnerable family member during the school day. Will the Minister give an explicit assurance that young carers will be included in the exemptions alongside children with SEND and medical needs, and that these arrangements will be straightforward rather than creating additional barriers for vulnerable pupils?
Finally, I strongly support the principle that head teachers should have the flexibility to decide how best to implement a phone-free environment in their schools. Schools have different circumstances, communities and practical challenges. A one-size-fits-all approach to enforcement will not necessarily work. Flexibility must be matched with resources, clear guidance and proper support. Will the Minister commit to working directly with school leaders and representative organisations to ensure that the revised guidance is practical and properly funded, and does not simply transfer additional costs on to already stretched schools and parents?
Our children deserve classrooms where they can concentrate, learn and enjoy their childhood without the pressures of smartphones and social media. We on these Benches have been campaigning for this change for a long time and we welcome the Government finally moving in the right direction. But we must now ensure that this policy works in practice for every school and every child. I look forward to the Minister’s response.
The Minister of State, Department for Education and Department for Work and Pensions (Baroness Smith of Malvern) (Lab)
My Lords, in January 2026 the Government strengthened their guidance on mobile phones in schools, making it clear that all schools should have mobile phones policy that prevents pupils having access to their phone throughout the school day, including during lessons, the time between lessons, break times and lunchtimes. This guidance was put on a statutory footing during the passage of what became the Children’s Wellbeing and Schools Act, and schools have been required to implement it since September 2026. However, evidence and feedback from the sector—and from noble Lords in this House—suggest that challenges persist.
That is why the Government are announcing that we will update statutory guidance to be clear that schools should have policies that ensure children cannot have unsecured mobile phones in their bag or blazer throughout the school day. This backs teachers and leaders with the clarity that they are asking for. This may mean phones are collected at the start of the day, kept in secure lockers, stored in a lockable pouch, or any other strategies that ensure phones are not accessed at any point during the school day.
Noble Lords opposite raised points about the timetable. While the new statutory guidance will be introduced from September 2027, it is of course the Government’s wish—I believe evidence suggests that this will happen—that schools move more quickly towards the implementation of this policy. Of course, we have seen evidence in the last year with a near doubling in the numbers of schools that are ensuring that pupils cannot have any access to their phones during the course of the day. This answers the point made by the noble Lord, Lord Mohammed of Tinsley, about resources.
All the evidence about the different ways in which schools have approached this issue suggests that it is culture, leadership and clarity that are the most important elements in ensuring that schools are successful in carrying out this policy. We are confident that schools will be able to move more quickly than the beginning of the revised statutory guidance in September 2027. Of course, we will want to work with leaders and others within our schools to ensure that this policy is both supported by government and put in place in our schools.
The noble Lord made a particular point about young carers. It is quite tricky because, arguably, young carers, as much as any other child, deserve the opportunity to have a mobile phone-free experience in school. I am not sure that specifically exempting them is the most appropriate way forward, but we would expect schools to recognise the need for young carers sometimes to be able to phone home or to be contacted. Using the school office, for example, to facilitate that might be a good way forward.
Noble Lords raised points about edtech safety certification. Technology is now an integral part of education, supporting teaching, learning and the smooth running of schools, colleges and early years settings. It is essential that children and young people learn to use technology confidently and safely, so they are prepared for and can thrive in a rapidly evolving digital world.
However, technology should support learning, rather than get in its way, and it must be safe. The Department for Education has developed and already sets standards for the safe use of technology in education settings, including digital and technology standards and generative AI product safety standards, setting our expectations for the safe use of technology in education settings. However, schools and other education settings often have to make complex technical judgments when selecting technology without clear and consistent evidence about product safety. That is the thinking behind the consultation launched yesterday on proposals for edtech safety certification.
This is about getting ahead of the curve and ensuring that the Government are not passive to technological change but actively ensuring that it is safe for children and supports their development, and also supports schools with difficult decisions about appropriate edtech in a rapidly changing technological environment.
I do not think the noble Baroness, Lady Cash, really means that there should be no use of screens in classrooms. One of the things I regret from my time teaching is that I never got the opportunity to use a whiteboard, for example, in the imaginative way that is pretty well taken for granted in most classrooms now. Nor did I get to use technology to support group work and learning, in some of the ways where I think there is evidence that it supports, rather than replaces, pupils’ learning. Of course, it is important that we are clear about how it is used and that we agree that schools need good evidence about whether technology is effective.
We think that safety and effectiveness require different approaches. Safety can be assessed against clear expectations, while educational effectiveness depends on the pupils, the setting and how a product is used. That is why we are addressing effectiveness through the £24 million national edtech test bed programme, to build evidence about what works, for whom and in what contexts. We think that together these two approaches will help schools to make informed decisions about technology that is both safe and effective and, in doing that, provide the support and evidence that teachers need to ensure access to learning and the space to do that without being sidetracked by the use of mobile phones. That is what our children deserve.
Baroness Barran (Con)
My Lords, first I thank noble Lords who were so generous in their remarks about my part in getting us to this point. As was noted, I was definitely not alone; other noble Baronesses who are in the House tonight were there on the journey. I am not sure what the Minister and I will talk about if we cannot talk about “not seen, not heard” any more, but I hope we will find something else.
I have a few specific questions for the Minister; if she would prefer to write on any of them, I would be very happy with that. First, the Statement talks about there being flexibility around children who have medical needs and SEND. Could she give the House an example of where a child with SEND would need their personal mobile device, as opposed to a school-provided device that would meet their needs? Secondly, will the guidance cover school trips as well as the school day? We know that some pretty terrible things have happened with phones on school trips. Also, are the Government planning to future-proof the guidance? Schools are talking about smart watches and smart glasses. How do the Government intend to approach that?
I was very pleased to read in the Statement that the Government plan to talk to head teachers. Many of us in this House know some really pioneering head teachers, including those who have prohibited phones completely, used brick phones or taken other approaches. I am sure they would be delighted either to meet directly with the Minister or to contribute as the guidance is developed.
Finally, in our debates on mobile phones and on social media, we learned that health professionals were often the first to spot a lot of the problems that we are now talking about. Speech and language therapists, opticians and so on were noticing changes in children. Is there a place for some of those health experts as the edtech kitemark is developed?
Baroness Smith of Malvern (Lab)
I thank the noble Baroness; it is certainly the case that she has been tenacious on this issue. We have talked about lots of other things, and I am sure we will again in future. I am slightly fearful about what she will choose to get her teeth into next.
On the examples, in this House we have previously talked about specific assistive technology that might be important for young people and medical technology that is linked to a phone, for example for diabetes monitoring. Those would be the sorts of things that would fall into that category.
On the point about school trips, it is not the intention of the guidance that this policy will apply when children are travelling to and from school, so I feel it probably would not cover school trips. I will come back to the noble Baroness if I am wrong about that.
The noble Baroness makes an important point about future-proofing all this. The fact that we have updated the guidance and are taking further action around edtech demonstrates the situation we find ourselves in. Both the evidence and technology are developing fast, and of course we will want to keep up with that.
On the methods and gadgets that the noble Baroness discussed, we intend to produce AI in education guidance that will help identify some of the opportunities and issues in other areas. I do not know how long I will be here, particularly given the way I am feeling this evening, but I have no doubt that this will not be the last time I talk about how we are updating our work in government to ensure that the objective that all noble Lords share—that children need to be able to focus on learning rather than scrolling or the distraction that comes from screens—is at the heart of our work.
Her final point about health experts was a very good one. I will certainly take that back and consider how we engage with health experts as part of this work.
Baroness Kidron (CB)
My Lords, I too pay tribute to the noble Baroness, Lady Barran. Tenacity is a good word; I was thinking of something a little tougher earlier.
I really do welcome this Statement and join with others in regretting that we have had to fight so hard for it. I looked this up in Hansard and noticed that the first time we debated this was five years ago. The battle of last year, or a couple of years ago, was the culmination of us all coming together. I say that not to take anything away from that particular fight but to make a broader point about the things that we did not get in that Bill.
I thank the Secretary of State in particular for the Statement and for getting it over the line now. She has succeeded where others have failed. I really want to recognise that moment.
I welcome the Government’s commitment to independent certification of educational technology—something else that we have fought for over many years—and in particular its references to filtering and monitoring. I was very grateful for the letter from the early years Minister and his officials earlier in the week. However, I am concerned about the focus on safety; it is much narrower than I and other noble Lords have been calling for. I absolutely understand what the Minister here said about safety being a crucial factor, but it is a minimal bar: children flourishing in education is what we all seek and I think that would be a better bar. I am sure that we all recognise, just as with mobile phones, that the question is not simply whether technology is safe but “What is it replacing?”
I was at a conference about AI in education a couple of weeks ago, and the overwhelming evidence was—as the noble Baroness, Lady Cash, mentioned—that many of the AI products currently available produced better results in tests, but then the children failed to retain what they had learned. The response at the conference, which was largely focused on putting AI into schools, was simply that the tech would get better. That is tantamount to asking children to teach AI, rather than AI teaching children.
I am sure that the Minister will remember that I had amendments in the same Bill on edtech and on standards for efficacy, et cetera. I recognise that the Government have chosen to do this in guidance, but I ask that they take a broader view on what we need to look at in edtech. Schools are places where children grow, not just learn, and where relationships, confidence and agency matter just as much as passing tests and measurable outcomes. I will again say that I welcome the Statement, but I ask the Minister to ensure that independent certification and the Government’s wider approach to technology in schools protect the things that most matter for a child’s development and cannot be readily measured.
Baroness Smith of Malvern (Lab)
I thank the noble Baroness for the work that she has been engaged in, alongside our officials, in the scope of the certification scheme. That has been welcomed. On the point about whether the focus is only on safety, I think we have a broad conception of safety in the standards against which the certification will be made.
For example, as I said, this will be certification against the standards, including our world-leading generative AI standards, which recognises that cognitive development of children is an important aspect to be considered when thinking in broad terms about safety. I do not think that the certification will have quite the narrow scope that the noble Baroness suggests, but I reiterate the point that we are interested not only in certification of products but in research on what is effective, how and where, and for whom—we are investing money in that—and we are looking forward for other uses of AI in education, where we will produce further guidance.
Lord Addington (LD)
My Lords, I thank the Minister for giving us a chance to discuss the Statement. It is an odd thing. It starts off about mobile phones. There are three pages of it, and it stops talking about mobile phones after one-and-a-third pages, or one and a quarter, I think. When we are talking about educational technology, we are probably going to be covering assistive technology as well and SEN, and I remind the House yet again that I am a dyslexic. I am a dyslexic who needs assistive technology to write accurately. The assistive technology that I had at school was a person I had to dictate to. I am a big lad, but even I do not want to carry around another adult with me all the time.
