NHS 10-Year Plan
Debate between Baroness Blake of Leeds and Lord Scriven(4 days, 17 hours ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Scriven (LD)
My Lords, we on these Benches welcome the Minister to her place. I know that, when I say that we hope that she is not too long in her place and that the noble Baroness, Lady Merron, is with us again soon, she will understand that I say it in the nicest possible way.
From these Liberal Democrat Benches, our unwavering commitment to the NHS remains absolute. We welcome any stated ambition to improve the health service, particularly with a focus on prevention, leveraging technology and moving care closer to people’s homes. However, our support is contingent on plans being genuinely deliverable, properly funded and, crucially, addressing the interconnected crisis in social care. We have long championed that you cannot fix the NHS without fixing social care.
I confess that, as I read the Government’s new 10-year plan, a familiar echo resonated through my mind. Having started my career in the early 1990s as a manager in the health service, much of what is proposed sounds eerily familiar. This plan speaks of a network of new neighbourhood-based care that provides services between general practice and traditional general hospitals. This mirrors strikingly similar initiatives from previous governments—echoing, for example, the advocacy of the noble Lord, Lord Darzi, for polyclinics in 2007.
What does history teach us about such wholesale shifts of care from hospital? It tells us that this inevitably involves running the old and new systems simultaneously, which is, without exception, expensive. Hospitals will continue to perform their essential functions, and their fixed costs will remain. The new community service demands significant new investment in buildings, staff and technology, and there are no immediate savings to fund the shift. Let us not forget the stark reality: we currently lack the capital simply to repair our existing crumbling health estate, let alone build numerous new hubs.
Crucially, for any plan that speaks of shifting care out of hospitals, the most frequent users of the NHS are our elderly population. Keeping them well and out of acute settings profoundly depends on effective social care, yet this essential pillar remains largely absent from this new plan. We search in vain for a decade-long funding and development road map for social care, or for a stand-alone, fully resourced social care strategy. This is a crucial strategic failure, undermining the very foundation upon which this shift to community is based.
Moreover, while the enthusiasm for digital transformation is understandable, the detailed implementation plan of how to do it is absent. The app is a diagnostic tool; it does not provide direct care, it does not give the jabs and it does not provide the treatment. The King’s Fund has shared its concern on this:
“AI scribes can only transform the productivity of the NHS if staff don’t need to spend 30 minutes every morning logging into multiple out-of-date IT systems”.
The fundamental question remains unanswered: how will this be delivered? The plan is ambitious, but it has been launched into an incredibly chaotic delivery environment marked by significant structural change within the health system bureaucracy. The key question for the Government is how this will be delivered. I therefore have a few questions for the Minister.
What precise funding strategy is embedded within the 10-year plan to deliver the necessary reform and integration of adult social care? Given the dual running costs of new neighbourhood health facilities, can the Minister provide a year-by-year financial breakdown of expenditure and demonstrate how these investments will lead to overall system efficiencies and net savings? Will the Minister commit to publishing within the next four months a comprehensive, independently overseen delivery road map for this 10-year plan that details specific year-by-year objectives and names leads and mechanisms for public reporting on progress? While we wish the ambitions well, the key challenge for this Government is how they will deliver and being open and transparent on that.
Baroness Blake of Leeds (Lab)
My Lords, I also start by sending my very best wishes to my noble friend Lady Merron. No one more than me is looking forward to her making a very speedy recovery. I am very pleased to hear from her that she is making good progress, so we look forward to her return. I think it is appropriate that I declare an interest: my son is a GP, which I think is perhaps slightly relevant to the debate before us today.
To recap before I go into more of the details, I emphasise that this plan is different in so many ways to the NHS plans that have come before it. As we have heard, it is a road map for radical reform that is built on three fundamental shifts. Those of us that have been around the health agenda for a while recognise the past aspiration for some of these measures, but there was never a bold, innovative, collaborative plan to take our ambitions forward.
From hospital to community care, bringing care closer to home and making access to GPs faster and simpler is absolutely fundamental, particularly in the current climate—and from analogue to digital, giving staff modern tools and patients the kind of convenience and control they expect elsewhere in their lives. All of us have heard heartbreaking stories of patients who go from one specialist to another, and there is not that join-up. This has to be changed. There is no reason why this cannot apply across all the experiences the public have, regardless of where they are seeking services.
Many of us have been talking about the need to move to prevention in so many areas of life. Where better than people’s health, looking at the root causes of poor health and making healthy choices? It is the easy choice, but at the moment it is not that easy.
