Corridor Care

Baroness Finlay of Llandaff Excerpts

Tuesday 20th October 2026 Lords Chamber

[Baroness Merron (Lab)]

The principle of assessing patient experience, as my noble friend described, is absolutely key to the Health Bill, and I know we will discuss this more. Since my noble friend was a young pup—as he described himself, in a different way—we now have the facilities to be much more transparent and to use data. It is important to say that the collection of data is new—it started only this year and did not exist before—and we are continuing to work with providers to improve the consistency and quality of reporting. That is absolutely key.

[Baroness Finlay of Llandaff (CB)]

My Lords, given that three-quarters of physicians report difficulties in accessing essential equipment, sometimes including resuscitation equipment, for patients in corridors, and even more report compromised care, what work are the Government now undertaking with the Royal College of Emergency Medicine to increase the provision of medical assessment units, particularly working with the clinical governance leads for those emergency departments?

[Baroness Merron (Lab)]

All of this is important, as the noble Baroness said. We are already undertaking a number of actions and one is about additional urgent care capacity; for example, in total some £2 billion is going into urgent care, particularly capital projects, which the noble Baroness did not specifically mention. The improvement of facilities, which is part of this, is absolutely key, as is getting care closer to home. With the kinds of improvements we are already seeing—for example, the emergency departments at Basildon and North Tees have had refurbishments—and by working with clinical leads, we will improve a long-standing situation that should never have been normalised and should only be exceptional.

Patient Data: Research

Baroness Finlay of Llandaff Excerpts

Thursday 10th September 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My noble friend Lord Patel, in introducing this important debate, spoke about health data secure systems. I will speak about the Secure Anonymised Information Linkage system—the SAIL database—based in Swansea and funded by the Welsh Government, which runs on the mantra of “public data for public good”. It has been going for almost 20 years and has data reaching back a quarter of a century. The SAIL Databank was highlighted in the Health Data Research Service (HDRS) Digital Ecosystems Analysis report, because it has expertise in data pipelines, advanced data linkages and secure research infrastructure, powered by the Secure eResearch Platform, or SeRP. These capabilities are essential for the future of health data research.

The SAIL database is very widely trusted, because it was so carefully set up and is so carefully managed. The report identifies it as one of the UK’s established examples, with

“documented transformation logic and quality assurance”

built in. The database has an extensive number of research projects internationally, and it reinforces the importance of trusted research environments, TREs, and secure data environments, SDEs, where approved researchers analyse sensitive data within secure settings, rather than downloading or transferring information. That model has maintained public trust while enabling high-impact research.

Professor Simon Thompson, a co-director of the SAIL Databank and SeRP, has pointed out that they have been

“recognised as a benchmark for the UK”

and that their work linking

“Welsh population data across health, education, housing, justice and beyond shows what’s possible when secure, person-level linkage is done properly and at scale”.

It is one of the leading environments.

Sharon Heys, the head of legislation and due diligence at SeRP, has discussed the difficulties in defining the lines of anonymisation and whether data is likely to be identifiable. I am grateful to my noble friend Lord Tarassenko for talking about the Biobank data. I had the privilege of being on the ethics committee as Biobank was being set up. The durability of Biobank and of SAIL represents the importance of considering all aspects before you even get started.

Funeral Directors: Regulatory Regime

Baroness Finlay of Llandaff Excerpts

Wednesday 9th September 2026 Lords Chamber

[Baroness Merron (Lab)]

This is the way that we are conducting ourselves. It would be a bit premature to draw conclusions on any funding requirements—we are, of course, talking about private businesses. However, we are looking—as we always do, but particularly in this area—at the costs, benefits and the impacts of different approaches before decisions are taken. Within that, we are working with the full range of funeral providers and not just the large funeral providers.

[Baroness Finlay of Llandaff (CB)]

My Lords, this is much to be welcomed, because a funeral is a very important part of marking the passing of, and respect for, a person. So, in the consultation, will the Government ask hospice bereavement counsellors—specifically those who see people on the ground face to face—for their comments? Often, managerial people higher up in the bereavement service may not know some of the details that have been extremely important to families and that may have caused great offence or may have been particularly helpful, and they can get lost in the retelling as things are passed up the chain.

[Baroness Merron (Lab)]

The noble Baroness is quite right that funerals are very personal matters—personal to the deceased, who may or may not have left their wishes, and personal and affecting for those left behind. So hospices and other groups will be worked with closely in the way the noble Baroness describes, as they are important stakeholders for us.