Can we make sure that we allow people into the system by the use of technology? I am also chairman of Microlink PC. We are also making sure that those who have a disability can address it. The fact remains—I said this before, but I lost a Division on it—that the mobile phone is a wonderful platform for carrying assistive tech. Visual impairment and deafness can be addressed, to an extent, by it. New products are going out the whole time and, if I had longer, I would give your Lordships a commercial on some of the things that I have seen today.
Unless we get an assurance from the Government that they are going to use technology to allow people into the system, we are never going to address all the problems in special educational needs by means that grant independence and a way in. Also, I do not know if a Kindle is regarded as educational technology, but I am sure nobody here would accuse somebody of not reading properly if they read a book on a Kindle or via audio technology. Can the Minister take this opportunity to guarantee that the Government will allow people with special educational needs into the system by using technology whenever that is deemed appropriate and that it will be an ongoing process?
Baroness Smith of Malvern (Lab)
I think that the way that the noble Lord describes the issue as letting people in is very helpful in thinking about our approach more broadly to special educational needs and disability reform, where we want our schools and learning for children to be as inclusive as possible. One way, as the noble Lord frequently identifies, is through the use of assistive technology. I can assure him that that will be an important part of the SEND reforms and will be maintained through the guidance on the use of phones, as I think I have already set out.
Baroness Thornton (Lab)
I very much welcome this Statement, particularly the edtech safety certification that is in it, because it will support the very difficult decisions that schools are having to take about what to purchase next, how to purchase it and what they and their pupils should be doing with it. Before I ask my question, I want to say that I was slightly surprised by the noble Baroness, Lady Cash. Her championing of paper sounded a bit Luddite to me. If the weight of my granddaughter’s backpack is anything to go by, given the books and papers that she has in there, I think paper at her school plays a very large part in her education. However, her maths homework is set on the tablet that she does it on, and the fact that the homework is set online means that my daughter can watch, supervise and make sure that it gets done. I think that those are excellent uses.
The question I wanted to ask my noble friend was about young pupils whose parents cannot purchase the devices that they might need to help them with their education and whether there is some recognition that there is an inequality here that could be perpetuated by the use of technology. I know—I hope—that my Government are recognising that, as usual.
Baroness Smith of Malvern (Lab)
I thank my noble friend. She ably makes a point about the range of uses to which technology may well be put and the ways in which it may well, depending on the evidence—which of course we are developing—support children’s learning. She also makes an important point about the use of devices. Our view as a Government is that any expectations on students should not require them to purchase screens or digital devices, for precisely the reason that my noble friend outlined. To return to the noble Lord’s point, the use of technology has to include people, and not exclude them by virtue of their family background or their income at home.
Baroness Penn (Con)
My Lords, I welcome that the consultation on certification for technology covers early years settings. We made good progress on the Bill earlier this year on guidance for parents and carers of early years children and early years settings in terms of screen time and the use of technology. Can the Minister update us on two areas with regard to that? The first is what the DfE is doing to understand whether that guidance is reaching parents and carers, whether it is understood by them and whether they are changing their behaviour in any way on the back of it. The second is what progress the DfE is making on consulting on more substantive changes to the early years foundation stage statutory framework, following the welcome update in September, to link to updated guidance. The DfE committed to further changes looking not just at pedagogy but at safeguarding. It committed to implementing that by April 2027, so time is a bit tight if there needs to be consultation and other action along the way.
Baroness Smith of Malvern (Lab)
The noble Baroness makes two important points. On the first, early evidence on the impact of the screen time guidance is encouraging. Independent research from Internet Matters found that three in five parents of children of five and under had heard of the Government’s screen time guidance, and 88% found it helpful, while 94% said, after reviewing it, that they were already taking or planned to take action.
On the point about the early years framework, in July 2026, the department published screen use guidance for early years settings. That builds on the guidance for parents published in March 2026 and was produced with contributions from sector experts, including the Digital Standards for Early Years Children Action Group and the Early Years Screen Time Advisory Group. As the noble Baroness argued for, that guidance is designed to help early years settings support children’s healthy development, which evidence shows requires sufficient sleep, play, real-world interaction and responsive adult engagement, while ensuring any use of screens is purposeful, safe and appropriate. That statutory early years foundation stage framework came into force on 1 September 2026, and it requires early years practitioners to have regard to the screen use guidance in their setting. However, I suspect that the noble Baroness is right, as I suggested earlier, that in all these areas, as technology and evidence develops, we will want to return to this to make sure that, whatever age our children are and whatever setting they are in, their use of technology is informed by the very best evidence and is safe for all of them.
Health Bill
(1 day, 6 hours ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Coffey (Con)
My Lords, where do we start? Where did we end and where are we going? That is part of the challenge of a mid-group break, especially when this is a large group which covers a number of important areas. I am conscious that the noble Lord, Lord Austin of Dudley, has said a fair amount of what I had planned to say. I am concerned that a single company is being singled out and about comments made regarding wacky views of somebody who has an ownership in it. I think that the Church of Scientology is wacky. It does not stop me watching a Tom Cruise film. Wackier is the statement made by Green Party members that Zionism is racism. That is pretty wacky. Nevertheless, it is for them to decide and a matter of freedom of speech and freedom of thought.
Coming back to the substance of this group of amendments, I am conscious that we will come back in more detail to the single patient record. Looking at aspects of the amendment tabled by the noble Baroness, Lady Kidron, there is a lot of merit in thinking about how we put a shell around data in this country. I understand the sovereignty approach. For example, all the DWP data, on very vulnerable people, used to be held in Ireland because the data was held by Amazon Web Services. That saved money for the taxpayer. We had no problem at all, until we left the European Union and made the decision to bring all that very precious data back into the UK in case of other rule changes which may have restricted our access to that data or new laws applying because of where it was held. Therefore, there is a lot of merit in saying that it must be here.
It is worth noble Lords looking at the letter sent by the Health Innovation Minister, James Frith MP, to Layla Moran, who chairs the Health and Social Care Committee in the Commons. It tackles some of the issues that have been raised. People do not want their data to be all around the world. They are scared that it might expose them to something. That should be safeguarded against. That letter covers a lot regarding IP rights and how the NHS either owns it or has, effectively, a permanent licence or right to deploy the technology that was there.
However, I am concerned when we start getting into, “If this prioritisation of researchers is in the UK, that’s sort of okay and we prioritise public over private first” and so on. We are missing the point that this data is being released in an anonymised way for the benefit of patients. It is not a bad thing that a private company can make some money. It is not a bad thing that GSK or Pfizer may start to make tailored medicines and medications based on the evidence of what has been happening with patients in the UK. I accept that is a very rich dataset. Not then being allowed to develop new medicines and, therefore, make profits feels an unnecessarily Soviet-style approach when we are trying to ensure that a lot of this linking together is being done to improve the health of people in this country. Approaches could be modified.
I am also a bit of a purist. We should not be legislating about how the NAO should do its work or the work it should do. The NAO is a body of Parliament. Its chief executive is an officer of Parliament. It is not in legislation but under our Standing Orders it is responsible exclusively to the Public Accounts Committee and has a broader duty regarding understanding value for money and the use of taxpayers’ money. Some of the actions that are being referred to may well be stuff that it will wish to take forward in its analyses.
However, it would be helpful for the Government to appreciate that Minister Frith’s letter to the Commons Select Committee was targeted only in a particular response to certain points that had been made during that evidence session, correcting an important error that had been made in the DPIA. It would be helpful for the Government to have a more open approach in sharing how this will all work and how it is already working, and in giving assurances to parliamentarians of both Houses on how it will work in practice to quash this myth that, all of a sudden, stuff is being done that will expose vulnerable people.
This is the wider point about IT and digital sovereignty. We have a National Data Guardian, which has already been put in statute. By the way, I recall that, when NHS Digital was a separate legal entity, it refused to give information to the chief executive of NHS England when certain data was requested. At one point during the Covid crisis, it refused to give information to help the Government function more effectively. With these sorts of issues, it is almost as if what is perfect for privacy, or for this, that or the other, becomes the enemy of the good in what we are trying to achieve, which is the good use of technology and the federated platform to improve productivity.
I know that there have been disputes. It is important that the Office for Statistics Regulation, the parent organisation of the ONS, did that review. It pointed out issues that need to be addressed in future, but it did not say: “Actually, the information that the NHS has given out is largely wrong”. How do we try to improve from where we are right now and not miss out on the genuine opportunity of trying to work through, and make the most of, our technological advances?
I appreciate that there are also thoughts about whether it should just be a UK supplier. Again, this is the wrong approach and mentality. The DHSC and the NHS have got more sophisticated in their way of doing procurement, so to rule out any IT company that is not headquartered here in the UK would be a huge error.
There are other broader elements around where we are heading. I will leave some comments for our later debate on SPR, but there is something here about making sure that there is privacy by design—I think that was the phrase used by the noble Lord, Lord Clement-Jones. I have been weighing this up, and I will come back to it on SPR, but it concerns me somewhat, because we might think that we will happily hand it over to this or that clinician, or it will be used more broadly, but who really gets to see it? All this data is being used in an anonymised fashion. If, for example, GSK was purchased by a foreign pharmaceutical company, some of these amendments—I appreciate that they might be probing, although their level of detail suggests that this is exactly what noble Lords want them to achieve—would start to allow legal challenges about how this could be done. As I say, do not let perfection in one aspect be the enemy of the good in another, which is making the best of NHS resources to improve people’s health. I am sure we will return to this on Report, but I encourage noble Lords who will be writing amendments to reflect on how far into that level of detail they need to go.
Lord Kamall (Con)
My Lords, I am grateful to all noble Lords who have brought forward amendments in this group. I well recall the debates that the noble Lord, Lord Clement-Jones, and I had during the Health and Care Bill in 2022. I think he was surprised to find that we agreed on far more than he thought we would. What was very helpful in that Bill, if I remember correctly, was that there was an official who had been seconded from the Cabinet Office to the Department of Health, whom we were both able to trust to find a solution that we were both happy with in the end. Sadly, having reached that really good solution, it has all been undone by this Bill. I therefore completely understand the reasons for the amendments tabled by many noble Lords in this group.
I will speak briefly to the amendments tabled by my noble friend Lady Neville-Rolfe, who is not in her place, and by the noble Lord, Lord Austin of Dudley. Although these amendments approach the question of NHS procurement slightly differently, they raise important questions about the principles that underpin the way in which taxpayers’ money will be spent. While NHS procurement should always support the delivery of safe, effective and high-quality care for patients, we know that the NHS is not only a provider of healthcare but one of the largest purchasers of goods and services in this country and a major employer. It has an enormous impact on the wider economy, with the potential to support British businesses, to encourage innovation and our domestic manufacturing capabilities, and to create skilled employment in areas such as medical technology and life sciences research, where the United Kingdom already possesses considerable experience.
