Lords Chamber

Tuesday 13th October 2026

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None Portrait Introduction(s): Lord Leunig and Baroness Usher
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Charles Charles III. Charles III. By Charles III. By the Charles III. By the grace Charles III. By the grace of Charles III. By the grace of God, of the United Kingdom, of Great Britain and Northern Ireland, and of her other realms and territories. King, head of the Commonwealth. Defender of the Faith. To all Lords, spiritual and temporal, and all other. Our subjects, whatsoever to whom these presents shall come. Greeting. Know ye that we. Of our especial grace, certain knowledge and mere motion, in pursuance of the Life Peerages Act, 1958, and of all other powers in that behalf us enabling do by these presents advance, create, and prefer our trusty and well-beloved Timothy Charles Lord Leunig to the state degree, style, dignity, title and honour of Baron Lord Leunig of Surbiton, in the Royal Borough of Kingston upon Thames, and for us our heirs and successors do appoint, give, and grant unto him the said name, state, degree, style, dignity, title, and honour of Baron Lord Leunig, to have and to hold unto him for his life.

Willing. And by these presents granting for us our heirs and successors, that he may have hold and possess a seat, place and voice in the Parliaments and public Assemblies and councils of us, our heirs and successors within our United Kingdom, amongst the Barons, and also that he may enjoy and use all the rights, privileges, preeminences, immunities, and advantages to the degree of a Baron duly and of right belonging, which Barons of our United Kingdom have heretofore used and enjoyed, or as they do at present, use and enjoy in witness whereof we have caused these our letters to be made patent.

Witness ourself at Westminster in the afternoon of the 27th day of August, in the fourth year of our sign-manual.

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I, Tim Lord Leunig, do solemnly, sincerely, and truly declare and affirm that I will be faithful and affirm that I will be faithful and bear true allegiance to his Majesty. King Charles, his heirs and King Charles, his heirs and

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And.

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Charles Charles III, Charles III, by Charles III, by the Charles III, by the grace Charles III, by the grace of Charles III, by the grace of God of the United Kingdom of Great of the United Kingdom of Great Britain and Northern Ireland, and of our other realms and territories. King, head of the Commonwealth. Defender of the faith to all Lords, spiritual and temporal, and all spiritual and temporal, and all other. Our subjects, whatsoever to whom these presents shall come.

whom these presents shall come. Greeting. Know ye that we. Of our special grace, certain knowledge and mere motion, in pursuance of the Life Peerages Act, 1958, and of all other powers in that behalf us enabling do by these presents advance, create, and prefer our trusty and well-beloved Catherine, an usher to the state degree, style, dignity, title and honour of Baroness Ussher of Burnley in our county of Lancashire, and for us our heirs and successors do appoint, give and grant unto her the said name, state, degree, style, dignity, title and honour of Baroness Ussher to have and to hold onto her for her life willing, and by these presents granting for us our heirs and successors, that she may have hold and possess a seat, place and voice in the parliaments and public Assemblies and councils of us, our heirs and successors within our United Kingdom, amongst the Barons, and also that she may enjoy and use all the rights, privileges, Preeminences, immunities, and advantages to the degree of a Baron duly and of right belonging, which Barons of our United Kingdom have heretofore used and enjoyed, or as they do at present, use and enjoy in witness whereof we have caused these our letters to be made patent.

Witness ourself at Westminster. In the forenoon of the third day of September, in the fourth year of our reign, by warrant under the

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King's sign-manual. By Catherine Baroness Ussher. Do

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By Catherine Baroness Ussher. Do swear by Almighty God that I will be faithful and bear true be faithful and bear true allegiance to his Majesty. King Charles, his heirs and successors Charles, his heirs and successors
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None Portrait Oral questions: Impact of industrial electricity prices on the international competitiveness of British manufacturing
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My Lords, I. >> Beg leave to ask the. >> Question standing in my name and the Order Paper.
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None Portrait Oral questions: Price of petrol and diesel at motorway service stations
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Fourth Oral Question Lord Moylan.
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None Portrait Legislation: Health Bill - second reading
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Baroness Merron Portrait Baroness Merron (Labour)
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Hear, hear! >> I beg to move that this bill be. Now read a second time. My Lords, the NHS matters deeply to people across our country. It profoundly touches all of our lives. Every one of us will have our own experience of the National Health Service. We will all have our own appreciation of the care it provides, and we will all have hopes for its future. And as the needs of patients are evolving, so must the National Health Service.

My Lords. Our job is twofold. First, getting the NHS treating patients on time again, and secondly, reforming the health service so it is fit for the future. These ambitions run throughout the core of this bill. My Lords, modernisation does not simply mean change for its own sake, but actually what it means is making considered changes that drive real and tangible benefits to patients who are at the heart of all that we do. It does mean making better use of technology.

It means empowering local leaders to meet patient needs. And it means taking a clear view of what needs to be done nationally, so that more funding and resource reaches the front line. Before turning to the substance of the legislation, I do want to make a few points of gratitude and note, first of all, to all peers who have engaged constructively with the development and scrutiny of this bill and who I know will continue to do so. I also want to appreciate the work of my ministerial colleague, the Minister of State for health, Karen Smith, MP for leading the bill through the other place where there was considered debate of more than 400 amendments during committee report and Third Reading stages, the bill was approved both at second and Third Reading without dividing, which is a sign of the broad consensus on its central aims.

My Lords. On a number of issues, the government has listened to concerns and has amended the Bill. We remain committed to working with both noble Lords and the other place as this bill continues its passage. I am confident that this House will take a characteristically constructive approach in its important role of scrutinising every line of this bill, and I want to thank all noble Lords who have already discussed the Bill with me, who have attended the information session after first reading, and I look forward to further discussions in the days and weeks ahead.

My Lords, I am sure you would also want me to congratulate no fewer than five noble Lords, which I understand is the most unusual number in a good way. And those five noble Lords. I am congratulating on the occasion of their maiden speeches, and I thank them for choosing this bill in which to make their own introduction to this House, and I look forward to hearing from them, and I warmly welcome them to your Lordships House. And as the Chief Whip said, we have a world first today, and I'm most grateful to the noble Lady, Baroness Campbell, for making this happen and for making AI make.

Help her make her speech. And I am grateful not just to the noble Lady for choosing this bill in which to do this, but also to the parliamentary authorities for making this possible and to ensure that accessibility prevails in this House. So, my Lords, turning first to what I believe is one of the most important reforms in the bill, the single patient record. For many years, patients, carers, clinicians and campaigners have spoken to the shortcomings of fragmented information systems.

Too often, information follows institutions rather than individuals. Too often, patients and carers repeat the same story over and over again to different professionals. And all too often, healthcare staff are making decisions without a complete picture of a patient's needs. When records are incomplete or inaccessible, opportunities for mistakes increase, and continuity of care can be compromised. At worst, these consequences can be deadly. A report on maternal deaths published in 2025 found that failures to share critical information between providers were indeed a significant factor.

In nearly half of the cases examined. This could have been avoided, so the bill establishes the legal foundations for the single patient record to create a single, secure and authoritative account of patient information. It will bring together health and social care records so that those providing care can access the information that they need and when they need it. It will empower patients to make informed decisions about their health, while supporting clinicians to provide safer, more joined up care.

Public support, I'm glad to say, is strong. Independent public deliberations show that 76% of participants supported the principle of a single patient record, and the benefits are real, including every year, 20,000 fewer A&E attendances, 6000 fewer hospital admissions, more than £20 million in medicine savings and the release of around half 1,000,000 hours of doctor's time. This, surely, my Lords, is a price prize worth having. I am grateful to noble Lords who attended the single patient record round table.

I recognise the concerns that were expressed about privacy, confidentiality and public trust, and so I can assure your Lordships House that the single patient record will operate with strict safeguards. Strong cyber security measures, clear controls over access, robust oversight arrangements and full compliance with existing legal protections. This bill is about safer care, not about weaker protections. It is about empowering patients. It is not about diminishing their rights. My Lords, I now turn to the abolition of NHS England and the guiding principle of the democratic accountability of our health system.

Since NHS England was established, the number of staff working across NHS England and the Department of Health and Social Care has increased substantially. I have experienced the overlapping responsibilities and convoluted processes that slow up decision making and divert attention away from patient care, something I know that none of us want. So this bill will return the functions of NHS England to government and the wider NHS system where appropriate. In doing so, it will provide greater clarity for the system.

It will restore democratic accountability and free up resources to be reinvested on the front line where we want to see them. There will also be greater clarity about where responsibility lies, ensuring that Ministers are accountable for national decisions, whilst devolving more power to local NHS organisations. And let me on that point, turn to the matter of devolution and local leadership. This government does believe that a more devolved NHS will be a more effective NHS. Those closest to patients are best placed to understand their needs, and that is why this bill devolves decision making, empowers local integrated care boards, strengthen strategic commissioning and provides greater flexibility for local leaders.

Having said all of that, I also recognise concerns around local representation and expertise. We listen carefully to those concerns during the passage of the bill in the other place. As a result, the government amended the bill to restore the requirement that every ICB includes a local authority member jointly nominated by relevant upper tier local authorities. I believe that this amendment strengthens the bill. It ensures that important expertise, expertise on social care and public health continues to inform decision making and helps lay the ground for future social care reform.

Looking ahead, integrated care boards will act increasingly as strategic commissioners of local health services, with responsibility for a broader range of services and resources, and holding that responsibility in their own right, rather than as duties delegated to them by others. We want decisions to be made as close to communities as is feasible, with the ICBs providing strategic leadership whilst working closely with local authorities and other local partners, and neighbourhood health will be at the very heart of this approach.

My Lords, I know that patient safety is a concern shared by noble Lords across the House. Before turning to that issue, I would like to extend my congratulations to the noble Lady Baroness Neuberger on her appointment as chair of the Care Quality Commission. Yes, and I look forward to working with her, and I'm sure we all wish her well. My Lords. No government should ever pretend that things do not go wrong in the NHS when they do. Patients, families and the public must have confidence that lessons will be learned and acted upon.

So the independent review, led by doctor Penny Dash, identified a patient safety landscape that has become cluttered and confusing. The sheer number of recommendations to health bodies in this landscape over 1400 in the last 30 years can make it very difficult for them to focus on doing the right thing. So this bill streamlines that landscape. It transfers the functions of the Health Services Safety Investigations Body to the Care Quality Commission, helping to create a clearer connection between learning from failures and improving care.

At the same time, we will ensure that vital, safe space protections remain in place. The government also recognises the importance of ensuring that the CQC is ready to take on these functions, and that is why we are taking a carefully managed approach to implementation and have been working closely with the CQC to monitor their operational readiness. This transfer will only happen when CQC is ready, but before I move on to the next point, I want to assure your Lordships House how seriously we take consideration of patient safety, and we will listen to the concerns of your Lordships House and keep noble Lords updated on any and all progress in this important area.

Moving now to patient voice, the Dash review also spelt out how to simplify the arrangements for the patient voice. The bill abolishes Healthwatch England and local Healthwatch, placing responsibility for listening and responding to patients and the public with the organisations that plan and commission services. ICBs and local authorities. Again, I recognise that noble Lords have raised concerns about these reforms and I am grateful to my noble friend, Lord hunt, for meeting with me to discuss this. I look forward to continuing discussions with noble Lords as part of our review of these measures.

My Lords, I'm going to take just a moment to remind the House of the additional amendments that the government has made during the passage of the Bill thus far. They relate to pharmacy regulation, visiting in health and care settings, and reforms relating to medicines and medical devices. Together, these changes support patient well-being, access to high quality care and innovation. And in bringing my opening remarks to a close, I do wish to highlight one further commitment relating to a statutory maternity and neonatal Commissioner.

The government accepted the recommendation of the noble Lady, Baroness Amos, and I want to thank Baroness Amos and her team for all of her hard work in delivering the National Maternity and Neonatal investigation. The Secretary of State has made it a priority that we should bring forward an amendment to establish a statutory maternity and neonatal Commissioner to provide independent leadership, oversight and accountability for maternity and neonatal care in England. This is an important opportunity to strengthen accountability and champion the interests of women, babies and families throughout the system.

So I want to thank noble Lords for the questions and points they have raised about the role, and I look forward to working with noble Lords on this important development. So, my Lords, this Bill will not solve every challenge facing the NHS. But what it will do is to be a significant and necessary step towards a modern, accountable and patient centred health services health service. It will help information to follow patients rather than institutions. It will reduce bureaucracy and strengthen accountability.

It will give local leaders greater freedom to deliver for their communities. And it will place patient voice closer to decision making. And I, for one, welcome all of that. I beg to move.

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My Lords, it is a pleasure for me to open our first discussion. On this very. Significant bill. And I should

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Significant bill. And I should like to begin by thanking the Minister for introducing it. In her customary. Clear way. I don't think the Minister. Would don't think the Minister. Would disagree with me if I described this bill as a landmark measure, this bill as a landmark measure, proposing, as it does, a range of major changes to the way in which healthcare in England is organised, commissioned and delivered. It's therefore, I confess, a somewhat
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Earl Howe Portrait Earl Howe (Conservative)
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steering through your Lordships House, a number of the measures which this Bill now seeks to unwind. which this Bill now seeks to unwind. For a good many of us here, I suspect the very difficult suspect the very difficult parliamentary process that we had to go through in 20 1112 is seared on the memory. And notwithstanding the fact that a large element of what we were seeking to achieve through the underlying policy. Let's remind ourselves, commanded widespread support. What were we seeking to achieve? Well, there were two principal policy aims.

One was to bring decision making around the design of health services much closer to clinical leaders, and simultaneously to redefine the role of Ministers as that of setting the broad strategic direction for the health service, empowering clinicians and local managers was seen as a way of bringing to fulfilment the work of the noble Lord Lord Darzi when he was a health Minister, which was to enable the system to commission for quality. In other words, to Commission for patient outcomes, whose quality could be measured by reference to defined national standards.

That was the first policy aim. The other main aim was to give public health a place at the table that it hadn't had for many years. With the creation of Public Health England as a discrete body within the National Health Service. Government Ministers were made directly and unambiguously responsible for population based health policy and delivery in the round. Therefore, the intention was to make the system more responsive to people's needs and in so doing, to improve patient care and better protect the health of the nation.

Now, the upheaval arising from the reorganisation or reorganisation of NHS structures, and I don't deny it was an upheaval, was the price that we thought worth paying to achieve those desired ends. My point in recalling all this is not to rehearse the 2012 Act Health and Social Care Act. It is simply to point out that there was a purpose behind the act that reflected an explicit intention and desire to benefit patients. The White Paper published by the government in advance of the bill was called liberating the NHS and the creation of NHS England as the National body accountable to Ministers for the delivery of NHS services was one of the principal measures designed to achieve that liberation.

The bill before us proposes a step that is, I suggest, every bit as momentous, complex and time consuming as the creation of NHS England, which is to take NHS England apart and abolish it. The need to take such a step is is something which I don't doubt Ministers are convinced of, despite what will undoubtedly be a painful process for many committed and skilled men and women in the NHS who have lost or face losing their jobs. Let us not forget them and equally, let us not forget NHS patients.

The labyrinthine process of reabsorbing roles and responsibilities into the Department of Health and Social Care, and parcelling out other roles and responsibilities to ICBs bodies that are themselves undergoing restructuring, is one that as sure as night follows, day will eat up large slices of leadership capacity, capacity which would otherwise be devoted to service improvement. Now that dilution of leadership bandwidth, with all the costs associated with it, is a big price. And for that reason, I strongly suggest we need to hear rather more from the Minister than we have hitherto about how she believes the abolition of NHS England will benefit those whom the NHS is there to serve, not how it will benefit the system, not how it will benefit the spending review, but how it will benefit patients.

For my Lords, that is surely the prime test against which this entire Bill should be judged. Now, as regards patients, the government has repeatedly stated that its intention is to devolve greater responsibility to integrated care boards to allow decisions to be taken closer to the communities whose needs those boards are intended to understand. The bill accordingly, places a much greater proportion of commissioning responsibility directly with Icbs, including formal responsibility for primary care and other services, which they currently commission under delegated arrangements.

However, at the same time, the bill transfers to the Secretary of State, extensive powers of oversight and direction. It creates a new general power to direct ICBs as to the exercise of their functions. It allows the Secretary of State to require Icbs to exercise health service functions on his or her behalf, and it transfers to the Secretary of State, NHS England's existing responsibilities for ICB resource allocation, financial directions, appointments and oversight. The forces created by this Bill are therefore pull in two opposing directions, one which devolves responsibility for commissioning, the other which centralises significant powers over the way that that responsibility is exercised.

Now, that is not merely a source of tension. It promises to be a source of confusion if NHS England is to cease to exist. The arrangements that replace it to be effective must make authority and accountability completely clear. That clarity matters on three levels. Those working within the health service need to know who is empowered to take a decision. Patients and the public need to know who is responsible for what. Parliament needs to know whom it should hold to account when services improve and, crucially, when they do not.

We surely cannot have a situation in which, let us say, services at a local level deteriorate and fingers of blame are then pointed in multiple directions as a bare minimum. The least that we should be looking for with ministerial powers of direction is transparency in their use. What the reasons are for using them and what their financial and practical consequences are expected to be. More importantly, perhaps, I think we will need to examine at later stages whether the broad powers of direction granted to the Secretary of State should be circumscribed in order to ensure that NHS organisations enjoy sufficient autonomy both to innovate and to be accountable to their for their own performance with the communities whom they serve.

What matters to those communities is the health service in their local area. My Lords, as we speak, the NHS is undergoing upheaval and change at a time when powers and roles are being shifted to the centre and icbs are being told to reorganise themselves onto different footprints. The risk of service disruption becomes that much greater in a situation of this kind. It is surely all the more important that we have systems in place that can sound the alarm. Should any risks to service quality appear to be emerging.

Yet clauses 70 and 71 of the bill, together with schedules ten and 11, would abolish both Healthwatch England and all local Healthwatch arrangements. The very organisations which are there to meet that need. I state here and now my grave concerns about this proposal. The value of Healthwatch is not simply the feedback that it sends to commissioners and providers. It is a route independent of the wider system, through which patients and service users can gain a voice.

It is a way for them to highlight inequalities of access or of outcomes, and in doing so, help to eliminate them. It's a means by which any worrying patterns of service provision can be identified in a timely fashion. The insights provided by Healthwatch are often very local, and so not ones that necessarily become visible through published performance data. If we are to abolish these arrangements, we need to put something equally effective, equally accessible and equally trusted in their place.

And what this bill proposes as a substitute for Healthwatch is not, in my view, likely to tick any of those boxes. My noble friend Lord Kamall will say more on this subject when he comes to speak later on. Healthwatch recommends itself as a model for patients and public involvement because it is trusted by the ordinary citizen. We risk squandering that trust at our peril. It was put to me recently that trust is a commodity that arrives on a tortoise and leaves on the back of a racehorse.

The same maxim can be applied to the proposals for the Health Services Safety Investigations Body, which, under the Bill, as a noble Baroness Casey explained, is to be abolished as a separate organisation, its functions being transferred to the CQC. I've not yet heard a convincing argument in favour of that idea. The CQC is a regulator and inspector who performs a deliberately different function. Its purpose is to investigate systemic patient safety failures in order to understand what went wrong, and for that reason, it relies on people being willing to speak frankly about a serious safety event with a guarantee of anonymity.

Now, whatever Chinese walls may be put in place within the CQC to keep the two functions separate, it's the way it looks. Once contributors fear or suspect that the information that they supply is going to be fed through to a regulatory body, their confidence to speak up will evaporate. So where does all this leave us? My Lords, the government's case for abolishing NHS England rests in significant part on the proposition that doing so will remove duplication between NHS England and the department, reduce bureaucracy and release resources for frontline care.

Ministers have said that the reforms are intended to save about £1 billion a year by the end of the Parliament. Against that, the government now estimates that paid exits and redundancies across the department. NHS England, ICBs and commissioning support units will cost approximately 1 billion to 1.3 billion. On top of that, there is the cost of establishing the new commissioning arrangements. It would therefore be most helpful if the Minister could tell the House what assessment the government has made of the net financial effect of the reorganisation.

When does the government. When does the Department expect the cumulative savings generated by the new structure to exceed the costs of implementing it? And what mechanisms will Parliament have to assess whether those savings have actually been realised? My Lords, there is a legitimate case for asking whether the present architecture of the NHS is too complex, whether responsibilities are sufficiently clear and whether resources which are currently devoted to bureaucracy could be used more effectively elsewhere. But any reform should make things better.

Responsibilities should be clear. Accountability should be identifiable, savings should be demonstrable rather than assumed. Operational risks should be understood before functions are transferred, and reforms intended to simplify the system should not, in practice, create new ambiguity elsewhere. Above all, patient patients and the ordinary citizen should not be forgotten. My Lords. Lord Darzi's review of the NHS, which was commissioned by the government in 2024, contained conclusions and recommendations which were warmly welcomed by Ministers.

But Lord Darzi ended up saying this a top down reorganisation of NHS England and integrated care boards is neither necessary nor desirable. Constant reorganisations are costly and distracting. Was the noble Lord right or was he wrong? I hope and trust that our further debates will come up with the answer.
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Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (Liberal Democrat)
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My Lords, it is an absolute pleasure and privilege to. Follow directly on from the noble Lord Earl Howe. I, too, speak as a veteran of the 2012 Bill, and I'm very much looking forward to no less than five maiden speeches. As we've heard, this bill introduces significant structural change to the NHS, although some of them do feel somewhat contradictory. And of course, the development of a single patient record. But, my Lords, these must be viewed within the wider context of the state of health and care in this country.

According to the Health Foundation, whilst we have seen some welcome improvements, the big picture is that health inequalities, particularly life expectancy between the richest and the poorest, are widening. Healthy life expectancy is falling. Declining working age health is costing the economy dear, and waiting times remain unacceptably high. So the big question for me is whether this bill provides the legislative framework to enable those three big shifts set out in the ten year plan, because there is a clear consensus that we need to move to a more preventative, community based health system.

The obvious concern is that these structural reforms will simply serve as a distraction from much needed improvements in patient care, service design, workforce planning, and productivity gains. I will touch briefly on four key issues. Other very important issues, including structures, a single patient record and patient safety, will be covered by my noble friends. My Lords, the bill transfers to the Secretary of State a duty to consider inequalities in access to health services and outcomes achieved whilst welcome. I don't think that is nearly strong enough.

The Bill should place a clear duty on the Secretary of State to act to reduce health inequalities, a call supported by many external organisations, and this needs to be accompanied by coordinated action across government to tackle the wider social determinants of health, along with transparent reporting on progress. There is a golden opportunity in this bill to put tackling health inequalities on a statutory footing, and I look forward to working with other peers. Other noble peers to get the bill substantially strengthened on patient voice.

In the debate on The King's Speech, I expressed my serious concerns about the proposal to abolish Healthwatch England and local Healthwatch now at Report stage in the other place, following strong concerns about removing trusted and independent channels for people to make their voices heard. The government committed to review the Healthwatch provisions. I welcome this and very much hope that the government will think again. The Bill is currently drafted unhelpfully separates public voice functions concerning the NHS from those related to social care and public health.

It would not put an equivalent independent, national and local patient voice function on a statutory footing. And I know that many noble Lords like me will want to see the government's review deliver a service, a system which both preserves independence and has sufficient authority to secure action when consensus, when concerns are raised. My Lords, at the risk of stating the obvious, the most cost effective route will be to stick with the current arrangements, particularly the trusted local relationships built up by local Healthwatch over 13 years.

So could I ask the Minister what the scope and timescale is for this review and who will be consulted? I now turn to unpaid carers, and I pay tribute to the 4.7 million unpaid carers in England whose contribution is vital to our health and care system. The value of the care they provide is estimated at 152 billion a year in England, roughly equivalent to the NHS budget, and unpaid carers outnumber NHS staff by around 3 to 1. But despite this, carers can too often feel invisible and unsupported by the NHS.

This bill provides an important opportunity to ensure that carers are recognised by the NHS and can rely on support, such as respite breaks actually being available. So I intend to bring forward an amendment to introduce a new duty on ICBs to identify unpaid carers to match what already happens within local authorities. And in addition, an amendment to strengthen provision for breaks for unpaid carers. I just want to talk briefly to talking about what I call the forgotten areas.

Adult social care is largely absent from the bill, a real missed opportunity for integration. Now, of course, the Prime Minister has brought for publication of the final review report of the Commission to next summer and committed to setting out plans for a National Care service before the next general election. My Lords, I do not think we can wait that long. Significant challenges remain in the short term. Pressure on providers, workforce shortages and unmet need continue to pose major challenges to both social care and the NHS, meaning urgent action to stabilise the sector is vital while longer term reforms are developed.

My Lords, there are other things I would have liked to have said, both on children and young peoples health and mental health services. But. But time prevents. But they, in my view, are also very much overlooked in this bill, and I intend to return to them at Committee stage. In conclusion, I would very much welcome further discussion with the Minister and her team on the issues I have raised, and look forward to working with her, along with other working with her, along with other noble Lords, on all benches.
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Baroness Campbell of Surbiton Portrait Baroness Campbell of Surbiton (Crossbench)
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Before I contribute to this debate. I would like to thank the Procedures Committee for allowing me to bring my AI generated voice into the chamber, and also the technical Department and other members of the House of Lords staff who have made this possible. This model is cutting edge technology, and it will enable me to contribute to debates in my own. Once clear voice before it begins to deteriorate due to my disability. I hope that your Lordships will agree with me that this is an exciting development for the House of Lords, showcasing to the world inclusion in democracy at its best.

So Zero Lords, I introduce you to Baroness Lords, I introduce you to Baroness Campbell, but to. My Lords, I welcome this Bill and share much of its vision. The government's commitment to integrated personalised care and support is long overdue. If implemented correctly, it could transform thousands of lives. However, I also feel compelled to deliver a warning against the potential re-emergence of an institutional medical model. For decades, the Disabled People's Independent Living Movement has fought clinical paternalism, which defines us by our medical condition.

We are individuals with the right to control our lives, choosing what we do and who supports us. NHS personal health budgets were designed to give individuals support to lead ordinary lives on their own terms. However complex their medical needs, the 2019 guidance promised greater choice and control and enhanced independent living. Direct payments enable people to employ personal assistants, pay and decide how and when they are supported. So I am nervous when I hear the Prime Minister speaking of healthcare and social care staff as one workforce.

We must not replace personal control with a one size fits all service. Notional personal health budgets in a National Care service could squeeze out direct payments in favour of standardised care packages. Where a PhD is a direct payment. Individuals have greater control over NHS funding and offer better value, with average savings of 12 to 16% compared with conventional services. My Lords, some ICBs are showing creeping rigidity over the use of pH. As I recently highlighted in the Guardian, individuals have been prevented from using budgets to enable their PA slash carer to support them when away from home.

Lucinda Ritchie was forced into residential care from hospital against her will, rather than returning to her adapted bungalow, and her experienced PA team. Only after we raised the alarm and involved the BBC did her ICB change its mind. My Lords, this will not do. In July, the Minister and I discussed my proposal for an inquiry into ICB practices to address these issues. Perhaps she would update me on this, and whether the government remains committed to FBS for 1 million people by 2030, and anyone who would benefit by 2035.

Sadly, evidence from the coalition for Personalised Care tells a different story. Since the restructure, hardly any ICBs have a named lead for FB expansion without the dedicated NHS England team. FBS dedicated NHS England team. FBS have declined from 188,489 in 20 23 to 24. An NHS funded PA carer provides essential support for people with complex needs. I am here today contributing equally with your Lordships. As a result of a pH B, I am fortunate denying portability effectively institutionalises a person at home.

When systems dictate that people cannot travel or place rigid rules around support. They treat the home like a hospital ward flying in the face of article 19 of the convention on the Rights of Persons with disabilities, ratified by the UK in 2009. I will therefore be scrutinising the Bill to ensure integration and devolution to ICBs does not weaken HB protections and freedoms. Choice must be safeguarded through stronger guidance, including a right to portability and flexibility. ICBs must not use residential care or budget withdrawal to coerce individuals.

My Lords, let us ensure the medical model does not swallow decades of progress on disability rights and independent living. I am not a medical diagnosis, but a wife, grandparent and working member of the House of Lords. ICBs would do well to reflect on that.
16:16
Lord Bishop of Newcastle Portrait The Lord Bishop of Newcastle (Bishops)
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Thank you. >> My Lords. It is an honour to follow the noble Lady Baroness Campbell of Surbiton, and I note her excellent speeches. Historic nature. I also congratulate noble Lords making their maiden speeches and welcome the wisdom and experience they will bring to your Lordships House. I welcome this Bill's ambition to improve care and make better use of resources. I want to highlight three interlinked issues trust, health inequalities and the relationships on which good care depends.

First, trust matters between government and the workforce, between national and local institutions, and between communities and those providing care. Transferring NHS England's responsibilities must bring clear accountability while sustaining local decision making. Restructuring must support staff and protect their capacity to deliver care. The proposed abolition of Healthwatch sharpens these concerns. Independent local organisations give people somewhere trusted and accessible to speak, including where services have failed them. Their independence enables them to challenge decisions and bring forward experiences that might otherwise remain unheard.

And so I welcome the government's commitment to reconsider these provisions. Whatever arrangements emerge, independent scrutiny and established local relationships should be protected. Patient voice should influence decisions, particularly where people struggle to navigate the system. Trust takes time to build and can be quickly lost. As we have heard from other noble Lords. Secondly, reform must narrow health inequalities in the North East. Healthy life expectancy is around 57 years for both men and women, the lowest of any English region.

Behind that figure are people whose working lives, family responsibilities and opportunities are constrained by illness, often alongside poverty and insecurity. In Newcastle and across Northumberland, access to care is shaped by transport, distance and available support. Greater patient choice means little if someone cannot afford the journey. Digital access and a single patient record offer opportunities, but those without connectivity, competence or someone to help must benefit too. Faith communities and voluntary organisations bring trusted relationships and local knowledge.

They should be partners in shaping services. Thirdly, integration must strengthen the relationships that sustain care. Social care must be a full partner in neighbourhood services and shared records with safeguards for privacy. Duties to commission palliative care must translate into dependable access wherever people live. John's campaign, with which I have had a long standing connection, expresses the importance of relationships. Powerfully founded following the experience of John Gerrard, who had dementia. It champions people's needs to have someone they trust alongside them whenever they receive care for someone with dementia, a familiar person may help them communicate, eat, understand what is happening and feel safe.

They may recognise pain or distress that would otherwise go unnoticed. Their presence is integral to safe and compassionate care. With that, I welcome this bill's provisions for promoting, visiting and accompaniment. Essential personal support must, however, be distinguished from general visiting, and I will seek to support amendments moved by the noble Lord, Lord Hunt of Kings Heath, who follows me in recognising and protecting that distinction. Children's needs also need attention and support, ensuring that adopted children's health records remain safely connected with confidentiality protected, so that fragmented information does not compromise care.

My Lords, I note that children's distinct needs receive too little explicit attention in this bill. My Lords, structural reform must strengthen human relationships, protect patient voice, and improve access for those whose needs are greatest. These are the principles against which I will continue to consider this bill as it proceeds.
16:21
Lord Hunt of Kings Heath Portrait Lord Hunt of Kings Heath (Labour)
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I'm very grateful. >> Right reverend Prelate for supporting amendments around the rights of carers. We look forward to debating the overall. I welcome the bill. I see it as removing the last vestiges of the 2012 changes introduced by the noble Lord Lord Lansley places Ministers at the heart of decision making and improves patient outcomes through the single patient record. I my Lords, I listened with great interest to the noble Earl. Lord, how we've been debating NHS structures for far too long.

And he looked back, of course, to the 2011 debates that we had on that bill and in your Lordships House in October 2011, we had two days of Second Reading debate with over 100 speakers. Such was the concern about the bill. My noble friend Baroness Thornton played a leading role in that. My Lords, he said, noble Earl, that the upheaval then, was a price worth paying. But I would put it to him. My Lords, it was a hugely unpopular, hugely expensive and damaging restructuring, and I did look at his speech at Second Reading.

Then he anticipated that to an extent. But essentially he argued, and he said it today, that the aim of Lord Langley's proposals and will hear from the noble Lord very soon on this was to make the service patient centred and to give greater autonomy to clinicians. But, my Lords, that didn't really end well, did it? Because the reality was anything but. In essence, GPS were not prepared to essentially take on the task of commissioning services. NHS England never established full independence and Ministers refused to take responsibility for large aspects of the running of the service.

And what is so tragic? Looking back is the government. The coalition government had inherited the NHS in the best condition it had ever been. Waiting lists had been virtually eradicated, with the 18 week wait for elective surgery, the four hour wait in A&E, 100 new hospitals had been built or being built were in the process of building new services like NHS direct, which was far, far better than the current service that we have because qualified nurses were the people who took the calls.

I mean, Lords public satisfaction in 2010, British Social Attitudes Survey public satisfaction was an all time 70%. By 2024, it had fallen to 20% and 70% to 20%. Now, my Lords, during the years following those changes, of course, there's been a continuous stripping away of that blueprint, but the framework lingered on and undoubtedly contributed to NHS performance deterioration. So, my Lords, that's why I do welcome direct ministerial control and the resulting enhanced accountability to Parliament.

My noble friend stressed devolved decision making. And with that, what I'd say to her is that then has to be balanced out by strengthening mechanisms of local accountability and scrutiny as well. That's why I very much welcome the review in relation to Healthwatch and my Lords, my hope is that a strong, independent public voice at local level will be maintained. I also hope and urge my noble friend to relook at the proposals to abolish Council of Governors for foundation trusts.

My Lords, they play a really effective role. Local people get involved in the running of their hospital by electing governors. The governors hold the board to account. And actually, my Lords, I think they are a vital safeguard, being the eyes and ears of local people in their local institutions. They can broaden the trust connection with local communities. Numerous visits to patient areas provide valuable feedback, and I think the National Governors Association has shown in their briefings to us that they can be a statutory independent warning system.

Escalating frontline safety concerns to non-executive directors. So I hope, my Lords, the government will look again at these proposals. My noble friend rightly pinpointed the single patient record as most important aspect of this bill. I agree with her. She will be asked questions about the confidentiality of patient information. She will have seen, I think the recent HHS Sky news survey that showed most NHS trusts are ill prepared in order to protect patient information, and she will have seen the prosecution in some cases, and certainly disciplinary action against staff who looked inappropriate.

Patient records. And clearly, my Lords, that will be a matter for debate. But overall, my Lords, I very much welcome this Bill and look forward to our debates in committee.
16:26
Lord Lansley Portrait Lord Lansley (Conservative)
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My Lords. straight after the noble Lord Lord Hunt of Kings Heath. May I say, having listened to my noble friend having listened to my noble friend Earl Howe on the front bench, noble Lords will be aware of how lucky I always was to have him on the health team. And speaking on behalf of the team in this house means I don't have to revisit all those issues. I thought he explained perfectly well what the intentions of the 2012 act were. I would just add this single point.

