NHS 10-Year Plan

Baroness Bottomley of Nettlestone Excerpts

Wednesday 9th July 2025 Lords Chamber

[Baroness Blake of Leeds (Lab)]

I thank the right reverend Prelate for his very thoughtful contribution. It is particularly of the moment, and I completely recognise everything he said about this needing to focus on people.

We have to look at this technology as enabling better care and freeing up time. How many of us go to the GP and experience frustration at the restriction on the time that we are allowed to spend with the GP, because so much of their time is taken up with admin? Of course, data protection is central. The health service is not the only area where we are looking at systems of data protection, and the normal protection methodology will be brought to bear. We have to make sure that, in governance, there is a much more transparent and open style, which, frankly, we all have to admit has been missing in some cases. This is an opportunity to look at that.

I must admit that I will have to have a conversation about where the ethical discussions will actually take place, but I know that, throughout the professional bodies, these considerations are taken into account all the time. It is fundamental. The direction of travel is to have people at the centre, building the workforce, so that they have the opportunities to thrive and do their jobs to the best of their abilities for their patients.

[Baroness Bottomley of Nettlestone (Con)]

My Lord, this is a pot-pourri of worthy aspirations, with the most extraordinary sense of déjà vu: hospital to community; sickness to prevention; a patient-driven NHS; league tables; foundation trusts; funding following the patients and outcomes. I was a contemporary of Alan Milburn, and he is behind this; these were all measures that we were discussing long ago. Maybe they have not been sufficiently implemented—and I so welcome the noble Lord, Lord Scriven, asking where the timetable and implementation plan are, and how this is going to happen.

But I must leap forward to the most serious issue of the day. We are all united on the importance of the NHS. It is incredibly difficult to change it, manage it and lead it. How can it be right for resident doctors to be taking industrial action for five days later in July? They have had an incredible increase compared with other members of the public sector, and the Government have said that they will help them on their work conditions. For those who say that their greatest pride is in helping patients, this is a shocking state of events—in a career that people want to join and that has long-term respect. Will the Minister ensure, very specifically, that the department checks up on whether any junior doctor taking industrial action then moonlights in another health authority, or in a private health provision, so that while they are taking industrial action they are also earning, at a premium rate, making up the gap left by the other doctors on industrial action?

[Baroness Blake of Leeds (Lab)]

As someone who has been involved in the plan, I start by saying to the noble Baroness that although it might echo things that have happened in the past, there is an enormous difference now. There is a depth of collaboration, bringing people together and recognising the different cultures in organisations. Of the 200 bodies that are going to be dismantled, Healthwatch is one; it has been very positive and has contributed to the future plan for how this is all going to look. There has been a step change in how we get out and work with people. It is a very ambitious plan, which I am pleased about. I am also very optimistic, because, quite frankly, too many professionals have gone too close to the edge and they realise what is on the other side if we do not all pull together and do something about this.

We are disappointed about the BMA decision to strike. The majority of resident doctors did not vote to strike, and threatening strike action that could harm patients will set back progress. I assure the noble Baroness that no one on these Benches is welcoming the strike. The basic truth is that, thanks to this Government, resident doctors have received a 28.9% pay rise compared to three years ago, and the highest pay award in the entire public sector this year. The Secretary of State met the BMA yesterday. Although he has made it very clear that the Government cannot go further on pay than we already have this year, he has offered to work with resident doctors to resolve issues they might face around working conditions. It will, of course, be down to their managers to work with staff to come up with a plan to deal with the action that is being proposed.

Social Cohesion and Community during Periods of Change

Baroness Bottomley of Nettlestone Excerpts

Friday 6th December 2024 Lords Chamber

[Baroness Bottomley of Nettlestone (Con)]

My Lords, I am delighted to speak in this debate, which always has a particularly important place in the calendar. I look back fondly at our debate this time last year on families and the really wonderful work that the outgoing most reverend Primate the Archbishop of Canterbury did on Love Matters, helping people accept families as they are in the present world. These are not always wonderful—we remember RD Laing and the schizophrenogenic mother—but, for the most part, families are the building block of society. That seems to me to be the right place then to move into social cohesion, such a critical issue.

I am alienated by the Library briefing referring to the United Nations Economic Commission for Europe to give me my definition of social cohesion. Social cohesion goes back to Durkheim, the French sociologist and founder of sociology, 150 years ago; to Max Weber and Karl Marx trying to understand how societies would operate in the face of declining social and religious factors and the change in the workplace. They talked about social cohesion and the outfall of suicide, delinquency and deviance if social integration was not properly respected. Of course, in today’s world, social cohesion is even more difficult.