My noble friend Lady Neville-Rolfe probes the Government on how we use that purchasing power intelligently, not only to secure the goods and services that the NHS requires but to support resilience, innovation and wider economic prosperity in the country while adhering to the principle of value for money. It also raises an important question about how we assess value for money. As the noble Lord, Lord Tarassenko, said, the cheapest initial purchase is not necessarily the best in the long term.
Baroness Coffey (Con)
Amendment 277 is not in this group, according to the list circulated today, unless there has been more than one of them.
Lord Kamall (Con)
My understanding is that it is in this group, but maybe other noble Lords can confirm. There is a slight disagreement between my noble friend’s and my understanding of that.
I repeat that important point made by the noble Lord, Lord Tarassenko: the cheapest initial purchase is not necessarily best in the long term. There is also a legitimate question about whether procurement requirements have become unnecessarily complicated, which the noble Lord, Lord Austin of Dudley, calls for in his amendment, around clarity and consistency about the objectives against which procurement decisions are assessed.
I turn to the wider concerns raised in this group about patient data, digital sovereignty and the security of NHS information systems. Patients need to have confidence that their data is secure and their privacy is respected. I quite often like to quote my favourite philosopher, Jimi Hendrix. I have cited this more than once. He talked about building castles made of sand that fall into the sea eventually. What we do not want is the single patient record or the federated data platform to be that castle made of sand that falls into the sea eventually because there is no confidence from patients and they want to opt out of the system. We have tabled our own amendments on the single patient record that speak directly to some of these concerns. I will return to those points when we reach that group.
The crux of the matter is Palantir, what people really think about Palantir and whether it should be here. When I was the relevant Minister, I was told quite clearly by my officials that Palantir had by far the best solution to deliver the federated data platform. We should acknowledge the contribution it has made in increasing discharges, reducing discharge times, identifying and contacting patients who need to come back, making sure cancellations are reduced, and all those sorts of metrics that we want to see.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I am most grateful to noble Lords for their contributions to this debate. As before, I will focus on the amendments before us. I start with the future of the NHS federated data platform and the noble Lord, Lord Clement-Jones, who spoke to his Amendments 158, 159 and 172E, and the noble Baroness, Lady Bennett, who spoke to her Amendment 172B.
As I hope noble Lords will agree, decisions about public contracts must be made through fair, open and non-discriminatory processes, which is the point the noble Lord, Lord Kamall, was making. This is governed by UK procurement law and it ensures we get the best outcomes and solutions for the National Health Service. NHS England is reviewing the contract to determine whether it should continue, subject to standard contract management processes and government approvals. This process remains ongoing and decisions will be announced formally.
I can assure your Lordships’ House that the FDP operates under the direction of the NHS and each trust and ICB that has signed up uses it as it sees fit. Furthermore, Article 25 of the UK GDPR, which requires organisations to include data protection by design and default, already applies to the FDP. Were data to be anonymised as Amendment 158 proposes, it would prevent the delivery of national services such as national vaccination and screening, and key activity supporting the management, operation and provision of national health services.
I feel it would be helpful to set out the potential implications of Amendment 172B. When it was tabled, the usual channels received advice from the House authorities that the amendment would, in their view, risk making the Bill hybrid as it seeks to put in the Bill that the contract of one specific company is not extended. If the Bill is hybridised through amendment, those affected will have the opportunity to petition, after which the Bill will be referred to a Select Committee.
Lord Clement-Jones (LD)
Can the Minister confirm the date when the decision will be announced on whether or not there will be retendering of that FDP Foundry contract?
Baroness Merron (Lab)
I am not able to confirm the exact date, but I can say, as I said earlier, that the decision will be announced formally, so noble Lords will be made aware.
On the questions of security, resilience and sovereign capability, as raised in Amendments 53, 171 and 289 by the noble Lord, Lord Tarassenko, the Government share his determination to protect patient data and to support the strong UK digital health market. However, I am not able to commit to an NHS digital sovereignty strategy, nor additional legislation. Supply risk is not determined by nationality or jurisdiction alone. What matters is the data involved, who can access it, the supplies controls and the contractual protections in place. We already have robust safeguards. The Procurement Act 2023, about which much has been spoken, provides powers to exclude suppliers where appropriate, including on national security grounds. It also provides for setting data protection and cyber security requirements.
I note specifically the noble Lord’s concerns about the procurement of the single patient record, and I am looking forward to a more focused discussion, as I know all noble Lords are, on the SPR at a later Committee stage. I can confirm now that the procurement will have to ensure the resilience of our systems, how we keep within the UK jurisdiction and that the data remains under NHS control. The noble Lord, Lord Tarassenko, raised concerns that foreign laws could require an overseas supplier to give access to NHS data. We take that risk extremely seriously and aim to ensure that the legal, contractual and cyber-security safeguards are in place to avoid this.
I fully endorse encouraging domestic innovation, as I hope noble Lords are aware. As the Chancellor set out in the recent Budget, the Government will use public procurement strategically to back British firms to strengthen domestic capability and to build resilience in key supply chains. We will continue to promote international investment and trade and to open opportunities for British businesses at home and in markets around the world.
The noble Baroness, Lady Kidron, indicated her agreement with the noble Lord, Lord Tarassenko, in this area. The points on sovereign data being an asset will come back in the group beginning with Amendment 142, and again I look forward to debating that. We want a vibrant UK market for tech, and practical action is already under way. NHS England is engaging industry ahead of procurements, structuring opportunities to increase SME participation, and using social value to support good jobs and skills, which we all want to see.
I turn to Amendment 279A, tabled by the noble Lord, Lord Austin. He too raises the important question of accountability within this amendment, and we agree that contracting authorities should be accountable to the objectives of the Procurement Act, which already apply directly to covered procurement. The Act also provides transparency and oversight mechanisms, including powers to investigate compliance. The Procurement Act 2023 already requires publication of contract details for contracts worth over £5 million and, where applicable, key performance indicators and annual assessments of supplier performance against them. This makes a further NHS-specific annual reporting duty unnecessary in our view. For medtech, our value-based procurement approach further supports decisions focused on patient outcomes, total care costs, and longer-term value.
Lord Scriven (LD)
The amendment from the noble Lord, Lord Austin, refers to
“medical devices, consumables and services”.
There are two laws in place for procurement for the NHS: one for services and one for goods. What about the services? We have heard about the goods, but what about the accountability and feedback for services?
Baroness Merron (Lab)
I made reference to the Procurement Act 2023, and that is the guide by which we go.
Lord Scriven (LD)
It is for goods, but NHS services come under the 2022 health Act. There was discussion about whether it should have all fallen under one procurement law, but for NHS goods it is the 2023 Act, and for services it is the 2022 health Act that is applicable. If the Minister could write to me and place a copy in the Library, it would be helpful to see how the health Act also applies.
Baroness Merron (Lab)
So many health Acts. I would, of course, be very happy to do that.
I turn to Amendments 144, 147 and 160, tabled by the noble Lord, Lord Clement-Jones. I recognise the importance of ensuring that NHS IT and data procurements are fair and competitive, and protect the interests of patients and taxpayers. However, there is already extensive procurement law governing the department and NHS organisations. The Government agree with the objective of avoiding supplier lock-in. However, ownership of all connector IP is neither necessary nor the most effective means of achieving that. Appropriate licensing rights, interoperability requirements, open standards and exit provisions can protect portability and future competition without prescribing a single ownership model. Similarly, a blanket prohibition on suppliers that have previously provided free services could have unforeseen consequences, including for voluntary sector providers. Existing procurement rules provide safeguards against unfair incumbent advantage.
Lord Clement-Jones (LD)
The Minister mentioned existing procurement rules, and she gave a partial nod to my Amendments 144, 147 and 160, but said it was not always desirable for all those elements to be observed. Perhaps she could write and say which bits of those amendments—which are quite technical, I admit, dealing with interoperability, data connectors and the prevention of supplier lock-in—she means. It would be helpful if she could write and explain how the procurement rules that she prays in aid achieve some of those objectives.
Baroness Bennett of Manor Castle (GP)
The Minister referred to national security grounds being considered in the letting of these contracts. When we talk about national security, traditionally we have thought about hostile states proving a threat, but now we are in the context of the broligarchy—tech oligarchs who wield enormous power and influence, frequently opaquely held, with links to far-right politics and Governments who are funding far-right forces in the UK and around Europe. Is the Minister confident that that kind of national security threat is adequately considered when we look at contracts?
Baroness Merron (Lab)
That is not a matter I feel able to reply to in detail right now, although I will gladly write. However, to the best of my knowledge, the interpretation of what represents a threat to national security is set out and is understood.
Lord Tarassenko (CB)
I thank all noble Lords who have spoken. I think we have mostly sung from the same hymn sheet, with perhaps the odd discordant note—maybe even a few bars, maybe even a whole movement, some people might argue. I am grateful to the Minister for her comprehensive reply.
I found it heartening last week to hear the Secretary of State speak positively about sovereign data and sovereign AI—those were her words. We now have an opportunity to go from concept to implementation within the next two years—namely, the single patient record contracts; that is, not the FDP contracts but the new contracts for the single patient record.
I believe, and I believe that many other noble Lords agree with me, that we have a highly capable—world-leading, I would say—UK medical technology and software sector, with companies that are often university spin-outs now ready to scale up. None of my amendments is in contradiction with the Procurement Act. I believe these companies can win these SPR contracts on merit. We are talking about supporting UK excellence, but we need to remember that the US spends billions to support technology in a radically different, profit-driven healthcare system, which often produces software that has a very poor fit to the NHS. I am sure the noble Lord, Lord Lansley, will be able to tell us that the original EPRs, the electronic patient records, from companies such as Epic and Cerner were a poor fit because they were designed for billing purposes, not for optimising patient outcomes. We made that mistake with the EPRs; let us not make the same mistake with the SPR.
In general, because the UK businesses are much smaller than the Oracles, the Epics, the Palantirs and the IBMs, we need a level playing field. I suggest that we need a signal from the Government to those companies that the Government are keen for them, as was mentioned by the Minister, to use procurement strategically to back UK business. I think that signal is the NHS digital sovereignty strategy, and I believe we will come back to it on Report. I beg leave to withdraw my amendment.
Lord Rennard
“Duty as to a smoke-free EnglandIn the National Health Service Act 2006, after section 1CC (inserted by section 6 of this Act) insert— “1CD Duty as to a smoke-free England(1) In exercising functions in relation to the health service, the Secretary of State must act with a view to England becoming smoke-free as defined in section 7(1) of the Health Act 2006 (offence of smoking in smoke-free place).(2) The Secretary of State must, within 12 months of the day on which the Health Act 2026 is passed, publish a roadmap setting out how the health service will contribute to England becoming smoke-free, including interim targets and the stop smoking services to be commissioned by integrated care boards.(3) The Secretary of State must lay before Parliament an annual report on progress against the roadmap.””Member’s explanatory statement
This amendment would add a duty as to a smoke-free England to the Secretary of State’s health service duties, and require a roadmap and annual progress reports.