The 2012 act wasn't implemented. Clinical clinical leadership on the part of general practitioners was stifled pretty much at birth by the by the way, in which the management systems in the NHS told them they could live with the deficits or they could have autonomy. They couldn't have both. And the NHS England was not created by the 2012 act. It was the accretion of subsequent responsibilities. It. What was created was the NHS Commissioning Board and the focus on commissioning and clinical leadership is what we should continue to have at the forefront of our mind.

And if there was duplication with the department, it was largely because the department never let go and Ministers didn't understand that they had to let go. They had to give the NHS autonomy and they otherwise there would inevitably be confusion and duplication. But it may I say I read the bill and I read it looking for the positive purpose, and all I find is abolition, abolition of NHS England, abolition of Healthwatch, abolition of the HSSIB, abolition of foundation trusts.

What I wanted to find in the Bill was positive purpose, and I think I follow not least the noble Lady, Baroness Tyler and Baroness Campbell of Surbiton, in saying there is much we can do now actually to deliver on a government manifesto commitment. None of these things are manifesto commitments in the Bill. What there is, is a commitment to a National Care service, and I think we should we should use this bill and the debates around it to help to fashion that by strengthening, as the noble Lady Baroness Campbell said, the existing statutory provisions for personal budgets that combine health and social entitlements by strengthening joint commissioning between ICBs and local authorities through devolution, by implementing the cap on care costs in the Care Act 2014, which has been in legislation for 12 years and no subsequent executive has seen fit to implement Parliament's intentions and to strengthen.

I listened with interest and I'd say with approval to what the Prime Minister said about the difficulty of people with severe dementia not accessing NHS, continuing care in circumstances where somebody with cancer would. Well, we can deal with that. And I will bring forward an amendment that should, if it works, enable more people with severe dementia to access NHS continuing care. So I think we can do positive things with this Bill and I hope we shall. But when it comes to abolishing NHS England, I'll just say to the Minister, be careful what you wish for because every issue will land on the minister's desk and at the moment Ministers are still wandering around, I think, saying, you know, they've cut waiting lists by half a million.

Good grief. When I left office in from the department, the waiting list was 2.64 million. It's now 7.37 million. The numbers are going up, not not going down in the last three months and the number waiting. She says patients should be treated on time. When I left, 162,000 patients were waiting more than 18 weeks. It's now 2.25 million. There is a very, very long way to go. And if she thinks running everything from the Department of Health is going to solve the problems, she might like to talk to her former colleagues in Cardiff, because running things from Cardiff didn't sort the problems of the NHS in Wales.

So I think she might like to think again about whether this will solve her problems. I don't need to repeat what my noble friend said from the front bench about the importance of the independence. Both of the HSSIB in relation to its investigations and the independence of the patient voice through Healthwatch, and I hope this House will be robust in defending those. I do hope that the single patient record will work. I'm scarred with trying to manage the results of past past administration on introducing new technology in the NHS, but I think this time we really have to crack it.

And I think it's important that both to have the statutory provisions and the implementation very firmly in our debates. And finally, I just say this my noble friend was right. Commissioning and leadership. Clinical leadership in the NHS is exactly where we should focus our efforts and make sure that we give clinical leaders in the NHS the autonomy to make that happen.
16:31
Lord Stevens of Birmingham Portrait Lord Stevens of Birmingham (Crossbench)
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Thanks. intruding on private grief as this debate unfolds. But what a pleasure to join so many distinguished former colleagues from across the National Health Service. And frankly, there is much to welcome in this bill. But at its heart is yet another top down administrative reorganisation of the NHS that folding NHS England into a government department and converting operational managers into Whitehall civil servants clearly corresponds to the current zeitgeist. But as we legislate, I would suggest that we should be clear eyed about both the potential benefits and the inherent risks.

The strongest argument in favour of folding NHS England and the Department is clearly that it offers the opportunity to reduce duplication, fewer checkers and more doers. But in fairness, I think it's also the case that the Secretary of State could have achieved the same result with a more explicit division of labour between NHS England and the Department of Health and Social Care, which is what the government's own impact statement says, namely, that headcount reductions could have been made by the Department of Health and Social Care without legislation and picking up on the point that Earl Howe made, I think it is surprising that a year and a half after the announcement was made as to the abolition of NHS England when describing the so-called full economic assessment of what the costs and the benefits will be in the impact assessment, all of the cells where there should be pound notes are blank.

The costs are described as not available and the benefits are described as not available. All we have is the press release that was issued at the time of the original budget. As to the philosophical argument about the need to promote more democracy, let's be clear this isn't a binary. It's not about control or no control by the Secretary of State. It's matters of degree. Our Health Secretary sets the NHS budget, sets its priorities, oversees its performance. And since the 2022 act, and although we've cast our mind back to 2012, let's not forget that Parliament in 2022 set up the arrangements we're now about to disband.

Since the 2022 act, the Secretary of State has also had a legal general power of direction, and this bill proposes even more of that. Particularly striking are measures that would allow political appointments throughout the NHS locally, turning the clock back 25 years. Schedule three gives the Health Secretary the power to appoint political place people to every hospital board in the country. Even more surprisingly, clause 37 allows the Secretary of State to fire individual named executive directors of foundation trusts, and clause 11, in effect, means that for the first time ever in the history of the National Health Service, local health Board chief executives serve at the pleasure of the Secretary of State, who.

Subjective opinion determines their hiring and firing. Now, however sanguine we may be about the way in which those powers would be exercised by the current government, one only has to look across the Atlantic to envisage a future in which that cause, that could be a cause of considerable and deep seated concern. So, yes, removing duplication, a debate about what democracy really means in this context. But the third D, of course, is the risk of disruption. And frankly, the NHS at the moment is feeling the effect of that.

The new Secretary of State, Yvette Cooper, has reportedly and rightly been asking, how is all of this administrative turbulence affecting the big patient care challenges facing the NHS? Waiting lists stubbornly over 7 million, despite heroic efforts across the service to get them down. Cancer waiting times are off track by up to three years. Maternity in early years again, as Yvette Cooper has rightly focussed on the need for further attention, Parliament has just had a divisive debate on assisted dying. One thing we all agreed on was the need for better palliative and end of life care.

The modern service framework is currently missing in action, so all of this runs the risk of potentially distracting from the things that were genuinely make a difference to patients. And instead, 18 months on from the original announcement, we still don't have the operating model, which the NHS is supposed to be putting into place from April next year. We have unclear resourcing for ICBs, who won't even know their boundaries, apparently until at least 2028, and the role of the regions not mentioned in the in the bill as yet undefined.

As the old adage says, only two things will survive a nuclear war. Cockroaches and the regional tier of the National Health Service. So it would be good to hear a little more on that front. The practical test for this bill, therefore, is will the change is actually improve patient care? Will they drive value for taxpayers? Many believe that this is, as we progress, the triumph of hope over experience. Our job at. The amending stage of this legislation is to try and improve the chances of success.
16:37
Baroness Jay of Paddington Portrait Baroness Jay of Paddington (Labour)
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For. I'm glad, very glad to follow the noble Lord Lord Stevens, with whom, as another old colleague, I have had many discussions on many issues on the health service. Not always an agreement, but I congratulate the government on introducing this Bill to modernise the service with its explicit emphasis, and I emphasise explicit on patient experience the plan to place patient experience alongside clinical outcomes as a key measure of care and quality of care quality is enormously important, and I would say to the noble Lord Lord Lansley,

**** Possible New Speaker ****

A very positive purpose of this particular legislation and some of these proposals that he will know these proposals that he will know too well have been in the pipeline a long time, and it is very welcome that they will now be properly that they will now be properly enacted. Interest of time. I will just mention some of the improving changes which particularly have changes which particularly have occurred to. And then I would raise a couple of questions about delivery. First, I am extremely delivery.

First, I am extremely pleased that every in every integrated care board will have members representing local authorities and that, as the noble Minister has said, Commons amendments have already strengthened this membership. I am certain from previous experience on district health authorities that including some of the people from neighbourhood services such as housing and transport, will improve public health and indirectly reduce inequalities. A major change which will directly benefit patients is the one which other speakers have mentioned the final arrival, and it is a final arrival of the single patient record.

It seems extraordinary to me that it was 25 years ago that I was the Minister responsible for trying to streamline patient records in this way, and after a lot of effort, that proposal was bogged down in many objections about shared technology and confidentiality. So I'm sure the new details about the new electronic patient record will be rightly closely examined in committee, because there are, in fact, new digital age in this new digital age, some justifiable concerns, some of them from across the Atlantic about who is ultimately handling and indeed owning the confidential patient data.

To me, it's reassuring that in future, overall responsibility for patient experiences will be integrated into a new directorate with responsibility at ministerial level. I would be welcoming the fact that it may be possible to revive the original Nye Bevan commitment to answer all questions about the health service at the despatch box. However, in spite of the new directorate, I do have some questions about how public involvement and patient voices are to be effectively organised, and I don't think it can be stressed too often, as speakers have done before me.

Now that a successful system must be independent and easy to access and have clear lines of accountability. Anyone wanting to express an opinion about their care or raise a complaint about treatment should be sure that this can be done in a straightforward way to an independent authority and if necessary, quick action will be taken. My main concern about patient voices is, as has already been mentioned, is the abolition of the Healthwatch structure, particularly at a local level. I can understand completely the laudable ambition to bring patient voices directly to the boards, who commission and organise their services, but I am afraid that this can appear a more daunting official channel than the informal and many people safer space of neighbourhood where Healthwatch.

I was frankly alarmed to learn that the figures show in 2024 are. Over half of those people who experienced what they described as bad care, so they didn't report it because they feared doing so might jeopardise any future treatment. My Lords, we do need to be certain that any new system doesn't deter any service user from coming forward, especially, for example, if they are particularly vulnerable in some way, or maybe put off by complicated IT systems. The Minister has already helpfully said that the government is committed to reconsider some of these proposals, and in this House, and I also note that at the Commons Third Reading, the Secretary of State, the Secretary of State spoke of a quota to some previous arrangements.

May I ask the Minister and her colleagues to look again at the record of community health councils, which were abolished in 2003, but I think may still hold some valuable ideas for the development of patient empowerment in 2026. I look forward to further proceedings on this important modernising bill. Thank you.
16:42
Lord Young of Cookham Portrait Lord Young of Cookham (Conservative)
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It's a. this bill should be judged against the three priorities that the government set for the NHS two years ago, and these were from analogue to digital, from hospital to community and from sickness to prevention. First on analogue to digital and the single patient record. We don't actually have a national health service. We have a series of local health services, medical centres, pharmacies and district general hospitals held together by a network that is often not fit for purpose.

And quite often it is not the individual treatments or consultations that go astray, but the communications between them. Hence the need for a single patient record and a recent personal experience confirmed this at a routine annual check-up. The consultant recommended a precautionary jab for shingles and she would notify my GP two weeks later nothing had happened. So I contacted my GP and I quote from her subsequent reply to the consultant. I quote the letter we have received includes an attachment PDF, but we are unable to open this link in the format that you have sent this letter.

Please could you send us the PDF document as an open document to action? And this is an NHS GP communicating with an NHS consultant within the same foundation trust about a treatment. Technology has transformed what used to be a doctor's instruction, which was illegible to one that is now to one that is now inaccessible. Now, now in my. In my case, it didn't matter. But it does show how the professionalism of those working for the NHS can be let down and hopefully a single patient record will will remedy this.

I note that GPS have experienced have expressed some reservations. I know from my experience as a Health Minister over 40 years ago that the GPS can defend their corner with vigour. At that time, the BMA negotiators were their chairman, Sir Anthony Grabham, and their future vice president, David Bolt. And when it came to negotiating resources for the GP contract, Grabham and bolt is exactly what happened. My Lords, on the on the second priority from hospital to community, the ICB will have more commissioning powers to focus on primary care and community services, and I very much welcome that.

But I fear the major shift from hospital to community has been kicked into the long grass by the government's approach to adult care, as mentioned by Baroness Tyler. This is the fifth Parliament since 1997, with a healthy government majority. To duck that issue every day, there are 13,000 people in hospital who don't need to be there because of the absence of reform of social care. The dish that was oven ready in 2019 is still waiting for a recipe.

My Lords, if Louise Casey had been instructed to report within two years, we could have had her report by now, and we could have legislated in the next session. And this unforgivable procrastination will make achieving the targets in the ten year plan more difficult. Finally, my Lords, on sickness prevention. I very much welcome the tobacco and vape bill with the generational ban on selling cigarettes, and I welcome the record investment in smoking cessation services. But funding that was previously ring fenced at ICB level is now going to be part of a baseline budget and under threat.

And research from ash has found that the removal of this ring fence has already led to services being decommissioned, and some 83% of services said they face an uncertain future because of a lack of secure funding. My Lords, when it comes to funding prevention, we actually have the mechanism for raising £5 billion over five years through a polluter pays levy on tobacco manufacturers, which Lord Rennard and I have been advocating for many years, and which the noble Lady the Minister actually supported in opposition.

So with the with the Chancellor searching for cash, we could both begin by recommending that suggestion to him.
16:46
Lord Patel Portrait Lord Patel (Crossbench)
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I can. could always read my writing most of the time. I had accused the noble Earl Howe previously of being a class act, and I repeat that today with his usual silken charm. He demonstrated how wonderful the 2012 Bill was that he took to this House. He succeeded partly because he had his ironclad majority of a coalition government, and despite hundreds of amendments, he could. He was successful in not giving a quarter to any of them.

But I do compliment him on accepting that Healthwatch. England. The public health measures that were put into the Bill and the safety arrangements were part of his doing in this House that he conceded to not through amendment, but for his own charm. This bill is a second bill in 30 year history of major reorganisation of every part of the NHS. But the research by think tank shows that they end up often not achieving what they set out to do.

As the 2012 bill proves. Some say the bill is not necessary. Certainly in some parts of it are probably not. But the Bill should be judged not simply against the organisational reforms it introduces, but whether it strengthens the NHS ability to deliver on government's wider agenda to improve health and health outcomes of the most disadvantaged. The Bill abolishes NHS England and transfers its power to Secretary of State. Additional powers extend far beyond this. What is the powers of Secretary of State are wide and far ranging.

There is nothing in the bill but powers to improve health of the nation, tackle variations in care and reduce the inequalities of healthy life expectancy and outcomes. I hope through amendments, to try and have discussions around improving health of the nation and reduce inequality. Healthwatch has already been mentioned several times, and I agree that the bill abolishes abolishing Healthwatch, the only independent voice of the patient is probably not necessary. Annexing of Healthwatch England with ICBs and Healthwatch local with ICBs weakens both the independence and the voice of patients, particularly the voice of the marginalised and the frail, and it is in the whole is a poor at listening to the voice of patients, often patronising, as evidenced by the reports of the many inquiries from the Francis inquiry on the midst of the recent maternity services inquiries.

All of them reported that the patients voices were not listened to. Making structural changes will not lead to making the voice of the patient stronger. While there is some variation in local Healthwatch, they have been mostly successful in bringing together the communities, social care and the public services. Equally, abolishing HSSIB in my view, is unnecessary and we should restore it. In fact, we should give it more powers to establish a process of reporting of incidents.

In my view, the clause 65, therefore is not necessary. I welcome the single patient record strategy. It has much to offer, but how it will be implemented will be in secondary legislation. There are serious issues related to transparency, confidentiality, control of access to data and importantly, public trust that need to be addressed. As a noble Baroness, the Minister mentioned in her own speech, how will information that patients do not want to share, such as in maternity and mental health, are to be handled? I have concern about lifting of common law of confidentiality abiding to which is a promise that all health professionals make through taking an oath and never to be broken.

I intend to amend clause 52 to reinstate the common law of confidentiality, so that it applies to all those who share patient data. At the same time, it will help public trust. I hope they will. I hope the House will find a common cause with that amendment implemented with care. SDR has the potential to improve patient and population health and drive innovation. My Lords, it is disappointed the government did not take the opportunity, this bill, to address some of the commitments already made, such as in rare cancers, neonatal care, mental health and importantly, end of life care, which is espoused by the Prime Minister.

I look forward to our discussions and I will enthusiastically support any amendments that improves the bill, and I hope my amendments will also do so.
16:52
Lord Jabbar Portrait Lord Jabbar (Labour)
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OK. >> My Lords, it is. >> With great humility and a profound sense of privilege. I rise to make my maiden speech and to follow the noble Lord Patel. I wish to begin by expressing my sincere gratitude for the very warm welcome I have received from all sides of the House since my introduction several weeks ago. I am particularly grateful to Black Rod, the doorkeepers, Clerks of Parliament, and all other staff of the House for their generous patience and guidance.

As a new member, I have quickly come to appreciate how much this House relies on their professionalism, knowledge and efficiency. As all here today will know, new members must learn very quickly the rules, practices and conventions that are unique to this very special place. I was recently informed one afternoon, most politely, I must add by one of the doorkeepers as I came into the palace greeting. Good afternoon to House staff that irrespective of the time on the clock, it remains the morning until the House begins its proceedings.

As a newcomer, I of course, accepted this without question. Indeed, such is my eagerness to learn and my deference to all, and any advice received within the House that in my current state of mind my fear is that if anyone were to inform me today that the world is flat, my inclination would be to take a detailed note rather than challenge it. I should also like to express my gratitude to my supporters, my noble friends Baroness Kennedy of The Shaws and Lord Hermer.

Their commitment to justice and the rule of law is a source of inspiration. And having worked closely with them throughout my career, I was honoured that they agreed to support my introduction to your Lordships House. As the son of immigrants seeking opportunity and a better future for their children, I count myself very fortunate to have benefited from the possibilities this country has provided. I grew up in Manchester and attended the local comprehensive. My parents believed in education and hard work shaped my life profoundly.

It is only sad that they are not alive now to have joined me for my introduction, but it is their values that make my standing here today in this chamber deeply meaningful. Before joining your Lordships House, for more than three decades, I have worked in the field of international human rights and criminal justice. As co-executive director of the Death Penalty Project, an international legal action organisation seeking criminal justice reform and abolition of capital punishment around the world. Through this work, I have engaged with foreign governments, policy makers, the judiciary, civil society and others across the Commonwealth in particular, seeking to strengthen criminal justice systems, protect fair trial rights and advocate for reform.

I think it is fair and right to say that all sides of this House have consistently shown leadership in this area, rejecting the idea that state sanctioned killing is a policy that we should support. And I have worked with many people across this House for which I am very grateful. The reporting of a botched execution and statements around public executions in the United States in the last few days, is a reminder that this subject is far from remote for anyone interested.

But perhaps a speech for another debate and not this one. I hope to bring to this House the experience I've gained in criminal justice areas constitutionalism and the rule of law. This work has taught me the importance of evidence based policy making of strong institutions to ensure policy remains anchored in the experience of those it is intended to serve, and that any change is grounded as far as possible by building consensus through diplomacy, perseverance and understanding. The bill before us today concerns the organisation and delivery of healthcare through abolition of NHS England, establishing single patient records to make data available across healthcare settings and directly to patients.

Whilst health is not my area of expertise. For me, as I'm sure for others, it can also speak to personal concerns and experiences. A few years before my mother's death, she suffered a very severe stroke that left her paralysed and unable to speak, while she remained brave and stoic in the face of her adversity. Our family experienced first hand the challenges of dealing with the healthcare system to ensure she receives the treatment, care and dignity she deserved. Like many other families facing similar circumstances, we came to understand that organisational structures are not abstract matters.

They directly impact both access to treatment and how families must navigate this process during immense vulnerability and uncertainty. This experience has taught me that healthcare is not only about treating illness, but also about preserving dignity for all. Throughout my professional life working in the area of judicial administration, I have seen that institutions command trust when they seek to combine effectiveness with accountability. My Lords, I join this House mindful of the distinction of its members and the importance of the work it undertakes.

I look forward to hearing from noble Lords across the House, and hope in the years ahead that I can contribute to the thoughtful scrutiny and debate for which this House is rightly recognised. It is an honour to make my first contribution in this debate, and I thank the House for its indulgence.
16:58
Lord Bradley Portrait Lord Bradley (Labour)
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And. friend Lord Jabba on his excellent maiden speech. It was a wonderful contribution to our deliberations today, full of warmth, humility and humour. I am particularly pleased to welcome a fellow Mancunian to our Lordships House. Since Lord Jabba lived and was educated in my former constituency. Although I take absolutely no credit for his future eminent career. So many congratulations again for your speech and we all look forward to many more in the future.

So, my Lords, my own brief contribution to the Second Reading of the health Bill, I carefully listened to my hon. Friend the Minister's opening of the debate. But I still have to say I'm rather perplexed, because it is still not clear to me whether the bill is a key part of the government's drive for devolution. To transfer the power to local communities to determine how they tackle huge local health inequalities. With the development of neighbourhood care centres moving services from acute hospitals to primary and community settings.

Or is it a centralising bill with the Secretary of State for Health and Social Care taking back huge powers to determine the priorities for healthcare across the country? I do accept that these are not binary positions, but clarity of purpose and of responsibility. And accountability, I think is essential. And I think throughout our deliberations on the bill, we'll be seeking such clarifications. For example, clarity of how the public's voice and, crucially, the patient's voice will be heard loud and clear and independently at local level.

Following the proposed abolition of Healthwatch and Council of Governors of Hospital trusts. Clarity on exactly when NHS England will be abolished. Is it 2027? Is it 28 or is it beyond? Because there is still confusion amongst the staff in both the NHS England and the Department of Health for exactly when these things will actually happen? And these are costs that are building up within the health service. We need clarity on the role and accountability of regional NHS offices, particularly in relationship to commissioning.

And for my particular interest in the commissioning of health and justice and the relationship of elected mayors with their direct appointment to ICBs on the strategy for local healthcare and an assurance from the Minister, which I hope she'll be able to give me today, that the provision in the Health and Social Care Act 2012 that every ICB should include a non-executive director to have specific oversight of mental health services in local areas is maintained. A brief further word on specialist commissioning, currently undertaken by NHS England again in respect of health and justice, because under the new commissioning plan, such services will be devolved to ICBs.

So will the Minister confirm that all resources will be transferred from specialist commissioning at NHS England to ICBs, and in future, will the Department of Health have overall overall oversight and accountability for the continued development of health and justice services? Next, a brief comment on the single patient record, which I greatly support, and I thank my noble friend the Minister, for her letter last week attempting to clarify the government's position regarding the criminal justice system.

The letter states that relevant healthcare professionals providing direct care in criminal justice settings will be able to access the single patient record information, but this would not give police, courts and other criminal justice personnel general access to the single patient record. So would the Minister provide a clear definition of direct care and also confirm liaison and diversion? Healthcare staff, especially mental health nurses providing crucial healthcare support in police stations, in courts, in prisons and in street triage.

Will have access to these records. Two quick final points. First, to advocate again for allied health professionals and noting my own interest here in the register, including speech and language therapists, that they will be afforded appropriate prescribing rights to facilitate the development and efficiency of neighbourhood, neighbourhood healthcare. Secondly, the government has confirmed today that they will bring forward an amendment in the House to establish a maternity commissioner, which I fully support. Why? However, I do have to say I find it strange that I and many other noble Lords advocated for a Mental Health Commissioner during the recent Mental Health Bill deliberations.

It was vigorously resisted by the Minister, arguing that the then government was opposed to the establishment of commissioners and that the regulator, the CQC, was the appropriate body as the regulator to oversee to have oversight of such mental health services. So has the government now changed its mind, and is it now the intention that commissioners can be further established? I suspect this may be further debated during this bill.
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17:04
Lord Black of Brentwood Portrait Lord Black of Brentwood (Conservative)
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prevention. So our second outing today, over 3 million people in England live with osteoporosis. My Lords, many do not know it with Lords, many do not know it with damaging consequences for their health, ability to work and quality of life. Half of women and 1 in 5 of life. Half of women and 1 in 5 men will break a break a bone because of it and the end result of untreated osteoporosis. A hip untreated osteoporosis. A hip fracture is the second largest cause of unplanned NHS bed days.

An horrendous postcode lottery means people from deprived areas are at a 25% higher risk of fractures. The Prime Minister wants good growth in every postcode, so I hope he'll start here as good health is crucial to good growth. My Lords, much pain and suffering is avoidable. We have safe and effective medicines and a proven model of fracture liaison service which picks up people after that first fracture and make sure they are diagnosed and treated. It will pay for itself in two years.

Filling in the gaps in coverage would save health and social care services more than £600 million over five years. Now, none of this, my Lords, is in dispute, and I know the noble Lady who has been stalwart in her support of this cause, understands that it was fantastic that the government committed to a national rollout of FLS to every part of England before the election. But progress has been achingly slow. We still have no confirmed funding, roll out plan, implementation timetable or clinical leadership, and that's where this bill comes in.

My Lords, in 2024, the government inherited a position, as I said earlier, where FLS served half of NHS trusts. Ministers pledged to roll out these services to every part of the country by 2030 and so far, 50 plus additional FLS are required to fulfil that commitment. But since the election, as we heard earlier from the noble Lady herself, only five have been established. All the result of local initiatives by determined doctors. Over that period. The message from Ministers has been consistent.

The rollout will happen. The deadline is 2030. We have time consistent. That is, until this summer because now Minister Karen Smith, in the other place, has taken to relying on ICB level coverage figures to make a perhaps dubious claim that the rollout is 9,092% complete. These figures are irrelevant, my Lords, because the reconfigured ICBs are enormous. Within them, the service footprint has hardly changed. 94% of the services Ministers are counting are the ones they inherited in 2024. At the current rate of progress, fulfilment of the government's commitment will take 38 years.

My Lords, where government fails to fulfil a pledge, I think it's up to this House to do something about it. I expect an amendment to this bill to be brought forward, to require a clear implementation plan for fracture prevention, along the lines of the one tabled in the other place, with support from government and opposition MPs. To be clear, its aim won't be to create a new policy simply to ensure existing commitments are adhered to. My Lords, there are a couple of issues in this bill which relate to people living with HIV.

I declare my interest as a trustee of the Terrence Higgins Trust. First, this bill will legally transfer commissioning of specialised services, including HIV care, to ICBs. There is a danger that as a result, HIV care will be deprioritised. Commissioning of HIV care is delegated from NHS England to ICBs from April 2024, and THT and other HIV charities warned that NHS England was giving up a key lever for ending new HIV. HIV transmissions. As of June 2025, only 21% of ICBs reference HIV in their joint forward plans.

This makes the local. The development of local HIV action plans and clear reporting against National Care standards essential. Will the noble Lady please set out how the government will ensure that transferring HIV commissioning to a. To ICBs does not lead to HIV being Deprioritised. Second, my Lords, there are concerns around the welcome introduction of a single patient record which will be particularly important for the two thirds of people living with HIV who also have co-morbidities. There is a danger in how patient confidentiality will be safeguarded, as HIV remains highly stigmatised in some areas.

10% of people living with HIV have not shared their HIV status with their GP. It is vital that confidentiality is central to the development of this record, and that the development of a single record includes consultation with directly with people living with HIV. I look forward to the noble Ladies response on these points, and to engage in constructively on

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this and other matters in committee. I want. To start by applauding the speech by my noble friend Baroness Campbell and I agreed with every word, and I won't repeat any of her aspirations. Success of the government's ambition to improve the delivery of health care and to promote more integrated services closer to people's homes, will partly depend on clinical partly depend on clinical leadership and commissioning patients. People view success
17:10
Baroness Hollins Portrait Baroness Hollins (Crossbench)
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according to the relevance, quality and speed of care and support that they receive, not on the they receive, not on the statistical findings that are reported. Clinicians need to agree the best possible outcomes with each patient, given their own history and preference. history and preference. Operationalising care pathways must never lose sight of the individual patient. The noble Lady, Baroness patient. The noble Lady, Baroness Tyler, reminded us of the importance of the social determinants of health. The health also requires a joined up financial partnership with other policy areas including education, social care, housing and criminal justice.

If population health is going to improve and evidence based, evidence based prevention is as effective as it could be, my own expertise interest is in people with mental illness, people with learning disabilities, and autistic people whose voices are too often unheard. And it's through this lens that I will raise a few concerns. The Royal College of Psychiatrists has rightly argued that workforce planning must be central to the success of this bill. But of course, my Lords, this must include retaining the staff that we currently have, and we know that there are a lot of stresses and a lot of illness in NHS staff across the whole service, so attending to the mental health needs of the staff is going to be important.

There is no health without mental health. Going back to the 2012 act, the one thing that I fought for was for parity of esteem, for mental health. There is still a huge amount of work to do, and the integration that this bill seeks to promote must include the integration of psychiatric expertise across the wider health and care system. The Health Bill seeks to strengthen the duty of the Secretary of State to reduce inequalities. My Lords, people with learning disabilities arguably face the greatest inequalities of all, and the latest LiDAR report tells us that adults with a learning disability still die on average 19 years younger than the general population.

39% of deaths reviewed were avoidable, with failures to provide adequate care, not being isolated errors but being described as systemic failures. Concerningly my Lords, the future of the leader programme is in doubt. Describe, despite describing it as imperative that we commit to continue to identify and to reduce these health inequalities. I recently met with people with learning disabilities, with family, carers, academics, charities and professionals to precisely discuss this problem. There was considerable agreement that we need a new national learning disability strategy, co-produced with people with learning disabilities and their families.

Bringing together what we already know works and identifying where further evidence and work is needed. Short term crisis management rationing approach to community support is contributing significantly to poorer health outcomes for people and greater cost to the public purse over time. This has been so well documented in many reviews over decades, and I ask the Minister, will His Majesty's Government consider developing such a strategy with measurable objectives for reducing these extraordinary inequalities in both health, health and social care? We could create a health and social care system that works for everyone.

And to make this a reality, people with learning disabilities and their families cannot be an afterthought, but must be at the forefront of co-producing the new National Care Service, which really ought to be part of this bill. I welcome the single patient record and provided it's a summary that is not overinclusive of confidential personal information for people with learning or other communication disabilities, having key information that is relevant and up to date and available across all areas of health and care could help to integrate care, avoid duplication of effort and error, and highlight areas of unmet need.

As ICBs take on new commissioning functions, we need to be confident that there is effective national oversight and consistency and where there are smaller patient groups with quieter voices, that they are not just forgotten about. Healthwatch, of course, is a vital

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voice. And to follow the noble Lady Baroness Hollins with her excellent expertise. My Lords, I want to expertise. My Lords, I want to really focus on not the main issue of the bill, which I think is a really useful bill. I think it has really useful bill. I think it has a huge value, but I feel also at the same time, while we discuss
17:15
Lord Winston Portrait Lord Winston (Labour)
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the same time, while we discuss this, we discuss other issues which are not really fully mentioned in the bill. One, of course, I think, is whether or not the whole financing of the NHS is appropriate. We do not have enough transparency about that. I think ever since we have, the internal market has been a big problem with competition, and I think that's still raises issues with not understanding what procedures actually cost, how much they cost us as as taxpayers and how much they really cost in terms of different areas of the country.

And when you have localisation, as we intend, that makes it rather more difficult. I think the other issue too is the issue. What this bill, this bill does not describe, which is the issue really of just compassion. It's a very it's a it's a it's a great bill in terms of what it actually says. But the way it's expressed is very difficult to read. And I think it doesn't help us very much when we think about what we are actually doing with patients in a hospital or indeed in in general practice.

I have a colleague, a friend, and she's a cleaner who, who I don't know well, who went into hospital vomiting some months ago, bleeding blood in her vomit and obviously with pain in the abdomen. A very short history. And she lay in hospital for 2 or 3 days and she never was examined physically. That's not untypical, because of course, that, in my view, is the essential way of actually getting to understand that patient. And we're not providing that people are not being examined at any stage at the moment in their in their initial treatment.

And of course, what follows is, is an inadequate history of the patient's illness as well. Finally, on the fourth day, I think it was that she told me that because I spoke to what was happening on the phone, she said, well, a doctor walked past me and looked at the notes and said, oh, you've got stomach cancer, and walked on. That was her first idea that she might have something seriously wrong. Now that actually is something which is really happening. And I've seen this again and again.

We are not communicating. It was, in fact, until I complained to the chief executive of that hospital a lot later. It was difficult to find him because it's very difficult actually to find their phone number. I had to use a rather nasty way of doing this by actually saying on the phone to the press department of the hospital that actually I was writing a letter to the the one of the newspapers, and perhaps before I actually sent this, I wonder whether or not the chief executive would like to see it.

That, of course, in fact, didn't meet. I still didn't get a response, but the following day I went to visit my patient in hospital. My patient, my friend and my telephone rang and it was the chief executive and he said, is that Robert Winston? I said, yes, I didn't say where I'd come from. He said, where are you? Can I, can I speak to you sometime? He said, I said, yes, you can speak to me. Of course you can. He said, where are you? I said, well, I'm actually in your hospital at the moment.

He said, well, so I said, well, I'm in the ward upstairs on whichever floor. It was a huge ward. And he came straight up and he did something quite remarkable. This chief executive, he got down on his knees in his trousers on the floor. The patient was lying in bed, and he put his face right up against her. And he said the right things to her. So we have that ability, but we're not doing nearly enough. It shouldn't actually take that from a chief executive.

It should actually be a doctor or a nurse. But all the doctors in that hospital, most of the time when I saw them, when I was actually in as a patient, are in fact operating computers outside the wards, not actually with the patients. In fact, I never knew in 11 days when I was in hospital the last time with my dog, who in fact was running the ward, I never saw the the what would we now call the chief nurse? I don't know, actually.

That is. And most of the nurses I saw were not very well qualified at all. And indeed one of the one of the trainee nurses who was dressing my leg at one point he had plenty of time to talk because it was late at night. And he said, you know, I've got these ten nurses that I'm trying to train. And he said, of these ten, they're all really good young women. I think if I'm lucky, three of these women might actually stay in Britain because they're so disenchanted.

We can't have that happening in our health service. We have to understand that so much part of our service is not this dry language we need to use in a bill, but in fact, the warmth that we have of the need of actually communication and listening to patients, we have to have people who are listening and who are facing the patient and not facing a computer. We talk about personalised medicine. I've said this before, but the medicine that we're doing now is impersonal. Unless we actually, in fact, make certain we are touching the patient

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and listening to the patient. My Lord.

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My Lord. This bill is wide ranging and touches all parts of the structures of our NHS, but I'm going to use this Second Reading to focus specifically on the impact of people with autism and ADHD. Last Friday, the government published its own independent review of ADHD and autism services. It found more and autism services. It found more than half a million referrals for ADHD and more than a quarter of a million people waiting for an autism assessment. I thank the Minister for her introduction, and I'd like to add my congratulations to Lord Jabba on his maiden speech.

I'm very much looking forward to
17:21
Baroness Leaman Portrait Baroness Leaman (Liberal Democrat)
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the full maiden speeches. Still to come, my Lords, this bill does not mention autism or ADHD, but it mention autism or ADHD, but it changes who runs. Three things those patients rely on the national programs, the data and the patient programs, the data and the patient voice. I want to ask the Minister about each of these so that patients aren't lost in the move. patients aren't lost in the move. So first, the programs Professor Fogginess review and the ADHD task Fogginess review and the ADHD task Force before it points the same way.