The new NHS has patients at its heart, will deliver equity and quality, is devolved and decentralised so that we are more responsive to local community needs and the front line is freed up to harness innovations, and the rules and incentives in the system support clinicians and lead us locally to be able to make the right decisions. This means that there is no simple chapter or section within the plan for individual conditions or groups setting top-down actions. The impact on particular services and outcomes will be through successfully transforming how our health ecosystem works. As we will come on to with the more specific questions, this is very much a work in progress. I am delighted by the reach the consultation has had over the last year. That has informed the debate and the outcome that is seen in the plan, so there have been no surprises. Many people who have been involved recognise what is in the plan.
The plan is backed by £29 billion per annum of extra investment by the end of the review period and, crucially, by a drive to cut unnecessary bureaucracy and empower front-line staff, giving them the tools to do what they do best: caring for patients.
I thank the noble Lord, Lord Kamall, for his very constructive comments; they were exceptionally helpful. Across the House, we all look forward to taking this extremely seriously and moving forward.
Turning to the comments of the noble Lord, Lord Scriven, on social care, he and I share a very positive background in local government, and nothing could be closer to our hearts than working out how we are going to bring the two together. That is fundamental. Both noble Lords made the point very clearly, and we welcome that.
Over the next three years, we will focus on the neighbourhood health approach to those most let down by the current system. That includes older people with frailty and those in care homes. Social care professionals will work alongside NHS staff in local teams, supporting recovery, rehabilitation and independence. We have examples from around the country where this is already happening: services are joined up and the cultural differences between the NHS and local government have been successfully broken down. We need to make sure this is replicated and spread to every part of the country. We need to enable care professionals to take on many more health-related responsibilities, such as blood pressure checks and reducing avoidable hospital administrations. Of course, pay terms and conditions have to be improved through fair pay agreements.
In the longer term, the noble Baroness, Lady Casey, will produce an interim report next week, but it is very much a work in progress.
Health and Social Care Information Standards (Procedure) Regulations 2025
Debate between Baroness Blake of Leeds and Lord Scriven
Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)
My Lords, these regulations were laid before the House on 25 March 2025. If approved, they will make provision about the new procedure that must be followed by the Secretary of State for Health and Social Care and/or NHS England when preparing and publishing information standards. Information standards relate to the processing of health and adult social care information. They can facilitate information to be shared easily, in real time, between health and adult social care organisations, providing a common set of requirements that must be followed. They are fundamental to ensuring interoperability and delivering a more integrated system in health and social care.
Currently, the health and adult social care system lacks a joined-up approach to technology and data solutions. This is in part due to low compliance with information standards, which are not yet mandatory. This makes it hard to achieve change or deliver improvements that are consistent across health and adult social care. For the health and adult social care system to work effectively, data needs to be processed in a transparent and standardised way, using common specifications, so that it can be understood and used by health and care professionals across different settings. To be effective, standards should be mandatory, as they will be in the near future, following commencement of the relevant provisions in the Health and Care Act 2022.
Noble Lords will appreciate that this was legislation made under the previous Government. I would hope that the current Government, in taking this forward, indicate a degree of unanimity on the need for a good system of standards, which support interoperability. Existing standards have not undergone a standardised approach to their preparation or review. This inconsistency has contributed to low compliance with information standards, which has made it harder for health and adult social care providers to understand what they are being asked to do and for data to be easily shared between different services.
Building on the provision in the Health and Social Care Act 2012, the Health and Social Care Act 2022 makes compliance with information standards mandatory. These procedural regulations that we are considering today set out a specific process that must be followed in developing and publishing all information standards going forward. Parliament permitting, once the Data (Use and Access) Bill becomes law, they will be mandatory for not just providers of health and adult social care services but the IT providers with which they contract.
I draw noble Lords’ attention to the element of consultation that the regulations would require. This has also been part of the process of developing these regulations, as there has been a public consultation and extensive engagement with stakeholders to ensure that we get this right; an impact assessment has also been published. The procedures outlined in this instrument have therefore been carefully considered and developed, taking into account views from stakeholders across the health and care sector. They will ensure that information standards are fit for purpose, kept up to date and reviewed regularly as needed; and that they keep pace with technical developments and evolving priorities. I beg to move.
Lord Scriven (LD)
My Lords, although we recognise the ambition behind these regulations to foster better integration and data sharing across health and social care, we harbour some reservations regarding their scope. We are deeply concerned about their implementation, including the costs there, and the potential impact on individual liberties.
