Healthcare Services: Acute, Primary and Community

Baroness Cass Excerpts

Thursday 25th June 2026 Lords Chamber

[Baroness Cass (CB)]

My Lords, I declare an interest as a veteran of many health service reorganisations, through which I have consistently advocated for children and young people not to be forgotten, so it will not be a surprise that I am doing the same today. I have also spent many years making the case for better integration across primary, community and acute services, particularly increasing delivery of paediatric care in primary and community settings. The Government’s commitment to shift care from hospital to community settings is welcome, but we have heard similar aspirations before. How do we ensure that this time it becomes a reality?

I have four asks of the Government. First, I echo the comments of the noble Baroness, Lady Lane-Fox, about thinking about the patient journey. Please map child and family journeys clearly, so that people can understand where and how they access support. The 10-year health plan mentions children frequently, but, after reading it and its supporting documents, I was still unclear how neighbourhood health services will fit alongside family hubs, Young Futures hubs, community paediatric services and other existing models. Neighbourhood health services could provide the glue that joins these services together, but there is a risk of duplication and confusion.

My second ask is: build on existing good practice, rather than embarking on another cycle of pilots that are never adopted at scale. For example, the Well Centre in Lambeth—well known to my noble friend Lady Gerada—which is run by Dr Steph Lamb, a superb GP, provides integrated support for 11 to 20 year-olds, bringing together mental, sexual and physical healthcare, alongside social prescribing and community support. It already demonstrates much of what is envisaged for Young Futures hubs, yet remains partly dependent on charitable funding. We should invest in and replicate successful models such as this.

Similarly, the Children’s and Young People’s Health Partnership in south London has demonstrated that local child health clinics delivered by paediatricians and GPs and a nurse-led early intervention service can address unmet needs, reduce inequalities and reduce hospital attendance. This model has already been adopted elsewhere and provides an evidence-based example of community-based care in action.

We have another valuable community resource in the form of children’s hospices, which support children with life-limiting conditions not just at end of life but over a very extended period, as well as supporting their families. In 2025-26, their average caseload rose by 11%—a growing cohort that would otherwise fall to the NHS. Meanwhile, statutory funding has failed to keep pace, accounting for just 25% of hospice expenditure, with the rest dependent on charitable donations. If we do not fund these services properly, care will move from community to hospital rather than vice versa.

My third ask reflects concerns raised by the Royal College of Paediatrics and Child Health. As these reforms progress, how will the Government ensure that integrated care boards consistently prioritise and adequately fund children’s health? Will executive children’s leads within ICBs be protected? More broadly, how will changes to ICB membership ensure strong clinical leadership for children’s services and an appropriately planned and funded workforce? We are desperately short of community children’s nurses and school nurses. If the community workforce is not valued, incentivised and supported, there will be no meaningful shift of care into the community.

Finally, please listen directly to young people. Alex Parton, a youth intern at the Well Centre, said,

“healthy children become healthy adults, but”

young people are too often treated

“as bystanders rather than future citizens”.

He said that if, as the Secretary of State has said,

“the 10 Year Health Plan will ‘put a megaphone to the mouth of every patient’, it must make sure young people get a turn on the mic too”.

I look forward to the Minister’s response and am very happy to share my little black book—or little black iPhone—of very useful contacts of good practice.