Both want more of the routine, ongoing care for adults with ADHD to be provided by GPS rather than by specialist clinics. The task force had no power to act on its own findings. That job fell to NHS England, which this bill force abolishes. I asked ADHD, UK what this means for the people it represents. Its chief executive, Henry Shelford, told me it was hard fought to get anyone in NHS England with responsibility for ADHD at all. His fear is that ADHD will now be lost again.

He also asked me a very simple question when do the reports end and the action begin? This government has said it will respond to the review in a mental health strategy in the coming months, and I welcome that. But could the Minister tell the House who in the department will lead this work once NHS England is gone, and when can people waiting today expect to see a difference? The same question applies to autism. NHS England runs the national programme for autistic people and people with a learning disability.

Can the Minister tell us where it will sit next year and who will run it? Secondly, the data and two kinds of matter here. The first tells us how many people are waiting. NHS England publishes those regularly. The second tells us how many people are autistic or have ADHD in the first place. And here the review found very little. There's no recent England wide study of autism in children, and the best ADHD figure dates from 2017. My own written questions have confirmed that the government doesn't centrally assess whether there are enough assessment services, so the waiting figures are the best evidence we have.

This bill moves the teams who produce those figures into the department. ADHD UK warns that if that work is split up, the national ADHD data dashboard will lose the figures. It depends on. Could the Minister reassure us that they will still be published on the same schedule and in a form we can compare with today's. The government commissioned the regular surveys and the review recommends. Thirdly, my Lords, the patient voice. Locally, Healthwatch is often where a parent turns. When the school, the GP and the hospital each say it's someone else's job.

My Liberal Democrat colleague Helen Morgan pressed hard on this in the Commons. So I welcome the Minister's commitment to review the plans for local Healthwatch. Her letter to peers says the new Patient Experience Directorate will focus on seldom heard groups, many autistic people and people with ADHD will never fill in an online survey or sit through a public meeting. So how does the department intend to reach them? As many other noble Lords have said, there's one part of the bill I warmly welcome, and that's the single patient record.

When an adult's and an adult is diagnosed with ADHD by specialist, the GP is asked to take over prescribing the GP declines due to a lack of funding. The specialist has already discharged them and the patient runs out of medication. A shared record could help to prevent that and it could also help 18 when too many young people have to start again with adult services. My Lords, I understand the government's aim of a simpler NHS. I hope the Minister can reassure the House that simpler will not mean these patients become easier to overlook.

More than half a million referrals for ADHD, more than a quarter of a million people waiting for an autism assessment. Each of them deserves to know who will answer for their care once NHS England is gone.
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Baroness Coffey Portrait Baroness Coffey (Conservative)
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My Lords, I congratulate those making their maiden speeches today. I must admit I'm particularly looking forward to the noble Lord, Lord Wormald, who was my permanent secretary, albeit for a short time, but a brilliant civil servant, and I'm sure we will learn a lot from him. I'm also looking forward to hearing from my noble friend Lord Singh of Solihull, who, with his expertise in psychiatry, I'm sure will add to many of the comments that have already been made. My Lords, real culture difficulties cannot be addressed by legislation.

It's by standards and leadership. However, what I do think this bill does is actually put back in the control of the government, of the Minister of the Secretary of State, when actually things go fundamentally wrong in the NHS, and it is because of that direct level of accountability that an elected government has. And when we're considering that 40% of day to day spending is spent on the NHS, it's absolutely right that the elected politicians of the government does have the levers to pull.

Now, one of the things I would point out to the House is that, for example, it. I think I remember challenging the NHS chief executive that I knew that it really would matter to them about really the culture of basically saying almost the NHS can do no wrong or we'll make sure it gets better is if they were to actually remove the foundation trust licence of some of the worst performing hospitals in the country, and they wouldn't do it. They wouldn't do it because that's not the NHS culture.

So what I do hope, actually, is that this bill gets strengthened, but I hope it doesn't get watered down. And I say that in a number of ways. I would like it to go further. In the link between decision makers and accountable representation, I welcome the amendment that was made actually reinstating local government onto ICB boards in the other place in the in the House of Commons, rather. But what I've heard about the patient voice. I'm really sorry. Healthwatch has never delivered properly.

The patient voice locally, nationally? Not really. Nor is the Investigation Board. Look at the outcomes it's produced. Not very much. Meanwhile, there are people. There are MPs, there are local councillors, there are people involved. Patient participation groups. As the formal structure of powers within hospitals that try and gets things fixed. But too often patients are scared, particularly when they're in hospital, to make a complaint. If all of a sudden, because of their concern about culture, their treatment will get worse, not better.

And it does take some bravery to stand up against it. But it's brave. You can be braver once you're out of the hospital doors and back at home. So I think this is the element that coming. Building on what the noble Lord Lord Winston has talked about and how patients get treated has to be key to this. And albeit I was Secretary of State for a short time, one of the things I'm proud of is that we put together the starting point with the plan for patients, and I desperately encourage the Prime Minister today, who have been Health Secretary in the past, used to mainly talk about staff and systems and very rarely ever used the word patients.

And I know that the Minister that we have today will certainly not go down that track. Now, in terms of thinking through about where potentially there could be some improvements in this bill, I wonder if actually the idea, a bit like we have the environment plan going for a long term, could we have have the health improvement plan that statutory needs to be updated every so many years? I personally think that we should look more at the role of health visitors and think how that can be delivered locally in terms of the local NHS, not just for children, but also considering about pensioners.

Could we do something here in this bill about palliative care? Could we do something in terms of transparency? My noble friends on the front bench have already talked about if we are getting away with taking away certain things, we need to increase the amount of transparency. I fully agree with that, not only in potentially ministerial directions, but more broadly. And I will say this Wes Streeting mocked me when I set a target of somebody being able to meet their GP within two weeks.

It's still the government policy today, by the way. But this was designed to open up how patients were able and what was happening in their surgeries on the grounds that not everybody needs to be treated within 48 hours or 24 hours. But those people have discovered a bit of a lump feeling comfortable, and then just keep putting it off because it's not urgent. But that's how we miss cancer. It's how we miss other health conditions. And that's why making sure that we have patients at the heart of what we do will be critical in the outcome of making sure this bill is success.

The SDR will help it, but I actually hope the patient owns it. Not the doctors, not the NHS. It's the patient's property.
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Lord Kakkar Portrait Lord Kakkar (Crossbench)
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To follow the noble Lady Baroness Coffey. And in so doing, I add my own thanks and congratulations to the noble Lady, the Minister, for the very thoughtful way in which she's introduced this bill and laid out the arguments for bringing it to your Lordships House. In so doing, I also declare my own interest as chairman of the King's Fund and chairman of the King's Health Partners. But, my Lords, I think we need to look at the arrival of this particular health bill in your Lordships House in the broader fiscal context, in the past 60 years or so, we have seen an increase in health expenditure on health care from some 2.8% of national income in the mid 1950s to some 7.3% by 2020.

At the same time, expenditure on defence has fallen from some 7.8% of national income to 1.9%. So there has been a substantial shift in the priorities of the state over that period of time. That has allowed a substantial additional investment in the provision of health care, the development of the NHS. And indeed, if one looks over the 40 year period prior to Covid, in only two of those 40 years was the budget that had been agreed for expenditure in the NHS in the previous year actually delivered.

More often than not, it was overspent, on average by some 1.3%. And the question we have to ask ourselves, in considering the provisions laid out in this bill, is, are we now moving into a fiscal situation where it may be impossible for future governments to provide year on year increased expenditure to support the delivery of health care in our country? And therefore, this bill represents a substantial opportunity to address questions about whether the structures are indeed correct, that those structures will provide us with the opportunity to address not only clinical challenges, organisational challenges, workforce challenges, but also fiscal challenges where it will not be possible necessarily to provide as much as has been provided by repeated administrations over many decades.

Within that context, then one has to try and understand what is the lens through which any of the provisions of this bill, and indeed scrutiny by all Lordships should be conducted. And of course, we've heard that ultimately, the purpose of the health service is to ensure the best clinical outcomes for every patient delivered, of course, compassionately and sensitively, to secure the safety of all those engaging in health services, but to ensure that the service is delivered with maximum efficiency, ensuring that valuable taxpayer contribution is delivered for the greatest benefit.

In addition, it's vitally important that any measures that your Lordships decides to adopt are also able to ensure the adoption of innovation at scale and pace, because that is the only way, ultimately, that substantial amounts of public expenditure committed to the delivery of the NHS might be broadly more distributed. To ensure that we can start to address a prevention agenda, because large amounts of additional expenditure will probably not be necessary. Now, we've heard that there are many areas of this bill that should rightly be scrutinised.

I completely agree that there needs to be clarity of understanding in terms of the distribution of responsibility, powers and accountability between those being drawn back in to the Department of Health to be exercised by the Secretary of State, and how that sits with a broader devolution agenda, ensuring that integrated care boards have the capacity to really deliver what needs to be done at a local level and should fundamentally determine how the health service is delivered. It's critically important that we ensure that legislative measures are able to secure the social licence, public confidence that will allow for the delivery of the single patient record, which ultimately will be transformational in how care can be delivered both safely, effectively and in a cost effective fashion.

And then the patient voice is critically important. If we go to other jurisdictions around the world that have put a lot of effort into gathering in real time the experience and views of patients, we see substantial improvements in clinical outcomes and safety in those institutions. These are vitally important matters, all to be considered in the broader context of the challenges now facing our country. If we're going to provide what we must do, adequate scrutiny and then delivery of vitally important reforms to the delivery of health care.



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My Lords. Thank you so much for the welcome you have given thus far to welcome you have given thus far to this Leeds lass. Thank you to the whole House members and staff for your kindness to me since joining. your kindness to me since joining. Thank you too to my noble friends Baroness Taylor of Bolton and Baroness Blake of Leeds for so Baroness Blake of Leeds for so generously introducing me in September. And finally, thank you September. And finally, thank you to Black Rod and especially the doorkeepers who have been so helpful in explaining the right
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Baroness Lowe of Armley Portrait Baroness Lowe of Armley (Labour)
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procedures to follow and rescuing me when I have been wandering the corridors, lost for the umpteenth corridors, lost for the umpteenth time to say, I was surprised to be among you all would be an among you all would be an understatement. On the day that it was announced that I was to become a member of this House, my daddy a member of this House, my daddy would have been 9170 years after he arrived on these shores as a member arrived on these shores as a member of the Windrush generation.

A proud Yorkshireman despite his roots. My daddy loved this country and was a passionate supporter of all its institutions, especially his Queen Elizabeth the Second, his daughter's elevation to the House of Lords would have been beyond his wildest imaginings. And yet I am here because of him and the values that he and my mum instilled in me, for which I will be always grateful. I also had the privilege of serving the Labour Party for 29 years as a Leeds City Councillor for the wonderful ward of Armley, hence my chosen name.

I am currently the Deputy Mayor for Policing and Crime in West Yorkshire, working for our mayor, Tracy Brabin, to hold policing to account for the public of our wonderful county. My Lords, today I will speak on the health Bill and as a former chief executive of touchstone for 17 years. Touchstone is a mental health charity based in Leeds. I believe I have some insight to share. In 2013, touchstone was commissioned to provide Leeds first ever local Healthwatch, which is the statutory locally rooted infrastructure organisation for gathering and representing people's experiences across both NHS and social care services.

Now a standalone CIC, Healthwatch Leeds, has been hugely successful, adept at gathering data and insights to support health and social care service reviews and improvements for the people of Leeds, particularly those who are marginalised, underserved or seldom heard. It has also been a strong, independent voice challenging those same systems when they get it wrong. When NHS 111 became the primary route to access mental health crisis support across Leeds and West Yorkshire in 2024, Healthwatch Leeds responded on behalf of the thousands who were adversely impacted.

They conducted in-depth research with hundreds of affected people, including unpaid carers, and as a result, 371 people engaged. Multiple system level changes were delivered in real time. A text crisis service is currently being developed, and the research is being used to inform the 2026 recommissioning of this service. Healthwatch can work despite reservations from some, and I am pleased to see the Minister agree to think again about plans for its abolition. Though reform is required, criticism about variation in visibility, influence, consistency and resourcing is fair.

The foundations, though, remain strong and should be retained and built upon for the future, as is evidenced by the example of Leeds and many other local Healthwatch organisations. And so I look forward to Healthwatch becoming a bigger and better voice for the public.

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Thank you. My Lords. It gives me enormous

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My Lords. It gives me enormous pleasure to follow my noble friend Baroness Alison Lowe, a fellow Baroness Alison Lowe, a fellow Yorkshire woman. It is true. I'm from Bradford and she's from Leeds. And those of you who know that And those of you who know that their historic issues there. But nonetheless, I have to say that she, nonetheless, I have to say that she, Alison, brings wonderful experience and knowledge to this House, which she's amply illustrated in her maiden speech and the themes which run through her life are public
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Baroness Thornton Portrait Baroness Thornton (Labour)
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Service. In Leeds. Race. >> Equality and mental health, as she mentioned. CEO of touchstone. >> And her serving her time on the

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And her serving her time on the City Council. What she didn't say was that she was the first black woman elected to Leeds City Council ever. She's also my youngest sister's counsellor for all of that time. And she testified to the fact that she was very effective indeed. And then she stopped being a councillor in 2019 and went on to be an alderman in the city. And then she became our deputy mayor in West Yorkshire, which she still a position she still holds today.

So I think I want to welcome this new Yorkshire woman to our chamber. And

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I know that she has a great, great contribution to make to our work. Hey.

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Hey. Can I thank my noble friend the Minister, for her excellent introduction to this bill and the many meetings that she's had, and many meetings that she's had, and also so many maiden speeches with such excellence and quality. So far, such excellence and quality. So far, we are blessed, my Lord. So in this short time, I want to make three points and questions. But first, I points and questions. But first, I feel like many other noble Lords today, a veteran of NHS reorganisations for the last 28 years I've been here.

One feels slightly like back to the future part two with this bill, if I may say. Now that's a great film. So that is not a criticism. It's not a bad thing because like the noble my noble friend, the Minister, we were Ministers when the NHS was run from the department, and it will be again. So can I also thank many organisations and the library for the briefings that we've received. And many make it clear there is work to be done.

As still a relatively new chair of Social Care, Institute for excellence, which the noble Lady Baroness Campbell was indeed its first chair when it was created by my government in 2002. Three. Something like that. Yes, some time ago. And can I say how

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inspired I am by the speech that you made and the method by which. You made.

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You made. The question I want to put is that is to do with social care. It concerns social care with both the concerns social care with both the Prime Minister and Baroness Casey focusing on its future. It is now focusing on its future. It is now way up the public agenda and indeed way up the public agenda and indeed a focus for both lived experience and in inequality which need to be tackled. The question is, will this bill help that process in the local systems it's proposing? I have to say, my Lords and not having local authorities on ICBs in the first draft did not augur well for me.

How will integrated preventative neighbourhood help be delivered if there is not true cooperation on an equal basis between the NHS, social care, local councils and communities in terms of commissioning local services. One representative on ICB I don't believe is enough. In my ICB that will be one representative representing, I think, nine councils. That's my first question. Linked to this is the question of the single patient record. How will that interface with social care records and data so that patients do not have to keep with the existing social care, do not have to keep repeating over and over again the same information.

And indeed, of course, there is a question of confidentiality. My noble friend Lord hunt will be exploring this also, and I will be joining him in that debate. That's my second question. The third concerns the patient voice, which many, many noble Lords have mentioned. I'm a veteran of community health councils, actually, where I served in Bloomsbury about 40 years ago and was indeed in your Lordships House, and I think possibly even the Minister, when we actually abolished community health councils and introduced Healthwatch.

I think my noble friend in the Bill team will by now realise the abolition of Health Watch is not welcome. The NHS marking its own homework is not a good idea and may well be very risky indeed, as we know. And just being permissive in the bill about the patient voice to local level is not sufficient. There needs to be nationally funded with national powers to deliver proper, proper, patient voice at a

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local level. So, my Lords. I welcome.

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I welcome. This bill. I absolutely see the importance of streamlining the NHS importance of streamlining the NHS in the way that this has. I like in the way that this has. I like the noble Earl, Lord Howe. I was offered. We swapped places several times over the 15 years as times over the 15 years as Ministers and shadow Ministers, and I agree with my noble friend Lord hunt, that he is the person who delivered that bill in the.

The Lansley bill. Through his expertise in handling it in your Lordships House. However, it didn't make it a right bill. I think it's cost the NHS probably billions and billions in bureaucracy. That was unnecessary. So I welcome this Bill on the basis that the accountability will be put back where it should be, which is in the department, and that that actually, I think, will lead to a much more effective NHS. Thank you, my Lords.
17:46
Baroness Neville-Rolfe Portrait Baroness Neville-Rolfe (Conservative)
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As a peer who normally speaks on the economy, I'm conscious that health is the largest recipient of public spending, with 203 billion spent in England alone in the current year. This is significant not only in terms of personal welfare but also economically, a healthier population not stuck at home on waiting lists or with chronic conditions would aid growth. Health is a subject dominated by experts, but many of us have experience of the strength and weaknesses of very large organisations standing black.

It's clear to me that the NHS is much too big and complex, too much bureaucracy and too many managers overlapping with one another. Accordingly, I support the abolition of NHS England. I've become increasingly sceptical of the value of such stand alone government bodies, unless they are small and expert. They lack day to day contact with Ministers. They become self promoting with PR, HR and higher pay than civil service equivalents. It's a recipe for expenditure growth and poor value for money, and it may not be good for consumers.

Patients in this case who need to be looked after. As we've heard from the noble Lord Lord Winston and my noble friend Lady Coffey. Historically, hospitals and specialist care were run by doctors, very clever people who really understand their work. Now they run by managers, often paid more. And there are several layers bureaucracy making work for each other and for the medical staff. So I asked the Minister, how many management layers are there in the DHSC Directorate overseeing the NHS, and how many within the NHS itself? Is there a plan for cutting out layers and generating savings from the reduction in duplication? The Bill promises.

What are the salient numbers? These are questions in addition to the good questions asked by my noble friend Lord Howe, about the costs and the benefits. I experienced the limitations of the present arrangements when I was a Minister in the Cabinet Office, where I was trying to speed up hospital building. The truth is that the differences in arguments between the Health Department and the NHS were a major cause of delay. When modern hospitals are built, think Chase Farm in Enfield, they are transformational for patients and for staff.

So can I ask the Minister how long the last five new NHS hospitals have taken to complete, and how much of that time is taken in the approval process, as opposed to actual construction? And by how much will the reforms in the bill reduce the delays? Now, I think the best way to improve healthcare would probably be to restore the effectiveness of the GP service, which is taking a reducing share of resources. Now, a weakness of the present service is the lack of continuity of care, an issue I will return to in committee.

It's very difficult to see or talk to the same doctor on a regular basis. GPS constantly need to familiarise themselves with the basic facts. What a waste. I support the single patient record, the NHS app and interconnectivity across the NHS. If, for example, you attend A&E, a great deal of time and cost can be saved on tests and analysis. However, there is a huge gap which I'd ask the Minister to investigate. The recording of care provided by the private sector.

Many people are lucky enough to have employee schemes, and yet the test results hardly ever seem to get onto the NHS record. I believe in the value of outsourcing appropriate services. Advances have been made, for example, in audiology and optometry. However, there is a worrying shift in culture under this government. I have an example in eHealth clinics, which I've asked the Minister to investigate. I'm told that they have to operate to an indicative activity plan. They cannot exceed a monthly quota of operations, and they are obliged to operate a minimum waiting time decided by reference to the NHS offering, and that if the NHS providers slow down, they have to slow down to even if they have spare capacity.

Now, if half of this is true, it represents a poor state of affairs. My Lords, whether the objectives of today's legislation are achieved, including the clarity of authority and accountability sought by Earl Howe, depend on the implementation of all that is replacing them. My Lords, we need to know a lot more.
17:51
Lord Patel of Bradford Portrait Lord Patel of Bradford (Non-affiliated)
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My Lords.

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Peers on their maiden speeches and nobody will be surprised. I'm particularly pleased another person particularly pleased another person from Yorkshire is part of this house now. My Lords, there's much to welcome in this Bill. For example, the single patient record could improve continuity, consistency and safety, consistency and safety, particularly for people with complex needs. But sensitive information, including mental information, including mental health records, needs robust protection. Patients must understand how their information is used, and those unable to access digital services must not be excluded.

In the time available, I will touch very briefly on five areas where I will seek further debate and scrutiny and pursue a support amendment. First, on patient voice, abolishing Healthwatch and removing the statutory foundation trust governance model, I believe risks weakening independent challenge, particularly for people whose voice is the least heard. As a former chair of a Teaching Hospital Foundation Trust, I know the value of governance as a bridge between communities and hospital leadership. Amongst their many valuable roles, they appoint the chair and the non-executive directors, approved the chief executive's appointment and hold non-executive directors to account for the board's performance.

These, my Lords, are substantial powers of public accountability, which should not be lost without an effective replacement. We know Healthwatch effectiveness varies across the country. Partly, I would argue, because of unequal funding. The answer should be to strengthen its resources, independence and influence. If Ministers nevertheless proceed with abolition, which I hope they don't. A credible replacement must be ready before long. Established and trusted local relationships are dismantled and lost forever. Secondly, in respect of independent patient safety investigation, clause 65 would abolish H, S, S, I b and transfer functions to the CQC.

In July 2024, the Secretary of State, Wes Streeting, described, and I quote CQC as not fit for purpose. Of course, its new leadership deserves support and time to put its house in order. But rebuilding CQC will take considerable time and resources. Hardly an ideal context for a complex merger. I know that Ministers have stated that transfer will only happen when CQC is ready, but what timetable do they envisage and how will staffing expertise from an ongoing investigations be protected? Meanwhile, my Lord is crucial, therefore, that Parliament requires published tests of readiness and assurances of continuity.

The bill thankfully retains safe space protections. But how will investigations remain operationally independent of regulation and enforcement? I will pursue or support safeguards that give staff and families confidence to speak candidly. Thirdly, mental health. Having steered the mental health Bill through this House last year, the noble Baroness. The Minister knows very well how far we still have to achieve to go to achieve parity of esteem. This Bill must protect mental health parity and funding. The Commons Health and Social Care Committee recommended making compliance with the Mental Health Investment Standard a statutory requirement.

That my Lords deserves serious consideration. Fourthly, in respect of ministerial powers, clause ten permits variation the balance of provider types where the Secretary of State considers it in the interests of the health service. Clause 11 adds a broad power to direct integrated care boards. My Lords, these powers need clear limits and transparent justification. Patients should not wait longer because suitable capacity to treat NHS patients, including in the independent sector, is disregarded solely because of who provides it. Finally, efforts to reduce health inequalities, I would argue, must address geography.

Nearly 1 in 5 people in England live in coastal communities. That's 20%, professor Chris Whitty report in 2021 on health, coastal communities highlighted their heavy burden of physical and mental ill health in some coastal communities. Male life expectancy is as much as ten years below of that in inland areas and suicide rates. My Lords are more than 50% above the England average. My Lords, these inequalities risks remain stark and unacceptable. How will the Minister ensure that commissioning, prevention and workforce plans address coastal disadvantage? Poorer health outcomes in coastal communities will continue to hold back national progress, even when national averages improve.

They can mask persistent inequalities in communities that are left behind. My Lords, I want this bill to succeed. Ministers therefore, report must report transparency on reorganisation costs and benefits so Parliament can judge whether these changes deliver better care. Success must mean better care, a stronger patient voice and healthier lives.
17:56
17:57
17:57
Baroness Pitkeathley Portrait Baroness Pitkeathley (Labour)
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I've participated, but I can be sure of one thing in each Health Bill I would have begun my Second Reading speech by a plea to Reading speech by a plea to Ministers. Indeed, a rant that it was of no use bringing about any reforms in healthcare without including social care, since the two are inextricably entwined, two are inextricably entwined, entwined not only in how they are delivered, but in the minds of patients and families who understandably have no ability to distinguish between a medical bath and a social bath.

There are a few of us in your Lordships House have been saying this for a very long time indeed. I've often referred to them as the usual suspects. Imagine, then, how I and others feel as we contemplate this health bill. The atmosphere has changed completely even since this bill was introduced into the Other place. Social care is at the top of the agenda now, where it should be and where we have been hoping it would be. Some of us for more years than we care to admit.

The bill provides the legal basis for the largest NHS reorganisation in a decade. But let us never forget, my Lords, that structural reform rarely of itself improves care for patients and their families. It is the practical changes which follow that deliver better care. I welcome the bill's ambition to modernise the way health information is shared, particularly the development of a single patient record. This could be genuinely transformative for unpaid carers. At present, carers can spend an enormous amount of time repeating invitation information, navigating different parts of the NHS and trying to make sure that professionals understand the circumstances of the person they care for.

A more joined up record could reduce that burden, and, with the appropriate permissions and safeguards, make it much easier for carers to be properly involved in managing someone's care. There have been debates about this in the other place, and I'm hopeful that carers may be included in the regulations, as people who can have access to the single patient record with the right safeguards. I'd be grateful if the Minister could confirm this, that carers will be explicitly recognised in those regulations. But information sharing is only part of the picture.

We also need to make sure that the NHS actually recognises who its carers are and understands what they need. There is strong evidence of under identification, particularly in primary care, and carers do not feel consulted or asked about whether they are able or willing to provide care at hospital discharge. In spite of legislation to the contrary, identification is important because carers need information and advice to carry out their role. They may be administering medication, using health care equipment or helping someone to move safely.

Yet there is not always a clear point of contact within the NHS for making sure they receive the information they need. A Labour government introduced the first systematic identification of unpaid carers through the GP contract, which sadly has been stopped by later governments. There is potential in this Bill to do more to ensure that carers are better identified by the NHS and consistently supported. We need to ask whether the system is delivering what carers actually need, and I hope the government will continue to work with carers and their organisations to ensure that they can.

They are supported to sustain their vital role. The more we focus on social care, the more we must ensure that the relationship between health services and local authorities is strong and productive. We are. If we are to make the shift to community based services from hospital services a reality. We have to ensure the two services are equally valued and equally understood. The influence of local government at ICB level is crucial for supporting people at home, preventing crises before they arrive, and improving the wellbeing of communities.

I thankfully, the original proposal to remove the statutory local authority seat has been revisited, but I think we still have to consider whether at least one board member from local authorities is adequate. So far as patient voice is concerned, and for me that includes the voice of carers and families. The issue is not so much the structures, but the outcomes. We have to ensure that at a time of significant change for both health and social care, the patient voice is at its strongest and I am glad that carers are also to be recognised by local bodies.

Thus far, what seems to be missing is an independent national voice, and I hope the Minister will confirm that we all have responsibility to ensure the patient voice is strengthened, not weakened by whatever provisions finally emerge. About this bill. The noble Lady Gerada remarked to me that she'd.

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Been through. At least. 15 major reorganisations of the National Health Service. Well, I can beat her. I have been endured at least her. I have been endured at least 22. I joined the NHS in 1966 as an auxiliary nurse, is what we called auxiliary nurse, is what we called healthcare assistants for three months before going up to medical months before going up to medical school in Manchester. I worked on the John Player Award at Nottingham General Hospital.

Well, we were very near the player factory, you understand. And one of my jobs was
18:02
Baroness Murphy Portrait Baroness Murphy (Crossbench)
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polishing the brass ashtrays. I kid polishing the brass ashtrays. I kid you not. So perhaps some things do change, and I take heart from that. But the Minister will understand if But the Minister will understand if there is a somewhat jaundiced view amongst old hands at this game. We fear very little will change substantially for patients experience of the NHS or the outcomes of care. On almost every measure, the NHS now compares very badly with other OECD countries, including most of Europe.

The weaknesses of the delivery structures of health and social care are evident. Of course, modest improvements happen when another bung of money is provided, and hard pressed and talented staff are grateful for that. But the NHS is slow to adopt innovations, unable to drive increased productivity, cut waste use data, effectively reduce variations in care, nor in outcomes related to inequality and deprivation. Everyone is so absorbed in struggling with day to day troubles, the future can go hand. Now, it would have been nice to have a health bill that recognised some aspects of the current system.

Seriously neglect some groups. Of course, the largest group, perhaps of all neglected is those with dementia. There is no ambition here to make the NHS social care services work for them, or indeed the other groups that have been mentioned by many people around this house. Although, of course, we are grateful for the recent investment of research monies. We do need radical service transformations, a change that involves a more sophisticated model of primary care, properly resourced, providing continuity of care which the noble Baroness Neville-Rolfe mentioned and able to deliver on diagnostics.

So much more is carried out by GPS and their associated staff in the community. In other countries, both in Europe, Canada, Australia. And I'm not going to get started tonight on mental health services as I fear I won't be able to stop. So we're chucking out NHS England. Well, I supported its creation. I thought the Department of Health was consumed by NHS acute hospitals to the exclusion of everything else, and the idea was to create a body that would focus on the NHS, machinery and nothing else.

Removing the NHS from political interference and leaving the department to pursue all its other responsibilities, including public health and social care. But it didn't work, partly because the noble Lord Lansley's bill was not implemented. He said himself, and it was only half implemented. So now we have a government that wants to bring all these key, arm's length bodies back in house. It will be the same stuff as usual. Different titles. Absolutely nothing will change except there will be a resumption of ministerial meddling.

As always, there will be a hope of saving money. But fat chance, I fear. Coming back to other provisions of the bill, ditching governors of trusts. Well, I, I hold no particular torch for governors. We wait to see if the alternatives work. The department's going to appoint chairs of trust now, guaranteeing further political meddling there to abolishing Healthwatch. Well, some are doing great work, and we've heard about some of that. Others are not. But I'd like to know how the Minister thinks local patients voices are going to be heard in reality.

It's very vague indeed. The one positive about this bill we've all mentioned is the single patient record. If we can get it to work without spending billions, and if we do, that'll be a real miracle. Watching the presentations, I was thinking back to visiting an acutely mentally disturbed people, creating mayhem in the community in south east London, and wondering if I would have access to a user friendly single patient record on my phone. Well, I hope so, my Lords. I'm an optimistic soul.

But 60 years on from my first job in the NHS, it's time to hold on to the principles and to find a better way of delivering them. It's not cheap anymore. People are voting with their feet if they have the money. Of course, that doesn't help for the vast majority of people who we need to provide for. We are failing to. Willingness of successive governments to grasp the challenge, to create a better system, which so many other countries now have.
18:07
Baroness Morgan of Drefelin Portrait Baroness Morgan of Drefelin (Labour)
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Lord Mair. I would like to start by congratulating the government on their commitment to improving outcomes for patients, and I would particularly like to congratulate the maiden speeches, the speakers, the maiden speeches, the speakers, for absolutely wonderful contributions, and I look forward to hearing the others to come. My Lords, I welcome the proposal wholeheartedly for a single patient record. Many people with cancer, particularly those who have faced lengthy diagnostic journeys, will benefit from no longer having to repeat, repeat and explain their history again and again to different professionals.

My Lords, many patients simply believe that we've got one already, or can't believe we haven't in this day and age. So we need to crack on with this. We need to tackle the safeguards. But we really do need to crack on with this. My Lords, in following the 2012 reforms, I was incredibly disappointed to see the disbanding of the cancer networks. Those were a collection of bodies that were there set up to influence to deliver the first NHS cancer plan that was published in 2000.

And they became very, very strong. So I would like to focus on three issues that are of great importance to cancer patients regarding this bill. Firstly, protecting cancer services during the transition and looking at ensuring that cancer outcomes remain a national priority priority, and that we continue to work on unlocking faster clinical trials. As the members of of the One Cancer Voice Charity coalition have argued, it is essential that these functions required to deliver the recently agreed and widely welcomed cancer plan are protected through this transition.

The plan is extremely ambitious. There are over 100 recommendations and its success depends on effective national leadership, accountability and strong delivery. This matters, my Lords, particularly to people with rare and less common cancers, where progress has often been slower. Key functions and delivery that must be protected include, for example, a collection of robust data around metastatic cancers, research infrastructure National oversight programmes such as for screening and the capacity to commission vital, highly specialised services.

My Lords, there is a tension and we have to be realistic about this. Between neighbourhood health services and the need for cancer patients to access extremely specialist services. And so there must be full integration so patients can continue to receive the expert support they need. So I hope the Minister can assure me and the House that cancer services and specialist commissioning, screening programmes and research infrastructure will be protected through this bill. I'd also like to ask about the what the future of the the measure in the Health and Care Act 2022, where the mandate was established and there was a mandate as part of the mandate.

There was a commitment to focus on monitoring cancer outcomes. Now, this the mandate will disappear and we don't know what will happen, what will come in its what will replace it. So I'm concerned to know what will replace the mandate and how will cancer outcomes be expressed in that process. And the last thing I wanted to just very quickly talk about, my Lords, is the importance of research in the NHS, for example, clinical research we know has transformed outcomes for cancer patients over recent years.

We've seen improvements in survival and quality of life. A thriving clinical trial environment is vital to this. It's vital to our life sciences sector and to improving outcomes for patients as we go forward. So the government's ambition to reduce clinical trial set up times needs to be carefully thought through here. And can we ensure that that ambition is applied to non-commercial trials, as well as the commercial trials, that there appears to be much progress being made because 95% of participants in clinical trials are ones being led by charities and the NHS.

So a non-commercial. So I look for these reassurances from the Minister that the cancer plan will remain on track. That will will see how improving outcomes will be maintained within the. Whatever the replacement for the mandate will be, and also that patients can expect to see continue to see faster improvement in access to clinical

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trials and innovation, including those for less common cancers. Yeah.

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Yeah. I too wish to congratulate the superb maiden speakers we've heard so far. I'm sure that those yet to so far. I'm sure that those yet to come will be equally excellent, and I wish to address a matter which ought not to be controversial in any civilised society. The right of women to privacy, dignity and safety in NHS services. For years there has been a deliberate erosion there has been a deliberate erosion of the rights of biological sex women across all parts of the health service as men claiming to be women, have occupied spaces specifically created for biological
18:13
Lord Blencathra Portrait Lord Blencathra (Conservative)
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sex. Women. Different trusts have adopted different policies. Professional bodies have issued conflicting guidance. Many of them have stated that men calling themselves women, but who are full male genitalia, should have full access to women only spaces. Women access to women only spaces. Women and NHS staff alike have often been left uncertain about their rights and responsibilities. However, my and responsibilities. However, my Lords, the legal position is now crystal clear. The Supreme Court has clarified the meaning of sex in has clarified the meaning of sex in law and the Equality and Human Rights Commission statutory code has now come into force.

The question before us is no longer what the law means. The question is whether the NHS intends to implement it or will it continue to obfuscate. Yet, despite the clarity provided by the courts and the statutory code, the NHS appears to be moving at a glacial pace. Guidance promised months ago has yet to provide the certainty that women in healthcare staff deserve trust, remain uncertain, patients remain uncertain and the risk of inconsistency remains widespread, as well as hostile action being taken against women who request single sex provision.