Lord Rennard (LD)
My Lords, I will speak first to my Amendment 279QA, which would require the Secretary of State to review the funding available for NHS stop-smoking services in England, including options for contributions from the tobacco industry. It is a moderate and, I hope, acceptable amendment in that it asks the Government to think about whether further funding to tackle the harms caused by tobacco should come from the hard-pressed taxpayer or from those companies that are responsible for the huge costs associated with smoking tobacco.
We need more onus on the tobacco industry to pay up from its huge profits to help reduce the huge damage done when it makes its victims addicted to nicotine. It would not in itself increase the financial burden on smokers, as funds would come only from profits, not consumers. I hope that the Minister will accept that my approach in this amendment is not about further taxes on unfortunate consumers. It is about the “polluter pays” principle being applied to tobacco companies.
Action on Smoking and Health estimates that smoking costs £44.8 billion in England alone every year. There is a huge financial burden on our NHS, our social care system and wider society through large-scale losses in productivity that are caused by tobacco smoking. Tobacco addiction places a huge burden on mental health, and it causes great damage through increased levels of ill-health generally, disability, and all the consequences that come from bereavement. My argument is simply that it is right that tobacco manufacturers, whose lethal and addictive products kill two-thirds of long-term users, should pick up more of the tab.
The APPG on Smoking and Health is arguing this at a time when the Government need to raise more funds and when they do not want to increase the burden on ordinary taxpayers. It is no wonder that, in opposition, Labour was emphatically in favour of this principle. On Report of the Health and Care Bill, the noble Baroness, Lady Merron, said that the principle
“strikes me as wholly pragmatic”.—[Official Report, 16/3/22; col. 297.]
Earlier in Committee, she said that such a measure had
“broad cross-party … and public support”.—[Official Report, 4/2/22; col. 1266.]
The noble Baroness, with her eloquence, helped to persuade the House to carry the amendment in support of considering a tobacco levy, by 213 votes to 154. In the Division, 86 out of 87 Labour Peers voted in favour of the principle of a tobacco levy. They included the noble Baroness, Lady Merron; the present Leader of the House, the noble Baroness, Lady Smith; the Deputy Leader of the House, the noble Lord, Lord Collins; and the Government Chief Whip, the noble Lord, Lord Kennedy. They cannot all have been wrong on this occasion.
The Treasury is reluctant to have such a hypothecated tax, however popular it might be, but the Treasury should consider how Prime Minister Andy Burnham has expressed his desire to extract revenue from businesses that do not make a positive contribution to communities. I simply ask: could there be any businesses in this country that are more negative in their impact on communities than the tobacco industry?
The Prime Minister and the Chancellor are desperately seeking ways of raising cash. Depending on the levy agreed, a levy could be applied to the profits of tobacco companies, raising perhaps £5 billion over five years. A very poor argument comes back from the Treasury to try to suggest that it might not raise very much because the actual level of the money raised would depend on the level of the levy, which it does not know and has not set. But there is great scope for taking taxes from tobacco companies’ enormous profits, and the revenue could be quite considerable.
I make a request to the Minister. Can she press His Majesty’s Treasury to meet the APPG on Smoking and Health, which strongly advocates the tobacco levy, to discuss this issue? The levy has been shown to be a revenue raiser, supported by 76% of adults in England. To fulfil the aims of the Government and all of us seeking to reduce further the prevalence of tobacco by helping smokers to quit, we need to do more and to find the money to pay for the action required.
In some respects we are going in the wrong direction, and we have to address that. We want to help the Government with their manifesto commitment to deliver opt-out smoking cessation support within routine care. Amendment 53A in my name would provide for a specific duty concerning a smoke-free England to be included in the Secretary of State’s health service duties and would require a road map for making further progress with annual reports to Parliament.
The world-leading Tobacco and Vapes Act will introduce a smoke-free generation from next year and marks the beginning of the end of the tobacco epidemic in this country. However, it is not job done. There are still 4.9 million smokers across the UK. We need a new target for ending smoking in this country. The previous Government had a target of Smokefree 2030, with less than 5% prevalence of smoking tobacco by that year; sadly, that target is now unlikely to be met.
I applaud the ambition of the Government with the “stopping the start” programme to try to prevent the tobacco habit being taken up in the first place, but we need a similar ambition for current smokers. Less than 5% prevalence would still leave millions of people smoking, and the Government should set a bold new target for when smoking rates will be less than 1%. We need a plan for how that will be achieved, a road map. This would set out which populations have the highest rates of smoking, where we are going to target our efforts and how we will do that. We are making progress. We know it can be achieved when we have clear, funded policies such as financial incentives, a bold target and system-wide change to support quit journeys. I beg to move.
Baroness Bennett of Manor Castle (GP)
My Lords, it is a pleasure to follow the noble Lord, Lord Rennard, and to agree with every word he said. I would have signed the amendment had I caught up with it.
I will speak to my Amendments 267 and 274 in this group. These line up very well with Amendment 224 in the name of the noble Baroness, Lady Walmsley, about a duty to promote public health. I do not think they are contradictory; they could both be included and would work together quite well. My Amendment 267 would add a new clause to establish a public health committee and health creation unit to promote public health and cross-government policy-making. At Second Reading there was a lot of discussion that this Bill is about institutional arrangements and has very little in it about actually delivering health; a number of amendments in this group, including mine, seek to address that.
This amendment builds on a proposal put forward by MPs at the Commons Committee stage. I am bringing it forward again because I do not think we can keep treating public health as the responsibility of one government department. We are in a terrible condition. Life expectancy gains have stalled and healthy life expectancy is falling. The latest ONS figures show that healthy life expectancy has dropped to its lowest level since records began in 2011 to 2013. Men in the UK can now expect just 60.7 years in good health and women 60.9 years. Those statistics represent millions of people spending more of their lives in poor health and reflect deep inequalities in our society.
Lord Young of Cookham (Con)
My Lords, I will speak to Amendment 224 on a duty to promote public health. When the Government came into office, they said they had three priorities:
“hospital to community … analogue to digital … sickness to prevention”.
I want to focus on the last. If the Government are going to achieve that ambition, it may require some rewiring of how the NHS works and how funding is distributed. Over the past few years, we have seen acute services taking a growing share of the budget. One understands all the short-term pressures on Ministers, who tend to ignore the long-term benefits.
Tucked away in the Budget Statement was a welcome and important statement. The Chancellor announced ring-fenced prevention spending that will bring down costs in the future. Hurrah for that; it is absolutely the right step to take. I wonder whether the Minister can answer a few questions related to that. First, how will preventive spending be defined? If it is too broad, it becomes meaningless; if it is too narrow, you end up with a number of very small pots. Will it include items that the noble Baroness, Lady Bennett, has just mentioned, such as the warm homes fund? Will it include adult social care? Do the Government plan to use existing definitions of preventive spending, or are they planning to invent a new definition of their own?
Secondly, if there is going to be a ring-fenced preventive spending pot in central government, will that then be distributed down the chain to ICBs, local authorities and GPs? Will it continue to be ring-fenced as it goes down? Thirdly, relevant to that, when will this be introduced? Will it be in the next spending round, or is it going to take longer than that?
Finally, I reinforce what the noble Lord, Lord Rennard, said on Amendment 53A. In earlier debates, I have very much supported this and may have moved some of the amendments myself. Given the pressure on government expenditure, not to explore further the potential of hundreds of millions of pounds, if not billions, from a levy, which does not, as the noble Lord explained, feed through into the consumer prices index—it is not reflected in the price of cigarettes, but comes from the profits made by tobacco companies—I hope the Government do not have a totally closed mind on Amendment 53A.
Baroness Cass (CB)
My Lords, I am sorry that the noble Baroness, Lady Walmsley, is not able to be in her place this evening. I had the privilege of serving on the Childhood Vaccinations Committee, which she very ably chaired. I think it will produce a report which Members of the House will find informative and helpful, and I hope the Government will feel similarly. During the course of that report, we spent a long time talking about the relative impact of problems in access and in vaccine hesitancy. Within vaccine hesitancy, multiple different factors affect how parents feel about vaccinating their child. Among those is medical disinformation. We need to understand more about that and what vaccination and the risks mean to different communities and cultures. Much of that work happens on the ground, on the front line, with community leaders, health visitors and GPs working locally. However, that is not a reason for us not to take a national strategic approach.
The second reason I signed this amendment is that it uses the term “medical disinformation strategy” and talks about anti-vaccination and medical disinformation. The Government need to think about how we tackle medical disinformation much more broadly than just within the vaccine arena. I have talked often enough in this House about my review, but I have not on any occasion put on record what it felt like to do that review and, more particularly, what it felt like and has continued to feel like in the two years since.
The disinformation about my review started six hours before the report was released. It was a funded disinformation campaign, and it continues to date. One of the extraordinary things that were said was that I did not speak to any trans people during the review. We spoke to the support and advocacy groups every four weeks and I spoke to the gender clinicians working at the Tavistock every two weeks. It was said that we threw out 98% of the papers on the subject, which was clearly nonsense. It was said that we did not publish the name of the author of the review—and what did “CASS” stand for, by the way? That was probably one of the most extraordinary ones. Then there are those that I take less seriously, which are more recent, on why I have supported the puberty blocker trial. These range from my being the victim of a Russian kompromat, having a trans child of my own, and—this is the best one—that somebody has kidnapped my cat and is holding it to ransom. I am not particularly concerned about the personal attacks, of which there are many, but I am concerned about the disinformation that misleads children, young people, families and clinicians who are looking after them.
During those last two years after the review, I worked first for NHS England. I declare that I am currently an independent adviser for the DHSC. Colleagues have been supportive, but the burden of what to do about the direct disinformation at the end of the day rested with me. DSIT, as it was, seemed to be the locus of how we dealt with disinformation at that time, but it did not own the strategy, and neither did NHS England or the DHSC—although the DHSC has been very supportive in trying to get a communication strategy in more recent times.
My point in going through all this is not as a “poor me” about my experiences, but because it should never come as a surprise to us that there is disinformation, which is going to be an increasing problem going forward. It is no more surprising than bed pressures and flu in winter. Therefore, I suggest to the Minister, who has been exceptionally supportive to me over these matters, that, in thinking about the structures of the NHS, we need to consider strategically how we will be prepared for disinformation strategies, not just in vaccine services or gender services but in many areas as they arise.