We understand that the need for seamless information flow to improve patient care and service delivery is undeniable. We as Liberal Democrats have long championed a more joined-up approach—one that empowers professionals with the right information at the right time. However, as always, the devil lies in the detail. This statutory instrument, while aiming for laudable goals, raises several critical questions that demand thorough scrutiny.
First, we are concerned about the breadth of the data being mandated for collection and sharing. Although the consultation response attempts to address concerns about proportionality, the regulations still appear to cast the net very wide. We must ensure that the data collected is strictly necessary and proportionate to the intended purposes; and that robust safeguards are in place to prevent mission creep and unwanted intrusion into individuals’ lives. The potential for sensitive personal information to be accessed and shared across numerous entities requires the highest level of scrutiny and ironclad guarantees against misuse.
Secondly, the consultation response highlights ongoing concerns regarding interoperability. It is worth noting at this point that there were only 132 responses to the public consultation. That is rather worrying considering that we are talking about nearly 2,000 private sector entities involved in providing the type of health and care about which we are talking.
There are real issues around the technical capability of various organisations, particularly in the social care sector, to implement these standards effectively. Many providers, especially smaller ones, lack the digital infrastructure and resources to integrate the new data systems seamlessly. Without adequate financial and practical support, these regulations risk exacerbating existing inequalities and placing undue burdens on already-stretched services. We need assurances that the implementation will be phased and adequately resourced, ensuring that no part of the health and social care system is left behind.
At this point, it is worth pointing out that, if the impact assessment were in a kitchen, it would be a colander: it has so many holes and assumptions that it is not worth the paper it is written on. I have read many impact assessments but never have I read one that says, basically, that, because we do not know the standards, we have not spoken to the IT suppliers and we do not really understand what it is we are asking to be implemented, we cannot make a real, positive determination of costs. In paragraph 24, it says:
“In brief, as future information standards remain an unknown, the costing has had to be based largely on a set of informed assumptions”.
However, when you read the informed assumptions, you see that they are not informed—they are just assumptions.
The impact assessment goes on to say that it has not really been appropriate to speak to IT suppliers as it is too early to have an indicator of the compliance costs. It also makes it very clear that the way in which small social care providers will potentially have the ability to implement this cannot be guaranteed; and that there could be market fragmentation. I have some questions for the Minister about the impact assessment and the robustness of the assumptions made. When the Minister read the impact assessment, what concerns were raised to her? What assurances have been given to her, particularly regarding small social care providers’ ability to implement what is being asked of them?
On costs, what assurance has the Minister been given with regards to the quantum of costs? The impact assessment makes it clear that these costs cannot in any way, shape or form be guaranteed to be the total cost, particularly for small to medium-sized enterprises. What assurances can the Minister give the Committee that, if certain costs go beyond a certain ceiling, the implementation period will be either extended or paused? This is an important point, particularly when many social care providers are already on the brink of financial instability; many talk about not being able to absorb further costs. If the Minister cannot give me assurances, I will probably raise this matter on the Floor of the House; it may be that, because of the details that I require, the Minister offers me a meeting to give me reassurance before this is discussed in the House.
We also note the continued ambiguity surrounding the explicit consent mechanisms and the rights of individuals to control how their data is used. Although the consultation touches on these matters, the regulations themselves lack the clarity and strength needed both to guarantee genuine informed consent and to provide individuals with meaningful choices regarding their data. We believe that individuals must have a clear understanding of what data is being shared, with whom and for what purpose; and that they must possess the right to object in appropriate circumstances.
Lord Scriven (LD)
I therefore wish to pose the following extra questions to the Minister. My first is on the timescale of and reasons for bringing this statutory instrument forward. Based on the fact that the impact assessment says that,
“despite best endeavours to collect and draw upon strong evidence, cost and benefit assumptions remain uncertain and based on limited evidence availability in places”,
why has this statutory instrument been brought forward? Why could it not have been brought forward when there was more certainty and understanding of the implications of its implementation?
Secondly, given the breadth of data mandated for collection, what specific purposes will the Government put in place to ensure strict proportionality and to prevent the collection and sharing of information that is not absolutely necessary for the stated purposes of these regulations? Also, how will the Government guarantee that these measures will be actively monitored and enforced?