Women should not have to argue for rights, which parliament has already recognised, and the courts have already clarified. A woman of biological sex admitted to hospital should have confidence that a woman's ward is exactly that a warrant for women of biological sex a woman requests receiving intimate care should be entitled, whenever reasonably practicable, to request a female clinician or chaperone without being made to feel awkward, unreasonable or discriminatory. A woman who asks for female only a provision should never be criticised, stigmatised or treated as though she has committed a hate crime or daring to ask.

Indeed, the evidence we have all seen in the last few years shows repeated cases where women and female NHS staff have suffered detriment, harassment or disparagement when raising concerns about sex based facilities. My Lords, that is wholly unacceptable in a modern healthcare system. This is not about hostility towards any other group, since every citizen should be treated with dignity and respect. But rights based on gender identity cannot be allowed to raise rights based on biological sex. Parliament created single sex exceptions for good reasons for privacy, dignity, safety, cultural needs, religious needs and the protection of vulnerable patients.

Those protections matter most when people are at their most vulnerable, ill, frightened, recovering from surgery or receiving intimate treatment or coping with trauma. I therefore ask the Minister three straightforward questions. First, when will the government publish definitive NHS guidelines implementing the lowest clarified by the Supreme Court and reflected in the new Ehrc code? Second, will that guidance make clear that women are entitled to single sex accommodation based on biological sex, and that requests for female clinicians or chaperones should be respected wherever reasonably practicable? And third, will the government ensure that no woman and no NHS employee is subject to disadvantage, disciplinary action or accusations of prejudice simply for seeking or defending lawful single sex provision? The time for consultation could delay and equivocation is over.

The NHS now needs clear instructions, clear leadership and clear accountability to ensure that single sex provision exists not merely in theory but in practice. My Lords, the courts have spoken, the law has been clarified. Women have waited long enough. The NHS must now obey the law. Finally, my Lords, a word about the Quality Care Commission mentioned in the Bill. In my experience, it's a useless waste of space. As a Public Services Committee pointed out a few years ago in our inquiry into home delivery of medicines.

It has brought about only about 100 criminal prosecutions in its history, and the overwhelming majority have been against private care homes and smaller providers. Yet some of the greatest scandals in modern NHS history, involving hundreds of deaths, emerged without any prior criminal prosecution for the regulator. When a resident falls in a care home, the UQ, the CQC rushes in to take action. But when systemic failure occurs across major NHS hospital trusts, the CQC arrives after the scandal rather than before it.

They cannot be trusted, in my opinion, to investigate NHS scandals unless they are beefed up in this bill. There seems to be a cosy consensus between the health watchdog and the Department of Health never to investigate NHS, almost like an old boys club in the past. My Lords, I look forward to the Minister's reply on my points about single sex provision and on my latter comments on the CQC.
18:17
Baroness Rafferty Portrait Baroness Rafferty (Labour)
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I to. Congratulate noble colleagues on the excellent and inspiring nature.

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Of their maiden speeches and look forward to those to come. I also commend the Minister for introducing this Bill and promising introducing this Bill and promising a form of joined up care on a scale that has eluded successive that has eluded successive governments. But integration is not achieved by structural change alone. It is achieved when there are It is achieved when there are enough staff on the ground, with communities having a meaningful say in how that care is designed.

And I speak today as a district nurse and former governor of a large NHS Foundation trust. That is why I want to focus on two connected points. What the bill's changes to integrated care boards could mean for community nursing, and what we risk losing when foundation trust governors are abolished. The bill strengthens ICBs as strategic commissioners, and that ambition matters profoundly to community nursing. District nurses, specialist community nurses, health visitors. As my noble colleague Baroness Coffey also flagged their importance.

Public health and practice nurses. Those care for people with complex needs in their own homes, care homes, schools and local clinics. They help people manage long term conditions, recover from hospital, avoid unnecessary admissions and receive palliative care near the people and places that matter to them. According to the Nuffield Trust health thinktank, district nurse numbers fell by 43% in full time equivalent terms over the past 15 years, from over 7500 to just under 4500 in 2023 to 4.

With a patient to population ratio of 1 to 14,000. So when we talk about moving care from community hospital to community. That shift needs enough skilled staff with enough time for visits, reliable access to equipment, clinical support, safe caseloads, and proper investment. If hospital activity moves into the community without the workforce and resources moving with it, the result will not be integration, rather unmet needs transferred to patients, families and overstretched nurses. The Association of District Nurse Educators have also registered their concern that the proposed reprocurement of community nursing education programmes may reduce the number of providers even further.

The transfer of powers to the Secretary of State, outlined in clause seven of the Bill for Education and Training, sets out a duty to ensure that there are sufficient people with appropriate education and training specifically to meet the workforce needs of the health service. It also requires that there is an effective system in place for the planning and delivery of education and training of people to meet those needs. In the light of this, can the Minister confirm that attention will be given to community nursing services as a matter of priority, to stem the dwindling numbers and boost much needed capacity? This brings me to the question of public voice, and I won't reiterate the excellent points that have been made by my noble friends Lord Hunt of Kings Heath and Lord Patel and others earlier, but I'd just like to flag the value of volunteers in.

As members of a Governors of Foundation trusts. In my trust, there were over 1000 volunteers and they did excellent work and provide an invaluable source of soft intelligence for the board. So can I ask the Minister whether she might be willing to reconsider the abolition of governors and undertake an evaluation of best practice case studies, so that expertise will not be lost in translation to the new arrangements which might eventuate? I hope these points will prove constructive and supporting the progress of the bill, and I look forward to working with the Minister to achieve that.
18:22
Baroness Browning Portrait Baroness Browning (Conservative)
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Thank. >> A pleasure to follow the noble Lady and my congratulations to the maiden speeches that we have enjoyed and are going to enjoy enjoyed and are going to enjoy today. I'd like to thank the Minister for the time she has spent in organising briefings for us on the subject of this bill, which is a very long and large bill, quite complex, I think, but I do support it in general. The single patient record is urgently needed, but I suspect will not be urgently delivered.

And so I'd like to ask the Minister if, in the course of our deliberations, she will set out some sort of timetable. My anxiety she's probably already aware of this, is that I can think of very few large government computer systems that have been an absolute joy to behold. And I just wonder what she and her department are doing to make sure that the single patient record is going to be commissioned in a way that we can all have confidence that when it is available, it's going to work and it's going to work properly.

Already in this debate, we've heard from Baroness Leaman and Baroness Hollins about the impact of this bill on particularly people with learning disabilities and autism, and of course, the single patient record is going to be so important for anybody with a vulnerability. I hope she will countenance adding to the single patient record, not just the key medical requirements that need to be on it, but also some of those other pieces of information that make all the difference to somebody.

For example, with autism. Many of them already have hospital passports, which they take into hospital with them. And we know that these aren't just simple little bits of information that are trivial. We know from reports from organisations such as Mencap that failure within hospitals particularly, and I'm not talking about mental health hospitals, but on general wards, to fully understand how an individual with autism functions has actually left led to deaths of very fit and able people who should never have died on a ward.

So I see the single patient record as being a good step forward. ICBs I have some concerns about this because they are in a state of reorganisation at the moment. I do worry about their ability to commission for areas that are particularly large. If they contain, for example, large rural areas and some urban, that the rural areas will get missed out in terms of the demography of what their needs will be. And I'm particularly concerned because, of course, commissioning for end of life hospice care lays with the ICBs.

And we know that hospices are under huge pressure at the moment. I was at a meeting earlier today on this very subject, and was horrified to find that there are several hospices around the country with quite large numbers of empty beds, empty beds, not because there are not patients for them, but empty beds because they actually can't afford to fill those beds at the moment. So we realise there is already a serious problem. But surely if commissioning for a local community is a responsibility of these ICBs that we can at least get right the end of life care.

Certainly at the very end of life, when palliative care and possibly hospice care is needed. But at the moment that doesn't seem to be working as it should. We know that very many people die on busy, noisy hospital wards, when in fact, the reason they're still there at the point of death is because there have been no alternative arrangements for them. And death, of course, can come quite quickly. And I'm particularly thinking of people with dementia and Alzheimer's.

A diagnosis of Alzheimer's, of course, is a diagnosis that, you know, is a terminal illness. But very often the decline in the final weeks can be quite rapid. And if that happens very often, that person is not in the right place to care for the final weeks, albeit sometimes days, and there isn't time to move them. So I hope that as we progress with this bill, we will be able to have time to talk about these individual situations because although this is the minutiae of the bill, the devil is always in the detail.
18:27
Baroness Janke Portrait Baroness Janke (Liberal Democrat)
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Yes. >> My Lords. >> It's a great privilege to speak in this Second Reading debate today, and I'd like to congratulate noble Lords who've already made their maintenance speeches and on their very eloquent remarks. I look very eloquent remarks. I look forward to hearing those that are still to come. Health services are a top priority across the nation, so I do hope, as many noble Lords have said, we can address our fellow citizens concerns through the progress of this bill.

Most people judge the quality of service on their own experience of front line care, yet many have extreme difficulty even getting a timely doctor's appointment. Anxiety and fear are the facts of life, particularly for elderly and vulnerable patients who worry they will not have proper access to healthcare when they need it. So much so that the A and E, the A and E has become the default destination for desperate patients who are unable to find timely care or advice from their local surgery.

Analysis from the Health Foundation shows that over the decade to 2020 224, healthy life expectancy in the UK fell by about two years to 60.7 years for males and 60.9 years for females. Of 21 high income nations analysed, the UK had the second steepest decline. As other noble Lords have said, health inequalities are worsening the gulf in healthy life expectancy between the most and least deprived parts of England is now 19.4 years for males and 20.3 years for females.

Cuts to local authority services over more than a decade have severely limited public health services, and their ability to effectively deliver policies that prevent sickness, squeeze schools budgets and cuts have led to less effective health education, whilst cuts to community healthcare professionals such as health visitors, school nurses, district nurses, dentists, optometrists have whittled away at community whittled away at community healthcare with devastating effects. Ability to work increased from 26% in 2015 to 44% in 2025, and local pharmacies, which have been the pillars of community health, are in widespread decline due to a 2 billion funding gap, with 45% relying on personal savings or remortgaging their homes just to keep their doors open to the public.

I know on this side, we've welcomed focus on primary healthcare in the ten year plan and the Prime Minister's plans for devolution, but this bill does not reflect these principles. It is a driver of greater centralisation and unprecedented powers to Ministers, as many noble Lords have said, at the expense of local involvement and accountability. To abolish Healthwatch is to lose the voice of patients and local communities, the very areas that actually need to be strengthened. No good reason has been given for this and the abolition of the SIB, with transfer of their functions to the CQC, is not justified in the light of the well-documented shortcomings of the CQC, the vision of a well-resourced, community based health service is very powerful and what our residents want and need, but it's hard to see how the bill before us will deliver the government's ten year plan to shift from sickness to prevention, and from hospital to communities.

With the current crisis in community and primary care, and where are all these devolved functions that we have been promised in the Cabinet statement? Rewiring the state, we on this side will press the government to address these fundamental problems throughout the progress of the bill, including more resourcing into primary care through a primary care investment standards. My Lords, the King's Fund echoes the thoughts of many people looking at this bill from the point of view of a patient.

For those on the outside looking in this looking in these technocratic restructures might look like rearranging the deck chairs on the Titanic. Whilst many core problems around the nation's health remain unresolved, and for every minute spent navigating reorganisation is a minute not spent planning and delivering high quality healthcare, which is what we all want here, here.
18:32
Baroness Sugg Portrait Baroness Sugg (Conservative)
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Well done. approach to the Bill and other noble Lords who share their significant wisdom and experience, b through that long term careers in b through that long term careers in the health service or their lived experience of previous health bills and NHS reorganisation. I and NHS reorganisation. I particularly welcome the maiden speeches we've heard and those to come, and I'm sure they're all noble. Lords share the desire to ensure that the modernisation and reform of health care leads to better outcomes for patients a reform, a more productive, efficient and accountable NHS and improves value for taxpayers money in the time available.

I'll focus on three issues relating to women's health, which I know in her role as women's health Minister, she has a clear focus on first, the government's commitment to introduce an amendment to this bill to appoint a maternity and neonatal commissioner as the noble Lady, the Minister stated. This was a recommendation from the final report of the National Maternity and Neonatal Review, led by the noble Lady, Baroness Amos. The noble Lady. The Minister will be well aware of the many reports identifying systemic failures in maternity care, alongside repeated recommendations that have yet to be implemented.

It is therefore unsurprising that the latest survey from Savanta, published last weekend, found that 75% of adults are concerned about standards of maternity care in NHS hospitals. The maternity and neonatal commissioner must have the power and resources needed to deliver the National Action Plan, which we expect in December, which the government says will overhaul services and drive long term change. Can I ask the noble Lady, the Minister, when the amendment on the commissioner is likely to be tabled, to ensure that your Lordships have sufficient time to scrutinise it properly in committee? Second, the single patient record, as the King's Fund has observed, the single patient record presents a significant opportunity to improve people's experiences of health and care by bringing together fragmented information and giving patients full access to their records.

I am grateful to the noble Lady, the Minister and her department for the helpful meetings and briefings provided ahead of this debate. However, much of the detail will be set out in secondary legislation. There are understandable concerns around privacy, around public trust access, data governance and NHS interoperability, and until greater detail is available, questions will remain for patients and healthcare professionals. The noble Lady the Minister, acknowledges this in her opening speech, and I was interested in the noble Lord, Lord Patel's idea around this issue.

I have particular interest in privacy, especially around sexual and reproductive healthcare and other sensitive treatments, such as mental health and addiction. Or, as we have heard from my noble friend Lord black, HIV treatment, the SPR could significantly improve patient experience and eligibility decisions by reducing reliance on patients. Recounting complex medical histories. However, patients may not wish to share every aspect of their healthcare and see every aspect of that history appearing within a standardised record, or to be readily available and accessible through a mobile device, albeit with a password.

These concerns are particularly acute for women and girls at risk of domestic abuse or honour based abuse for young people under 16, and for patients whose close relatives or associates work within the NHS, it is important to protect the long standing right for patients to access sexual health care and related services anonymously, and the role that this plays in providing inclusive public health services. While I recognise these matters will be addressed through secondary legislation, it will be helpful to understand how these regulations will be developed and consulted upon, and in particular, can the noble Lady, the Minister, provide any reassurance that explicit patient opt in consent on a by episode basis will be considered for highly sensitive records are included within the SPR, with patients retaining the ability to withdraw that consent at any point.

I also echo the request of my noble friend Lady Browning, for a timetable around the delivery of SPL and finally, other measures in the Bill related to women's health. The move towards ICB commissioning may well create opportunities to tailor services more effectively to local needs, but a key concern is whether women's health will remain a national priority rather than access to services varying according to where women live. An amendment to the Bill on implementation of the Women's Health Strategy was tabled in the other place.

Six months have now passed since publication. The publication of the refreshed plan, yet progress against its 117 actions appear limited. An amendment was also considered on ensuring waiting times for gynecology and women's health do not exceed average. NHS waiting times and gynaecology waiting lists have increased for five consecutive months, with more than 585,000 women in England currently waiting for care and less than 60% being seen within the 18 week target, which is well over the average for other NHS treatments.

These issues deserve consideration as we scrutinise the Bill. I do recognise that our scrutiny ought to remain firmly on the contents of this Bill, and we should resist turning it into a vehicle for everywhere the cause, but we cannot allow women's health to be treated as an afterthought in the reform and modernisation of our health service, whether through maternity safety, digital patient records or the delivery of the women's health strategy, these issues must remain central to the bill's scrutiny and implementation, and I look forward to working constructively with this government as the bill progresses.



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My Lords, it is an honour and a privilege to be making my maiden speech today and to be doing so on speech today and to be doing so on a subject on which I have spent a significant part of my career. I should add my congratulations to my noble friend, Lord Jabbar, Baroness Low, Lord Singh of Solihull and Lord Smith of Ranmore, on also making their maiden speeches today. Before anything else, I would like Before anything else, I would like to put on record my thanks to the wonderful staff here that have made joining the House so smooth, and also to all the noble Lords on all sides of the House who have been so welcoming and helpful.

I join your Lordships House. After 35 years of public service in the Civil Service across four government departments,
18:37
Lord Wormald Portrait Lord Wormald (Crossbench)
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I had the honour of leading the entire Civil service. As Cabinet entire Civil service. As Cabinet Secretary, I have loved almost every minute of it. I might I might say some more, some other time about some of the minutes that were about some of the minutes that were less lovely, but in particular, I have worked with some truly amazing people civil servants, public people civil servants, public servants and advisers, and Ministers from across the political spectrum. While the civil service and the public service needs to modernise and evolve, we should be prouder than we sometimes are of those who work across the public sector.

I spent the majority of my career working on education and health, and they remain my two great passions. I began my career in 1991, aged 22, at the then Department of Education and Science, and I worked on city technology colleges, which at the time was seen as a failing policy, but which two decades later had become the foundation of both armies and free schools, which is an interesting lesson in consistency. I worked on education for 15 years and then returned from 2012 to 2016 as permanent secretary.

Of course, all that period I got to work with exceptional Ministers from all parties, many now members of this House who really cared about reading the evidence, both nationally and internationally, and focused on what worked. And we have seen the results in England's excellent performance in the recent International Pisa study. In 2016, I moved as permanent secretary of the Department of Health and Social Care. Again, I got to work with some truly incredible people, a number of whom are speaking in the debate today.

Time and again, I got to see the staff of the Health and Care Service step up to the plate to deal with the next challenge, not least during the Covid pandemic. It brought home to me how in those crucial public services, policy and legislation only works if it is enabling real public servants in real places to do their jobs better. Which brings us neatly to today's bill. There were many important features of the bill, as many others have. I would pick out the clauses on data sharing as particularly crucial, but many of the most important things in health are not in the bill, particularly in the government's three shifts set out in its ten year plan that others have mentioned towards prevention, towards community and towards digital.

We ought to test the provisions of this bill by questioning if they are helping the health and care system move in the direction the government has set out, and by doing so, if they are improving both patient care and population health and. And where does it risk being a distraction, as others have said, from those objectives, as as unfortunately, previous health acts have sometimes been, we should be particularly careful in this regard of the clauses around restructuring of the NHS organisations.

But I will finish back where I started. It is an incredible privilege to join this House and to get to debate these crucial matters, and I look forward to the next phase of my public service with both pleasure

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and anticipation. My Lords, I'd like to start by. Congratulating all five. Noble

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Congratulating all five. Noble Lords making their maiden speeches today, but particularly say what a today, but particularly say what a privilege it is to follow the noble Lord Wormald's excellent maiden speech. Many in this House will speech. Many in this House will have had the experience, either as civil servants or Ministers of the noble Lords calm wisdom and quick
18:41
Baroness Harding of Winscombe Portrait Baroness Harding of Winscombe (Conservative)
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noble Lords calm wisdom and quick wit, both of which we have seen already today, and will add considerably to the work of the House. Personally, I can honestly say that having worked alongside the noble Lord literally every hour of every day during the Covid pandemic, that that despite his insistence that yes Minister was in fact a training video, he has public service values absolutely second to none. And under extraordinary pressure. He is calm and thoughtful and always finds time for the team around him.

And as we've seen today, the noble Lord Wormald thinks deeply about these most important issues in our society our education and our healthcare services. And as such, I know he has already played a significant role in improving the lives of people, young and old, across the country, and I have no doubt that he will continue to do as a member of this House. In his quiet and thoughtful way. The noble Lord Wormald has also said some important things about this bill.

We pride ourselves in this House in going into detail that the other place doesn't. And in doing so, I think we all like to think that we improve legislation. And often that is true. But we can also go down cul de sacs or adorn bills with Christmas decorations and get distracted from the real problems of. Bill is trying to address. And those of us and many have already said this, who've been in this House for a while, know that health bills are particularly susceptible to this.

So, my Lords, I think it is important that we really do try to keep in mind the three shifts that so many people have referenced today to community, to data and digital are even. I'm now forgetting the third one, but underpinned fundamentally by patients. I think that I want to make three points about the bill. The first one is about the shifting of the organisational deckchairs. In my career, in business and in public service. I'm always skeptical that restructuring things will actually solve a problem, and I think we have to ask ourselves in centralising everything in the Department of Health and Social Care, are we centralising the right functions and are we decentralizing the right ones? More often than not, my experience of the NHS is it gets it absolutely back to front.

It's clear to me that digital things do actually need to be centralised. But decision making on who are the right people to run organisations out in systems. As the noble Lord Stevens said earlier, is highly unlikely to be, those decisions are highly unlikely to be taken well in Whitehall. So, my Lords, as we look, I am actually supportive of reducing the number of people working in NHS organisations that don't actually serve patients, of which NHS England is a very large one.

So I do think it's right to create one central organisation in the Department of Health, but we need to be really challenging. Are we putting the accountabilities in the right place? Are we really pushing subsidiarity down as much as possible, and are we doing it to be clear that it serves patients? Secondly, the single patient record, the clue is in the name. Are we designing it for patients or are we designing it for vested interests in the system and trust the trust that patients need to have in the data architecture of our healthcare system is going to be absolutely key.

And although it's only really one clause, clause 52 in the bill, I think we're going to spend a huge amount of time scrutinising it. Personally, I would like to see, on the face of the bill, clearer indications of who will be consulted and how they will be consulted. At the moment in section six of clause 52, the Secretary of State can consider whoever they think is appropriate in their consultation, and that, I think, is alarming because the the system doesn't usually consult patients enough.

So then the third area again, clue is in the name patients voice. Like many others today, I am really concerned about the abolition of Healthwatch, not because it is a panacea. As others have said, it isn't. I come from the sort of consumer business world, and compared to other consumer or consumer or citizen services, I think we all know that health care isn't actually very good at listening to its users and its patients, that that even our best parts of our healthcare system tend to be quite paternalistic and think they know better than patients.

So I can't get my head around how abolishing Healthwatch is going to make that better. I very much hope that through the course of this bill, as the noble Lady, the Minister said in her introduction, we will engage in a really constructive debate on how we turbocharge patients voice through our health and care system, rather than the opposite. There is undoubtedly enormous experience in this House on health and social care, and I very much look forward to working with everyone on this.

And as I started, I would like to finish. I really hope that we will do that to focus our healthcare system on the shift to community, the shift to prevention and the shift to digital. I remembered it this time.
18:47
Lord Tarassenko Portrait Lord Tarassenko (Crossbench)
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I congratulate my noble friend Lord on his excellent and engaging Lord on his excellent and engaging speech, informed by his eight and a half years as Permanent Secretary of the Department of Health and of the Department of Health and Social Care, working with, I believe, seven seven Secretaries of State. During that time I declare an interest, as I've held an honorary contract with the Oxford University Hospitals NHS Foundation Trust for the past decade, enabling me to be an investigator on research projects involving patient data.

I welcome this bill, especially the legal framework for sharing information through a single patient record. This represents a wonderful opportunity to improve patient care through the linking of multiple sources of health data, but delivering on this objective is fraught with technical difficulties, not just reading PDF files. Interoperability is an issue which continues to plague the NHS, and it is not clear yet how the single patient record data standards will be set, maintained and made binding on suppliers. There's also an opportunity to expand the legal framework underpinning the single patient record by giving our NHS data the status it deserves, making it a sovereign data asset at the core of an NHS digital sovereignty strategy.

The first consequence of this would be a binding requirement for the single patient record data to be stored in servers located on British soil. Secondly, we've been told that by DHS that there will be multiple contracts awarded for the development of the single patient record and NHS digital Sovereignty strategy would prioritise those technologies whose data control and support remain within UK jurisdiction to reduce our reliance on foreign technologies within the NHS. The selection of Kainos Software Limited, a subsidiary of a C2 50 company, as the development partner for UK Biobanks I put sharing system after a public procurement process, shows that there are UK owned companies capable of delivering state of the art software solutions for the NHS.

My Lords, we've been told that the use of data for research is not within the scope of the bill, but the SPR systems, the data sets, the governance arrangements will also shape our health. Data is accessed and used for research. It would be a mistake as the Health Data Research Service develops, not to address the barriers affecting this access. For example, the control of patient information copy regulatory Framework was first introduced in 2002 as a temporary measure more than 20 years ago, and we cannot wait for its reform to happen at some indeterminate time in the future.

The Bill needs to set out a timetable for the Secretary of State to complete the process of reforming the copy regime, following public consultation within a fixed period of Royal Assent. My Lords, recent polling has put a percentage of those willing to share their de-identified health records for research and between 75% and 80%, but such a high percentage will depends on the public maintaining a high level of trust. Again, this will be easier if the single patient record is given the status of sovereign data asset, which we all own within NHS Digital Sovereignty strategy.

A further implication of this status will be to set up a hierarchy of access to de-identified patient data from the single patient record for research, similar to that operated by MHRA for the primary care data sets, but expanded. This should soon be followed by the development of our own sovereign AI model capability for the NHS, using longitudinal data sets from the single patient record linking primary care and secondary care data with outcome data. These models will enable early detection of diseases such as cancer and cardiovascular disease, and contribute to the prevention agenda.

My Lords, the use of the single patient record has the potential to improve direct patient care, but it is also an opportunity through health data research, to make the UK a healthier nation. At the end of the current ten year plan for the NHS, we must not miss either opportunity. My Lords.
18:52
Lord Smith of Ranmoor Portrait Lord Smith of Ranmoor (Labour)
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Firstly, can I thank the Lord speaker and noble Lords from across speaker and noble Lords from across your Lordships House for the warmth and generosity of their welcome. Entering your Lordships House seems Entering your Lordships House seems a daunting privilege to a new peer but a helpful, friendly welcome I have been accorded should not go unremarked and I thank everyone for reminding me of the importance of this place. It gives me great pleasure to make my first contribution to this debate. On the Second Reading of the health Bill.

Before I do, I beg the indulgence of noble Lords to say a few words of thanks, beginning with the clerk of the parliaments, her staff, Black Rod, and his team. In my first few days I've been rescued, been reassured and pointed in the right direction by staff from across your Lordships House, and especially the doorkeepers, who have saved me more than once. The highlight witnessed by mercifully few noble Lords on day two, when I strode purposefully into the chamber and sat on the opposition benches, help was swift and subtle.

I will be very grateful if that level of support continues. I particularly thank my two supporters, the noble Baroness, Lady Batters and the noble Baroness, Lady Kennedy of Cradley. I have taken a Sheffield Place name. It's been a bit of a day for Yorkshire and its surrounding countryside and the city have shaped my life. My dad, a TEP teacher and mum, a teaching assistant. I was delighted that 92. My mum was here for my introduction, but I must tell noble Lords she was disappointed to find she wasn't the oldest person in the building.

I'm the only family member who didn't follow the family trade of educating young people. That is until much later when I became the proud chair of Sheffield Hallam University. This excellent post 92 university has a relevance to today's debate. It's a significant NHS workforce training institution, particularly for South Yorkshire and the wider Yorkshire and Humber region. Its importance goes beyond nursing, but it trains nurses, midwives, paramedics and a large range of allied health professionals. I had a long career feeding the nation, and my time at the Food Standards Agency took me into the world of protecting consumers from all the risks associated with food the acute mostly food poisoning, and the chronic of which obesity is the most significant.

Then I was both intrigued and shocked at the insidious impact that overweight and obesity is having on society. It has not got better. I was a pupil at the first purpose built comprehensive school in the UK, and I'd invite noble Lords to do as I have recently, and have a look at your school class photographs. Then look at your parents version, that of your own children, or perhaps even of grandchildren. What noble Lords would notice is not just the picture changes from black and white to color and then to digital, but there's an alarming shift in the number of children frozen in time who are obviously preventable, overweight or worse.

It gets worse the closer we get to today. I can put some definitive numbers on it. The evidence of our eyes. The latest UK estimate is that obesity costs the NHS more than 9 billion a year. But taking my food policy perspective, the starkest evidence comes from health inequalities now being observed. The government's own equality assessment specifically discusses obesity. In this context, it records that children in the most deprived areas were more than twice more likely to be obese in reception, and 2.3 times more likely by year six, when compared to children in the least deprived areas.

An obesity strategy implemented through the restructured NHS will have to be considered against our duty to reduce those inequalities potentially more consequential. The Bill moves to substantial commissioning responsibility towards icbs, including primary care, and establishes neighbourhood health plans for obesity. That could mean a shift from nationally specified programmes to locally commissioned prevention and treatment. This matters enormously for obesity, because local variation in commissioning could produce new variation in access to NHS weight management services, weight management clinics, anti-obesity medicines, bariatric surgery pathways, diabetes and so on.

Obesity was explicitly discussed during the bill's parliamentary scrutiny. Other place when the government's obesity, moonshot, weight loss medicines and the need for prevention were highlighted, we should be in no doubt that the responsibility for the future health of the nation is at least shared with the food sector, which, to my concern, is yet to properly shoulder that responsibility for your Lordships House. The bill's architecture potentially affects obesity policy because responsibility for population health and prevention sits within the wider NHS commissioning system, as well as in nearly every other government department.

My Lords, it is a privilege to be one of your number. I look forward to actively contributing to your work at the work of the Lordships House in the coming months and years, both on workload.
18:57
Baroness Crawley Portrait Baroness Crawley (Labour)
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Here, here, here. >> My Lords, many congratulations to all our maiden speakers today, and it is a very special pleasure to follow the exceptional maiden speech of my noble friend, Lord speech of my noble friend, Lord Smith of Ranmore. His CV reads like the making of modern British food standards, but his emphasis emphasis on obesity means that. I can't now say that all of us who enjoy eating are very grateful to him. The son of of Sheffield, a son of Sheffield, an alum of Leeds University, which he is obviously extremely proud.

My noble friend started his career at Northern Foods. He was appointed to the Food Standards Agency as CEO in 2008, after which he accepted a senior role at Tesco and is now chair of Cranswick plc and one of UK's most experienced people in food retail. Throughout his work, with several governments cross parties, he has chaired the Agricultural and Trade Commission and has been co-chair of the Food and Drink Sector Council, among other significant posts. He's also a trustee of the Natasha Allergy Foundation, which is very important in food safety today.

I'm sure all noble Lords will welcome my noble friend's immense experience to our house and look forward to his many contributions to come. My Lords, I usually stay away from giving my opinion on health bills. It's not my area of expertise and the NHS is challenged enough without my tuppence worth. However, I couldn't stop myself with the bill in front of us today because I was struck by its plan to enhance patient safety and the patient's experience through a new single patient record long in the making.

As my noble friend Baroness Jay has said, which this record could transform patient care. And as long as safeguards against cyber attacks and AI going rogue and so on, and as long as trans transparency is always at the forefront of our mind with the creation of this record, then. Patients will welcome this as much as we do tonight. And I welcome the noble Lord the minister's commitment in her opening remarks to this specific part of the Bill.

I support, my Lords, this Bill and the ambition of the Bill. It has its critics, of course, the trade union unison is concerned that the ten year plan, which the Bill will make law, could produce a larger role for private healthcare. The Patients Association, while welcoming the bill's stated intention to put patients first and reduce bureaucracy, points out as indeed many noble Lords have today, that any period of organisational change risks distracting from immediate patient care.

I'm sure my noble friend the Minister, who has a well-earned reputation for listening, will be aware of such concerns and perhaps may address them in. In her summing up as vice president of Rospa, the Royal Society for the Prevention of Accidents, along with the noble Lady, Baroness Watkins of Tavistock, and Lord Jordan, our president, I saw in the proposed single patient record an opportunity for far more accurate and meaningful data than is currently the case. Data from across the health service to be used more effectively for patients wellbeing.

As noble Lords will know, Rospa mission is to campaign to prevent serious injury and save lives. However, as it stands, injury prevention is hindered by fragmented, fragmented, incomplete and inconsistent NHS data. Data is often missing or provides only surface level detail, which makes comprehensive prevention policies when it comes to injuries extremely difficult. Information on injuries is from multiple sources, as we know, and multiple agencies, hospitals, ambulances, ambulance services, primary care, the public health data and so on.

The bill's new information sharing powers create a real opportunity not merely to further modernize digital records. And, you know, to be fair, it hasn't always gone super smoothly, the old digital record. But to provide a stronger, safer evidence base for prevention of accidents, to give noble Lords a couple of current examples. According to the latest NHS data, seven people were admitted to hospital in 2024 as a result of being bitten by a crocodile. Two people were bitten by a scorpion and 53 by a rat.

Three people were the victim of a volcanic eruption and 22 people were admitted to hospital due to a long stay in a weightless environment. No, I, I don't know what that means either. However, my noble Lords, when it comes to falls, which are the biggest cause of accidental death and injury in this country, falls, more than a third of admissions are simply recorded as unspecified. It can't be right that we know more about injuries caused by crocodiles than we do about hundreds of thousands of falls, many of them in our ever ageing population.

Will my noble friend the Minister, meet with myself and Baroness Watkins and perhaps representatives of Rospa during the course of this bill to discuss how the Bill will improve the quality of injury data and in doing so, enable prevention, save lives and reduce avoidable

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pressure on our overstretched NHS. I wish to make three points which the health Bill should which the health Bill should address. First, the greatest threat to uncontrollable government to uncontrollable government spending levels in the long run is from escalating health and care from escalating health and care costs. If we fail to provide for a solution to the growing crisis in social care, which is severely impacting upon costs to the NHS, and if we don't deal with the rising levels of ill health, with an ageing population, rising levels of obesity, diabetes and disability all of which are linked.

The excellent former pensions Minister, Professor Steve Webb, gave me these figures based on the proportions of GDP spent on health and on pensions, beginning in 2020 324, the proportion of GDP spent on pensions at the start of this period was 5.6%. In 30 years, this figure is set to rise to over 7.3%, and over 50 years it is projected to reach 8.9%. Meanwhile, spending on health as proportion of GDP. GDP is currently around 8%.

In 30 years. This is projected to rise to over 11% and over 50 years to nearly 15%, almost double the proportion of GDP spent today. So as we debate the structural reorganization of our health services, we must not lose sight of the overwhelming demographic changes and the financial realities that we face in the future. The escalating costs of health and adult social care are driven relentlessly by rising rates of obesity, diabetes, complex multiple morbidity and an ageing population living with higher levels of disability.

So my second and third points are both about limiting those rising costs. Smoking is still the single largest driver of preventable ill health and health inequality in the United Kingdom. It accounts for nearly half of the gap in healthy life expectancy between the richest and poorest communities. We have made great progress. Recent ONS figures demonstrate that fewer than 1 in 10 people across the UK now smoke.
19:07
Lord Rennard Portrait Lord Rennard (Liberal Democrat)
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This achievement has required great determination to uphold good public determination to uphold good public health policy with effective regulation, both to help prevent regulation, both to help prevent people taking up the habit, and to help the majority of smokers who help the majority of smokers who wish to quit. But more can be done. So I urge the noble Lady, the Minister, to commit to publishing a clear roadmap to a smoke free country, underpinned by sustainable funding for that program, including a targeted levy on tobacco industry profits that could raise billions of pounds for public health and address the funding gap.

