Health Bill

(Limited Text - Ministerial Extracts only)

Committee stage
Wednesday 11th November 2026 Lords Chamber

I have nothing more to add, noble Lords will be grateful to hear. I just wanted to make that point, based on my experience. We look forward, much more than to my contribution, to the Minister’s response.

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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 Merron (Lab)]

I will be pleased to do so and thank the noble Lord.

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.

--- Later in debate ---

[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.