Integrated Care Boards: Access to Services

Baroness Finlay of Llandaff Excerpts

Tuesday 8th September 2026 Lords Chamber

[Baroness Merron (Lab)]

I understand why change creates worry, but I reassure the noble Baroness that the 10-year health plan set out the role of ICBs and, as I mentioned, for the strategic commissioning of health services and neighbourhood providers. I believe it will help to move towards fewer integrated care boards; there are currently 36. That will mean a pooling of budgets, greater efficiency, a reduction in running costs and more resources going to the front line. In all those ways, I intend for the change to deliver a better service locally.

[Baroness Finlay of Llandaff (CB)]

My Lords, what are the criteria that ICBs plan to use to monitor 24/7 access to services in the community? At the moment, the pressures are on emergency departments, where ever more patients arrive, because that is where the lights are on. We have heard about the governance problems of clinical errors occurring where staff are under extreme pressure and patients are in corridors.

[Baroness Merron (Lab)]

One of the major shifts for the NHS now and in the future is about moving services from hospitals to communities; we had a Question on that just yesterday. It is important to say that the fundamentals of oversight, which we are improving, will be through the NHS oversight framework, which will be clear about delivery and approach. I should add that NHS England will be able to focus on helping the most challenged organisations with their performance and capabilities. If there are problems such as those that the noble Baroness described, they will be identified.

People with Learning Disabilities: Acute Illness

Baroness Finlay of Llandaff Excerpts

Monday 20th July 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, the report highlights that, for almost two-thirds of these patients, there was no assessment of mental capacity. However, when people are ill and frightened, mental capacity is incredibly important for being able to communicate with people, to make a diagnosis and to monitor a response to treatment. Without communication, of course the outcomes are worse than they might otherwise be. How will the Government improve the assessment of mental capacity across the board and implement the recommendations in the report?

[Baroness Merron (Lab)]

Guidance was issued not many months ago on this point, and I expect to see improvements. The report found that well under 50% of patients or their carers were asked about reasonable adjustments. It is not acceptable, but that is why we have brought in the mental capacity assessment guidance and the reasonable adjustment digital flag. These will make a major difference.

Children’s and Young People’s Mental Health Services

Baroness Finlay of Llandaff Excerpts

Thursday 2nd July 2026 Lords Chamber

[Baroness Merron (Lab)]

Important though they are, we are accelerating the rollout of mental health support teams, because we now want to meet a more ambitious target of achieving full national coverage by 2029. We have already made progress. As of March this year, some 60% of pupils in schools and learners in further education were covered by a mental health support team. That is up from 52% the year before. The principle of integration where young people and children are is absolutely right. That is why we are not just investing in but accelerating the coverage of mental health support teams.

[Baroness Finlay of Llandaff (CB)]

Do the Government recognise that, as the report said, school staff often see the antecedents of mental health? Two areas where there is strong evidence are parental alcoholism, with a threefold increase in children considering suicide and a fivefold increase in eating disorders, and repeated physical punishment, particularly of children under the age of seven, resulting in emotional harm, so that simply intervening on the child may be too late, and intervention must be earlier to prevent problems.

[Baroness Merron (Lab)]

I agree with the noble Baroness’s observations. Early intervention is key. That is what our entire focus is on, in the ways we have already discussed, and also on developing a children and young people’s modern service framework because we want to reduce variation and ensure that children get the right support at the right time.

Foetal Alcohol Spectrum Disorder

Baroness Finlay of Llandaff Excerpts

Thursday 25th June 2026 Lords Chamber

[Baroness Merron (Lab)]

In addition to the ring-fenced funding I spoke of, we are going further on alcohol labels to get across the important points. In 2022, NICE produced and published a quality standard, which the noble Baroness referred to, so that the system can help diagnose but also support those affected by FASD. I am not aware of there being widespread difficulties with its adoption, because it is so fundamental to pre-pregnancy and pregnancy care, but, if the noble Baroness has particular examples, I would of course be pleased to look into them.

[Baroness Finlay of Llandaff (CB)]

My Lords, the Government’s initiatives on alcohol prevention in pregnancy are to be welcomed and are very impressive, but can the Minister assure us that the industry itself will not be involved in consultations and in designing public health programmes? To date, the tiny pictograms on bottles, particularly of wine and other alcohol products, are so small that they are ineffective. We really need consistent messaging in a much broader sphere where people eat out, drink out and socialise, and in all public health measures.

[Baroness Merron (Lab)]

I take the noble Baroness’s point, which is why I am glad that we committed in the 10-year health plan to making it a legal requirement—therefore strengthening it—that alcohol labels display health warnings and consistent nutritional information. That is something else that noble Lords have raised. As was referred to in the previous question, it is also important that we note that part of care for pregnant women is dealing with alcohol consumption.