This money is needed by a healthcare system and not by the tobacco oligarchs, who profit so much from products that kill half their customers and impose massive costs on us all financially and in terms of wellbeing. Thirdly, I want to highlight the growing costs arising from the complications associated with poorly controlled diabetes. Diabetes may already take up about 10% of the NHS budget, with 80% of those costs spent on the complications associated with it. But by 2035, diabetes is projected to take up around 17% of the NHS budget.

As this legislation abolishes NHS England and transfers its function centrally, we must guarantee the momentum is not lost in diabetes prevention, treatment and clinical innovation. The Bill should place an explicit duty on the Secretary of State to promote innovation in diabetes care, specifically accelerating the rollout of continuous glucose monitoring and hybrid closed loop artificial pancreas technologies, diabetes related health inequalities, whether in access to insulin pumps or structured education, must be named as explicit statutory consideration in the duty to reduce health inequalities.

With action on these issues, we can begin to close the looming gap between what the country can afford and what needs to be done for health and wellbeing in this country.

**** Possible New Speaker ****

Lords, may I congratulate noble Lords on their excellent maiden Lords on their excellent maiden speeches. With the abolition of the NHS England transferring its functions to either Icbs or the Department of Health and Social Care, as duplication currently exists in functions and job roles, exists in functions and job roles, so further clarification is required to the full timetable and required to the full timetable and cost of abolishing NHS, reducing bureaucracy, streamlining NHS structure and improving delivery must directly address severe capacity and accountability gaps,
19:10
Baroness Redfern Portrait Baroness Redfern (Conservative)
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in particular in cancer treatment. First must be to thank all First must be to thank all frontline staff across the NHS who do incredible work 24 over seven. We so need standards that are evenly served across urban and rural areas, supporting a commitment for the NHS to be truly commitment for the NHS to be truly fair and fit for all. There is no doubt a new approach is urgently doubt a new approach is urgently required, bringing together people's health and social care records digitally must and has to be secure and responsive to urgent requests in one place.

So we need clarity on how the single patient record would work and how data would be assessed and governed, and how data is kept secure. There must be sufficient consultation, engagement and planning with all providers, including the independent sector, with realistic and properly resourced implementation plan. This should address the full cost of developing and maintaining records and and arrangements, including cyber security. Three areas I'd like to focus on first eye tests and to call for explicit statutory safeguards for national NHS sites, testing and mandatory inclusion of optimists in ICB planning.

This Bill must protect meaningful patient choice across all suitable NHS funded providers and ensure local commissioning decisions do not restrict capacity but safeguard, safeguard ophthalmology referral pathways. I turned to pharmacy, noting the cost. The loss of 1500 pharmacies in the last ten years is concerning to people who access pharmacies up and down the country. The pharmacy teams must be recognised as central to deliver this ten year plan. Pharmacies already increase access to care closer to home and support prevention strategies.

NHS England NHS in England spends more than £19 billion on medicines each year, the second largest expenditure after workforce. In the context of new trade deals on medicines and adjustments, with systems that are appropriately incentivised to optimise medicines for patients and reduce overprescribing. Thirdly, to radiotherapy, highlighting the importance of a national framework for improving access to radiotherapy services, where radiotherapy plays a central role, particularly in cancer treatment. Significantly more staff are needed as cancer incidents rise, as workforce has shortages, which directly affects treatment capacity, waiting times and the ability to adopt a modern technology and an end to recruitment freezes.

With equipment shortages and ageing infrastructure, machine deficits are approaching or have already exceeded their recommended replacement lifespan. Steering clear leadership, transparent accountability and strategic planning for radiotherapy, which is essential to the government's ambition on cancer waiting times. Ensuring every patient receives access at the right time. Finally, my Lords areas with no regional mayor, the requirement remains that Icbs must include at least one board member jointly nominated by an upper tier local authority, and again with a requirement of clear lines of responsibilities accountable and transparent to Parliament, including who should be accountable.

But when when services fail and and we also must have inclusion for GPS. We all want the very best healthcare and the most efficient first class NHS with reduced bureaucracy. Finally, I look forward to clarity on issues raised and to have a health bill strengthened so patients can benefit promptly from treatments wherever they live. It's a pleasure to contribute to the debate, and to have heard the previous maiden speeches, and I look forward to the subsequent ones.

I note not only the great increase in representation from the North, but in mental health, which everybody knows is my interest. So I'm very pleased to see that. I just want to say one thing before I start what I've actually written, and that is we've talked a lot about patients, but actually the public fund, the NHS and the particularly the young, use it relatively little. If I'm talking about people aged 20 to 40, and yet many of them contribute
19:15
Baroness Watkins of Tavistock Portrait Baroness Watkins of Tavistock (Crossbench)
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significantly. We are seeing across Europe complaints from younger people because they are not getting people because they are not getting what they think they're paying for, either in education or in other either in education or in other areas. And I think we've got to be really explicit about the what the really explicit about the what the NHS will provide for everybody from the centre, so that we don't get the centre, so that we don't get too much differentiation as delegation occurs, else I think we will lose the commitment that those of us that have been supportive of the service for so long assume the next generation want.

And I just want to just put that on record. But I'm really supportive about this bill, and I have some concerns on the ability of the health service to monitor, investigate and learn from its own performance with the new structures and believe that we have a responsibility to do that, because during a period of huge change, the health system needs to have in place the ability to monitor its effects and flex and change to ensure that two things happen, that our manpower planning is right and that productivity increases because of the use of technology.

If we don't, we're not going to be able to deliver. I also want to say that though I agree with much of dot Penny Dash's review, I, like many others, do not believe that SIB should be put in to CQC at the moment. I think that the predecessor, the Health Safety Investigation Branch, was established following the Francis inquiry into Mid Staffs. Its purpose was clear to provide independent expert investigations into patient safety and to identify the systematic factors that contribute to patient harm.

The independence is fundamental. They investigate without apportioning blame or liability. It has worked hard to create a safe environment in which healthcare professionals can speak openly about safety concerns. And as a nurse, and through my conversations with colleagues across the NHS, I know that CPC is perceived very differently. I would urge the government to consider whether this is the right way forward. My Lords, I'm pleased that the Secretary of State confirmed that there will be a maternity commissioner, but as the noble Lord Bradley said, there may be a need for commissioners in other areas.

So I would support a further amendment allowing the Secretary of State to appoint commissioners in other areas of health care when significant concerns arise, given the flexibility, given this flexibility, it would allow expert commissioners to ensure that lessons learned and, crucially, that recommendations are acted upon. We're waiting for several reports into severe problems in mental health services, and this would be an example where I would like to see that flexibility when those come out. Finally, my Lords, I strongly welcome the commitment to the single patient record.

If properly implemented, it could definitely improve continuity of care, reduce duplication and ensure clinicians have the information they require. It would be a significant step forward. But as other noble Lords have expressed, the amount of detail of personal information that will be shared across different parts of the health service and indeed in legal services may have to be very carefully thought about. But what I would like to see is that there is an opportunity for advanced directives to be fully incorporated into the patient record, so that it is very straightforward in emergency care and also in end of life care, about what patients really want.

Finally, I thank the noble Lady, the Minister, for her letter, which I received this morning and ever incorporated into my last words relating to a question I previously asked about whether the mental investment, that mental health investment standard should be put on a statutory footing. The reply says the government is clear this funding is a priority and that it does not need to be stipulated in primary legislation. I think a probing amendment may be necessary on this issue because such reassurance may not withstand a years.
19:20
Lord Babudu Portrait Lord Babudu (Labour)
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No, Bill, this session will matter more to the health of the nation. Let me say at the outset nation. Let me say at the outset that I do welcome this bill and the principles behind it, whatever the aims in creating NHS England, the aims in creating NHS England, the way it was set up and run makes accountability hard to place, and it's added to what was already a considerable bureaucracy. That is no good. Some of the many exceptional professionals who have worked and continue to work in NHS England, but the government are right to ask whether a different structure could deliver better outcomes for patients at lower cost and at greater speed.

We should also be honest about the costs of reorganisations. We've had many of them and each takes longer to bed in than we seem to allow before the next one arrives. There is no perfect structure for the NHS. What it needs is one that is good enough and stable enough to let its people get on with their work. So I hope the government will now set out plainly how the new system will work in practice, and then complete the changes quickly.

Our focus. The rest of my remarks on three things prevention, patient voice and integrated care boards. First to prevention. The main drivers of our health lie well beyond the health system. Our health is shaped largely by the food we eat, the air we breathe, the homes we live in, and the work we do. Too often, the poorest communities have the least healthy food, the most polluted air, the worst housing, and the most insecure work. The ten year health plan is clear that prevention must play a far greater role in improving the nation's health.

The plan's own goal to halve the gap in healthy life expectancy between the richest and poorest regions will not be reached via a hospital door. I worry that the bill is not yet explicit enough about this. It creates space for preventative work commissioned by integrated care boards, it brings local authority and mayoral members onto those boards, but it does not make plain that moving resources towards prevention, broadly understood, sits firmly within the expanded remit of Icbs. Some will say that space has always been there, yet time and again, the chance to fund prevention is lost to the demands of ever more expensive clinical care.

In his 24 investigation of the NHS. Lord Darzi found that the share of the NHS budget spent on hospitals rose from 47% in 2006 to 58% in 2022. Successive governments have promised the opposite. Meanwhile, in the last decade, the public health grant was cut by more than a quarter per person. In real terms, the bill gives the Secretary of State a new duty to promote innovation. It restates the duty to reduce health inequalities. Prevention has no equivalent duty, and this House has no good way to see whether money is moving towards it.

There is precedent from this House for a clearer approach in 2022, after pressure from noble Lords, including my noble friend the Minister, the then government added a duty to their Health and Care Act. Each year, the Secretary of State must now publish whether NHS spending on mental health is expected to rise, both in cash terms and as a share of the total. That simple act of transparency keeps mental health spending in front of Parliament. Every year I ask the government to consider whether similar something similar for prevention, a clear duty and an annual statement of what the NHS and Icbs expect to spend on prevention so we can all see whether the shift the ten year health plan promises is happening.

Could my noble friend the Minister, say whether this is something the government will consider? Secondly. Patient voice. I've seen how local Healthwatch organisations up and down the country play a valuable role in raising the concerns of the communities they serve. Bringing that role closer to the centre creates a chance to champion those those voices better. But it also carries an obvious risk that fewer voices are heard and the voices most at risk are those that are already heard the least. So I look forward to working with the government to strike the right balance.

Fewer bodies capture patient voice, real independence, the full diversity of voices still heard, and a clear line from what people raise to what changes. I've also heard from patients worried about how the single patient record will work in practice. They see strong local voices as a key safeguard. Finally, integrated care boards with the number of icbs being reduced by a third, their running costs to be halved. And with new commissioning duties such as screening and vaccinations and the work of local health watches, many icbs have rightly warned they risk ending up with more to do and far less capacity to do it.

And in such cases, experience suggests things that are deemed discretionary, like prevention, spending and listening to patients are often the first to suffer. So I would appreciate if my noble friend the Minister could, when winding up, set out what discussions the government have had with ICB chief executives and chairs about the enabling measures they need to take a genuinely preventative, community rooted approach that is the shift from sickness to prevention. The ten year health plan promises this bill is our best chance to make that shift real.



**** Possible New Speaker ****

Interest as chair of the Governance Board of the Independent Sector Complaints Adjudication Sector Complaints Adjudication Service, and I too would like to congratulate noble Lords on their excellent maiden speeches. These proposed changes create the largest NHS reorganisation in over a decade, and whilst healthcare reform is to be welcomed where it improves be welcomed where it improves patient outcomes, systems alterations can also cause confusion. So ultimately we need to evaluate whether it will improve patient care and ensure accountability.

There is concern that this bill will over centralise decision making and weaken independent challenge. Indeed, former Labour Minister Lord Darcy, who led this government's investigation into the state of the NHS in England in 2024, said a top down reorganisation of NHS England and integrated care boards is neither necessary nor desirable. There has been much discussion about the creation of a single patient record and its potential to improve continuity, efficiency and patient safety, and clearly there are many potential advantages, but only if we ensure robust safeguards around privacy.

Whilst medical professionals have a duty of confidentiality, it is important that personal information does not get into the wrong hands. So it is not just a question of data
19:27
Baroness Hodgson of Abinger Portrait Baroness Hodgson of Abinger (Conservative)
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security, but also one of public trust. Does this bill help the GP system the most vital part of our health system, but at present under huge strain. A good GP service with huge strain. A good GP service with continuity of care is crucial to aid prevention and thus decrease aid prevention and thus decrease need. Studies show that where GPS know their patients, admittance to know their patients, admittance to hospital is lower, patients are less likely to die and their health is better.

But today, many of our hospital NI departments are overwhelmed by people who cannot get in to see their GPS, and GPS appear to be asked to take on too many patients. We need to enable that they have the tools and time to do the job properly. Like many, I am concerned about the proposed abolition of Healthwatch. An independent, patient voice is essential for accountability. Surely transferring this into an ICB could create a conflict of interest. Indeed, some suggest it's tantamount to marking their own homework.

Complaints need to be used for learning, but there is a tendency in many areas of healthcare not to be open when things go wrong, and challenging a service and addressing issues honestly can be used to improve care. I therefore urge the Minister that Healthwatch stays independent and is improved and strengthened. This bill should be an opportunity to improve the way that medical negligence is dealt with, both financially and the patient experience. Inevitably, from time to time, things go wrong, and in those cases, patients or their relatives should receive compensation.

The National Audit Office estimated that the accumulated clinical negligence liabilities as of the 31st of March last year were £60 billion. This has quadrupled since 22,006 to 7, making it the second largest provision on the government balance sheet after nuclear decommissioning in 2025 to 26. Medical negligence cost over £3.2 billion. Not only is this a huge amount that could be spent on care, but the years it takes for a patient to bring a case to court as hugely to the stress and distress, the annual cost to settle claims has more than tripled over the last two decades, and often the legal costs for claims under £25,000 vastly exceeds the damages payable to claimants.

Plans to control claimant legal costs by limiting the recoverable amount in lower value damage cases have not been implemented following the change of government in 2024. Can the Minister please say why? Surely we should be setting up a commission under an independent chair which includes clinicians, patients and legal representation to review the present situation and come up with a better model that will cut legal costs and give patients swifter resolution of all the negligent costs. Negligence costs a significant proportion 42% in 2024 to 25, amounting to 1.3 billion a paid out on maternity claims.

The maternity failures, highlighted by the Ockenden reviews and the Amos National Maternity and Neonatal investigations, are truly shocking. The 2019 civil Partnerships, marriages and Deaths bills required the Secretary of State to prepare a report. Report on whether the law should be changed to enable coroners to investigate babies dying at birth. What happened to

**** Possible New Speaker ****

Of this report. It also gave the Lord Chancellor powers to amend the Coroners and Justice Act, 2009 to Coroners and Justice Act, 2009 to enable coroners to investigate. This would stop the apparent present culture of cover up in so present culture of cover up in so many hospitals. The negative situation regarding maternity leads situation regarding maternity leads one to question how efficiently hospitals function in other specialties, and what the situation specialties, and what the situation is regarding unnecessary deaths.

It questions the effectiveness of the CQC inspections. My Lords, is it really wise to transfer the Health Services Safety Investigation Services Safety Investigation Investigations body into the. Investigations body into the. CQC at this time, potentially weakening the independence of patient safety investigations? My Lords, we need to make sure that we spend the healthcare budget in the most effective way to meet patients needs. Thus, we must ensure any changes to healthcare through this bill actually improves the system, lowers costs and delivers results in better patient experiences and outcomes, not just rearranging the deck chairs as others have already quoted in the other place.

Winston Churchill once said, healthy citizens are the greatest asset any country can have.
19:32
Baroness Cass Portrait Baroness Cass (Crossbench)
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My Lord. >> In congratulating those who have made their maiden speeches and extend my commiserations to Lord. Singh, who has drawn the short straw of speaking last. It's excellent to have another medic in the house. I declare my interest as an independent adviser to DHC as. As a paediatrician and somebody who spent much of my career advocating for children and young people within the health system. It won't come as any surprise that I wish to focus my remarks on the implications of this bill for children in terms of the broad aims of the Bill.

There is a strong case for simplifying structures, improving accountability and making better use of data. And like many others, I welcome the ambition behind the proposed single patient record. But with all of the health. Warnings given by my colleagues, particularly Lord Tarasenko and others. But nonetheless, we have to move on from a situation where Alexa knows within minutes that we're thinking about buying a new toaster. But our GP may not know for several days that we've been diagnosed with cancer. In particular, there is a real potential to improve continuity of care, particularly for children and young people with complex needs.

Now, many people have discussed all the operational practicalities of the bill, but for me, one particular concern did keep referring recurring, and that is that children. that children. Are that children. Are largely that children. Are largely absent from it. This matters because this bill arrives at a troubling time for child health. The recently published State of Child Health report, produced by the Royal College of Paediatrics and Child Health, paints a sobering picture across a wide range of indicators, progress has stalled or gone into reverse.

Vaccination rates have fallen, rates of childhood obesity are climbing, as Lord Smith has told us, mental health difficulties have increased and many health outcomes remain strongly associated with deprivation. Most troubling of all is that the inequalities begin early and can persist throughout life. Children grow up in growing up in the poorest communities experience worse outcomes from the very start. Infant mortality is more than twice as high in the most deprived areas compared to the least deprived. And far too many children continue to face poorer physical and mental health simply because of where they were born and grew up.

But the time a child starts school, substantial differences in health and development have often already emerged. So if this bill is intended to create a more accountable health system, it should also help us understand whether those inequalities are. Narrowing or widening. A health system should be judged not just by how well it treats illness, but how effectively it supports all children to have the healthiest possible start in life. So this raises a fundamental question. If the purpose of the bill is to strengthen accountability in the NHS, accountability for what? Much of the discussion has focused.

On structures the abolition of NHS England, the transfer of functions and the relationship between national and local bodies. But structures are not an end in themselves. The purpose of those structures is to improve health outcomes. As the bill progresses, I hope we can explore how children's health outcomes can be made more visible within these new. Arrangements. We should know whether outcomes are improving, whether inequalities are narrowing, and whether children are receiving timely access to the services they need. In that context, I'll be laying amendments that seek to ensure that waiting times for children are not lost within broader NHS performance measures.

Delayed treatment in childhood can have consequences that extend far into adult life. It's right that we consider whether the new arrangements provide sufficient visibility and accountability for children's access to care. I also hope that we will consider how children and young people's voices and interests will be represented within the new structures. Children often have little direct influence over the services they use. Yet decisions made. decisions made. During decisions made. During childhood can shape health trajectories for decades. This bill will reshape how the NHS is governed.

It therefore provides a valuable opportunity to ask not only how the system is organised, but what outcomes it's seeking to achieve. Children may occupy only a small part of the bill, but they will live longest with its consequences. So I hope that as the bill progresses through this House, we can ensure that improving child health and reducing child health inequalities become a more explicit part of its purpose.

**** Possible New Speaker ****

My Lord sir, I also welcome the maiden speeches. Of noble Lords and thank them for their wise words and look forward to them contributing to forward to them contributing to
19:37
Lord Scriven Portrait Lord Scriven (Liberal Democrat)
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your Lordships House in the. your Lordships House in the. Future. Now I come to this Bill as a former NHS manager, which will endear me to not many people. I understand that, but I started my career in the early 90s, and I lost count of the number of reorganisations since fundholding. Health authorities, primary care trusts, strategic health authorities, clinical commissioning groups, integrated care boards and now the abolition of NHS. England. Each arrived, promising less bureaucracy and a freer front line. The King from the King's Fund calls this the largest reorganisation of the NHS in more than a decade.

And they remind us that structural reform alone can be, in its own words, a huge distraction that rarely improves care. And I've lived through that distraction. Leadership time for years. Goes on new boards, new boundaries, and people reapplying for their own jobs, not focusing on patients and improving health outcomes. So let's start with simple questions. Who is using the NHS and why? What can we do about it and where? Waiting list remains stubbornly high above 6 million, healthy life expectancy has fallen to around 61.

Neither is caused by organisational names on a letterhead. The answer lies in social care. In children's early years, in prevention and early diagnosis. NHS structures are not the answer to those numbers, and any government or health Minister that thinks so is deluded. So what is in this bill? Well, first of all, a power. a power. Grab. a power. Grab. The a power. Grab. The Secretary a power. Grab. The Secretary of State takes many of NHS England's functions powers to direct icbs, even when they're performing well.

The powers to remove an ICB chief executive and direct the to the chair of who should replace them. My Lords, that's not accountability. That is political patronage. It also invites political interference in where capital is spent and directions on operational matters. Any such powers must be. Targeted, proportionate and subject to robust guardrails. And I will test this bill at committee against those standards. Meanwhile, Icbs have been ordered to half their running costs, some 12,500 posts to be deleted. Yet the bill gives them new duties, not just in commissioning, but in other things as well.

Who will be able to act on those new powers? With half the staff, a whole tier will be hollowed out. Asked to do more inevitably and inevitable inability to deliver. And what will happen? A consultancy tsunami is on the way. An extra cost. And here comes the farce. Last week, Icbs were told most planned cluster mergers will Footprints must wait until 2028. The operational model. Really? Still not there. And now we read that NHS England may go into the department or be a standalone body cut first, plan later.

That's not strategy. It will cause health planning, chaos and patient safety. My Lords, is my deepest worry. The Bill moves the work of the health Service Safety Investigations body into the quality care. The Care Quality Commission. Firstly, doesn't the SIB have powers to investigate the CQC? So how does that work in this new world of the Bill? The CQC itself has warned in May of a conflict of interest. Staff speak up because the safe space is at risk. The Minister needs to understand this is a dangerous move and will seriously diminish patient safety.

This is an area of committee that I'm sure I and others will return to. And on the single patient record, I support the principle. No patient should have to repeat their story, and technology only transforms care when it reaches the bedside. But trust is earned, not legislated. As reported in the Health Service Journal today, nearly 100,000 people have opted out of NHS data sharing this year and a alone, amid mounting controversy over questions of who controls the data and who is accountable remains deeply unclear.

The public need to be reassured on The public need to be reassured on these issues, and the. Minister must tell us plainly what role Palantir will play and how their involvement will not cause further public erosion of public trust. And I, for myself, will judge this bill on my own family's experience. Does it improve the health care and outcomes of people with learning disabilities? The noble Baroness, Baroness Hollins, gave the statistics, so I will not go further, but it will be a point that I will return to at committee.

My Lords, changing the name of who issues directives will not improve health care and outcomes. Only stable leadership focusing on commissioning the right things, along with true local autonomy and real accountability will have significant impact. The bill, if left as it is, will be another missed opportunity. That is why I will work to amend it in committee to make it fit for purpose and improve health care and outcomes.

**** Possible New Speaker ****

I do congratulate the noble Lords making the meeting speeches today. I also congratulate my noble friend, the Minister, for. Introducing this very important Bill with such clarity and commitment. My Lords, having served in the NHS as a frontline doctor for nearly 40 years, I believe this bold and transformative health Bill offers a significant opportunity to modernize health care and to tackle our nation's persistent health inequalities, and, I repeat, to
19:43
Baroness Nargund Portrait Baroness Nargund (Labour)
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tackle our. Nation's persistent health inequalities. There is much health inequalities. There is much in this bill that I welcome, and many areas which I would like to expand upon, but in the interest of time I shall touch upon four areas. First, my Lords, the abolition of First, my Lords, the abolition of NHS England is, in my view, long overdue. Transferring its functions to the Secretary of State and to the Secretary of State and Integrated Care. Boards removes unnecessary bureaucracy, as we have heard, and it brings decisions and resources closer to patients and closer to where they will have the greatest impact on patient safety.

These reforms could save £1 billion annually. My Lords, the abolition of NHS England means the abolition of one of the largest quangos and as a consultant, having worked for more than three decades, I have worked closely with NHS England and have seen too many tick boxes, too many checklists, decisions not being made and too much bureaucracy. I welcome this significant step. I am pleased that the direct commissioning functions are being transferred to Icbs, with an aim to deliver population health improvement plan for the whole area.

The icbs that are accountable to this must turn this ambition into action. My Lords, the single patient record is the highlight of the Bill. As we have heard from many noble Lords. It will improve patient experiences and outcomes. In my view, it is more likely to retain doctors and nurses who are leaving their natures because of the frustration of fragmented notes and the medico legal risk. It could also save. also save. Around also save. Around £20 also save. Around £20 million also save.

Around £20 million a year from reduced medical errors, reduced adverse drug reactions and duplicate prescribing, alongside better co-ordination of community services, and an estimated 20,000 fewer A&E visits. Of course, the strongest safeguards must be put in place, as we have heard, for security, privacy and public trust and I welcome the reassurances from my noble friend the Minister on this and that clinicians will not be authorised to access individuals records without a legitimate clinical need. However, I am concerned about the lack of clarity around sharing notes from the private healthcare patients increasingly move between NHS and private healthcare, and their medical history should move with them.

I therefore ask for reassurances that there will be provision for patients receiving private treatment, have their care data shared for the single patient record. My Lords, I particularly welcome the duty to promote and reward innovation within our NHS. We have a proud history of innovation in the NHS. In my own field of women's health, the development of IVF and introduction of ultrasound in obstetrics and gynecology were innovations which transformed lives globally. But now it is difficult for frontline clinicians to innovate within the NHS.

Innovation, my Lords, cannot depend on exhausted clinicians doing research in their spare time. They need protected time, support and opportunities to develop ideas into research that improves outcomes and reduces costs. In Britain, if we want to, if. If Britain wants to remain in Innovation Nation, then it just must not simply adopt innovation, but it must drive it. And we need further clarification on promotion and rewarding of innovation in this bill. Finally, my Lords, I want to turn to Neighbourhood Health, an area about which I feel particularly strongly.

The proposed plans are welcome, but local health needs can only be truly understood if all stakeholders are involved in shaping those plans are, therefore, urged the government to ensure that the voluntary community and social enterprise organisations are closely involved in these plans and are represented on health and wellbeing boards. My Lords, this Bill can deliver modern and efficient NHS. It can create growth efficient NHS. It can create growth and prosperity in every region. and prosperity in every region.

And has the ability to tackle health inequalities. I look forward to discussing the Bill at the Committee stage and contributing to the debate and supporting the bill throughout its passage through your Lordships House. Thank.
19:48
Baroness Manzoor Portrait Baroness Manzoor (Conservative)
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My Lords, may I also take the opportunity to congratulate all noble Lords on their maiden speeches, including my noble friend Lord, saying, when he gives his. My Lords, as we have heard, the health Bill proposes major changes to the Bill proposes major changes to the NHS in England and I welcome the ambition to reduce bureaucracy and improve accountability. But successful implementation of the Bill will depend on strong, effective leadership, managing significant organisational and operational risks, whilst maintaining a clear focus on health outcomes.

Creating structural changes in key NHS organisations at the same time could create disruption. Further duplication, inefficiency, poor value for money, workforce shortages, longer waiting lists and widen health inequalities. My Lords, the Bill leaves much of the detail to secondary legislation. Therefore, can the Minister clarify which new regulation making powers will be subject to affirmative will be subject to affirmative resolution, which will use the. Negative procedure and with the Parliament will receive a clear timetable of implementation and how these reforms will improve health outcomes.

Like others, I feel strongly that any reform of NHS services should be rooted in a strong and independent consumer and patient voice. Moving patient experience functions into icbs, and local authorities create. Significant independence problems. As organisations responsible for planning and commissioning services will also be responsible for gathering and responding to criticism of those services. The recent scandals in neonatal and maternity services evidence that, and I urge the government to give this issue further thinking. My Lords, I share the ambition for a Lords, I share the ambition for a single patient.

Record, but single patient. Record, but its successful implementation has challenges which will need to be addressed effectively and transparently. These challenges range from reliable interoperability across providers, data quality, cyber security, consent, confidentiality, information governance and public trust. The bill creates powers to require NHS providers, including GPS, to disclose information for the record, but successful implementation will depend on compatible systems, reliable data and effective safeguard legislation alone cannot do this. The record should also support the reduction of health inequalities, not inadvertently widen them.

Digital exclusion, variations in access to services, and differences in the quality of data about disadvantaged and underserved communities must be addressed, so that benefits of reform reach those with the greatest health needs. As the Minister and my noble friend Lord Howe have said, patient safety and public trust is key. But combining independent safety investigations with the regulator, the CTC, which itself is in. itself is in. Difficulties, itself is in. Difficulties, creates an important tension between learning and enforcement.

HSS Eib's investigative credibility depends on independence and a just culture. CQC has regulatory and enforcement responsibilities. The legislation must preserve genuine independence, And And again, And again, I And again, I urge And again, I urge the government to give this further thought. And, my Lords, the proposed maternity and neonatal commissioner creates a particularly important accountability question in a delegated commissioning model. The commissioner will need clearly defined powers, responsibilities and resources to work effectively across the the CQC, ICB trust and professional bodies. Undertaking professional bodies.

Undertaking merely an. Annual merely an. Annual report merely an. Annual report with merely an. Annual report with no enforcement powers will not be sufficient. Finally, my Lords, these reforms will require sufficient workforce capacity, education, supervision and professional leadership. Structural reform alone will not improve health outcomes. Its success will depend on sustained investment, effective governance, reducing health inequalities, meaningful patient and professional involvement, and clear accountability for delivery. Therefore, can the Minister confirm that the government will publish a comprehensive implementation framework setting out clear responsibilities, timescales, milestones, resources and deliverables with appropriate parliamentary scrutiny for implementing.

implementing. And implementing. And delivering implementing. And delivering those?
19:53
Baroness Gerada Portrait Baroness Gerada (Crossbench)
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I'm going to restrict my short time to just one issue, something very close to my heart, which has already been touched upon by a number of Lords already today, that of continuity of care. As I said in my maiden speech not even a year ago, my very first patient as a GP was a young woman who suffered a stillbirth more than 40 years later. I look after her children and now her grandchildren. That is her grandchildren. That is continuity of care. Nothing in this bill would stop that relationship, but nothing in it will protect it either.

The bill speaks of integration of joined up information and prevention. All very welcome, but it says precious little about the one thing that evidence shows makes the biggest relationship. relationship. With relationship. With a relationship. With a clinician relationship. With a clinician who knows them. Now, the government says that the single patient record will prevent 6000 admissions a year and 20,000 A&E attendances per year. And just put that in context, that's 0.3 every day for every A&E. So one every three days.

Continue care with a named GP is associated with 5 to 10 times that figure. A patient record tells a clinician what has happened. A continuing relationship tells them what it means, and only the second is linked to reduced mortality. When I know my patient, I know what is normal for them. They trust me enough to tell me what's really going on. That is how cancer or heart disease is picked up early. Someone who knows the patient notices something has changed. Now, this isn't a nostalgic anecdote.

Repeated studies link continuity of care to lower mortality, including a recent Norwegian study of 4.5 million people published in the British Journal of General Practice. It found that those who had seen the same GP for 15 or more years were about 30% less likely to be admitted as an emergency, 30% less likely to have an urgent out-of-hours contact, and. out-of-hours contact, and. 25% out-of-hours contact, and. 25% less likely to die than those whose relationship had lasted a year or less.

My Lords, few medicines could claim that, and I think no medicine could claim that continuity saves money. Fewer repeated stories, fewer repeated tests, fewer wasted appointments and continuity works for hospitals as well. We know that, my Lords, continuity of care is the golden thread of health care. It matters not only for long term conditions, but also for those leaving living at the deep end. The lower decile in our communities, the patients with multiple illnesses, the family in crisis, the homeless and the person whose story takes years to tell in practices serving our most deprived communities.

Need is greatest and lives are more complex. So if we lives are more complex. So if we are. Serious about reducing inequalities, we must fund according to need. Access matters. But access is not continuity. A system designed solely to get someone seen quickly can make it harder consult to consult with the clinician who knows you. And continuity doesn't just happen by accident. It must be designed and resourced into the system. As highlighted by the Royal College of GPS since September 2015. And please listen to this figure.

England has 142 fewer qualified GPS than it had in 2015. At the same time, the average number of patients per GP has risen by about 12%. My average surgery before I came to this house was about 70 patients per day, which is about the number of speakers you will hear today. Meanwhile, the number of doctors working in secondary care has increased over the same period by 46%, according to the British Medical Journal Association. So I have three questions to ask the Minister.

First, will the Minister place continuity explicitly within the bill's duties on integration, prevention and reducing health inequalities? Second, will the government make the resourcing and prioritisation of continuity part of how integrated care boards are held to account? And finally, will the Minister address GP workforce inequalities that are affecting delivery of safe, relationship based care, particularly at practice in the deep end? Thank you.
19:58
Baroness Wyld Portrait Baroness Wyld (Conservative)
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My Lords. I do not doubt for one moment that the government is very well intentioned in bringing forward this Bill, and there are measures in it that I support. Like others, my worry is that it is others, my worry is that it is heavy on structural reorganization, without yet a clear sense of how patients will benefit. I do want to patients will benefit. I do want to be fair minded, and I thought that the Minister set it out very thoughtfully and actually rooted thoughtfully and actually rooted her comments in patient.

her comments in patient. Experience. So that's appreciated. But we know that structural reform does not automatically improve culture. Safety and trust are built by people. And I thought the noble Lord, Lord Winston, spoke very movingly about the way people experience healthcare, when it goes right and when it goes wrong. And we need to remember that. But my hope is genuinely that we can improve this bill to ensure that the patient's voice is not drowned out and that it genuinely improves their outcomes. This obviously applies to all patients, but in the time allowed, I want to focus on maternity and neonatal services.

As the noble Lady, the Minister said, the government has rightly identified maternity and neonatal as an urgent priority. And there are some measures in this bill that reflect that intent. As referenced by my noble friend Lady Sugg and my noble friend Lady Manzur, the commitment to bring forward an amendment to appoint a. Maternity and neonatal commissioner is one such measure. But this cannot be the sole solution. As my noble friends have said, this newly created office will need close attention as the bill progresses and we will need clarity from the noble Lady, the Minister, on the exact purpose and powers of this role.

I would just point out that it is an enormous brief, spanning maternity and neonatal. We must ensure that equal weight is given to both services, which are distinct specialisms. My worry is, my Lords, how long all of this is taking? We have to remember why I came about following the noble Lady Baroness. Baroness. Amos's Baroness. Amos's harrowing Baroness. Amos's harrowing review where people bravely came forward. The government promised a national action plan by this December. So the Commissioner is due to co-chair the task force implementing the plan.

But of course, there's going to need to be an appointment process and time for the office to be established. So we need precision, but we also need some pace. It would be helpful to know. The timetable that has been set for the appointment, and how the Minister envisages the task force making progress in the meantime. Turning to the experience of families through clause 19, as amended in the other place, this Bill places a statutory duty on Icbs to promote patient visiting and accompaniment rights. However, I stress that a parent is not a visitor.