One reason I became Secretary of State for Culture, Media and Sport, when my boss had asked me to take a much chunkier department, was because my observation, as a social scientist, was that the framework that held people together was increasingly disintegrating. People were held together by the docks, the steelworks, the mines: that was the drumbeat of communities. In a world where people work from home, those common causes are no longer there, and it is the DCMS responsibilities that hold people together. Going to the Last Night of the Proms is an act of social cohesion. Going to the cup final at Wembley is an act of social cohesion: people are there together, regardless of their class, their background and so on. Museums, sport and galleries are all ways of creating social cohesion in a world where it is not always the Church that provides that cohesion. I regret that.

There was a time when political parties created social cohesion. Anybody who went to my constituency, when I was first an MP, joined the Tory party not because they were Tories but because they would meet nice people. I know that it was the same in a lot of Labour constituencies, but it is not like that any more. The work of the Church, and all faith groups, is enormously important because it gives meaning to life, it helps the needy, it helps the lonely and it helps people through the life cycle. The great thing about faith groups—religious, Muslim, Hindu, Christian—is that you celebrate birth, you celebrate adolescence, you celebrate marriage and you prepare for death. This is how we create communities that care for each other and understand each other. It was shocking, the most reverend Primate’s comment about people who are so obsessed with being online, they do not have a friend. How often do we see that with children? Their friends are their online friends. How dangerous and sinister is that?

I want to talk about this new development, articulated by Dame Sara Khan as “freedom-restricting harassment”. That is a rather fancy name, but we see it in the cancel culture in schools and universities—the idea that people are not free to speak the truth as they see it. The joy of the House of Lords is that we cannot be intimidated; we can say what we like without even having to be afraid of our constituents getting at us afterwards, as those who have been in the Commons will understand. I have spent many years in universities, as have many, and my message to graduates getting their degree is always, “University is the place where you have created your values, you decided who you are. It is not just about facts and knowledge, it is about wisdom, trust, values and what you believe to be right for the future”. The fact that our universities are particularly international in nature is all the more important, because the stranger factor is so sinister and dangerous, but if you have learned together, you work together and understand different cultures—how important that is for the economy.

Those of us who are followers of McKinsey will recognise that diversity is one of the critical factors in successful businesses. I applaud employers and I think we should say more about them in terms of social cohesion, and the work they are doing on diversity and inclusion. It sounds very woke but it really matters. Can you be yourself at work? Can you be the best possible person you can be? Can you give 110% of your effort? Because if you are feeling insecure about being of a different ethnic group, sexual orientation or whatever, you are not able, you are not liberated, to do the best you can in your economic enterprise.

How much more important is this now too, with all this working from home, which I have viscerally opposed? Except for women, or men, with childcare purposes, I will not believe that working from home is a healthy thing to do. We are social people. We need to go to work. Young people need to go to work to see grumpy old women like me at work, and grumpy old people like me need to see young people who will explain to them about TikTok. This is how we share values and how we change. The sooner we move away from thinking that working from home is a wonderful thing, I shall be delighted. I accept that it has transformed life for many women, and I will allow it there, but otherwise nothing will convince me.

On democracy, the most reverend Primate made really serious comments about people failing to vote, their alienation and disinterest. I get very angry when I hear people say, “All politicians are in it for themselves”. If you want to do it for £80,000 a year or whatever it is, working seven days a week, you try. I meet a lot of people in the business world who sneer at politicians, and that really winds me up big time, but there is an issue about the effect of social media. This is familiar. When we all went to political meetings when we were young—long ago—people would argue and debate. You would never leave a political meeting thinking it was 10-0 or 8-2, everything was divided, but social media is about assertion. There are no facts, no evidence, no logic; there is assertion, and this vulgarises and polarises debate.

I commend the most reverend Primate particularly on his presidential address at the York Diocesan Synod last March. He quoted Jonathan Sacks, with whom I used to work a lot, talking about the temptation for religious leaders to be confrontational, like politicians. He said, “I am trying to resist this temptation, please pray for me. And please resist it yourself”. He also said that with this divisive mindset:

“Choices must be set out as stark divisions. Not to condemn is to condone … A prophet hears not one imperative but two: guidance and compassion, a love of truth and an abiding solidarity with those for whom that truth has become eclipsed”.


It seems to me that that is what we have to do. I want to draw attention to the English-Speaking Union, which encourages young people to debate, to take each other’s sides in an argument, to speak with logic and rational purpose—to become the citizens we need.