Lord Scriven (LD)
I will quickly talk about my noble friend’s Amendment 224, on the public health duty of Ministers of the Crown. I think most noble Lords would agree that, if we are going to deal with prevention and the determinants of health, it goes far beyond the department to deal with the issues there.
It is always interesting and actually vital to read final impact assessments, because you will find little gems in them. In the final impact assessment on abolishing NHS England, it says:
“The Secretary of State will retain existing public health”
duties. But the NHS England functions to be repealed are not given to the Secretary of State. It says:
“NHS England’s duty to consult with public health professionals to obtain advice on the discharge of its functions will be repealed and not transferred to the Secretary of State”.
I have a very simple question for the Minister. I declare an interest in that my husband is a former director of public health. Anybody in the medical world who comes into contact with a doctor from public health will say that they are a very strange creature; living with one, I can confirm that is the case—but professionally, they look at things very differently. They are not about one part of the body or one disease; they take a much more holistic approach to the determinants of health and population health. Why is the Secretary of State retaining public health functions but not taking NHS England’s function to sit down with, listen to and consult public health professionals when carrying out those directions? It seems a very strange system to take the functions but not have the duty to sit down with and listen to public health officials. If that duty is not transferred to the Secretary of State, what body in law does the Secretary of State have to sit down with and listen to that is composed primarily of public health professionals?
Baroness Pidgeon (LD)
My Lords, I shall speak to Amendments 223, 224 and 231 in the name of my noble friend Lady Walmsley, who cannot be in her place today.
Amendment 223 would require Secretary of State to lay before Parliament an annual report on the performance of routine, seasonal and targeted immunisation programmes, which sets out the action plan for the coming year to address areas of low vaccine uptake. The report must also cover all eligible cohorts within the national immunisation programme, use consistent measures across programmes and include data that enables inequalities in vaccine uptake to be tracked by geography and population group. It should be in addition to existing vaccination coverage reporting. This would enable vaccine accountability and make sure it remains visible following the removal of Section 7A, with clear reporting on how national oversight is being maintained and how delegated responsibilities to ICBs and providers are being delivered.
Lord Kamall (Con)
My Lords, I am grateful to all noble Lords who spoke to their amendments in this group. I will mainly touch on three points. First, on vaccines, I remember that, when I was the Minister who had to answer questions on vaccines during Covid, we were trying to work out how to tackle so-called vaccine hesitancy. One of the things we thought we had cracked was that we worked with local communities and faith organisations, which are trusted far more than whichever Minister happens to be on TV or even the Chief Medical Officer, even though he was a very trusted person. The interesting thing was that we tried to work with local communities, but we found that some churches were saying, “Don’t take the vaccine”. That was a challenge we faced. We thought we had cracked it by working with local organisations.
We have to be careful about distinguishing between misinformation and disinformation. They often have the same outcome. Misinformation, though, is quite often unintentionally spread, whereas disinformation is deliberately spread. We have to be aware of that.
Secondly on vaccines, there was a denial that anyone could come to harm from taking the vaccine, but any pill or therapeutic has risks. I remember when I went to take my first mRNA vaccine. I sat down with the nurses in my local surgery and asked, “How risky do you think this is?” They said, “Don’t worry, it’s safer than the pill”. That is not particularly reassuring for the women out there but, statistically, they were absolutely right. If you tell people that, for example, one in 10,000 might get heart inflammation or whatever then that will scare an awful lot of people but you are actually being honest about the statistics and the risk. There is a real challenge in being completely honest about the risks and the numbers, because everyone will think they might be that one in 10,000 so they will not take it. I really have not worked out how to crack that.
We then seemed to pretend that no one was harmed by the vaccine. It is true that, statistically, very few people—a very small percentage—were harmed or killed by the vaccine, but that gave rise to conspiracy theories about hiding the fact that people could be harmed by the vaccine. In reality, all medicines have a very small risk factor. It is about how we tackle that, because if we are too open about it then people will think they are the one in a million or the one in 10,000. That is a real challenge we all face.
The second thing I want to talk about is public health. Last year, I taught an MBA module on health policy. As part of that, I spoke to a lot of public health academics. One of the things I was astounded to hear from them was that they think that an awful lot of top-down public health does not necessarily work. We spoke about the example of sugar taxes. We feel good about them because there is less sugar in our drinks but, quite often, if people are not actually helped to change their behaviour then all they end up doing is spending more on their fizzy drinks, or they swap from the branded fizzy drinks to Asda or another supermarket’s own brand. We might feel good about it, but we have not actually changed their behaviour.
Far more effective is working with local community organisations. I have often mentioned one that I am very aware of, BRITE Box, which produces 38 meals a year for families. It gives them the ingredients, and it has tested the instructions and the menus. It has done a lot of academic research and found that what is very attractive to children and families are pictures with three or four bullet points. What quite often happens is that these families learn to eat and cook healthier meals together, which they love doing, and now that they have the 38 recipes, they carry on using them. As part of that, they learn to budget as well. That is something that top-down public health cannot do.
Our challenge is how to encourage more of these local community organisations, which understand the people whose behaviour needs to change to eat healthily on more of a budget, rather than always thinking that we should have a tax on something and that will change behaviour. Quite often, all it does is lead to people paying more for unhealthy food, rather than actually changing their behaviour.
I try to be consensual at times—maybe it is my 14 years in the European Parliament—but, for my third point, I agree with the noble Baroness, Lady Bennett of Manor Castle: we are not paying enough attention to AMR. Let us be honest about this. I remember that in the first Session after the General Election, when we swapped sides and Benches, I was asked to speak for the Opposition on a Question on AMR. The Minister at the time, the noble Lord, Lord Collins, said quite clearly that the Government were going to take a cross-governmental approach to tackling AMR, but we do not seem to have made any progress. I wonder whether the Minister has more information than I have to say what the Government are actually doing on AMR, particularly on a cross-government approach but also on international co-ordination.
All the amendments in this group raise important points. I look forward to the Minister’s response.
Baroness in Waiting/Government Whip (Baroness Hyde of Bemerton) (Lab)
My Lords, I am grateful to noble Lords who have tabled amendments in this group and want to take the opportunity to thank all the directors of public health across the country who are doing excellent work, close to the ground, day in and day out, as mentioned by some noble Lords. I also add my thanks to the noble Baroness, Lady Cass, for sharing her personal experiences on disinformation and misinformation. It is much appreciated.
I turn to Amendment 224 tabled by the noble Baroness, Lady Walmsley—with thanks to her colleagues for speaking to it—and to Amendment 267 tabled by the noble Baroness, Lady Bennett. We agree that improving health and reducing inequalities requires actions beyond the NHS, across housing, education, employment and environment. Indeed, this was raised in an earlier group, where we discussed the fact that good health cannot be the sole preserve of DHSC. Ministers and officials already work across government to ensure that health evidence informs decisions. That includes some things mentioned by the noble Baroness, Lady Bennett, including action on poor-quality housing through the fuel poverty strategy, the decent homes standard and Awaab’s law, on work and health through the Keep Britain Working review—as alluded to in our first group of amendments today—and on air pollution through the environmental improvement plan. On Amendments 267 and 224, we are not persuaded that prescribing internal government structures or introducing a broad duty on Ministers in primary legislation is necessary. The Secretary of State already has a statutory duty concerning public health protection and powers to improve the health of people in England. Ministers also routinely consider the health implications of their decisions and work collectively in the public interest. Furthermore, through the English Devolution and Community Empowerment Act, we have introduced a duty for combined authorities, combined county authorities and mayors to have regard to the need to improve health and reduce health inequalities in the exercise of their functions. This duty complements that pre-existing local authority health improvement duty and role.
On the topic of public health, the noble Lord, Lord Scriven, raised a specific question about the small print in the impact assessment. As a statutory arm’s-length body, NHS England’s powers and duties are necessarily set out in statute, and it has a different legal role and responsibilities from the Secretary of State and the Department of Health and Social Care. While it was appropriate for NHS England to be bound by a duty to seek advice to ensure that it effectively discharged its functions, it is not necessary to bind the Secretary of State in that way. However, I can assure the House that the Secretary of State will continue to seek advice as appropriate.
The noble Baroness, Lady Walmsley, tabled Amendments 231 and 223. Although she is not in her place, I want to thank her for her work as chair of this House’s Childhood Vaccinations Committee. As other noble Lords have mentioned, inaccurate information can undermine confidence, but uptake also depends on access, deprivation and awareness. National communication, support for front-line professionals and monitoring of emerging narratives already address misinformation alongside these wider barriers. A statutory strategy focused solely on disinformation risks duplicating activity and reducing flexibility. The Government are acting to improve uptake more broadly, including by making it easier for families to get vaccinated, giving families more information about vaccination, investing in new digital services for vaccination and organising the NHS to promote improvements in uptake. To give an example, we have reformed incentives for general practice to incentivise improved uptake in areas with low uptake, rather than rewarding only those with high uptake. That can then support best practice among general practice and address the inequities in uptake.
On Amendment 223, UKHSA and NHS England already publish extensive, timely data on routine, seasonal and targeted immunisation programmes. Requiring consistent measures in primary legislation could impose artificial standardisation where programmes are not comparable. Instead, our priorities are to improve existing reporting and act on the evidence. This Government take seriously the fact that misinformation and disinformation does and can undermine confidence, but it is one factor among several. We would also include in that the role of social media, which the noble Baroness, Lady Pidgeon, mentioned. That is why we are working across a number of measures, around marketing campaigns, supporting health professionals to have those conversations with people who are vaccine-hesitant, as well as monitoring and responding to emerging narratives and trying to debunk, by “prebunking”, if I may, that kind of misinformation and disinformation.
I turn to Amendment 274 on antimicrobial resistance from the noble Baroness, Lady Bennett. As she said, this is being addressed through the United Kingdom’s 2024 to 2029 AMR national action plan. A stand-alone review of annual AMR-related deaths could duplicate the work already under way in that plan. UKHSA undertakes continuing surveillance and is developing a mortality metric to improve our understanding across different infections and settings. I hope that noble Lords will agree that continuing surveillance, modelling and reporting will provide more durable insight than a one-off statutory review.
Baroness Cass (CB)
Can I ask the Minister one more thing? The Government are being active on vaccines, as she said, but disinformation—the noble Baroness, Lady Pidgeon, made this point as well—goes further than just a vaccine strategy. It is really about the Government having a disinformation preparedness approach in the same way as they have preparedness for a pandemic, because there will be disinformation campaigns that we have not yet anticipated in other areas. Are there further thoughts on how that might be approached?
Baroness Hyde of Bemerton (Lab)
I thank the noble Baroness for that question. The Government are aware of the whack-a-mole nature of this and the constantly evolving picture. There are things that we cannot even imagine today that tomorrow will seem inevitable. I will write to her with a more comprehensive reply. We absolutely accept that this is not just about vaccines and that there is work to do.