Thirdly, acknowledging the significant disparities in digital infrastructure across the health and social care landscape—particularly in the social care sector—what concrete financial and practical support will the Government provide to ensure the equitable implementation of these standards? What is the projected timeline for achieving full interoperability across all relevant organisations? How will the cost implications of this implementation mean that that timescale could be flexible? Considering the fundamental importance of individual autonomy and data privacy, what further steps will the Government take to strengthen the explicit consent mechanisms in these regulations, ensuring that individuals have clear, accessible information and meaningful control over their own health and social care data when it is shared and used?
We believe in the transformative potential of data to improve health and social care. However, this transformation must be built on a foundation of trust, transparency and respect for individual rights. I therefore urge the Minister to carefully consider the concerns and ensure that these regulations truly serve the best interests of the individuals they are intended to benefit. I remind the Minister that it might be useful to meet before this goes to the Floor of the House, in particular with regard to some of the issues in the impact assessment.
Baroness Blake of Leeds (Lab)
My Lords, this has been a rather disrupted session, to say the least; I will do my very best to keep some continuity. I start by offering the noble Lord, Lord Scriven, reassurance that we are happy to meet, and we recognise the detail of issues that he has asked for. I will not be able to give a response now, but if he will bear with me, we will write to him to take the issues forward.
In summing up, I emphasise that the procedures set out in the instrument are a crucial pillar in the design of a robust information standards framework to cover health and adult social care. I believe they give a clear process for consulting to ensure that mandatory standards are appropriate, while avoiding cumbersome procedures. They will ensure that the appropriate procedural rigour is consistently applied—a major concern of the noble Lord—particularly while the information standard is being developed, and will make sure that the standards are all fit for purpose.
The noble Lord raised concerns about potential creep resulting from the regulations. I assure him that, where data is used for purposes beyond direct care, only data necessary to meet the specific purpose will be made available. Where data is used for purposes beyond direct care, it is normally anonymised, and patients are entitled to expect an obligation of confidence for the health and care services they receive. A number of safeguards ensure that data is used for the purposes for which it was shared. These include provisions of the Data Protection Act 2018 and the UK general data protection regulation regarding limitation of purpose, the Caldicott principles, security standards and toolkits, independent advisory bodies and a national data opt-out. These ensure that health and care data is used in a safe, secure and legal way.
The noble Lord also raised concerns about the burden of these procedures, particularly on social care, and specifically referenced small providers. I know that he is very active in this space and will be talking to people out there.
We need to make sure that mandatory information standards introduced as part of the staged process beginning later this year focus initially on those that are critical or most beneficial to improving integration of care. We need to remember throughout the ultimate purpose of this: to bring a better service to patients or users of services.
Lord Scriven (LD)
I fully understand and respect that answer, but it does not answer the question that I asked. I did not at any point in my intervention undermine why this was needed, and I actually said that we on these Benches are supportive. I asked why it is coming now and why it could not be delayed until we have further information. The Government’s own impact assessment says that,
“despite best endeavours to collect and draw upon strong evidence, cost and benefit assumptions remain uncertain”.
It is not just the cost and benefits; the assumptions remain uncertain and based on limited evidence. My question was why this needs to come forward now. What is the key issue that means this has to be debated and go through Parliament now? Why can it not come forward when some of those assumptions, and the uncertainty about the assumptions, are stronger?
Baroness Blake of Leeds (Lab)
I must admit that I had hoped that I had answered the question on the sequence of the processes. All I can say, again, is that it is about the whole process going forward, and obviously the costs and benefits will depend on the information that is gathered as we move forward with these principles. If the noble Lord is still not satisfied, this can of course be part of the information that I share with him going forward.
Moving on, the regulations set the process that will be followed in preparing and publishing information standards. Following on from that, it is absolutely appropriate for the Government or the body that they designate—such as NHS England—to set information standards for the health and care system to ensure that we have interoperability. As I have said before, we have run a public consultation and published its findings. NHSE has undertaken extensive stakeholder engagement, which will be ongoing. The last thing anyone wants to do is make the changes opaque and difficult to understand. Of course, we have to keep all of this in proportion, given the amount of information we are talking about, and make sure that it is completely relevant and fit for purpose.
The overriding conclusion is that we need to create a modern health and adult social care service where systems are integrated and staff have quicker access to patient data, freeing up time that could be spent with patients. Ensuring that information flows between services in the NHS and social care is a prerequisite of a responsive and effective service that meets people’s needs. Mandated information standards will set the technical means to ensure that this happens. I hope the Committee as a whole will recognise that setting these standards to ensure that IT systems and services can share data easily is fundamental to delivering the most effective health and care systems, and will agree that these regulations are practical and proportionate.