They are partners in care. To give one example, family integrated Care is a model of neonatal care that integrates parents as equal primary caregivers for their baby, alongside clinical staff, with strong evidence that this improves outcomes. This model has been. has been. Implemented has been. Implemented very has been. Implemented very well has been. Implemented very well in units in England, but its implementation is not yet uniform. We need to look at how we can better safeguard family integrated care and indeed wider parental involvement in care as the NHS.

As the NHS undergoes this transition. My concern is that the disruption brought about by restructuring may mean that we see even more patchy provision, and this is one issue I would like to return to in committee. This should sit alongside wider efforts to improve accommodation and facilities with parents, an issue that's been raised with the noble Lady, the Minister before. And I'll just make the point that there's a lot that the government could be getting on with alongside this bill. Turning briefly to the single patient briefly to the single patient record, which many.

Have record, which many. Have welcomed, I thought it was interesting that the Minister started with this. I recognise and support the government's ambition. I'm pleased that there are prioritising maternity and indeed frailty. I hope the government has thought through how the single patient record will connect maternal health data, with neonatal records. Currently, disjointed systems create dangerous information gaps. I genuinely hope this is a vital turning point, but core to this for all patients is trust. As many others have said, my Lords, the noble Lady, the Minister is, of course, Minister for Women's Health and Maternity, and I've genuinely welcomed engaging with her on many occasions.

I do accept that the government has made some important commitments, but what is unclear to me is how effectively these are being. being. Brought being. Brought together being. Brought together in being. Brought together in a coherent programme of delivery. With over 700 recommendations across multiple inquiries for women results.
20:03
Baroness Barker Portrait Baroness Barker (Liberal Democrat)
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I want to thank all the people who have made their maiden speeches today for their contributions, which I have found most enlightening, and I welcome them to this house. Like the noble Lord, Earl Howe, I bear the scars of many, many of these bills, and with others too. But this time for me, it's different, because for the last five years I was carer for my neurological. neurological. Condition, neurological. Condition, and neurological. Condition, and she died in June. And over the past five years, I've seen the NHS at its inspirational best and its infuriating worst.

And I offer one observation of my five years. I don't think anybody should be allowed to have a senior position of leadership or management or governance of an acute trust until they have had a carer come and let them washed and dressed in the morning, and that carer will probably be somebody who's here on a visa and there will be the sponsor and therefore likely to be at risk of modern slavery. And they then have to get themselves to an appointment at their.

Hospital, appointment at their. Hospital, use it in a wheelchair, not allowed to walk and using only patient transport to get them there and get them back. And then they've got to do it again another day. Being the carer of the person in the wheelchair. Only when you've done that do you begin to understand what the statements and intentions on your website look like and how hollow they can be. The second thing I want to say is that everybody talks about care pathways. Oh yes, but you know what? I don't think many people have actually ever seen one, and fewer still know who's in charge of them.

And that's why I think we should we should be so careful about talking about this, about the patient, about the about the single patient record. It in itself will not magically transform care. What will transform care is people understanding what the purpose of that information is, whose data it is, and who is ultimately responsible for it, and various members of staff, particularly the doctors, are absolutely right. There may be four different answers to who's technically legally responsible for it.

One of somebody I know has already gone to find that out, so it's not going to be any clearer and it's not going to it's not going to help. going to help. With going to help. With patient going to help. With patient care until less and until those fundamental points are understood by absolutely everybody in the NHS. And I have to say, as a carer, the noble Lord, Lord Hunt of Kings Heath was right. The the one one, one thing that you dread when you can't get an appointment is you'll have to speak to 111 that I understand, and I really don't want to sound like I was in any way at.

All disrespectful. My wife was a very, very complex patient, one of the most complex. Packing her off to 111 was never going to do any good to anybody, and we really have to go back and look at that. I also want to say that I do think that it is important that we get all of the protocols around the single patient record. Worked, worked up in great detail with the people who have the experience to understand it. And I have a particular interest in HIV and sex and reproductive health.

People in those communities are used to living with difficult information, and they know sometimes they are more open with it than you might imagine, but perhaps not not to the people that you might think. They quite often want to go to a specialist clinic rather than to the GP, where the receptionist knows their mum. So we need to think quite carefully about what, what, what information is included at the person level. SPR with explicit, explicit consent for people to opt out, to opt out on an episodic basis.

The final thing I would say is this. I've talked these days a lot to the neurology neurological Alliance. Neurology patients know that we are on the brink of some really big discoveries in that field because of. of. Technology of. Technology and of. Technology and medicine of. Technology and medicine going on. They desperately want to be involved in research. They understand that that's the way to stop other people from suffering, and they really, really want to be assured that they can do so in a way that does not jeopardise their jeopardize their, their status, their, their confidentiality, or other people's.

And if we're going to do anything in this bill other to do anything in this bill other than rearrange the. than rearrange the. Deck than rearrange the. Deck chairs than rearrange the. Deck chairs on the NHS Titanic, then we really owe it to people to put a lot of work into consulting on how this single patient record will work.
20:08
Lord Sahota Portrait Lord Sahota (Labour)
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Thank you. Firstly, the health inequalities affecting our minority communities and secondly, the enormous and secondly, the enormous contribution made. To the National Health Service by the Commonwealth Doctors and nurses. National Health Service has always been one of our greatest institutions. It is the envy of the world, available according to need, not ability to pay. But I have to say this some people from the ethnic minority communities continues to experience inequalities in access, treatment and outcome. Some patients face language barriers, some struggle to navigate an increasingly digital health service, and others feel that their symptom or concern are not always listened to or are understood.

That is why I have some. Concern about the proposed abolition of the Health Watch. Independent patients voices are particularly important to people who may already feel marginalised, reluctant to challenge the system. I therefore ask my noble friend the Minister, as these reforms are implemented, how will the government ensure that the voices of the ethnic minority communities, particularly those who face a language, cultural or digital barrier, are not weakened but are strengthened? The proposed single patient record also presents enormous. enormous. Opportunities, enormous.

Opportunities, but enormous. Opportunities, but we must ensure that digitisation does not inadvertently, inadvertently create another barrier. Elderly patients, those with limited English and people who are not confident using digital technology, must retain the ability to access health through traditional means and to speak to human beings when they need to. In other words, face to face. My Lords, I also want this bill to provide an opportunity for us to recognise something fundamental, something fundamental about the history of the National Health Service. National Health Service could not have been.

Developed as it did without the contribution of the people from the Commonwealth. Nurses from the Caribbean, doctors from the Indian doctors, from the Indian subcontinent and other parts of the Commonwealth came to Britain in 50s, 60s and 70s and helped staff our hospitals, surgeries and community services. They often worked long and unsocial hours and served in parts of the health service, where the shortage shortage was the greatest. Many experienced discrimination, as he was highlighted by BBC. highlighted by BBC. Documentary some years ago.

Some overseas qualified professional found that their qualifications and experience were not fully recognised. Other encountered barrier to promotion and progression and some still do. But they stayed and persevered. They served their patients and helped build the National Health Service that we know it today. My cousin, Doctor Harvinder Singh Sahota, who came to UK in the 60s, was one of them and he and he eventually went down to and went on to invent perfusion balloon used in unblocking the coronary arteries. And this is what he did.

We were reminded of these doctors death very powerfully during the Covid 19 very powerfully during the Covid 19 pandemic, when ethnic. pandemic, when ethnic. Minority health care workers were disproportionately affected. Many doctors, nurses, healthcare assistants, porters and other staff lost their lives while caring for the others. We applaud them for their steadfastness. Our responsibility is now to ensure that our appreciation is demonstrated not merely through applause, but through equality and fairness in the workplace. Perhaps the greatest tribute we can pay to these Commonwealth doctors and nurses who help sustain our National Health Service is to ensure that the next generation is treated with fairness, dignity and respect that some of their.

Predecessors were sadly denied.
20:14
Lord Bird Portrait Lord Bird (Crossbench)
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I would I think I'm kind of in the middle, aren't I? I'm a crossbencher, so I should look at you and I should look at you and I should say, well, you've got things right and you've got things wrong. What I find so interesting about this debate is that it's almost like a debate that you would have when the horse has escaped and is. And you're bolting the door afterwards. I was born in the slums of Notting Hill, and after the Second World War, I was born two years before they started the National Health Service.

And when I went to school at the age of 5 in 1951, they had us doing all the exercises, and they had us doing, you know, eating, you know, drinking milk and eating those little castor oil pills. And what they were doing was they were intervening in the idea of prevention. So I'm one of those prevention. So I'm one of those from from the from the people from the people who from the people who no part of society, no political section of society has ever managed to penetrate.

Those are the people who actually will probably make up a large part of reform, who will drive us from this Parliament, who because because they because they will because they will create because they will create a different kind of political situation. Those people who feel completely neglected and left behind. I was born into the inheritors of poverty. And what was so interesting about being born into the inheritors of poverty is that you were you. You never arrived at the starting line. You only got to the starting line often late in life or never in never at all.

The thing I'm talking about is, why is it that the NHS, probably 50%. According to the BME, the BMA. Why is it that 50% of their efforts go into trying to address the problems of people born in poverty, who live in poverty and continue to live in poverty because they have inherited poverty? Why is it that we may want to make great changes in life? But unless we address the reasons why people are ill and the vast majority of people who are ill until until we until we do until we do this exercise, which we don't do, because everything today that I have heard is all about the emergency response to the problems of the NHS.

The NHS is going nowhere if it doesn't get off of its back poverty. If 50% of all the its back poverty. If 50% of all the money you. Spend money you. Spend in money you. Spend in the money you. Spend in the NHS money you. Spend in the NHS is spent, according to the BMA and according to the teachers, sorry, the. The doctors that I speak to at Addenbrooke's is poverty. Then when is the NHS going to wake up and say to society and say to the government, when are you going to allow us to do our job, which is to keep people in health when we have to spend.

to spend. So to spend. So much to spend. So much on to spend. So much on the to spend. So much on the problems created by poverty? Now, I find that extraordinary. Why are us a load of great grown up people? Loads of wise people, the best. I don't think there's anybody in this house who would not want a better NHS left, right and centre. I think you are all. And I'm sitting on the mid on the the crossbenches. And I look at you and I look at Lord Howe and what he says, his commitment to a better, a a better health service is there.

And I look at Baron, Baron Merryn Merryn, thank you very much. She is totally committed. The only problem is that you both do not agree with how you arrive at that. So we've got this uniformity, this brilliant uniformity. The unfortunate thing is that there are millions and millions of people who come from poverty, who fill up our aliens, who fill up our prisons, who fill up our streets and who fill up our Social Security. And most of those will at some stage become a.

become a. Problem become a. Problem for become a. Problem for the become a. Problem for the NHS. become a. Problem for the NHS. My brother died in a place called I forget what the place he was born

**** Possible New Speaker ****

Downing down in Canvey Island. I, I, I appreciate the noble Lords contribution, but I want to point out you spoke. Forgive me, I know. Forgive me. Anyway, I was just going to finish with my. My brother. with my. My brother. Died with my. My brother. Died in with my. My brother. Died in in with my. My brother. Died in in the NHS. Sorry. He died in the. He died in in. Canvey Island. Forgive me. I shouldn't have gone for a meal before.

Forgive me. Anyway. So he died. But he spent hundreds of thousands of pounds was spent on him because nobody ever addressed the reasons why he came from poverty. The poorest people in society are the poorest. Sorry, the

**** Possible New Speaker ****

most expensive people in society of poorest. My Lords, it's a pleasure to

**** Possible New Speaker ****

My Lords, it's a pleasure to follow the noble Lord, Lord bird, and also a challenge to maintain
20:21
Baroness Bennett of Manor Castle Portrait Baroness Bennett of Manor Castle (Green Party)
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formidable formidable and formidable and compelling contribution. Perhaps counterintuitively, I'm going to. Again, as did many early speakers in this debate, take the House back to 2012, for I was heavily involved outside Westminster, often far from Westminster, in the resistance to and reaction to the 2012 Health and Social Care Act. My early years as the leader of the Green Party of England and Wales saw me frequently at protests, at rallies, at marches at protests, at rallies, at marches opposing the changes.

Brought opposing the changes. Brought in opposing the changes. Brought in by the 2012 act. It was, as Lord Hunt of Kings Heath said, a hugely unpopular reorganisation to single out just one group. He did great work alerting the public to its damage. I'm going to mention the group, affectionately known as the Darlo for Darlington Mums, who organised the modern day Jarrow march, which I joined to highlight particularly the privatisation being hidden under the comfortable mantle of the NHS logo. I have to mantle of the NHS logo.

I have to reflect on the. Speech of Lord Winston, noting the issues created by the internal market and the focus on competition rather than compassion and care in changes made to the NHS over recent decades. That led me back to a joint comment piece by Yanis Varoufakis, John McDonald and myself in the New Statesman in 2021, which called for the restoration of a market free system that delivers care as a right, not as a commodity. It noted, rightly, that what the British love about the NHS is freedom from the market.

Back in 2015, my hon. Friend Caroline Lucas presented in The Other Place as a private member's bill. With widespread support, the NHS reinstatement Bill, of which this bill might be described as a pale imitation. Crucially, Caroline Lucas's bill allowed commercial companies to provide services only if they were essential to patient welfare, and the NHS could not do it itself. That might have been a model for this bill and I regret that it. Wasn't. So I will be seeing what I can do to amend this bill to address the continuing privatisation and financialization of our NHS.

There are many issues and so little time, although I do acknowledge the words of the noble Lady, the Minister, that a single bill cannot solve every challenge facing the NHS. I'll begin something of a shopping list that I'll be trailing through the aisles of the Committee stage. The health Bill is currently silent on. Climate and environmental matters. That matters both in mitigating damage to climate and nature and dealing in the built in damage on our nature depleted islands. The state of nature reflecting that of our public health, which is parlous.

As the noble Lord, Lord Patel outlined, healthcare in England is responsible for 4 to 5% of national carbon emissions, and around 40% of all emissions are produced by the public sector. Plastic use is enormous and not all properly dealt with. That despite the determined, innovative efforts by many in the healthcare system. And I will ask the noble Lady, the current Minister, as I have asked previous Ministers to visit the County Durham and Darlington NHS Durham and Darlington NHS Foundation. Trust to see the wonderful work made on these issues there.

They acknowledge that the environmental impact of care matters, particularly in serving a economically disadvantaged area. Much of our focus will undoubtedly be on the many issues around the single patient record, something that already exists in Taiwan, as I saw on my recent visit there. And I declare the support I received as recorded in the register for that which I'll be bringing to later discussions. Now, the right Reverend prelate, the Bishop of Newcastle, spoke on the importance of trust in the context of the single patient record, the huge public concerns about any involvement from Palantir is something I've raised in your Lordships house before, but overall sovereignty over those.

sovereignty over those. Records sovereignty over those. Records is going to be a huge issue. Not to have our records, our NHS in the hands, the tender hands of US tech bros. We must ensure that the Bill adequately acknowledges the needs of disabled people as the innovative and important contribution from the noble Lady. Baroness Campbell addressed, as indeed did Baroness Hollins. If we ensure that the NHS caters to the needs of the most vulnerable, we will build a better NHS for everyone. Now this Bill is mostly about structures, but we need to make sure those structures are dealing with issues like antimicrobial resistance.

This is something that we cannot afford to ignore. And finally, while this is not a public health bill, I'll be interested to see the amendments to which Lord Patel alluded for. There is no doubt that for the future of our NHS, we have to improve the our NHS, we have to improve the
20:26
Lord Carter of Coles Portrait Lord Carter of Coles (Labour)
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congratulating the noble Lords on their maiden speeches. They were really excellent and most interesting, and I look forward to seeing in a few moments. My Lords. Last Tuesday I visited a friend in a local hospital. It was a delight. a local hospital. It was a delight. It was shiny, modern, and she sang the praises of the NHS and she hadn't got one bad word to say. It was highly positive and it reminded me that much is superb in NHS. We should not forget that.

But the difference between. Good and bad practice is really palpable now. I think we all recognise the need for continuous reform. Probably we have to look at it every 10 or 15 years, and I think I really welcome this bill because it gives us a chance to take the next step in the modification of National Health Service. But it's going to require, as we have heard tonight, significant amendments. As it stands, it will not be effective. And I think also that the test will be will it deliver sufficient benefits to pay for the disruption that it has caused and will cause in the next two years? And I think we should not forget for one moment this is going to do little to improve care or anything else in the National Health Service for three years.

We've got three more years of challenges. As this becomes effective. Could I draw attention to my interests as recorded in the in the register? Now, my Lords, the Bill has two objectives the single patient record and the need to rationalise the NHS bureaucracy to streamline it, to get through. Frankly, neither of these are new. As a neither of these are new. As a noble Lady. Baroness. noble Lady. Baroness. Indicated that we've been on this for 20 years, Baroness Jay Thomas.

We've been on this journey for 20 years, and I really wonder if, when it comes into effect in 2025, maybe we should get ready for a sort of silver jubilee, really, to highlight the fact that we've been persistent, we've hung on to it, and it is going to make an enormous difference. This is the real cutting edge of technology. It's not going to be easy, but it's absolutely critical. Similarly, I think we've known for years we've got a delay of the NHS. If you look around the world, the characteristic of failing healthcare systems is layers and the successful systems strip them out, make those relationships very out, make those relationships very clear between the.

clear between the. Commissioners, the people who actually deliver the care and the regulators. And it's got to be absolutely clear. And that's what we need to do. But of course, we perhaps we should ask ourselves, what's the problem we're trying to solve? And a little look at where we stand today may be a good starting point. Patients, if you speak to patients, as I did the other day in the system, they're pretty grateful. They're very grateful to the staff for everybody what people are doing. I think people are grateful for the investment where they can see it.

And if they were to think about it, I think they're grateful for the fact it's free at the point of delivery. We should never forget that. By contrast, if you aren't in the system, it's pretty miserable. You're one of 7 million people You're one of 7 million people waiting for. Treatment and you can't see a GP. So if people are in pain, if they're waiting, they're anxious, they can't go to work. And also, my Lords, they're disappointed. This is not the NHS we were promised next.

The staff, well, they're not happy either. If you talk to HR professionals, they'll tell us that bullying, harassment, high sickness levels are indicators of a dysfunctional workforce. My Lords, we have the workforce. My Lords, we have the highest in the. World. And finally, my Lords, the money. Where's the money gone? This is the key. In the last 7 or 8 years, real per capita expenditure in England on the NHS is up 14%. That's £650 per person, right? But output's down. So money up output down is quite an achievement.

Now, if you compare that to Denmark, real per capita expenditure in those years has risen 1%. So there's some lesson out there. We're clearly not doing things right. So look we are where we are. We need this bill to go through. So just quickly to the Minister. The key points are patient choice. That is the best guarantee of actually people meeting those standards. Of course. I totally subscribe to Health Watch, and I agree with the noble Lady, Baroness Coffee. We need to actually make it work better on staff.

The key issue and really the issue here is management. The management needs to be sorted out and I hope the bill will make it clear later on about the Minister, the Secretary of State taking powers to herself to intervene directly. We need a better solution than that, and we need clarity so people can get on with it. And finally, my Lords, the money. Will the Minister comment on the fact we should scrap block funding beloved of the Treasury because they can deal it out.

But actually, really the handmade of inefficiency and what we need is a return to tariff so that people are paid for what they do, innovate. So I look forward to supporting the bill. It's a great chance to take this forward, and it presents an amazing opportunity.
20:31
Baroness Maclean of Redditch Portrait Baroness Maclean of Redditch (Conservative)
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My Lords, I would like to raise >> My Lords, I would like to raise two key issues. First, many noble Lords have spoken about the single patient record, which appears to me patient record, which appears to me to be laudable and sensible, but it isn't enough. If I may explain, around 25 years ago, I had a breast scan that showed an abnormality and I went to see consultant Ian Paterson at Spire Parkway Hospital in Solihull, a private hospital. The only time in my life I actually had private health care.

I had a minor op, but nearly two decades later it emerged that I was one of his many victims. My OP had been unnecessary. He practiced across the NHS and the independent sector. And like many thousands of women across the West Midlands, I put my faith in him to heal me and I was fortunate compared with many others. Some women were totally mutilated. Their breasts were removed without any justification. It's awful. And they've had to wait years to find out the truth about their operations and treatment.

But he isn't the only rogue surgeon. For example, at Great Ormond Street, an independent review found that 94 children suffered harm attributable, attributable attributable to the surgeon Yasir Jabbar. The Paterson inquiry reported in 2020. And its first recommendation was a single repository covering consultants whole practice across the NHS and the independent sector. And it hasn't been implemented and I can't see any plans for it in it for it in this bill. And I hope noble Lords can see that that does serve a different purpose to the proposed single patient record, and without it, more criminal doctors could fall through the cracks.

May I pay tribute to Deborah Douglas, who chairs Breast Friends Solihull? She's campaigned assiduously for the inquiry and she's helped so many other victims. Turning to the second key point I would like to raise, and that's protecting vulnerable young people within the area of gender medicine. Children distressed about their gender deserve compassionate, evidence based care and rigorous safeguards. And as we know, this isn't always what happens on the ground. The scandal at Welby N, which was an NHS GP practice in Brighton, found an independent patient safety investigation, found inappropriate prescribing of puberty blockers and cross-sex hormones to 78 children, some without even a face to face consultation.

Potential harm and serious failures of clinical governance were found. It was totally shocking and these young children and their families were badly let down. This was happening within an NHS practice, but outside that nationally commissioned specialist pathway. And that again, adds weight to the argument that I've made about having oversight and governance of clinicians working across different settings. So the NHS needs to be able to quickly flag up where this is happening and put a stop to it, because after all, the NHS will be there.

It has to pick up the pieces when things go wrong in private clinics, or even for treatments that people have abroad. So the test for the government in this bill is that similar failures such as these will be quickly identified, and those doctors stop before more patients come can be harmed. And I want to also raise in this context, the support for young adolescents and young people who have had gender reassignment surgery and who now regret having undergone that life altering surgical treatment.

And they want to detransition. The Cass review recommended provision for these patients. And yet the written answer to the question I table says that consultation for a service will only begin in the autumn of 2027, and presumably, services are still a few years beyond that. It's much too long for young people to wait who've already been through so much, and we don't have reliable figures for how many this affects. And many struggle, of course, to come forward. Some detransitioners describe shame and rejection by communities they previously felt part of and been supported by.

They do need help now. So could the Minister say where will this Detransition service fit into the new structures? My Lords, I welcome this Bill. I want to help make it stronger. But of course, patients need independent voices, effective oversight and timely action when things go wrong.
20:36
Baroness Martin of Brockley Portrait Baroness Martin of Brockley (Labour)
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It sounds like I'm. >> Not alone in welcoming this bill. Many of its ambitions, not least the single patient record, are the ones I strongly support. Done well, ones I strongly support. Done well, the SPR will transform patient care, streamline decision making, and help realise the potential of the UK's incredible health data. So I'm delighted that this government has grasping the nettle and getting on with it. The SPR help helps to pave the way to use technology and specifically AI more effectively to spot disease earlier, to personalize treatment and to help people stay well for longer.

I'd like us all to think more ambitiously about AI in health and across our public services. But today, I want to focus my remarks on two opportunities created by this bill that can help support our economy. The first is research. Commercial clinical trials are a crucial feature of our health system. Just this morning, I was at the Oak Cancer Centre at the Royal Marsden, where they're researching and testing cutting edge treatments, which will improve survival rates and can transform the quality of life of cancer patients.

Research by the AP by Frontier Economics in 2022 alone. Industry clinical trials generated £7.4 billion worth of GVA for the UK economy and created 65,000 jobs. The bill rightly places a new duty on the Secretary of State to promote innovation, but it's essential that this duty at the top translates into delivery on the ground. That's why we need robust accountability mechanisms to ensure Icbs build real capacity for clinical trial infrastructure. So I ask my noble Minister, how will the Secretary of State work with Icbs to deliver on this vital duty? Now, the second opportunity is how we use health spending to help grow our economy.

Health is one of the largest areas of public spending in this country. How that money is spent is one of the most powerful levers the government possesses to support innovation, back UK entrepreneurs and create good jobs in every part of the country. The Prime Minister understands this. At the Innovation Summit in Manchester on Friday, he was clear that this government will, in his words, make British public procurement work harder. Indeed, the First Secretary of State has already taken welcome steps to reform central government procurement rules and through the Life Sciences Sector Plan and DC's SME Action Plan.

The direction of travel is clear, but my concern is whether this bill does enough to support the government's goal to use procurement to strengthen our economy. Now, as I've discovered over several increasingly acronym heavy weeks, health procurement is pretty complicated. But the thing that is clear is that this bill transfers vast commissioning responsibilities from NHS England to icbs. The DHS own figures show that Icbs will control around 93% of NHS healthcare commissioning budgets. That's about £179 billion in the next financial year alone.

That represents huge purchasing power. So I ask my noble friend, the Minister, in correspondence, whether Icbs fall within the government's own SME procurement targets. I am grateful for her reply, but sadly it confirms that they do not. And that's not only that's not the only area where there's a risk of a mismatch between rhetoric and action. When asked if the DHSc would encourage contracts for the single patient record to be awarded to UK firms, they said this was a matter for the Cabinet Office and that they're taking a, in their words, supplier agnostic approach.

Now I understand and totally respect the importance of open competition. But if our flagship health technology programme can't be used to back homegrown innovation, what can. So I ask my noble friend the Minister, will the Department consider a system wide stocktake of how health, commissioning and procurement can better support your enterprise and innovation, so that this House and the public can see where the opportunities lie and how we can realise them. My Lords, both points come down to a single principle turning ambition into delivery.

This government has set out bold goals for an innovative, innovative NHS and for public procurement that drives British growth. I support both wholeheartedly, and I look forward to working constructively with my noble friend to help make them happen.
20:40
Lord Hampton Portrait Lord Hampton (Crossbench)
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That's fantastic. debate because, unlike the veterans of many of the previous bills, I know very little about the subject, apart from a vague agreement that the NHS is an extraordinarily good thing. Then I read a briefing from the Royal College of Pediatricians and Child Health with some serious concerns. And as you can imagine, as a secondary school teacher, I got quite involved. The r, c, p, c h have concerns and I quote, children remain largely invisible in this bill and the wider NHS reforms, which has been mentioned by several noble peers.

This is echoed by one cancer voice who are concerned at the loss of specialist cancer capacity and expertise, which would particularly affect children and young people. Now, my Lords, I did a word search on the bill. The word children appears 20 times, but only in previous children's acts, and the word child appears once in a sentence on child abuse. That's not much. Now I wonder, could the Minister tell us why children do not appear as a distinct group? I remember this issue we had with the a few years ago with the Victims and Prisoners bill, where we had a real struggle differentiating children and adults as victims.

Children and young people often experience long waits for treatment, which is particularly critical in the young. According. Again to the RCH. In community health, 25% of children waiting more than a year, compared with 1% of adults. There also needs to be better reporting on waiting times and outcomes for the young, whilst the Milburn Report talks about how inequalities start before birth, a point made very, very powerfully by my noble friend Lord bird, we need meaningful statutory targets to reduce health inequalities.

At the moment, my Lord. Another interesting mine is training and skills. Now a shout out for the mod, which is the biggest provider of all types of apprenticeships in the UK, with its roughly 200,000 employees. Now it's difficult to compare like with like, but with the NHS and its 1.5 million employees, and I know that there have been all sorts of issues with apprenticeships in the NHS, but given the opportunities for social mobility, given the Neet crisis, I would like the Minister to take the opportunity of this Bill to commit the NHS to become the biggest provider of apprenticeships and formal training in the country.

Now there's a legacy.

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Bill focuses more on structural change and less on patient outcomes. When patients share confidential information with their GP, they don't expect companies, politicians don't expect companies, politicians or others to access it. Yet. That is what would be facilitated by the is what would be facilitated by the single centralised patient record. I would like to hear more about how the government is going to preserve the confidentiality of patient information. This bill pushes centralisation and hands the Secretary of State power over day to day decisions of the NHS, which would slow down local responsiveness as the minister's decisions are awaited.

And what about the patient outcomes? In May 2010, 2.3 million patients awaited 2.6 million NHS England hospital appointments by July 2024, 6.4 million patients were waiting for 7.6 million hospital appointments, currently, 6.21 million patients await 7.33 million appointments and the waiting list has increased for the third time in the last four months. Can the Minister explain why the bill has no targets for reducing NHS queues? The rich can have medical treatment whenever they want.

The rest pay with their lives. In August 2023, from a small sample, the then shadow Chancellor, Rachel Reeves, estimated that 120,695 people a year died while waiting for hospital appointment from a much larger sample. The times estimated that 300,000 people a year died while waiting for hospital treatment. Yet there is no official data published to show the number of lives are sacrificed to appease the gods of fiscal rules, bond markets, austerity, low wages and and poverty.

Can the Minister explain why that is the case? As methodology for estimating the number of deaths clearly exists and has been used by very senior politicians? This bill does not expand the NHS capacity. The UK has 2.4 NHS beds per 1000 people, compared to 12.6 in Japan, 7.7 in Germany, 6.6 in Austria, 5.4 in France and the OECD average is 4.2. Homerton University Hospital NHS Foundation Trust has 0.9 hospital beds per 1000 people, less than the average for Mexico.

Bedfordshire Hospitals NHS Foundation Trust has 1.7 beds per 1000 people, about the same as in Colombia. People are dying prematurely. Can the Minister give a commitment as to when the government will hit the OECD average? This bill facilitates further privatisation of the NHS during the Second Reading and Report stage in the Commons, MPs asked questions particularly about clause ten and the possibilities of further privatisation. The government did not respond. Can the Minister now respond, please, and explain what the long term plan is? All too often, Ministers say that the NHS will continue to be funded from the public purse and will be free at the point of delivery, but remain silent about what happens between the two points.

We have seen cataract surgery, knee and hip replacements, blood tests, scans, physiotherapy and many other services handed to the private sector. The NHS is fast becoming a shell, doling out contracts to the private sector. Some £12 billion worth of contracts have been handed to private operators in 2023, 24 and 2425, generating 1.6 billion profit for those private operators, which inevitably means there is less available for other frontline services. Cataract surgery has a profit margin of 32% to 43%.

Most of the profits from private operators are booked in offshore tax havens, and the UK taxes are dodged altogether. Yet I see nothing whatsoever in this bill or anywhere on how to deal with that. So can the Minister explain how the government will stop creeping privatisation of the NHS and privatisation of the NHS and profiteering from it? My Lords, I rise with. rise with.
20:49
Lord Singh of Solihull Portrait Lord Singh of Solihull (Conservative)
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Gratitude, humiliation and I must confess some astonishment. I came to Britain at the age of 30, with three £1 coins and a job offer. The fact that I am standing here says something remarkable about British democracy. I thank the noble Baroness Falkner and my noble friend, Lord godson, for supporting me during my introduction, and as the other Lords who are giving their maiden speeches have said, Black Rod doorkeepers, clerks have been unfailingly courteous and kind to a new and nervous member, being a fifth in the maiden speech makes it seem like a mature reflection rather than a maiden speech.

But here I am. I come from very modest background. Neither of my parents went to school. My grandfather, who died in 1948, scarcely believed that India had been ruled by some people called white. My father, when he was nine, left home because the family could no longer feed him. He sought refuge in a Sikh temple, taught himself for languages and wrote several books. He poured his meagre earnings into educating his children from his life. I learned that our beginnings do not have to determine where we end up.

My Kashmiri Sikh clan has faced violent displacement across generations. My first experience of ethnic violence was 1984 killings of Sikhs that followed Mrs. Gandhi's assassination. I was training to be a surgeon. I channeled my distress into running a small clinic for affected children. There was a boy who used to occasionally go up to the roof of high rise apartments and threaten to jump unless his father's killers were caught and punished. I would have to talk him down.

Later, his skin would burst out with blisters. How does mental trauma become a sign on the skin? That is the question that drew me into psychiatry. My mother was horrified. She was worried that I would catch mental illness. My father had a different worry. A surgeon is a catch. Who would marry a psychiatrist. 30 years later. Nearly 30 years later, I went with a BBC team to look for that boy. He. We couldn't find him. We were told that he had taken his own life, but we met others who were in their 40s who used to come to our clinic as children.

They had rebuilt their lives. We speak often of post-traumatic stress, but there is also post-traumatic growth. People don't just survive trauma. They can learn from it. They adapt, they grow. They can even flourish. And that's the belief with which I started early intervention in psychosis, getting young people's trajectory from a serious illness back to normal life. Like the recent ADHD review shows, a diagnosis is just a description of difficulties. It need not become a prophecy for the future.

With other colleagues, we developed early intervention, which are now admired internationally. Which brings me to the bill. Before your Lordships, we've heard about the importance of continuity. I. I did some work showing that when young people turn 18 from child to adult services, they come to a cliff edge with a precipitous drop in care. A young person turns 18 overnight. Their needs do not change overnight. They don't have to tell their story all over again. So this ambition for a single patient record is a very good one.

We produced a tool that helps young people navigate the transition from child to adult services. It works, but as others have mentioned, we need a safe guards and make sure that it's implemented in a way that implemented in a way that confidentiality is maintained. I. Have worked in countries where mentally ill are still chained and incarcerated, so I realise how precious our NHS is. I'm a critical friend of the NHS. There's much to improve, but something very precious to protect.

So my Lords, I finish where I began in 1927. A hungry nine year old boy sought refuge in a temple. Today, 99 years later, his son stands before you. 1984 children taught him that despite adversity, lives can be rebuilt. That's what I hope to bring to this House a respect for evidence, faith in education, compassion for suffering, and a firm conviction that circumstances, adversity or diagnosis should not set limits to human life.
20:55
Baroness Cash Portrait Baroness Cash (Conservative)
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Yeah. to. to. >> Follow my noble friend Lord Singh, and I congratulate all noble Lords who have given maiden speech Lords who have given maiden speech today. But I particularly want to welcome him to our benches and to welcome him to our benches and to explain we've heard about his intelligence and his phenomenal career in psychiatry, but he's very typically humble and hasn't described his true character of kindness and humility and the fact that he really is a true radical, because when he sees an intractable problem and when he sees received wisdom, he does not hesitate to challenge it, which is why he pioneered treatment of psychosis, which was really one of the greatest mental health reforms since the era of deinstitutionalization, and that his work with young people in the 16 to 24 year old bracket has kept people off the streets and many of them from suicide.

It's, again groundbreaking. But perhaps the greatest courage of all he has shown in challenging another received wisdom that treatment in psychiatry was racist and at great personal cost to himself. He undertook a massive piece of research, a study in all of the studies to date, to find that the evidence simply wasn't there. And he did that first because it was an intractable issue, but secondly, because he was worried that young people of colour and young black people were not coming forward to seek the treatment they needed.