Lord Rennard (LD)
My Lords, I thank all noble Lords who have spoken in this debate and particularly appreciate that we are all on the same page on the principles of these issues. However, when it comes to the tobacco levy, the Government Front Bench were more on the same page as us when they were in opposition than they are this evening.
I reiterate my invitation to the Treasury to come and meet the APPG on Smoking and Health to discuss these issues. We know that increasing the price of cigarettes has reduced consumption, but we worry about the fact that many smokers are poor. Often, they are poor because they smoke—and are in ill health. We want to improve their health. If we simply tax them more and not the tobacco companies, the wrong people will be paying for the damage caused by the industry. Looking at models, we see that in the pharmaceutical industry it is perfectly possible to tax profits while preventing price increases hitting the consumer. That is the principle we must examine.
On that note, I beg leave to withdraw my amendment.
Lord Lansley
“(za) in subsection (1), after paragraph (j) insert—“(k) such other services and facilities as are required for persons with a primary health need arising from a progressive or deteriorating disease which is reasonably expected to continue for the remainder of the person's life, including where the person's condition is intermittent or fluctuating, and without regard to the rate of such progression or deterioration or whether a person is entering a terminal phase of their life.””Member’s explanatory statement
This amendment would ensure that a wider range of serious chronic diseases, such as severe dementia, would qualify for NHS Continuing Care and not have eligibility restricted on grounds that the condition is fluctuating or is not deemed to be in a terminal phase.
Lord Lansley (Con)
My Lords, this group is essentially about the processes of commissioning. Other groups will touch on these issues, but Amendment 54 raises the commissioning of NHS continuing care. It is grouped with amendments that relate to other aspects of specialised commissioning.
I thank the Minister for her letter earlier today saying that she will be able to tell us quite soon what the division of responsibilities for commissioning between the national and the ICB level will be. She expects it to be broadly similar to the practical distribution of commissioning responsibilities now. That is a comfort to some of us in understanding how this will work in future. She was also kind enough to tell us, in the spirit of “the more things change, the more they stay the same”, that, following the disbandment of the commissioning support units, we will have the office of pan-ICB commissioning—which sounds awfully like the recreation of commissioning support units.
I am in favour of having commissioning support units. I was originally in favour of having an opportunity for independent support to commissioning, not just NHS-delivered support for commissioning and competition between commissioners in who provided them with that expertise. I will not get that, obviously, but having the ability to provide support to the commissioners collectively is clearly the right thing to be doing.
I do want to just say that, from my point of view, there is an issue about specialised commissioning, which the Minister’s letter touched on: the question of standards. When we took the responsibilities for some specialised commissioning away from primary care trusts, we found that there was substantial variability in what was being commissioned, how it was being commissioned and the standards to which it was being commissioned. One of the most expensive aspects of the reforms that we had to undertake was that we brought them to the same standard, the highest standard, which over recent years has been guided by the publication of the National Institute for Health and Care Excellence’s guidance and standards.
I hope that when we come to debate specialised commissioning in more detail, we will also look at ensuring that we continue to meet those high standards, notwithstanding that there is a difficulty in reconciling that with the budgetary decisions on commissioning that must be made by individual ICBs if they are responsible for specialised commissioning. We will have to find out precisely how that divides itself.
I do not want to say any more about specialised commissioning. I want to focus on Amendment 54, which is intended to deliver a very specific question to Ministers that I hope we will follow through. A couple of weeks ago, we all agreed during Oral Questions that this Bill is a big opportunity to improve social care. The Minister herself said that. Well, it is. There will be two or three debates, of which this is the first, at which I hope to bring forward ways in which this Bill can be used to undertake essential aspects of the future shape of what a national care service looks like.
I do not have to go into all the aspects of what a national care service is, but one building block in making it happen is for the NHS to take a greater and more substantial responsibility for providing continuing care to people who have a primary health need. Noble Lords may say, “But does it not do that now?” The point is that, presently, two-thirds of access to NHS continuing care essentially comes through the fast-track route. That pathway tool is very much focused on those who are reaching what is described as a rapidly deteriorating condition leading to a terminal phase of life. Unfortunately, this means there are very many who have a condition that I think NHS continuing care was, and is, intended to provide for, where the NHS takes responsibility for a person who has a primary health need which arises from a progressive or deteriorating disease expected to continue throughout their life. That is the fundamental definition, but that is not what the NHS is presently doing.
The Prime Minister himself gives us the classic illustration: he says, and said again on 1 September this year, that the NHS should support people with dementia as well as it supports people with cancer. This is precisely what does not happen. NHS continuing care is often available to people with a terminal diagnosis of cancer who are rapidly deteriorating, but, for a variety of reasons, somebody with severe dementia does not get it. They do not get it because it cannot be established: there is no prognosis in the way there often is for cancer. They do not get it because they are often in a situation where, from the point of view of the assessment, there is less clinical intervention, even though a primary health need gives rise to the condition; it is often intermittent, fluctuating and not predictable; and there are often episodes when somebody who is undertaking assessment will say, “Well, at the moment, this is manageable without all the clinical interventions that would be required if this were a cancer diagnosis”.
So I think we have a serious issue. This is why my Amendment 54 says that we should construct the legislation in a form that requires the persons using this decision support tool for NHS continuing care to have regard to whether it is a primary health need that gives rise to a patient’s condition and whether it is a long-term condition they will have throughout the rest of their life, in which case the NHS should therefore take on the responsibility.
Given the hour, I do not want to dwell on any further details or examples, but I think the comparison is very straightforward. It is increasingly clear that the reason people do not get access is because of the failure to observe the principle that the NHS should take responsibility where a primary health need gives rise to that social care requirement; in practice, principally for budgetary reasons, that has been narrowly confined. If the Prime Minister, as I understand it, is looking towards the state taking a greater responsibility, a very good starting point for that to happen would be for the NHS to take responsibility for those people whose social care requirement arises from a primary healthcare need. That is the principle of purpose of Amendment 54, which I beg to move.
Baroness Grey-Thompson (CB)
My Lords, I have Amendments 57, 73 and 80 in this group and will also speak briefly to Amendment 58, which is about allergies. Natasha’s Foundation submitted thorough and useful information to the task and finish group that I ran for the Department for Transport on improving aviation for disabled people. There needs to be more consideration of this area. Obviously, there is much movement, but there are still many issues.
The principle behind my amendments is national protection for all specialised services regardless of whether they remain nationally commissioned or transfer to integrated care boards. Patients must not lose safeguards because the identity of the commissioner changes. Nationally consistent standards, oversight, quality assurance and accountability must be statutory safeguards, not optional administrative assurances. Local flexibility must not become local inequality.
Amendment 57 says that a national framework is needed. The current wording may be narrower than the intended protection for all specialised services, but I seek ministerial assurance on how the universal principle will be secured. Some highly specialised services require dedicated condition-specific national frameworks. Generic service specifications cannot always protect the expertise, pathways and critical mass that they need. Amendment 73 seeks annual reporting to Parliament, which must cover all specialised services irrespective of the commissioner, so that changes in access, quality, outcomes and variation remain visible. Amendment 80 seeks clear national assurance and Secretary of State accountability; these are needed, including where commissioning responsibility sits locally.
It is important to have a robust impact assessment before any transfer happens, looking at clinical risk, patient safety, equity, workforce, specialised networks, financial sustainability and the effect on smaller patient populations. I am specifically interested in those with spinal cord injuries. I do not have a traumatic injury; I have spina bifida. Spinal cord injury services illustrate the stakes. There can be complex lifelong needs, but there is a limited number of specialist centres and there are risks of fragmented pathways to rehabilitation and follow-up. Government-NHS England discussions about a wider framework are welcome, but policy commitments can change and Parliament should secure enduring duties. I thank the Minister for the letter we received this morning and look forward to more information on commissioning, but how will universal coverage, condition-specific protections, enforceable national oversight and transparent parliamentary reporting be guaranteed?
Lord Hunt of Kings Heath (Lab)
My Lords, I have Amendments 58 and 71 in this group and I have added my name to Amendment 59 from the noble Baroness, Lady Pidgeon. I endorse everything that the noble Baroness, Lady Grey-Thompson, has said. At heart, the issue is that there is a lot of concern about ICBs’ ability to discharge the commissioning responsibilities they are being given. I refer my noble friend to a report on wheelchair commissioning issued this morning by the Public Service Ombudsman. She has used individual complaints to produce a thematic report on the effectiveness of ICBs in commissioning wheelchair service. She has found that ICBs are absolutely hopeless at doing this.
We will debate wheelchairs later in the Bill, but we then turn to allergies in my Amendment 58 and, again, one sees a depressing picture. It is a mammoth issue. More than 20 million people and approximately 40% of children have been diagnosed with an allergy. Any parent or grandparent knows the difficulty of getting access to the system. The National Allergy Strategy Group, to which I pay great tribute, has produced a framework which will ensure much better commissioning of the provision of services. It found that only 26 of England’s 44 ICB areas have a local adult allergy service. It makes you wonder why on earth we do not have an allergy service in each part of the country. Then you come to the specialist services, which are often represented by small NGOs that have no chance whatever of relating to ICBs. That is why they want a national commissioning process, because that is the only way that they can expect to be heard.
ICBs do not have the reputation of being open. They do not often respond to representations made to them. In fact, they have little contact with parliamentarians. This is at the heart of why there is concern about this process. The Government’s decision to reduce management costs also brings concerns about their capacity. In the end, we all want some assurance that ICBs will be beefed up and that the unit which the noble Lord, Lord Lansley, referred to is going to do the job for many of them, because what is the point of all these ICBs trying to reinvent the wheel? Why not produce some standardised commissioning and then help them commission and monitor it? That is where you get the benefit of what the Government are seeking to do, in delayering and reducing management costs and bureaucracy, but it has to be done in a way which does not leave all these services at the mercy of very varied ICBs.
Baroness Scott of Needham Market (LD)
My Lords, I have tabled Amendment 65 to Clause 15 on the topic of accessible patient involvement. It seeks to ensure that the arrangements for involving patients in commissioning decisions are accessible to those living with long-term, complex or fluctuating health conditions. I welcome the Government’s decision to retain and strengthen Healthwatch England and local Healthwatch organisations. It is an important recognition of the value of independent patient voice, and I am pleased that Ministers have listened to the concerns raised across both Houses and beyond. However, retaining that independent patient representation is only part of the picture. We must also ensure that the mechanisms through which patients are consulted and involved in the decisions which affect their care are genuinely accessible.
