Lords Chamber

Tuesday 13th October 2026

(began 6 hours, 6 minutes ago)

Share Debate
Watch Live
Skip to latest contribution
14:38
None Portrait Introduction(s): Lord Leunig and Baroness Usher
-

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.

**** Possible New Speaker ****

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

**** Possible New Speaker ****

And.

**** Possible New Speaker ****

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

**** Possible New Speaker ****

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

**** Possible New Speaker ****

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
14:49
14:51
14:51
14:52
14:52
14:53
14:54
14:54
14:55
14:56
14:56
14:57
14:57
14:58
14:59
14:59
15:00
15:00
15:00
15:00
15:02
15:02
15:03
15:04
15:04
15:05
15:06
15:06
15:07
15:08
15:08
15:09
15:09
15:10
None Portrait Oral questions: Impact of industrial electricity prices on the international competitiveness of British manufacturing
-

My Lords, I. >> Beg leave to ask the. >> Question standing in my name and the Order Paper.
15:10
15:10
15:10
15:12
15:13
15:13
15:14
15:14
15:15
15:15
15:16
15:17
15:17
15:17
15:18
15:18
15:19
15:19
15:19
15:20
15:20
None Portrait Oral questions: Price of petrol and diesel at motorway service stations
-

Fourth Oral Question Lord Moylan.
15:21
15:21
15:21
15:22
15:23
15:23
15:24
15:24
15:25
15:25
15:26
15:26
15:27
15:28
15:28
15:29
15:30
15:31
15:32
15:32
None Portrait Legislation: Health Bill - second reading
-

15:33
15:34
Baroness Merron Portrait Baroness Merron (Labour)
-
-
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.

**** Possible New Speaker ****

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

**** Possible New Speaker ****

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
15:50
15:50
15:50
Earl Howe Portrait Earl Howe (Conservative)
-
-
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.
16:05
Baroness Tyler of Enfield Portrait Baroness Tyler of Enfield (Liberal Democrat)
-
-
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.
16:11
Baroness Campbell of Surbiton Portrait Baroness Campbell of Surbiton (Crossbench)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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.
17:04
17:04
17:04
Lord Black of Brentwood Portrait Lord Black of Brentwood (Conservative)
-
-
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

**** Possible New Speaker ****

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)
-
-
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

**** Possible New Speaker ****

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)
-
-
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

**** Possible New Speaker ****

and listening to the patient. My Lord.

**** Possible New Speaker ****

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)
-
-
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.
17:25
Baroness Coffey Portrait Baroness Coffey (Conservative)
-
-
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.
17:30
Lord Kakkar Portrait Lord Kakkar (Crossbench)
-
-
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.



**** Possible New Speaker ****

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
17:36
Baroness Lowe of Armley Portrait Baroness Lowe of Armley (Labour)
-
-
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.

**** Possible New Speaker ****

Thank you. My Lords. It gives me enormous

**** Possible New Speaker ****

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
17:40
Baroness Thornton Portrait Baroness Thornton (Labour)
-
-
Service. In Leeds. Race. >> Equality and mental health, as she mentioned. CEO of touchstone. >> And her serving her time on the

**** Possible New Speaker ****

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

**** Possible New Speaker ****

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

**** Possible New Speaker ****

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

**** Possible New Speaker ****

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

**** Possible New Speaker ****

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

**** Possible New Speaker ****

local level. So, my Lords. I welcome.

**** Possible New Speaker ****

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)
-
-
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)
-
-
My Lords.

**** Possible New Speaker ****

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)
-
-
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.

**** Possible New Speaker ****

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)
-
-
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)
-
-
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

**** Possible New Speaker ****

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

**** Possible New Speaker ****

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)
-
-
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)
-
-
I to. Congratulate noble colleagues on the excellent and inspiring nature.

**** Possible New Speaker ****

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)
-
-
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)
-
-
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)
-
-
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.



**** Possible New Speaker ****

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)
-
-
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

**** Possible New Speaker ****

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

**** Possible New Speaker ****

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)
-
-
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)
-
-
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)
-
-
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)
-
-
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

**** Possible New Speaker ****

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)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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)
-
-
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
Feed Live - Click to view video
Return to start of debate - Return to top of page