So at no small cost to himself, he put them first. Yet again. He has enormous expertise in health, and I know he's going to bring great wealth to these benches. My Lords, return them to the bill. It's late. We've had a lot of comment on different aspects of the bill. I want to focus on inequality with my Shadow Minister hat on in respect of the inequalities that are not addressed by the Bill as it currently is drafted. The NHS still fails in too many respects to treat patients equally or safely as required by law.

There are too many failures to record data accurately, and it worries me enormously that while welcoming a single patient record, we still at the moment don't record things accurately and have not done the work needed to fix that before embarking on what is really a major change. With all the risks that other noble Lords have raised today, the Bill represents an important opportunity to do something about it, but the record must be consistent and reliable to ensure patient safety for both sexes.

Women are 50% more likely to be misdiagnosed after a heart attack because the textbook symptoms are male. British Heart Foundation estimates the cost of that to be more than 8000 women losing their lives over a decade. Screening for aortic aneurysm depends on knowing if someone is male. Osteoporosis in men goes undiagnosed because it is assumed to be a woman's disease, drug doses, side effects, reference ranges, and screening calls all run off sex data. There is a reason why every major research funder in this country now requires studies to account for sex.

And yet, it's only in the wake of the Sullivan Review that the former Secretary of State, Wes Streeting, accepted that we should record biological sex data on patient safety grounds. But it's just not good enough, my Lords, that this protection exists as merely an administrative standard. Revisable at any time. This Bill is an opportunity to make the requirements statutory and the same accuracy should apply to ethnicity. The NHS is still recording ethnicity against categories drawn from the 2001 census.

Even then, the Nuffield Trust found recording to be incomplete, inconsistent and least reliable for the patients it most needs to count. Black women are almost three times more likely than white women to die during or after pregnancy, the parliamentary inquiry into sickle cell care found avoidable deaths and serious failures in hospital care services can't be planned, costed or audited on data of this quality. Equal treatment begins with being seen. We need sex recorded as fact and ethnicity recorded as the patient states that in current census categories.

And then there's physical safety. Between January 2019 and October 2022, police forces in England and Wales recorded more than 6500 rapes and sexual assaults in hospitals 33 a week, 1 in 7 on a ward, barely 4% leading to a charge. Those figures, established by the Women's Rights Network report, written by Professor Jo Phoenix. The law is clear. The Supreme Court has confirmed it. The statutory code of practice about single sex, meaning biological sex is in force and the requirement for single sex spaces.

But the NHS is still failing to implement that judgment. Sadly, Peggy, the Darlington nurses, these women should not need tribunals to secure a safe changing room. There could not be stronger arguments for the need to mandate in statute the provision of single sex spaces. Women and children or the disabled should not be at risk of rape or sexual assault because hospitals are ignoring the law, and patients and staff should be safe and dignified in single sex wards, changing rooms and bathrooms, there's accountability attached to all of this, and I haven't addressed yet the issue of children and the elderly.

There is so much about this bill in respect of how we treat people equally. Before the law in the some of the most vulnerable times of their life, and I look forward to working constructively with the government through the passage of this bill to address these.
21:01
Lord Londesborough Portrait Lord Londesborough (Crossbench)
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Very good. >> Very good. >> It's a pleasure, as speaker 59 of 70, to have had the privilege to of 70, to have had the privilege to witness no fewer than five very fine maiden speeches, and I must salute Lord Singh of Solihull for his perseverance, having to sit patiently through over 50 contributions before he's been allowed to stand up to make his stunning debut. Welcome to the house, my Lords. This is a critical and complex piece of legislation and though well intended, there are some potentially very serious gaps.

There always are. When you reorganise and reverse structures. I will focus on the proposed neighborhood health plans and clause 25 specifically, which I feel has considerable scope to be strengthened. But first, I should acknowledge that I'm not a health care expert. I'm better known in this place for speaking about our economy, our entrepreneurship, my background, and the disturbing state of our public finances on which, of course, NHS funding depends. My Lords, three years ago I tabled an oral question on our treatment of migraines and the impact on the workforce.

There are 10 million migraine sufferers in the UK and I am one. I was astounded to discover that this was the first time this House had debated this condition since 1962. Despite its £10 billion annual impact on the economy. That in impact on the economy. That in itself tells you something. This and follow up questions have brought me into contact with the Migraine Trust and the wider neurological Alliance, representing the 1 in 6 of our population suffering from conditions such as epilepsy, dementia, Parkinson's and Tourette syndrome, as well as migraine.

And here we're talking about a £96 billion annual cost to the UK economy, of which at least £30 billion is potentially avoidable. So as a patient, stakeholder and employer, I have become increasingly concerned about the huge gaps in our health care system. For those people living with long term, complex or fluctuating conditions. To illustrate, let me refer back to migraines, where we have 5 to 6 million sufferers in the UK still lacking a diagnosis, while less than a third of those who do have a diagnosis are receiving any form of specialist care.

Many have to see a GP or I should say GPS six times before they're diagnosed. While huge and fast growing numbers end up in A&E, representing another inefficient drain on our health resources. The result, my Lords, is that we as a nation lose 55 million working days worth of productivity every year at a cost of 5 to £10 billion, and that is just for the condition of migraines. Now, this sort of data is critical when you come to examine how the neighborhood health plans under clause 25 of this bill will function and operate and, crucially, be held accountable for for performance, for its these NHS that will be tasked with identifying how the assessed needs of persons with long term, complex or fluctuating health conditions, including neurological conditions, are to be met.

Which raises the question what will be the measurable objectives and data sets for improving access, coordination, experience and outcomes, and for reducing unwarranted regional variations? Currently, there appears to be no explicit recognition of complex and fluctuating conditions in the Neighbourhood Plan guidance. This appears to be a serious omission. Can the Minister please comment? Can I also ask the Minister whether statutory guidance would explicitly cover neurological conditions and coordination across primary, community and specialist pathways? These questions become all the more pertinent if we lack a clear and fully funded home for the national neurological leadership.

That's a point that the noble Lady, Baroness Lehman, made in relation to autism and ADHD. My Lords, the risk is that health, devolution, restructuring, reorganisation, whatever you want to call it, may disrupt joined up care and actually weaken accountability, especially if NPS fail to efficiently and promptly connect people with complex conditions to highly

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specialist services. I approach this.

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Bill from a public health and prevention of ill health perspective because of my work in perspective because of my work in the House. Firstly, children's health and wellbeing, an aspect of prevention to which this government prevention to which this government is committed. I will be joining Baroness Cass and others in Baroness Cass and others in questioning how this Bill will improve the future health of our children through greater
21:07
Baroness Walmsley Portrait Baroness Walmsley (Liberal Democrat)
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accountability for child health, spend and outcomes. The abolition spend and outcomes. The abolition of NHS e the return of many of its duties to the Department and the Secretary of State, and Secretary of State, and commissioning of services to the Icbs when they are being merged and boundaries changed, is a major reorganisation to be the reorganisation to be the same time as reducing costs by 50%. Very dangerous, my Lords. I will be seeking to establish how this reorganisation will actually improve our health, especially that of children.

Clause four is crucial and it needs to be strengthened and widened. It specifies the Secretary of State's duty to have regard to the need to reduce inequalities in both access to health services and health outcomes. Not good enough, my Lords. My recent work chairing committees is very relevant to this clear duty. In 2024, I chaired the food, Diet and Obesity Committee, and the Labour Government has responded positively to many of our recommendations. I'm currently chairing the Childhood Vaccination Rates Committee and I hope for a similar result.

The committee will report early next month. While I cannot reveal our recommendations, I can reflect on the public evidence the committee has heard and how it relates to this specific duty of the Secretary of State. The evidence to both committees was clear about the magnitude of health inequality in our country. We heard evidence about the drivers of this inequality and its relationship to ill health, quality of life, life expectancy and cost to the NHS and the economy, unequal access to affordable, nutritious food, the ubiquity of cheap, poor quality food, and the advertising power of large food companies were shown to be barriers to poorer demographic groups maintaining a healthy weight.

How will the Secretary of State work across government to address these barriers? The vaccination committee has heard that there are several interconnected drivers to low coverage, resulting in wide differences in the rates of vaccinations received by different groups. This has led to preventable ill health, hospital admissions and deaths, as well as additional costs. I am hopeful that under clause four, the new Secretary of State will be as open to adopting our recommendations about vaccination as her predecessor was about taking action on healthy food.

I therefore ask the Minister, how will this duty be carried out? Will there be a regular report to Parliament about what actions her department has taken to reduce health inequalities, such as by improving and equalising access to health services, reducing obesity and increasing coverage of vaccination against preventable diseases? Will the Secretary of State report on the outcomes of these actions? Will there be specific inequalities, targets against which the department, the Icbs and health service providers will be held to account? How will the targets be arrived at, monitored and enforced, and what will be the principles on which funding is allocated? Clause seven changes The Secretary of State duties around training from maintaining an effective education and training system, to also ensuring there are sufficient appropriately trained staff to meet NHS workforce needs.

I can say no more than this evidence is emerging that staff shortages such as of health visitors, GPS, nurses and midwives are affecting vaccination at various levels in the system. Time pressures mean that health professionals cannot answer patients questions, and the training in how to do so effectively is deficient. Training must include how to communicate empathetically with patients to enable them to make informed decisions. This will be a specific challenge under clause seven. Evidence is already emerging that the transfer of commissioning is causing confusion, decreasing morale and risks, the loss of local knowledge of communities, which is so crucial in responding appropriately to variation in vaccine coverage.

So I ask the Minister how the government will ensure that the skills and knowledge currently found amongst NHS staff will be retained, and whether crucial budget lines will be protected. Who will monitor the performance of Icbs and hold them

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to account, and what is the system of quality assurance? Prime Minister.

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Prime Minister. Is right to focus his government on people and place, and to encourage collaboration across the encourage collaboration across the sectors, but the practical details really matter. If you review this bill alongside the Government's bill alongside the Government's neighbourhood Framework, NHS England's published position on the role of the voluntary community and role of the voluntary community and social enterprise sector, guidance on the wider determinants of health
21:12
Lord Mawson Portrait Lord Mawson (Crossbench)
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and recent NHS Confederation and Community health partnerships on neighbourhood health and estate neighbourhood health and estate optimisation. This bill, whilst containing some helpful provisions, does not translate the stated shift does not translate the stated shift from sickness to prevention into sufficiently clear duties, sufficiently clear duties, financial commitments or reporting requirements. My colleagues and I, in our working lives, are involved in our working lives, are involved in building with private and public sector partners the new integrated health infrastructure across the country at place.

That is going to be crucial if we are ever going to get beyond the fine words of countless politicians on all sides and get upstream into the prevention agenda, I declare my interests in the modern world. Health is everybody's business. The present biomedical model is creating a profound dependency culture across the country and is totally unaffordable going forward. Some of us are being practical and attempting to plant in the ground the seeds of these new, more joined up communities so many talk about.

But the challenge is to do it, not to talk about it. My Lords, now, in the real world, large parts of the public sector are restructuring, so everyone is looking for a new job. And here we have yet another restructure of the NHS, with another government in danger of restructuring parts of the restructuring that is already taking place. Collaboration, yes, but not chaos. We need to be practical. There is likely to be another election before any of this settles down and can properly function.

If you want to deliver, beware of the danger of too many moving parts. My Lords, for practitioners like me who are trying to be helpful in the real world, it's often like trying to build a house on the sand. So what do we make of this bill? I invite the government to consider six practical measures measures that will save money. First, the neighborhood health plans should be required to address the wider determinants of health, including housing, employment, education, skills, food security, transport, digital inclusion, the environment, loneliness and social connection.

This should not displace the responsibilities of local government, but it should require the NHS to recognise how these factors affect demand and to identify where joint action would improve health. Secondly, each ICB and its partner local authorities should be required to establish a published mechanism for meaningful, meaningful VCS participation in neighbourhood planning. There are. There are limits to what the state can achieve. This should include involvement in assessing needs and opportunities, designing responses, identifying underserved groups, and reviewing outcomes.

It must mean participation before decisions are made, not consultation after the principle decisions have already been settled. Thirdly, every neighbourhood health plan should be informed by proportionate social capital and community assets audit. This should identify local, voluntary and faith organisations, trusted networks, existing preventive preventative services, public and community buildings. Formerly void NHS space and is spent annually on NHS empty voids in buildings at a time when many community organisations face prohibitive accommodation costs, particularly in London and other cities.

Despite delivering low cost activities that address isolation. Fourthly, icbs should be required to identify transparently what they spend on prevention and community capacity. Fifthly, smaller community organisations need proportionate routes to funding multi-year grants, simplified agreements and collaborative commissioning arrangements should be available where continuity and local trust are central to the effectiveness of an intervention. Sixthly. The Bill should introduce a board, a broader public value or best value assessment for preventative investment. The social and business sectors may be cheaper than the public sector.

None of these proposals diminishes the importance of clinical services. On the contrary, they are intended to protect those services by reducing avoidable demand and enabling people to remain healthier and more independent. My Lords, neighbourhood health must mean more than healthcare delivered nearer home. It must mean creating health within neighbourhoods, supporting individual agency and recognising the local organisations that sustain wellbeing long before statutory services are required. My question to the Minister is what is the government going to do about the £90 million that is wasted on empty rooms in NHS buildings? Are they going to do deals with the voluntary charity and social enterprise sectors and open up these spaces?
21:18
Lord Rooker Portrait Lord Rooker (Labour)
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My Lords, I. >> Congratulate the maidens. We're a rich nation that allows citizens to miss out on scientific advances. to miss out on scientific advances. We're not good at preventative medicine, in particular micronutrients. I've checked the micronutrients. I've checked the latest nutrition survey. There are many losers, but in the main they are women of childbearing age. I give two examples. Iodine girls aged 11 to 18 and women of childbearing age 16 to 49 are below the threshold. Good levels are required during pregnancy and are vital for brain formation.

Secondly, folate, vitamin B9 in women of childbearing age, the figure for low folate was 83%. Folate is crucial to helping prevent neural tube defects in early pregnancy. The neural tube, which forms the spine and brain, closes at 27 days after conception, when many women do not know they are pregnant. Half the pregnancies are unplanned, so it's vital that folate status is improved before pregnancy. It is disastrous that governments and so-called independent scientific advisory committees have ignored the 1991 Medical Research Committee vitamin study, which demonstrated the connection so clearly between neural tube defects and folate deficiency.

The new policy of fortification of flour agreed by the previous government, implemented by the current government, required a change in the bread and flour regulations in January 2025. This means the UK will catch up next year with over 80 countries which operate mandatory fortification. The USA adopted mandatory fortification in 1998 and fortifies wheat flour, corn flour and rice in December 2015. In a paper by Morris J, K et al. An open access in the abstract, it said if the USA levels of folic acid fortification from 1998 onwards had been adopted in the UK, an estimated 2014 fewer neural tube pregnancies would have occurred, the writers concluded.

Failure to implement folic acid fortification in the UK has caused and continues to cause, avoidable terminations of pregnancy, stillbirths, neonatal deaths and permanent serious disability in surviving children. Since 2015, there has continued to be around 150 to 200 live births per year and 800 terminations. Following the 20 week scan, the non-economic costs to women and their families is monumental distress. In financial terms, the impact assessment covers a range of situations and conditions, but generally the lifetime costs of a neural tube deficiency live birth are in excess of £2 million.

There are strong grounds for an inquiry as to why this policy was delayed. For decades, the Scientific Committee on Nutrition has over the years, when over 80 nations were fortified on the basis of UK research from 1991, put barrier after barrier to adopting the policy. Following a debate on a bill on the 8th of July 2016, the then Minister, Lord prior, wrote to me in a negative way on Scotland's behalf. I passed the letter to Lord Turnberg, a leading medic now retired from the House, and he wrote to the Minister and I include just one sentence quote in summary, your advisers, that's the committee, seem to have ignored much of the scientific evidence that leads to the opposite conclusion, to the one they have reached, unquote, in the BMJ in 2024.

Nicholas Wald, who led the MRC study in 1991, quoted, amongst others, sir Harry Burns, the former Scottish Chief Medical Officer, on the new policy, quote imagine you have a wound requiring five stitches to prevent infection or further harm, and yet you're informed only one stitch will be administered, while admitting it will close 20% of the wound. You're told to be content with one stitch because it's better than nothing and a good start, unquote. So the new UK policy from January 27th is one stitch fortification.

Nick Wald, who Ministers and officials refused to talk to and always have done, quoted in the same article. It is not enough. It will result in more deaths and birth defects every year that could have been prevented. So I think there's a powerful case for an inquiry into the issue of the failure of professional duty in respect of public health policy, that we start to adopt a policy half heartedly, decades after other countries followed the UK research.
21:23
Baroness Kidron Portrait Baroness Kidron (Crossbench)
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I feel I should start by >> I feel I should start by declaring that I have a son who's a senior senior civil servant in the Department of Health and Social Department of Health and Social Care, and also that I'm not a health expert. So both he and the House will be pleased to know that my comments are entirely about the question of data. The UK holds one of the worst, the world's most valuable research assets in its health data.

Yet we risk both underusing and undervaluing it. Only this morning, 30 medical researchers wrote to me about their Health Data Research Service, a significant investment that promises to enable approved researchers to access UK health data safely and securely. These researchers, echoing concerns from NHS trusts, charities and the private sector, described a current environment with a fragmented data set, burdensome approvals, lengthy delays, sometimes requiring permissions for each data set. And they also suggested that these proposals come after research proposals in the ten year health plan, the life Sciences Sector plan, the industrial strategy plans and plans that span departments and commitments from other arm's length bodies.

So how the data is saved and secured and shared is material. Better access could transform UK research, discovery and growth. As the noble Lady Baroness Martin powerfully set out. But our health data is not only underused, but it's also undervalued. During the data use and Access bill I proposed with the support of my noble friend Lord Tarasenko, a sovereign data asset class with NHS data. A prime example since that time, contracts and memoranda of understanding have been signed with Palantir, open AI, Microsoft and Anthropic, each involving access to aspects of data held in trust for the public, including that in the NHS.

The controversy over Palantir usefully illustrates worries of vendor lock in, excessive access to UK data sets and products that under-deliver or cost too much. But my concern is more fundamental we're spending hundreds of millions of pounds on technology that creates capability elsewhere. Why not use the expenditure on that scale to build sovereign capability of our own? We are an enormous purchaser of technology. Government procurement could, should mean, should not mean accepting whatever the market offers in health or anywhere else.

It should establish purpose, contractual conditions, data standards and privacy, and help create capability that we retain here in the UK. My third point of concern is about inquest data. Coroners identify patterns where systems have failed, catastrophically. Taken together, their prevention of future death reports could provide a valuable resource for public health research, identifying emerging risks and preventable deaths. Yet unlike Canada and Australia, the UK has no systematic means of collecting and accessing them.

Doctor Georgia Richards, of King's College London, has set up the national coronial database to gather evidence. Her her Herculean task could become an effective system of prevention, public health and address the inequality that the bill sets at its heart. And I do hope the government will support an amendment to collect coronial report systematically. It is a small measure with enormous consequences and with with enormous consequences. My Lords, finally, I want to briefly talk about emerging forms of data neurotechnology, including consumer devices capable of reading brain activity, are developing rapidly.

According to Unesco, global private investment increased 22 fold between 2010 and 2020, reaching approximately $7.3 billion annually. Harry Lambert, a barrister founder of the center for Neurotechnology and Law, has written a series of fantastic articles in the new Law Journal about technology that we once associated with science fiction, but is already here. It. It offers enormous opportunities for healthcare, but without swift action risks a dystopian future with unprecedented threats to privacy and freedom of thought.

My Lords, improving access to health data, retaining its value for the public, learning systematically from preventable death reports, and updating the law for emerging technologies would ease frustration, prevent harm and create opportunity for the UK.
21:29
Baroness Lister of Burtersett Portrait Baroness Lister of Burtersett (Labour)
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Clear in its child poverty strategy that tackling child poverty is at the heart of its health mission and its ambition to raise the healthiest generation of children ever. The size of the challenge is underlined by the Royal College of Paediatrics and Child Health. Most indicators of children's health and wellbeing show a worsening situation or stalled progress, with children in deprived areas experiencing the poorest outcomes. It is therefore welcome that the Child Poverty Strategy states that addressing healthcare inequity is at the heart of the ten year health plan, and it refers to a new statutory duty to improve health and reduce health inequalities.

Yet despite the government's laudable commitment to tackling health inequalities and its understanding of the importance of this to its child poverty strategy, as we have heard, such a statutory duty to take action is conspicuous by its absence in this key piece of health legislation. In the Commons, Minister Smith reiterated that reducing health inequalities remains a priority for this government, but she did not give a very convincing explanation as to why simple empowerment to treat this as a priority is sufficient.

In contrast to Health Equals Coalition, supported by a wide range of organisations, including a number of the Royal Colleges, argued that a statutory duty is essential if the Bill is to provide the legislative framework to enact the ten year health plan, and that it is key to the preventative approach emphasised by my noble friend Lord Rabidoux, and that Minister Smith herself prayed in aid when opposing an amendment that would have required a cross-government health inequalities strategy. My Lords, an important dimension of health and other inequalities is the difficulties faced by marginalised groups such as homeless people, in making their voices heard, the government have taken important steps to address this.

For instance, through the co-production of the Tims Pip review and the ongoing engagement with parents and children in poverty in the development and implementation of the child poverty Strategy. In a foreword to the strategy, some of the parents involved in changing realities wrote, our involvement in this strategy has strengthened our

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belief that lasting solutions Policies. Are shaped with. People, not just for them. It's

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People, not just for them. It's just disappointing that the homeless and inclusion health charity pathway warned that the bill goes in the opposite direction in removing independent oversight in removing independent oversight of the NHS and failing to ensure Icbs seek the views of inclusion Icbs seek the views of inclusion health groups. The government had given an assurance that a new arrangement will ensure that the experience of seldom heard groups and diverse communities inform service design and delivery, thereby contributing to a reduction in inequalities.

But once again, there are no statutory provisions in. The Bill could therefore, my noble friend the Minister, explain what mechanisms are proposed to ensure that the views of seldom heard groups are able to inform service design and delivery. It was encouraging that a report. Stage in the Commons. There was a commitment to look at this issue again with members in both houses. That could. Again, my noble friend, tell us what is now being proposed on this. My Lords, one group vulnerable to poverty and ill health are carers who we have heard about.

Yet there is no statutory duty for Icbs to identify carers and there is no coordinated approach to carers support across the NHS. I therefore support carers UK's call for a clear duty to be placed on ICB to identify unpaid carers and ensure records are of them, are kept. In conclusion, my Lords, given the government's clear commitment to reducing health inequalities and to raising the healthiest generation of children ever, not least as an important element in its child poverty strategy, I hope it will be open to strengthening the Bill to make a reality of these commitments, as called for in many of the helpful briefings we have received.
21:33
Baroness Shawcross-Wolfson Portrait Baroness Shawcross-Wolfson (Conservative)
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My Lords. We have. >> My Lords. We have. >> Before us an. >> Enormous bill that upends the functioning of the NHS. We are less than six months away from the abolition of NHS England, and we do not yet have clarity on the future operating arrangements. On operating arrangements. On September 8th, the Secretary of State promised to update Parliament shortly on next steps, but this has not yet happened. Parliament and much more importantly, NHS staff are still in the dark. In the words of the NHS Alliance, there is an urgent need to resolve the division of responsibilities and to clarify the future role of the National Centre, NHS regions and ICB.

So I'd be grateful if the noble Baroness, the Minister, could tell us when this update will come. My Lords, I raise my concerns from the moral low ground in government. I saw the reorganisations brought about by the Health and Social Care Act 2012 and the Health and Care Act of 2022. On both occasions, I believe we underestimated the wider cost of reform, and I fear that this government is falling into the same trap. Of course, there is the financial cost. NHS England's accounts show more than £530 million on exit packages in 2020 526 alone, but even more difficult to manage as the noble Lord, Lord Scriven reminded us, is the frictional cost of change.

Uncertainty means talented people leave, decisions are paused, capacity is lost. And finally, there is the opportunity cost, the dilution of leadership bandwidth. To borrow a phrase from my noble friend Earl Howe. What else could this ministerial time and official energy have delivered? Take the NHS workforce plan originally promised for 2025, then spring 2026. In June, Ministers promised publication imminently. Now, we are told, will be updated on the publication timetable in the usual way in due course. My Lords, we have gone from imminent publication to no date for even announcing a date for publication.

But clause seven of this bill makes the Secretary of State entirely responsible for workforce planning and training, and workforce should be at the heart of any reorganisation. So again, I'd be very grateful if the noble Baroness, the Minister, could tell us when this workforce plan will be published. My Lords, while this Bill promises local responsibility, it also significantly expands ministerial powers, as other noble Lords have pointed out. Indeed, the noble Lord, Lord Hunt of Kings Heath and my noble friend Baroness Coffey welcomed more direct ministerial control.

Now I have great regard for the current Secretary of State. I also have great regard for the Secretary of State who introduced the bill and for the Secretary of State, who took it through Second Reading. In the other place, the noble Baroness. The Minister would, I'm sure, profess confidence in every future Secretary of State appointed by her government. But as the noble Lord, Lord Stevens reminded us, no one in your Lordships House could honestly say they would trust the judgment of any and every Secretary of State appointed by any and every future administration.

So we must debate that whether checks and balances are needed to temper these new powers. Let me give you three examples. Clause ten allows the Secretary of State to pursue changes in the public private provider balance, if they consider it to be in the interests of the health service, not in the interests of patients in the interests of the health service. Now, it could potentially be used to significantly increase private provision, as the noble Lord Nordzucker pointed out, or it could be used to significantly reduce it.

The clause requires no consultation, no published explanation, and no parliamentary approval. My Lords, are we really comfortable giving any and every future Secretary of State that power? Clause 11 allows the Secretary of State to direct integrated care boards even when they are performing well. No failure needs to be established and no appeals process is being created. My Lords, if the government wanted a top down NHS, I could understand this approach. But the noble Baroness, the Minister, told us the government's aim is to ensure decisions are made as close to the community as possible.

So why create this power without safeguards to prevent its misuse in the future? Finally, clause 52 establishes the framework for a single patient record. I am a passionate supporter of this proposal, but supporting the SPR cannot mean leaving crucial design choices to this or a future Secretary of State. I echo other noble Lords who asked how will sensitive mental health and sexual health data be recorded? Who will be liable if errors occur? What security protections are necessary? These questions, and many more remain unanswered in this bill.

Future regulations may require approval, but they cannot be amended, and arrangements set out in guidance will receive even less parliamentary scrutiny. Given the enormous risks of bringing together such sensitive information, Parliament should settle the basic protections. Now, my Lords, its in all of our interests for this reorganisation to deliver for patients. And I know the noble Baroness. The Minister will work constructively with this House to improve the Bill. I very much hope that we'll be able to agree that the test for any new ministerial power is not whether we trust those who would hold it today, but whether we would entrust it to

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those we'd oppose tomorrow. Yeah.

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Yeah. Clare. My interests. I'm patron of the Wheelchair Alliance. I support the Hughes Law campaign. I'm a member of the APPG for spinal cord injuries, and I'd like to thank the Spinal Injuries Association for their work. My Association for their work. My husband had a spinal cord injury 40 years ago, and I've made many friends once they've had an injury. But a few years ago, a non-disabled But a few years ago, a non-disabled friend had a traumatic injury and it would start to see how some services had changed and not for the better.

My experience of the NHS as a patient has generally been excellent, but over the summer I
21:39
Baroness Grey-Thompson Portrait Baroness Grey-Thompson (Crossbench)
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was quite unwell and had two stays in hospital. There was currently an ongoing discussion about the treatment I did, and possibly more treatment I did, and possibly more importantly, did not receive a top line summary. I was asked three times why I had a wheelchair beside times why I had a wheelchair beside my bed. My notes are quite clear. I'm paralysed. Specialist dressings had to be brought in from home. The had to be brought in from home. The district nurse was able to order them.

I could even get them on next day delivery, but they were not available on the ward. And earlier, the noble Lord, Lord Winston, explained how he was able to intervene to help somebody. That is not the norm. Worryingly, I was also asked why I didn't tell them I sat in your Lordships chamber. This should not impact my care and it's not OK. This bill should improve integration, reduce bureaucracy and strengthen patient care. And with patient safety not just being simplified as the impact assessment states, but improved.

We cannot lose national expertise, clinical standards and accountability upon which patients with rare and complex conditions depend. Spinal cord injury services require highly trained multidisciplinary teams, specialist rehab facilities, and coordinated care pathways extending well beyond individual integrated care boundaries. I am concerned that we could be preparing individuals to be looked after by the care industry rather than developing independence. The bill envisages transferring further specialised commissioning responsibilities to integrated care boards and retain national service specifications and clinical policies, supported by seven offices for pan ICB commissioning.

The question we must answer is how consistently the National Service Specification, which currently exists and covers children and adults, will be maintained and enforced under the proposed arrangements. National standards are only effective if there are clear mechanisms for monitoring compliance and addressing failures. The Spinal Injuries Association, working with the APPG on spinal cord injury clinicians and patients have raised concerns about the potential fragmentation of services, geographical inequalities and the sustainability of specialist centres. These concerns require careful examination before further commissioning responsibilities are transferred.

So will His Majesty's Government publish a service specific impact assessment before transferring responsibility for spinal cord injury services, including the implications for patient outcomes, workforce capacity, specialist centres and geographical access. How will the offices for the Pan ICB commissioning be held accountable for maintaining national standards? Who will intervene when commissioning decisions result in unacceptable regional variation? Will the government commit to publishing comparable national data on access to specialist rehabilitation, waiting times, capacity and patient outcomes? So there is possible to assess whether these reforms are delivering equitable care.

Specialist charities and voluntary organisations provide essential peer support, advocacy and practical assistance with rehabilitation, housing, employment and independent living. And the single patient record has been raised many times. The benefits and protections have been outlined, but will include mechanisms subject to explicit patient consent and appropriate data protection safeguards. Specifically, to improve referrals and connections to these specialist organisations. Who owns the data and how it be used needs to be transparent, so it can't be used against patients in any future insurance schemes.

My Lords, the central issue is not simply where commissioning responsibility sits, but whether the new arrangements can demonstrate that national standards are maintained. Specialist expertise is protected and patients receive equitable access to care, and I look forward to examining this further in committee.

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It was. Very good to hear Baroness Campbell in her own voice, and it Campbell in her own voice, and it was a real privilege to hear five excellent maiden speeches. I welcome this bill, which I believe will protect and strengthen our NHS as it is modernised, made more accountable and with more innovation. I fully support the innovation. I fully support the abolition of the NHS, which I believe should never have been there in the first place. And I
21:43
Baroness Royall of Blaisdon Portrait Baroness Royall of Blaisdon (Labour)
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think it's clearly ludicrous that one arm lengths, one arm's length body should be responsible for nearly one tenth of the economy. That cannot be right. I am That cannot be right. I am concerned, however, about the disruption of more reorganisation and job cuts on an overstretched and job cuts on an overstretched workforce, whilst understanding the need for Icbs to take on many more responsibilities. There appears to responsibilities. There appears to be a misalignment with the recent cost reduction requirement to reduce the ICB headcount by 50%.

More, not fewer skills are necessary, including in driving innovation. The close link between the NHS and mayoral strategic authorities is welcome, but I don't think that one representative on each ICB is enough. I would be grateful for an assurance from my noble friend, the Minister, that ICB will have the necessary capacity to deliver at local level, and that implementation of the Bill will not delay the development and delivery of health priorities. The proposed reforms to NHS structures and employment arrangements could leave some healthcare professionals without consistent statutory employment protections.

When services are reorganised. Successful reform depends on retaining the specialist expertise, experience and commitment of its workforce. This is particularly concerning to smaller, specialist professions where workforce stability is particularly important. Restructuring must support staff and must not hinder their ability to care. One health priority is the implementation of the government's very welcome commitment to universal access to fracture liaison services, which will reduce unnecessary hospital admissions. And I support the noble Lord, Lord black and everything, he said. As is so often the case, it is those already facing disadvantage who suffer most.

The UK's health inequalities are wider than ever. The gulf in life expectancy between the most and least deprived parts of England is now 19.4 years for men and 20.3 years for females. As the Health and Social Care Committee in the Commons recommended, this bill presents an opportunity to strengthen the duties on the Secretary of State and other Ministers to reduce inequalities through cross-government action. My Lords, silo working does not deliver equality. Such changes should ensure consistent duties across central and local government, ensuring the necessary balance between prevention and healthcare.

Supporting the strategic shift, which is central to the ten year health plan and devolution agenda. Many noble friends have spoken of inequalities. I hope that we will be able to make progress in this House on this. Remembering that prevention and inequality are inextricably linked. My Lords men face huge inequalities when it comes to the diagnosis and treatment of prostate cancer, the most common cancer in the UK. There's a stark north south divide when it comes to PSA blood tests to check for early warning signs, and there's a postcode lottery on early diagnosis.

Those living in areas of high deprivation are 29% more likely to find out that they have prostate cancer. When it's already spread. The disease kills one man every 45 minutes in the UK, but many of these deaths are preventable. So I will be tabling an amendment requiring the Secretary of State to lay before Parliament. A prostate cancer early detection implementation plan, including a funding assessment service specification, workforce implications and an equality impact assessment. My Lords, much has been said about the single patient long in gestation, which is much needed.

I will get to that at Committee stage, but I would say that I believe that the independence of a strong voice voice, patient voice is vital. The link between citizens and their local Healthwatch organisations is invaluable. It's a bridge between people and what can feel like an alien system. I acknowledge that the current system is wanting, but reform, not abolition, is the answer. We should build on the excellent example of Healthwatch Leeds, which demonstrates the power of the local voice. I would ask the government to work with local councils to develop an improved model.

My Lords, I end by saying that I agree with all noble Lords who said that the test of this Bill will be. If it can be trusted to deliver for the patients in this country in the future, whoever may be in power.

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Yes. My Lords. This has been. A wide ranging debate with

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A wide ranging debate with excellent contributions from across the House, and I particularly want to pay tribute to the high quality to pay tribute to the high quality maiden speeches from Lord Wormald, Lord Smith of Ranmore, Lord Singh of Solihull, Baroness Lowe of of Solihull, Baroness Lowe of Armley and Lord Jabour and I look forward to working with them on forward to working with them on this bill and beyond. And I'd also like to thank my noble friend Baroness Barker, for describing her very real experience of being a carer and navigating the health service with her wife.

Anyone who has had any interaction with the National Health Service knows that it is creaking at the seams. People are struggling to get GP appointments. Access to NHS dentists is impossible in many
21:48
Baroness Pidgeon Portrait Baroness Pidgeon (Liberal Democrat)
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parts of the country, and people are waiting for hours and hours are waiting for hours and hours waiting for care in our stretched A&E departments and the shocking state of our maternity services. We state of our maternity services. We have discussed many times in this chamber. The country is crying out for change in our health service for change in our health service and this bill does bring changes, but mostly structural changes. This but mostly structural changes. This bill will do nothing in the short term to improve patient experience and outcomes.