I take a close interest in ME. I have a family member with it and I am a member of the all-party group. For people living with severe or very severe ME, conventional forms of consultation can be extremely difficult and quite often impossible. Attending meetings, participating in lengthy phone calls or completing detailed questionnaires can worsen some symptoms considerably. I have spoken about ME, but there are many other conditions for which the same can be said. If patient involvement arrangements are not designed with these limitations in mind, there is a real risk that those people with the greatest need will have the least opportunity to influence the services which should be supporting them.
This concern is particularly relevant given the evidence of poor access to services now. Action for ME’s 2026 big survey gathered responses from more than 5,000 people living with ME and long Covid. They found that 83% of respondents reported barriers to accessing NHS ME services. I was also struck by the large number in the survey who were not able to access any kind of healthcare at all, including routine screening. This is totally unacceptable. We cannot expect services to meet the needs of these patients if they are effectively excluded from the decisions about how those services are designed and commissioned.
My amendment is very modest. It would require the Secretary of State to take reasonable steps to ensure that patient involvement arrangements are accessible and inclusive, with particular regard to disabled people and those with long-term, complex or fluctuating conditions. This could mean greater flexibility in how people contribute and how they are consulted. It needs to recognise the particular circumstances in which patients can participate. It will require a little imagination and quite a lot of empathy, but it ought to be possible. I would therefore welcome the Minister’s assurance that these patients will not be overlooked in the Government’s arrangements for patient involvement and ask whether she would consider putting something in the guidance to make sure that it happens.
Lord Scriven (LD)
It is a pleasure to follow my noble friend. I want to come back to the points that the noble Lord, Lord Hunt, made. I believe we are coming to a point in this Bill for us to make reasonable amendments and suggestions. Either we can continue to go down the road without the detail and let the service reorganise itself, or we can start to get some serious detail, particularly regarding specialised commissioning and the capacity of ICBs.
Just to understand, there are about 154 specialised services that are commissioned. Already, around 70 of those are commissioned via ICBs under delegated direction from NHS England, and the rest are commissioned centrally by NHS England. What the Government are asking is for the cuts to be made to staff, for the staff to go, and then for the detailed skills and knowledge that are required for the specialised commissioning to come after that process. The National Audit Office has put out a report which questions, even on existing duties, whether ICBs have the skills, knowledge and breadth to carry out what the Government want.
With these extra services, it could be that ICBs, the delegated strategic commissioners, cannot commission what Government wish them to commission. The noble Lord, Lord Hunt, and I both got quite cross with the then Minister, the noble Lord, Lord Kamall, during the passage of the 2022 Act, that things were happening in the system before Parliament had made the decision. That is what is beginning to happen again; things are happening. The offices for pan-ICB commissioning are not new; they were asked to be determined in April 2026. They were in the impact assessment for the abolition of NHS England, so they are already known about. The key issue is: what services are they going to have to give a joint response for? Will we have the list of specialised commissioning services carried out by ICBs and the Secretary of State by Report? Is that a commitment the Minister can give? If not, we cannot make a reasonable decision on Report about specialised commissioning with the depth and breadth of knowledge that is required. Can the Minister give us that commitment?
As the offices for pan-ICB commissioning—OPICs—were selected in April, can the Minister commit to giving us their duties and the budgets they will have, or will be able to direct, in writing before Report? What powers of direction will the Secretary of State have for consistency of ICB specialised commissioning, and can those be with us by Report? These are important questions that need to be answered because, if not, we will be getting to Report, being asked to support specialised commissioning with two bodies—the Secretary of State and ICBs—and, particularly for ICBs, we will not know whether they have the capacity to do it. I do not think that this House will be able to make a decision about whether it is reasonable, safe or justified for us to continue suggesting that this is a route for ICBs to commission.
Baroness Cass (CB)
Briefly, I support the comments of my noble friend Lady Grey-Thompson and the noble Lord, Lord Hunt, and thank the noble Baroness, Lady Pidgeon, for Amendment 59, which I fully support. It is all right for me to support all of these people, because according to the best disinformation sources, I am in the pay of the Tories, but not the other parties. I did hesitate over whether I should allow a friend on the Opposition Benches to buy me a cup of tea the other day.
On a serious note, I worry, as others do, about ICB capabilities, and my noble friend Lady Finlay and I have spent years struggling with a postcode lottery on the commissioning of specialist palliative care services for children. They are commissioned at the wrong level, and therefore vary hugely from ICB to ICB, and should be commissioned at a higher level. The notion of greater devolution fills me with anxiety, so I fully support that amendment.
Lord Sharkey (LD)
My Lords, I will speak mainly to Amendment 74, which is in my name and those of my colleagues, the noble Baronesses, Lady Chisholm and Lady Sater, and I am grateful for their support. I declare an interest as chair of the Specialised Healthcare Alliance—SHCA—a coalition of nearly 140 patient organisations and corporate supporters campaigning on behalf of people with rare and complex conditions. There are 3.5 million people in the UK living with a rare condition, and I have heard at first hand how vital specialised services are in ensuring that they receive the best possible treatment, care and support. The Health Bill before us has potentially significant implications for how these services will be commissioned in future.
Amendment 74’s purpose is simple: to ensure that specialised commissioning, whether undertaken by the Secretary of State or ICBs, continues to be informed by a strong national clinical leadership and specialist clinical advice. One of the great strengths of the current specialised commissioning system is the clinical infrastructure that supports it. There are national clinical directors; national specialty advisers, who are practising clinicians working part-time at NHS England to provide clinical leadership, advice, input and support; and clinical reference groups, which bring together healthcare professionals, patient representatives and other experts to help to design, monitor and improve specialised services. This includes supporting the development of national standards.
As we move towards the abolition of NHS England, SHCA members are asking what this will mean for the future of clinical leadership in specialised commissioning. At present there is considerable uncertainty. I have heard from individuals sitting on clinical reference groups, for example, who still do not know whether their role will exist in a few months’ time. The purpose of Amendment 74 is not to prescribe a particular organisational model. Rather, it is to establish an important principle that the planning, design, delivery and monitoring of specialised services should continue to be informed by clinicians with the relevant expertise.
As commissioning arrangements become more dispersed, national clinical leadership arguably becomes more important, not less. The Government have stated that national standards for specialised services will remain a priority, but it is unclear how those standards will be developed, maintained and monitored without the clinical infrastructure that underpins it today. I anticipate that the Minister will reaffirm the Government’s commitment to clinical leadership, and I would welcome that, but what would provide real assurance to patients and clinicians is greater clarity about how that commitment will be delivered in practice. In that spirit, can the Minister clarify what discussions have taken place regarding the future of national clinical directors, national specialty advisers and clinical reference groups? In general, how do the Government intend to ensure that specialised commissioning continues to be shaped by the strongest possible clinical leadership and specialist advice—and, of course, the patient voice?
I turn briefly to Amendments 57, 73 and 80 from the noble Baroness, Lady Grey-Thompson, to which she has spoken so eloquently. Together, they call for greater security of the delegation of specialised services and clear reporting mechanisms, something that SHCA members have repeatedly called for. The right checks and balances must be in place but currently they are not. For example, under NHS England, delegation decisions have been informed by formal assessments of service suitability and service readiness alongside board approval. No equivalent to this is set out in the Bill. The publication of an impact assessment before any specialised service is delegated to ICBs is a proportionate and reasonable safeguard. Before such a significant commissioning change is made, it is only logical to properly consider factors including patient safety, clinical outcomes and equity of access.
I also support the amendment from the noble Baroness, Lady Grey-Thompson, calling for an annual report on the commissioning and performance of specialised services. The Health Bill allows responsibility and, for the first time, legal accountability for specialised services to move away from the national level and towards ICBs. This makes transparency more important than ever, but a number of important questions remain unanswered.
For example, the Government have stated that there will be,
“enhanced oversight of ICB specialised commissioning to monitor compliance with national standards”,
but how will this oversight operate in practice? Some services have national standards that are more than a decade old or, occasionally, no national standards at all. What is the process for updating these? How will transparency be improved, given the current lack of publicly available data on whether national standards are being met? I recognise that we do not want to overload commissioners and providers with numerous reporting requirements. However, given that there are more than 150 specialised services, accounting for approximately 14% of the NHS budget, a single annual report does not seem an unreasonable expectation.
My questions for the Minister are straightforward. If the Secretary of State or individual ICBs fail to meet national standards, how will we know and what action will follow? In that context, does the Minister agree that existing accountability mechanisms, such as the NHS oversight framework, are nowhere near granular enough for specialised services and that an annual report would fill an important gap in accountability? I look forward to the Minister’s reply.
Baroness Chisholm of Owlpen (Non-Afl)
My Lords, feeling invisible, constant uncertainty, high rates of distress, caregiver burnout: these are only four of many problems facing those suffering from rare disease. That is why my name is on the amendments from the noble Baroness, Lady Grey-Thompson, and the noble Lord, Lord Sharkey. We have heard from the noble Baroness, Lady Grey-Thompson, about the importance of impact assessments. I am vice-chair of the Specialised Healthcare Alliance, along with my fellow vice-chair, the noble Baroness, Lady Sater, and the noble Lord, Lord Sharkey, is chair. It plays an important role in specialised services. I support the requirement for an impact assessment before any specialised service is delegated to ICBs. All that the noble Baroness, Lady Grey-Thompson, said makes a brilliant case for this.
I am really concerned that we still lack an overarching assessment of what the Bill could mean for specialised services as a whole. We need to have assurances on how the Government will assess and monitor the cumulative impact of changes on specialised services. I hope the Minister can reassure us on this point.
I strongly support what the noble Baroness, Lady Grey-Thompson, said about the importance of annual reporting. In fact, that is already standard practice in other major areas of the health service—for example, the newly established National Cancer Board. Surely the Minister must see that how important the tool of annual reporting is for driving accountability and improvement in cancer services. In which case, surely the same principle should apply to specialist services.
My name is also on Amendment 74 in the name of the noble Lord, Lord Sharkey, on the importance of clinical leadership. Given the number of people affected and the complex conditions involved, there is a strong case for a senior clinical leadership to provide strategic oversight across care, research and policy. The Future for Rare campaign, which the SHCA supports, is calling for a national clinical leader for rare conditions in each UK nation. Given the Government’s commitments to appoint a dementia tsar and a national clinical head for brain cancer, does the Minister agree that a similar role for rare conditions merits consideration? I look forward to the Minister agreeing to these very small but very important amendments.
Baroness Sater (Con)
My Lords, I will speak briefly in support of Amendment 74, to which I added my name, and I fully support all that has been said by my friend, the noble Lord, Lord Sharkey, and my noble friend Lady Chisholm. I declare an interest as a vice-chair of the Specialised Healthcare Alliance. I also put on record my support for Amendments 57 and 73 tabled by my friend, the noble Baroness, Lady Grey-Thompson. She made some very compelling points, particularly on the importance of proper scrutiny, transparency and accountability as we move towards these new commissioning arrangements. It is vital that we understand the impact of these changes and have the means to monitor whether they are delivering the right outcomes for our patients.
On Amendment 74, there is just one further point I would like to raise: the importance of patient and public involvement. While much of this debate has focused on clinical expertise, it is important that we recognise that clinical reference groups are also a key mechanism for patient and public involvement. If they are removed without a credible alternative, that patient voice risks being diminished. These voices are incredibly important. Through my work with the Specialised Healthcare Alliance, I hear at first hand from our coalition of nearly 400 patient organisations, campaigning on behalf of people with rare and complex conditions, just how important this involvement is.
There is no substitute for hearing directly from those with lived experience. Their perspectives are invaluable, and it is important that they continue to be heard as these new arrangements take shape. Will the Minister therefore set out how the Government intend to maintain and, ideally, strengthen patient and public involvement in specialised commissioning? In particular, I would welcome clarity on what role the new offices for the pan-ICB commissioning will play in supporting that engagement and ensuring that the voices of patients and their organisations continue to be heard.
I hope the Minister can provide some reassurance on this because, ultimately, the voices of patients and those who represent them must remain at the heart of specialised commissioning. I look forward to hearing the Minister’s response.
Lord Harlech (Con)
My Lords, I have been listening with great interest, and I am still none the wiser as to why my amendment has been crowbarred into this group. But I suppose it is quite apt to be discussing the medical situation of Reserve Forces personnel on Armistice Day. I declare my interest as a serving officer in the Army Reserve.
Amendment 279QE would require a health body, when dealing with an individual, to make arrangements to establish and record whether that person is a serving member of the Reserve Forces and then to have due regard to that individual’s need to meet the medical and dental fitness standards required for call-out. This amendment was debated at the Committee and Report stages of the Armed Forces Bill and I bring it here because, with respect, the reasons given for not accepting it do not survive examination. I should add that those answers came from the Ministry of Defence rather than from this department. I saw the noble Baroness, Lady Antrobus, in her place earlier and thought that perhaps the MoD had put her up to knock this one back again.
The first reason given was that the amendment risks undermining the principle that National Health Service treatment follows clinical need rather than employment status. My proposed new section says the opposite in subsections (2) and (7). More concretely, this Bill does not itself proceed on that principle without qualification. Clause 12 substitutes a new Section 3B into the National Health Service Act 2006, allowing regulations to require the Secretary of State to arrange
“services or facilities for members of the armed forces or their families”,
and subsection (4) of that new section defines them as including the Reserve Forces. The Bill before this Committee, therefore, already contemplates commissioning by reference to service status and names reservists when it does so.
Nor is the principle novel in practice. On Report on the Armed Forces Bill, the noble Lord, Lord Stevens of Birmingham, reminded the House that from 1953 until at least 1997,
“certain classes of veterans from the First and Second World Wars received priority treatment for certain conditions”,
and that today
“merchant seafarers receive fast-track access for routine care under the Dreadnought Medical Service on offer at St Thomas’ Hospital so they can get back to sea”.—[Official Report, 20/10/26; col. 608.]
Baroness Barker (LD)
My Lords, I have shared with the House the experience of caring for somebody with a very rare neurological condition. It was because of that that, a few days ago, I went to the meeting that the Minister was good enough to organise with people from NHS England, where we discussed this very topic with them. I think they were meant to assure noble Lords that the transition from NHS England to ICBs would be a step forward, but they did not—they really did not. I echo the point made by my noble friend Lord Scriven that we are still awaiting the detail on those 150 conditions that are currently commissioned by NHS England, 70 of which will supposedly be transferred down to ICBs, and how that will work. I know people who work in ICBs and have a great concern that, because they have been left in limbo about their employment status for so long, there is a haemorrhaging of staff out of those bodies. I do not know whether there will be the clinical experience and corporate knowledge within those bodies to take on the enhanced commissioning role.
I just want to pick up on what the noble Lord, Lord Lansley, said about continuing healthcare. If noble Lords think that SEND is a scandal, they have not paid any attention to what is happening in continuing healthcare. People who have complex conditions, from which they are never going to get better, get shoved around, batted back and forth between social services and particularly the health service, like hot potatoes. The summer before last, an edict went out that lots of people had to be assessed for continuing healthcare. They never got it. There was never a hope that they were going to get it. They just had to go through a cynical process that somebody thought up centrally and shoved down the line. I went through it—we went through it—and I know other people who went through it.
I wish the Minister could have been there to listen to those people as they said, “I can cope, but the NHS—that’s going to break me”. The continuing healthcare system is an utter scandal. I am really glad that the noble Lord, Lord Lansley, has begun to shine some light on it.
Baroness Pidgeon (LD)
My Lords, this has been a really interesting and important debate, trying to tease out many of the issues and concerns with specialist commissioning in the new structures set out in the Bill, and the worries about ICBs—their capability and capacity—and the access to services across the country.
I have two amendments in this group, which I will try to talk to briefly. Amendment 59, to which the noble Baroness, Lady Cass, and the noble Lord, Lord Hunt of Kings Heath, have added their names, seeks to require the Secretary of State to have regard to the specific needs of children and young people when considering devolving responsibility for specialist commissioning services. This has wide support across the sector.
Children and young people make up around 20% of the overall population. Therefore, commissioning arrangements designed at a scale for adults just do not work for the small scale required to be effective for children. Many children are dependent on specialist commissioning, and it is essential for the provision of care for rare diseases and complex conditions, such as childhood cancers. Children are disproportionately affected by rare diseases: 75% manifest in children. The benefits of specialist commissioning being centralised and co-ordinated at a national level are clear, given the small number of patients.
The Health Bill’s direction to split commissioning is of huge concern. There is huge uncertainty out there. We have been in this position before because specialist commissioning, as was mentioned earlier, had been devolved to primary care trusts. They experienced many of the concerns that have been raised today. The previous report by the noble Lord, Lord Carter, recommended that specialist commissioning should be overseen at a national level. We need to learn the lessons from this and not repeat the same mistakes. I hope that before any delegated arrangements are made for children and young people’s specialised services, full consideration is given to the impact on those services.
The other amendment I have in this group is Amendment 279N. I still cannot believe that access to IVF treatment is not equal across the country. Your chance of being able to have a baby is decided by NHS bureaucracy and where you live, rather than clinical guidance and your health. You can have people living in roads next to each other and they can have one round of IVF or three rounds of IVF, despite NICE having recommended three rounds of IVF. We have seen the provision continuing to be reduced. Kent and Medway cut its services earlier this year from two to one and also lowered the age when someone can have treatment from under 40 to under 38. Sussex slashed its services last year from three cycles to one, and now all 10 boroughs in Greater Manchester are reduced to one. Only two of the 38 ICBs offer the NICE-recommended number of three cycles of IVF. Fertility challenges affect one in six people. The physical and psychological impact is huge.
I know the Minister is hearing all our concerns that we keep raising throughout the Bill. I do not feel we are getting much back from the Minister. But surely this is one area where there might be some movement. I urge the Government to look carefully at this and the other amendments in this group. I look forward to the Minister’s response.
Earl Howe (Con)
My Lords, I start by welcoming Amendment 54, as tabled by my noble friend Lord Lansley. It raises an important concern about eligibility for NHS continuing care. Someone suffering from a serious chronic condition, including severe dementia, should not find themselves disadvantaged in comparison with someone with terminal cancer simply because their condition fluctuates or because they are not considered to be approaching the end of life. Eligibility should be determined by the intensity and complexity of a person’s needs rather than by arbitrary distinctions. Having said that, and while the concept of continuing care is one that we can all embrace, its quality and delivery, as the noble Baroness, Lady Barker, so succinctly reminded us, often fall far short of the ideal. Can the Minister therefore say whether the Government will consider making the existing eligibility framework more responsive to the patients that my noble friend described?
I also welcome my noble friend Lord Harlech’s Amendment 279QE. Recognising the particular medical and dental fitness requirements of reservists is a sensible and clearly proportionate measure. The amendment does not displace the key principle, as he explained, that clinical need must remain paramount in this context. Can the Minister explain how the Government currently expect health bodies to recognise the particular circumstances of reservists and whether further guidance might be necessary?
This debate has been characterised by a consistent measure of concern around commissioning. We have seen this through Amendments 57, 59 and 73, as tabled by the noble Baronesses, Lady Grey-Thompson and Lady Pidgeon, who are seeking greater transparency through impact assessments and reporting requirements, particularly where specialised services are transferred to ICBs.
The noble Lord, Lord Hunt of Kings Heath, in Amendment 58, similarly highlights allergy provision. All this argues for Amendment 80, as tabled by the noble Baroness, Lady Grey-Thompson, which seeks greater scrutiny of the performance of ICBs.
As a significant number of the amendments in this group highlight, including those from the noble Baroness, Lady Scott of Needham Market, and the noble Lord, Lord Sharkey, there is concern that the Secretary of State, with so many priorities, will be unable to provide acceptable standards for certain groups. Accountability and consistency of standards cannot just be taken as a given or as things that will come out magically in the wash. It would be helpful if the Minister could explain to the Committee how the Government intend to reconcile these objectives.
In particular, where specialised commissioning is transferred to ICBs, who will be responsible for ensuring that the necessary commissioning capacity and expertise will be in place? Amendment 74, from the noble Lord, Lord Sharkey, and my noble friends Lady Sater and Lady Chisholm, asks a corresponding and equally important question around clinical leadership. As the noble Lord, Lord Scriven, expressed so well, the amendments in this group demonstrate the complexity of the decisions involved in commissioning healthcare, particularly for specialised services. I do think that further and better particulars are required from the Government before any of us can feel comfortable with the direction in which we are heading.
Baroness Merron (Lab)
My Lords, I am most grateful for this debate. I will endeavour to pick up most of the main points, but if I do not manage to do that, given the hour, I will of course be pleased to review the points raised and pick them up—in particular, looking at how I could be more helpful in providing some of the broader information that is being sought.
Perhaps I could start by emphasising that the whole point about the Bill is that Ministers are, of course, responsible to Parliament for how they discharge all their duties, including how they promote the comprehensive health service that we all seek and how we reduce health inequalities in access and outcomes.
The regulations prescribing the services retained for national commissioning will be subject to parliamentary approval. I assure your Lordships’ Committee that, in putting forward the regulations, Ministers have to have regard to patient numbers, provision costs and the number of providers, because they all relate to safety, effectiveness and value for money of commissioning at various different tiers.
Lord Lansley (Con)
My Lords, there have been so many good speeches that I have listened to, on so many important issues. I know we will return to them on Report, so, specifically with that in mind, I beg leave to withdraw Amendment 54.