As Lord Carter of Coles highlighted, and as the King's Fund rightly has pointed out and mentioned by my noble friend Lord Scriven, and I quote, evidence from previous reorganisations suggests structural reform alone rarely improves care unless it is clearly connected to practical changes in services. Now the narrative from the government is about neighbourhoods, and I welcome neighbourhood health plans in the Bill. But plans and rhetoric are not enough. The money has got to follow. If we are to deliver services at the most appropriate level, centred around patients and their needs, not simply for the convenience of the Commissioner and the large trusts.

We on these benches believe that a primary care investment standard should be on the face of the Bill to increase spending on primary care services. To support this shift to neighbourhood health. And as the Royal College of General Practitioners has pointed out, and I quote, the current system focuses too much on hospitals and not enough on general practice. This has led to the proportion of the NHS budget spent on general practice falling to its lowest point in at least ten years.

This is not sustainable. As I've raised several times in this House, there are around 600,000 people waiting for hospital appointments. Many of these could easily be dealt with on the high street locally if they were commissioned. Basic services were just universal and genuine. Patient choice was supported. And as I see bees develop their commissioning roles, it would be helpful to understand the level of basic foundation services that everyone should have a right to wherever they live. It's a concern Baroness Redfern also raised, and my noble friend Baroness Janke raised, the important role of community pharmacies as another part of primary care.

Primary care must be fully at the table with Icbs if neighbourhood health is to truly work and this needs to change in the bill. Continuity of care is crucial. As Baroness Gerada set out. But as we've heard loudly and clearly, there are serious concerns with the abolition of NHS England that the Secretary of State will become the decision maker in micro decisions throughout the NHS. A politician getting involved in decisions which are for management. Government needs to remain strategic and not operational, blurring the distinction between day to day NHS management and political accountability is not going to end well.

That is why the new operating model needs to be published as soon as possible. Clearly setting out the responsibilities of the Secretary of State, the Department and Icbs so that we are able to better scrutinise the bill. Perhaps the noble Lady, the Minister, can advise when we might see this important model, and so many charities I have met are concerned about specialist commissioning and the capacity and capability of icbs in this area. Too often nice guidelines are being ignored and there are concerns this may also happen with nice recommendations with delays in implementation.

The Bill is an opportunity to strengthen confidence in access to innovation and strengthen implementation of Nice recommendations across the NHS. I hope the government will support amendments in this area, but charities are also concerned about the potential loss of central clinical expertise. How will the Minister ensure that sufficient expert clinical roles and expertise are incorporated into the department? Beyond the five cross-cutting national priority programmes? Diabetes is one such area as outlined by my noble friend Lord Rennard, and we've heard a number of other important health matters raised today, such as public health and vaccinations from my noble friend Baroness Walmsley, the need to reduce inequalities in mortality for people with a learning disability and autistic people.

From my noble friend Lord Scriven and also raised by Baroness Holland, and the issue of unpaid carers, including respite care from my noble friend Baroness Tyler and also raised by Baroness Lister and my noble friend Baroness Leman, talked about the impact of these structural changes on those with ADHD and autism. Important issues to consider as we scrutinise the Bill, as well as Baroness Cass and others flagging the absence of children and young people. But the Bill as it currently stands, plans to abolish Healthwatch England and local Healthwatch.

Stripping away the independent patient voice. For over 50 years there has been a statutory, independent, patient voice in the health and social care system and this needs to continue. The government has confirmed it is reviewing this part of the Bill, and I hope they will remove this section and go further and strengthen Healthwatch organisations across the country. You know, we have received report after report of failings in the health service. Patients often will not take action even when they've experienced poor health care, as they fear it's going to impact their ongoing treatment.

That is why we need an independent, patient voice to listen to patient feedback, expose challenges and to drive change locally. And other noble Lords have supported this today, including Lord Hunt of Kings Heath, Baroness Jay, Lord Patel, Baroness Lowe, who made a passionate speech outlining what was happening in Leeds, Lord Patel and many, many others. The Healthwatch organisations I've spoken to and heard from have been effective in working with local communities and being able to bring to health and care organisations any concerns or wider issues that need to be addressed.

This can't be done by an internal team in a trust or council. We await from the government some movement on this ahead of Committee stage. And then let's talk about safety. The health services safety investigations body. It was established to investigate specific cases or incidents of severe harm to produce lessons rather than blame. Rather like the model used for aviation and rail safety investigations. And it established the safe space model in law to encourage disclosures from professionals without fear of sanction.

So the decision to scrap SIB is a major concern and it's fraught with risk. A trusted and efficient safety investigation process is the best way of restoring trust, learning from system failure and preventing costly public inquiries. And Doctor Tim Meek, president of the Association of Anaesthetists, has said, and I quote, it is vital that each SIB remains its retains its complete independence from the NHS, the organisation that it is principally tasked to investigate. This lesson has been learned in other high stakes industries and we should take note.

We hope the government will reconsider this proposal. Putting this as part of the CQC will not be acceptable to anyone, as has been expressed clearly by noble Lords today, including Baroness Watkins of Tavistock. Now, maternity services have rightly been a focus and I know are a real concern to the Minister. Recent figures show that 75% of the public are concerned about hospital birth standards. Following recent safety inspection ratings. Women are overwhelmingly worried, with 79% expressing anxiety over maternity care, especially given that not one NHS maternity unit in England has an outstanding safety rating and two thirds of units have been flagged as unsafe.

We want to see 24 over seven consultants on every maternity ward and 1 to 1 midwifery care, and to drive the change, we need a maternity commissioner with the right resources and powers to make change happen. The government has indicated that it will support this proposal, and we hope that we can move forward to drive the change that is needed for women and babies. Perhaps the noble Lady, the Minister, can clarify how the role will sit with the National Maternity and Neonatal Task Force, and what powers the commissioner will have to ensure the change that is needed.

The Liberal Democrats welcome the move to create a single patient record. This is potentially the only bit of the bill that could transform patient experience and outcomes. People are tired of having to repeat their medical histories countless times to different medical and other professionals. And of course, patient harm can occur when clinicians have not had a patient's full medical history. However, as has been highlighted by noble Lords, this must come alongside new privacy protections and safeguards for patients.

Patients do not want their health data sold and used. There are challenges in developing the single patient record, and we look forward to working with others to ensure safeguards are in place that enable this development in a safe way. Data security and patient trust must be at the core, and Baroness Kidron set out some of the real key concerns around data in this area. Now, my noble friend Lord Foster of Bath had hoped to speak in this debate, but unfortunately he's got Covid.

I think it must be going around. I know he has a particular concern about the current levels of medical support, not least mental health support for prisoners both in prison and when they leave, and has questions about how the new arrangements will improve the situation. So I hope the noble Lady, the Minister, will agree to meet my noble friend to discuss this issue and maybe with Lord Bradley as well, who's also raised concerns today on that point. The one glaring omission from this bill is social care.

We have a crisis. The new Prime Minister recognises this crisis. Fixing social care is crucial to enabling our health service to function better. Better support for the frail and vulnerable is essential. There is the opportunity, whilst we consider this bill, to look at enabling options to help speed up delivering on social care. I hope the government will consider this as the bill progresses. So to conclude, in so many ways, it's easy to constantly look at the structure of the NHS and government after government have played with this time and time again.

But in my view, the key is to get services out of hospitals, into local communities and high streets centred around the patient. Shifting resources to primary and community care, which helps with the preventative agenda and also frees up hospitals to do what they do best. So will this bill make a difference to patient care? Will it strengthen the patient voice? Will it improve patient safety and reduce bureaucracy? These are the measures of success. And we on these benches will put forward amendments to improve safety services and most

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importantly, outcomes for patients. Hear, hear.

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Hear, hear. My Lords, can I begin by thanking the noble Lady, the Minister, for the way she introduced the bill, and to all introduced the bill, and to all noble Lords who spoke in this debate for reasons which noble Lords will understand. I will not name them all, but I was name them all, but I was particularly touched by the speech by the noble Lady, Lady Campbell of Surbiton, in her own voice, thanks Surbiton, in her own voice, thanks to AI, and also moved by the speech of the noble Lady, Lady Barker, in sharing her personal sad experience, and the maiden speeches from the noble Lord, Lord Jabbar, who spoke of the need for accountability.

The noble Lady Lowe of Armley, who shamed her, shared her experience with Touchstone in Leeds and the importance of the independent patient voice and the noble Lord, Lord Wormald, with whom I worked when I was a health Minister, and the noble Lord Smith, who spoke of the importance of a healthy diet, and my noble friend Lord Singh of Solihull, who humbly shared a hint of his considerable experience in psychiatry. Each maiden speech demonstrated experience and wisdom that we can look forward to in future debates.

If it's any reassurance to those noble Lords. I also still wonder what I'm doing here. And frankly, if I go over my speaking time, I fear many noble Lords will ask the same question. But before I go further, I should declare my interests as a professor of politics and international
22:01
Lord Kamall Portrait Lord Kamall (Conservative)
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relations at Saint Mary's University in Twickenham, where I recently taught an MBA course on healthcare policy, and I am also helping them with their new medical school. My Lords, does my noble school. My Lords, does my noble friend and Earl Howe said we on these benches support removing the unnecessary duplication of functions between NHS England and DHS as most noble to do. But as we have heard from noble Lord, Lord have heard from noble Lord, Lord Stevens and others, the reorganisation was announced without any clear idea of the costs and benefits.

So my first question to the noble leader, Minister, can the Minister tell the House when these costs and benefits will be explicitly published, and when will the operational model that the noble Lady, Lady Pidgeon referred to, when will that be published? So we can have a clearer idea of how this new world will work? My Lords, I do not doubt the government's good intentions, but legislation must be judged not on intentions, but on whether it improves the patient experience and health outcomes.

This means listening to patients when they tell us something is wrong and ensuring that those changes, those those warnings, result in change. That is precisely why an independent, patient voice matters, as noble Lords have said, Healthwatch provide that independent, patient, voice gathering experiences of patients and communities and ensuring that they are heard by those that are responsible. They speak truth to power. Now, while not perfect, an independent patient voice help health should not be seen as simply measuring satisfaction.

It warns of failures in the quality and safety of care, but it also raises flags for others to look at. And if you look at the volumes or the values of of from NHS resolution in compensation, in terms of billions behind every of those figures are patients and families whose lives have been profoundly changed and sadly, in many cases scarred and will take many years, if ever, to recover. But the government's proposals to bring those that patient voice in-house and to integrated care boards and local authorities does raise important questions about independence.

Now I understand the reasons for returning powers to Ministers, but if those responsible for the system are also responsible for gathering criticism of it, how can Ministers get guarantee that patients will have the same confidence to speak candidly, especially those also maybe from more deprived or difficult communities who don't often get the chance to speak to those in power? And given that the Prime Minister, when Mayor of Greater Manchester, wrote to the Secretary of State warning that devolved dissolving Healthwatch would risk losing an independent and trusted patient voice, I do wonder what conversations are ongoing within the new government on proceeding with its abolition.

Similarly, we share the noble Lord Lord Hunt's concerns about proposals to abolish independent health governors. They provide an important role in accountability, and we have to think very carefully about what happens if you remove that level of accountability. That question of independence leads to the proposed abolition of the health service safety investigations body and transferring its functions to CQC, who performs a different but equally important function investigating patient safety concerns, not to apportion blame or liability, not to point fingers, but to understand systemic failures and prevent them from happening again.

Its investigations operate within statutory confidentiality. Confidentiality protections. Now, Ministers have offered reassurance about maintaining autonomy, but legitimate questions remain. Will patients, families and healthcare professionals have the same confidence in the safe space principle? When the investigating body sits within the regulator? And how will its genuine independence be protected? These are questions that need to be answered. And, frankly, is the CQC able and competent to take on these functions? During the Mental Health Bill, these benches supported the government on resisting calls for an independent mental health commissioner, instead supporting beefing up the CQC capacity on mental health.

However, as the noble Lord, Lord Brady remarked, it's interesting that the government has since decided to establish an independent maternity commissioner rather than ask the Patient Safety Commissioner or to seek to take on that role. And even more recently, I and other noble Lords have repeatedly tried to engage with the CQC on concerns that many healthcare providers have over the CQC understanding of, and their ability to regulate sports and public events. And to be frank, I have not been impressed and I do not say this lightly, but I currently have no confidence in the CQC to regulate these events, and it's worth noting that the widely respected incoming chair of the QC, Baroness Neuberger, told the Health and Social Care Committee only last month that the CQC was not currently a trusted and respected regulator.

So given that assessment, what evidence can the Minister point to that demonstrates that the CQC is ready to take on the responsibilities currently held by him? My Lords, the objective should be fewer safety failures, not fewer safety organisations. A number of noble Lords have heard and perhaps repeated the mantra that you cannot solve healthcare until you fix social care. So we welcome the Prime Minister's commitment to bring forward the case review. But I'm sure noble Lords will want to probe the government further on its plans for social care.

During the spill, my Lords, like many other noble Lords, we support in principle the single patient record. As I found to my frustration when I was a health Minister. Patient information remains unconnected across different parts of the health and care system. The government itself notes that the clinicians can be left working with an incomplete picture, while patients find themselves repeatedly given the same medical history. A proper, proper, a properly implemented single patient record could be transformative, giving clinicians access to the right information at the right time, improving continuity of care, supporting early intervention and ultimately improving patient safety.

But that does not mean that we give the government a blank check on this, because there remain legitimate questions. Noble Lords may be aware of questions of what can be described as why are medical staff who access patient records after national scandals, even though they had no medical reason to do so? Or the senior consultant reported in the Guardian recently, who accessed an inappropriately shared the medical information of her ex-boyfriend's current girlfriend. This begs the question of who will be able to access and edit a patient's record.

How will patients know who has access their records? And in addition, how can inaccurate information be corrected and what additional safeguards will protect particularly sensitive information? I was contacted by a lady who found that notes from her psychotherapy at a South London trust, including correspondence about her concerns about a GP practice, were available through the London care record, including to the practice, about which she complained that she'd been previously assured that this would not happen and she had to pause a therapy after discovering this.

So we are not against a single patient record. In fact, we are in favour of it. But there has to be the right safeguards and different parts of the NHS continue to use different systems. Indeed, the government acknowledges this and so we have to look at their system of interoperability. While patients will benefit from a single patient record, they must have confidence that the most sensitive information they provide will remain properly protected. Otherwise, we risk creating a health service which is better in sharing information, but in which patients have less confidence.

My Lords, we discussed the reforms in the context of an ageing population, increased demand for health and care, a decline in people paying into the system relative to those who take out and public skepticism about immigration to replace our aging workforce and taxpayers. We have more doctors and nurses than ever before, but we need more capacity. The former health and care secretary Wes Streeting recognises and thought AI could be the solution. But what are patients doing? They are turning to independent healthcare providers and this is not new.

My father's membership of the Transport and General Workers Union included treatment for him and my mother at the Independent Manor House hospital. Today, trade unions offer private health insurance on health plans or or health plans as part of their membership package. In seeking to increase the capacity supply of supply of healthcare, is there a way that we can work together across the political divide on an increased role for non-state providers to complement the NHS, especially healthcare mutuals such as Benenden healthcare charities, friendly societies, co-operatives, social enterprises, non-profit private providers and, where appropriate, private providers.

If and where appropriate in this bill, I hope we can agree to increase independent healthcare capacity to complement, not replace, the National Health Service. And this will, of course, include appropriate access to the single patient record and appropriate safeguards. My Lords, these benches accept that reform may deliver savings, yet we await a timeline and proper cost benefit analysis. Removing unnecessary duplication, improving productivity and making better use of technology are objectives that we support. But the measure of successful reform is whether taxpayers receive value and patients receive better care.

The prize is considerable, but so too is the responsibility. These benches will be constructive in our approach. Where the government makes a clear case, we will support them. Where we have concerns, we will challenge and scrutinise, and we will work together with noble Lords across the House to deliver a Bill that enables a better system of healthcare for patients, no matter where they live or whatever their background.
22:11
Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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My Lords, I'm very grateful for the contributions from all sides of the contributions from all sides of the House. It has to. To put it mildly, been wide ranging, informative and challenging, as I would expect. And I would ask for the understanding of noble Lords that in the time that I have got available to me will not allow me to answer every point that has been made and answer every question, and indeed more will doubtlessly be unanswered than answered.

But I can say that I restate my commitment to work with noble Lords as the Bill progresses, and we will revisit many of the topics in the weeks to come. And I will also reflect on the points that are made, particularly those that are not within the remit of the bill, because I think a number of points that were raised were extremely helpful. I would just make the general point that not every matter that's been raised, as I know, noble Lords are aware, are ones for primary legislation or indeed unnecessarily matters for this bill.

And I blame not one noble Lord for taking the opportunity again, as I would expect, and we should also resist the urge, I think, to do something here in legislation where there are other means that could achieve the same outcome as is usual in terms of legislation. So it's quite a lot of health warnings there. But I particularly want to thank the noble Lords who brought their professional experience and also their personal experience of them themselves, or those who are near and dear to them.

And that was a number of noble Lords, but it included the noble Lady, Baroness McLean, my noble friend, Lord Winston, the noble Lord, Lord bird, the noble Lady, Baroness Barker, the noble Lady, Baroness Grey-Thompson, and the noble Lord, Lord Scriven. Because in all of these ways our personal experiences absolutely informs where we. What the way in which we see the way forward. And I also wish to associate myself with the. Congratulations on five excellent maiden speeches from my noble friend Lord Jabbar, my noble friend, Baroness Low, the noble Lord, Lord Wormald, and my noble friend Lord Smith, and the noble Lord, Lord Singh.

And I would associate myself with many of the points made by our new colleagues, including that where we start doesn't determine where we have to end up. That resonates very much with me, as does. We should be proud of those who work in public service, and indeed, we are. So I would say to our five new colleagues, we are absolutely blessed to have you all join us in your Lordships House, and we very much look forward to hearing more from you.

And a number of points have been made about where the National Health Service is at present, and I do think it's important just to make a few comments. I have welcomed those who have acknowledged the improvements that we've made, and also the position that we started from. But let me say, as of March this year, we met the interim target of 65% of patients who are waiting up to 18 weeks. When we were nowhere near that just over two years ago, and we will go further.

I would also add that patient satisfaction is rising. When I was previously a health Minister in the last Labour government, it was at its highest and sadly went to its lowest. We are rebuilding that and I am glad about the improvement. And similarly, if I look at the summer, June, July and August, and noble Lords will know the extra pressure of the heat waves that were experienced. A record 4.7 million plus treatments, procedures and appointments were carried out.

That's more than any previous summer. I'd be very happy to bore your Lordships house, if that's what it does to your Lordships House. With more evidence of the upward trajectory. But I do think it's only fair not to talk down the NHS where we have improvements. And I'm glad that so many noble Lords did actually acknowledge that. So let me run through some of the points that were raised, and I was most grateful for, I'll call it broad support for the bill.

And there were many supporters, including my noble friend Lord Hunt and Baroness Thornton, who both set out better than I would do, and so I do not need to repeat it. Actually, the impact of previous legislation and previous changes to the structure of the NHS. And we also. I also heard support from the noble Lady Baroness and the noble Lady, Baroness Neville Rolfe, amongst others. I have heard the argument that much of this could be done without legislation.

I would suggest that it's far better for the law to reflect the reality of the system that we want, one that has clear roles and responsibilities and, of course, to make the point, as many noble Lords have supported the abolition of NHS England, that cannot be abolished without primary legislation. With regard to transition arrangements and points were raised by the noble Lady, Baroness Gerada, the noble Lady, Baroness Wyld, the noble Lord, Lord Scriven, amongst others. We are committed to transparency and parliamentary scrutiny throughout this entire process and we will continue to publish updates and revised impact assessments, and we will expect to be held to account.

As I know, noble Lords would expect to hold us to account. There are strong arrangements in place to monitor delivery, including oversight of workforce risks, knowledge transfer and service continuity, and these changes are not distracting from our focus on performance. And I understand why that concern was raised, as I understand the reasons that all of the concerns that were raised today, and I know we will work through them all. But this summer, as I mentioned, has been the busiest in the history of the NHS.

And yet more patients than ever before have been seen within four hours in A&E this summer, despite record demand. With regard to costs and savings and benefits, particularly raised by the noble Lords Earl Howe and the noble Lord, Lord Stevens and the. And the noble Lord, Lord Kamall. With regard to the abolition of NHS and the restructuring of Icbs, we expect savings of up to £1 billion a year by the end of this Parliament. That is driven primarily by reductions in headcount, and we expect that savings will build year on year rather than being realised immediately.

With regard to the impact assessment, the focus will be is, as usual on the impacts of primary legislation rather than on secondary and consequential decisions, and our approach to the impact assessment which the noble Lord, Lord Stevens, kindly raised, is in line with Treasury, the Treasury, Green Book Guidance and Better Regulation framework, as I'm sure noble Lords recognise. And to my noble friend Lord Carter, I was glad that he made the point about the need to rightly be focused on outputs.

The input of money has clearly not delivered what any of us would have wanted over some considerable time. Our focus and measurement on outputs is absolutely crucial, and my noble friend Baroness Nargund, in respect of integrated care boards, I just want to confirm, as I said earlier, they will be the Strategic Commissioner, Commissioners of Health Services, and they will take ownership of areas which are currently delegated to them, such as primary medical care and dentistry, as well as delegated specialist services such as adult HIV services, as was raised by the noble Lord, Lord black and the noble Lady Baroness Barker, and also dialysis, and to support Icbs and to ensure national consistency.

We will use the power of direction over Icbs to set out the expectations, for example, in respect of access criteria or the types of services to be commissioned with regard to ICB membership. This bill will reform the required membership of ICB boards to align it more closely with their role as strategic commissioners, and I can assure my noble friend Lord Bradley that the requirement for a member of Nai CB to have mental health experience, as he referred to, does remain unchanged.

On accountability of Icbs and this was raised by the noble Lord Earl Howe, the noble Lady, Baroness Redfern, the noble Lady, Baroness Walmsley and Baroness Shawcross. Wolfson Integrated Care Board commissioning will continue to have clear performance and accountability arrangements in legislation, including a requirement to publish annual reports and accounts, setting out how they have discharged their functions and delivered against their targets. Now, I did write a very long list of noble Lords who made reference to Healthwatch and the patient voice, and I had to strike a pen through that, because it's nearly every noble Lord.

Unsurprisingly, who did make reference to that. But the fact is, we do not believe that the current structures consistently and effectively connect patient voice or lived experience to the decisions that shape services and deliver outcomes. So our feeling is that by placing responsibility directly with Icbs and local authorities, as I mentioned earlier, we will enable patient insight to inform commissioning, service planning and improvement. That said, as again, I said at the outset and I wish to re-emphasise we do recognise the strength of feeling about these changes and the reasons that noble Lords are raising their concerns.

I have already stated our commitment to work with noble Lords to review these measures to ensure that any arrangements really do empower local communities and are giving transparency about what people have told the system and how it has responded. And so this is an area for further work on each SIB and patient safety. Again, a number of Lords noble Lords raised this, including the noble Lady, Baroness Manzoor. Noble Lord, Lord Patel, the noble Lord, Lord Lansley, the noble Lady, Baroness Pidgeon and the noble Lady Baroness Watkins.

And I cannot overemphasize our commitment, which again, I stated at the outset to listening to noble Lords on this important matter, and I want to see a strong link between investigation, system learning and improvement and helping safety insights lead more directly to lasting change. And yes, I agree, patient safety does depend on a culture in which concerns can be raised, lessons are learned and meaningful improvement follows. And so I have emphasized our commitment to listening further to noble Lords.

Again, most noble Lords rightly raised about the single patient record, and I'm grateful to the noble Lord, Lord Carmel and the noble Lady, Baroness pigeon, from their front benches, for their support for this, which is central to our ambition for a modern, joined up NHS. And I know that noble Lords understand the reason that we've raised it. However, Lord Tarasenko, the noble Lord, Lord Tarasenko, was helpful in raising the important issue of health data for research.

And we know that data from the single patient record could offer significant opportunities, including more intelligently planning our health services and conducting life saving, saving research. However, it is the primary focus of the SPR to offer and support direct care, and the bill does not create any legal gateways, any new legal gateways to access health data for secondary purposes such as planning and research. Important though they are, nor does it enable data to be collected for these purposes, but it does contain a savings provision that it can.

That the SPR can be a source of data for secondary uses, such as planning and research, where there is a separate legal basis to do so, and this will ensure that we don't miss opportunities, but that we do guarantee strict legal, security and confidentiality standards are met, which are the concerns rightly, of noble Lords, and that will include existing data protection legislation. And I heard noble Lords, including the noble Lady, Baroness Kidron, and the noble Lord. Lord come alongside others who raised very important points about data security, public trust and privacy.

And when it comes to health data in particular, trust is everything. As many noble Lords have said, including the noble Lady, Baroness Harding, which is why the SPR will be designed with the highest standards of cyber security and information governance. And let me emphasise this access to patient information will be restricted to authorized users only, with an audit trail of who has accessed the patient's data in order to clamp down on some of the really serious transgressions that we have seen of late.

And the noble Lord, Lord Patel, I will come back to the noble Lord on the point of the common duty of confidentiality with regard to the Federated Data platform, I heard concerns from the noble Lord, Lord Scriven, and the noble Lady, Baroness Bennett, about Palantir. Let me say again, the single patient record is different. It is intended. It will be delivered through contracts with multiple suppliers. And I heard my noble friend Baroness Martin, heard her wish to see that that would be UK providers, which I certainly would share her wish and intent on women's health and maternity.

I am grateful for the acknowledgement that's been made by a number of noble Lords, including the noble Lady, Baroness Wyld, Baroness Baroness Manzoor, Baroness Pidgeon, Baroness Hodgson and other noble Lords. I appreciate the acknowledgement of the That the government is taking. I can say that we are, as I and we speak, working up the amendments for the maternity and the neonatal Commissioner. And I will look forward to engaging further on this, because, my Lords, it is a priority of this government to urgently tackle the systemic issues across maternity and neonatal care, which have been going on for so many years and are totally unacceptable.

So by the end of the year, we will be publishing a single national action plan. It will be overseen by the National Maternity and Neonatal Task Force, and it will drive improvement in maternity and neonatal care exactly where it matters to families, to clinicians and to others. And the plan will include recommendations from Baroness Amos independent investigation. And we are most grateful to the noble Lady for her work. It will include findings from the Third World Report and the reviews led by Donna Ockenden, to.

Because what we need is a single national action plan, which will fundamentally drive a systemic and sustained improvement that we have not seen. And it is the task force that will hold the system to account. And I look forward also to this House holding us to account on health inequalities raised by the Right Reverend prelate, Baroness Hollis, Baroness Cass. My noble friend Lord Sahota, the noble Lady, Baroness Tyler. The Bill does reaffirm our commitment to achieving greater equality in the provision of health services, both in their ability to access these services and the outcomes achieved, and its icbs that will lead on improving services because of their clarified role as strategic commissioners.

But they have to be delivering demonstrable improvements for disadvantaged groups and underserved communities, including those in the rural, coastal and deprived urban areas. We will also, as part of our ten year health plan, distribute NHS funding in order to better align it with health need, and that includes establishing a neighbourhood health centre in every community, beginning, not ending with beginning with places where healthy life expectancy is lowest. My Lords, I just briefly want to say an adult social care.

Our commitment, emphasised by the Prime Minister, is on building a National care service and that is why we brought forward forward the timetable for the noble Baroness, Lady Casey's vital independent Commission. But in the meantime we are acting on early recommendations including on dementia, motor neurone disease and safeguarding. And I can assure your Lordships House on mental health that the mental health Investment Standard will continue to apply in the same way that this government is committed to improving outcomes and reducing health inequalities for those with learning disabilities, autistic people and people with ADHD, as acknowledged by the noble Lady Baroness Hollins, the noble Lady, Baroness Browning and Baroness Liman.

I am immensely grateful, as I've said to noble Lords, for their contributions in what has been a very helpful debate, and I will finish by noting, as others have done, that the Bill marks that other groundbreaking moment for this House, and I know that she is watching us online, and that's the first use of AI to give voice to the noble Lady, Baroness Campbell. I pay tribute, as we all do, to the work that the noble Lady has done to make the rules of this chamber more accessible.

And the noble Lady, I would say to her that we are all very fond of the Baroness Campbell Mark one, and we are looking forward to getting more fond of the noble Lady Mark two, as she referred to her AI voice. Let us hear more of it, and I can assure the noble Lady that we remain committed to personalisation and personal health budgets. As in the ten year plan, so I know we will continue these discussions at Committee stage, both in and outside this chamber, and for now,

**** Possible New Speaker ****

I beg to move. That this bill be now read a second time. As many as I have that opinion will say content contrary, not content. The contents have it.

**** Possible New Speaker ****

not content. The contents have it. I beg to move the commitment motion standing in my name on the Order Paper.

**** Possible New Speaker ****

Order Paper. The question is this motion be agreed to. Amendment. Lord Rooker, the Lords. I want. To say in the House, but this is

**** Possible New Speaker ****

To say in the House, but this is an identical motion to the one I moved on the two previous bills, the representation of the people and the Hillsborough Bill. And basically the idea is to strengthen
22:34
Lord Rooker Portrait Lord Rooker (Labour)
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the role of elected members of the Commons. It's not to attack the Commons, it's to strengthen their Commons, it's to strengthen their role. They're in a position where every bill is guillotined in the Commons under a programme motion. We started it in 1997. It was a good idea when we started, but like good idea when we started, but like all good ideas, it's got a bit iffy because the effect is the government always wants to boast government always wants to boast about the numbers of bills, rather than done at the expense of the scrutiny of the bills.

The bills arriving in this House here as a result of inadequate scrutiny, we end up sending far more amendments back to the Commons than would otherwise be the case. And when they arrived down there, the government whips complained to the elected members that it's all the fault of the upper house and we need reform, but it's basically reforming. The Commons is needed when we return amendments to the elected members. They're limited in the time they can use due to the original programme motion, so they need more time for scrutiny.

Effectively, the government has taken some powers from Parliament, which it ought to give back, and asking for a list of what the government's got this list, by the way, because the bill team must study. I mean, you can work it out yourself. They will know what's been added to the bill. That wasn't debated as to this bill. Briefly discovering what's in this bill that the Commons has not scrutinised is not as clear as the two previous bills that I've drawn to the attention of the House.

The Report stage was over two days in the Commons. Two days. That's great. Two days. The programme motion changed from the original set out. Day one was Monday, the 7th of September, and the proceedings normally chopped at 10 p.m. that's normal. But the bill didn't start till 7:26 p.m. because the government laid no less than three statements. No injury time for the bill. That's the point. No injury time for the bill and be seeing seven between 726 and 10 p.m.

The Commons dealt with 50 new clauses and more than 40 amendments. They occupied 44 columns of Hansard, 44 columns of Hansard. In 2.5 hours were added to the bill. You can't really be certain from just looking at the outside. It's not possible. So we come to day two, Tuesday, the 8th of September, the start, 4:45 p.m. the chop was 6 p.m. Yeah, you heard that correctly. 6 p.m. for 1.25 hours. There were at least five government new clauses, 25 other new clauses and 20 amendments, some of which were government amendments.

After 6 p.m. Chop, another six government new clauses were added on the nod to the bill that you can see clearly. I'm not certain about any amendments. And for day two, by the way, I didn't count the columns in Hansard. I thought I'd made my point about the first day, the total time on report was less than four hours. That's the reality. So when the time comes later this year or early next year with these bills, when we get in a tussle with the other House about the amendments we're sending and threats are being made.

I want a good audit trail as to what we have tried to do. We're trying to strengthen the commons so that we end up with less work to send back to them, and gives them the chance to scrutinise the bills properly, rather than putting massive numbers of new clauses into bills that have never, ever been debated. That's crazy way to do legislation. I can't believe someone isn't advising the Prime Minister that we're going to come unstuck on this.

**** Possible New Speaker ****

I beg to move. No question. Was there a motion in the name of Baroness Marion be agreed to? Since when an amendment agreed to? Since when an amendment has been moved at the end to insert the words set out on the Order Paper? The question I now therefore, Paper? The question I now therefore, have to put is that this amendment be agreed to. Lords, I rise to be agreed to. Lords, I rise to support this amendment. I should be brief, and I shall endeavour not to repeat the points which have just
22:39
22:41
22:41
Baroness Merron Portrait Baroness Merron, The Parliamentary Under-Secretary for Health and Social Care (Labour)
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And, my Lords, the motion that the noble Lord, Lord Rooker, has tabled seeks information on the amendments debated in the Commons, and I felt, in keeping with responses to similar motions on other bills, it would be helpful to your Lordships House to set out the scrutiny that this Bill had in the House of Commons. The Bill had its Second Reading in the House of Commons on Monday, 1st of June. The House of Commons then ordered that the Bill should be committed to a public Bill committee for its Committee stage.

The public Bill Committee itself decided its sitting pattern. The committee completed its scrutiny in 17 sittings over nine days and, as usual, all clauses and schedules were considered, as were all proposed amendments and new clauses that were selected by the chair. The bill's Report stage took place over two days on Monday the seventh and Tuesday the 8th of September. The House of Commons ordered that consideration should conclude one hour before the moment of interruption. On the second of these days, all proposed amendments and new clauses selected by the chair were considered.

I have no doubt at all that noble Lords will add to the work of the Commons, with their usual high quality scrutiny, and there will, of course, be time to debate all the issues the noble Lords raise, and the noble Lord, Lord Rooker in particular on the detail as the Bill progresses through your Lordships House.
22:43
Lord Rooker Portrait Lord Rooker (Labour)
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I have a friend, but frankly she's the third Minister to read out effectively the same speech. And it's not good enough. I'm not arguing about what the Commons did arguing about what the Commons did at Second Reading, Committee stage and everything else. The question is, at Report stage, material has been put in the bill. That's never been considered. That's the point. They've considered all the rest of the bill. But at Report stage, the government's coming forward with sometimes dozens of new clauses, some of which are put in the bill without any debate.

And that's the point that we should be made aware of, because you you could print them in italics. The bill team must know about it, my noble friend, in all the amendments that she gets. And I'm not attacking my noble friend. I mean, she's just doing her job. But the fact is, all the amendments she gets, there will be a note on the amendment to say, by the way, this clause was never debated in the Commons, just to be aware. So the material is there.

I just want a government note about it. I can't make it up. I'm not. You know, if I was making this up, someone would challenge me, but I'm not. So I just want an official note about what's not been scrutinised in the Commons. I accept the Bill has been scrutinised, but it's the material that's been added at the last minute, massive amounts of it

**** Possible New Speaker ****

that's not been scrutinised. I beg to withdraw. Lord. Mr. President, the amendment was

**** Possible New Speaker ****

Mr. President, the amendment was withdrawn. The amendment is by the withdrawal. The question is the original motion be agreed to, then original motion be agreed to, then is that opinion the same content? Contrary, not content. The contents have it.

**** Possible New Speaker ****

have it. My Lords, I beg to move the house. Do now adjourn.
This debate has concluded
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