Compassionate Use Medicine Schemes: VAT

Baroness Finlay of Llandaff Excerpts

Tuesday 16th June 2026 Lords Chamber

[Baroness Merron (Lab)]

Cancer charities are important in this area, and we are certainly engaging with them; they are very invested partners. I understand why people are concerned. This is not instead of the NHS. NHS medicines are provided on the advice and guidance of NICE, and that absolutely continues. As I say, what we need to do, and what we will do, is work with everyone concerned to find a solution quickly, because we want to support the pharma companies that continue to donate what are very important medicines.

[Baroness Finlay of Llandaff (CB)]

My Lords, do the Government recognise that it has been estimated that, for each pound invested in research, there is an approximate 25p return on that in perpetuity. Therefore, we should avoid anything which disincentivises research investment in this country, which would include the inability to recruit patients if they have to be told that, even if the treatment is successful, they will not be able to access it on the NHS afterwards because the NICE approval processes are too slow for many of these substances. Will the Government therefore undertake to speed up the NICE assessment processes to make sure that patients are not disadvantaged and research is not disincentivised?

[Baroness Merron (Lab)]

Indeed, we will. I can tell the noble Baroness how important speeding up access to medicines is. That is why, in April, we introduced the joint MHRA-NICE pathway for medicines, which will speed up access to new medicines by some three to six very valuable months. We have also brought in the early access to medicines scheme, the Innovative Licensing and Access Pathway, and the innovative medicines fund. All these mean that, across the regulatory and access system, innovative treatments will be available to patients who need them earlier, as the noble Baroness rightly called for.

Cancer Outcomes in the UK

Baroness Finlay of Llandaff Excerpts

Tuesday 21st April 2026 Grand Committee

[Baroness Finlay of Llandaff (CB)]

My Lords, like others I am most grateful to my noble friend Lord Patel for securing this debate today, which is acute myeloid leukaemia day—so it seems very appropriate. I declare my interests as a professor of palliative medicine at Cardiff University and am employed at Velindre cancer centre, as well as my vice-president roles with various hospices, particularly City Hospice, Marie Curie and Hospice UK. I also declare my position with Cicely Saunders International, because its research in palliative care is the main research point not only for the UK but across the world. My other declaration must be as chair of the Bevan Commission in Wales, because I am mentoring one of our fellows on a project on early diagnosis of post-menopausal bleeding.

I will take a slightly historic view on this. The Calman-Hine report came out in 1995; it was the first report on cancer services and set out a cancer plan to take things forward. The current cancer plan reflects the importance of having vision and ambition because, without that, things will not change. One has to set a path forwards, and the Calman-Hine report did. It changed the organisation and structure of cancer services at the time, started multidisciplinary team working, and created centres and units.

That report was also the first time that palliative care was recognised as an integral component of cancer services from the time of diagnosis through all stages, not only in end-of-life care. It tried to set uniform standards and ensure a holistic approach, with early intervention that recognised the physical, psychological and social support needed by people from the time of diagnosis onwards. There is evidence in oncology that, usually within eight to 12 weeks of diagnosis, if palliative care services are available in parallel with the cancer services, there are improvements in quality of life and mood, patient and caregiver satisfaction, and cancer survival overall.

Unfortunately, though, the NICE guidance recommendations on 24/7 access to specialist palliative care services have not been fully implemented, neither those from 2004 nor from 2011. So will this plan integrate with the palliative care plan and strategy that we anticipate will come forward in the autumn? Without that integration, we will not meet patient need. It has already been said that two-thirds of hospice funding is from the charitable sector, yet Marie Curie estimates that about a third of people dying have unmet palliative care needs. It has been estimated that up to 90% of people dying in hospital without any specialist palliative care support available have their needs unmet.

Frailty, of course, makes everything worse in cancer treatment, from diagnosis right through to outcomes. As has been said by the noble Baroness, Lady Nargund, and the noble Lord, Lord Patel, for the ethnic minorities there is poorer access to everything, including palliative care. There is poorer access to emergency palliative care in both deprived areas and rural areas.

Where financial data is available, it has been shown by Peter May and colleagues from Hull York that, in England in 2022, specialist palliative care supported over 20,000 patients to leave hospital and have their care outside it. They calculated that, overall, this input from specialist palliative care saved £800 million, with a saving of 1.5 million hospital bed days. That is not insignificant at all. For each patient with home specialist palliative care involved, there was a saving of almost £8,000, with quality-adjusted life years also improved. For hospital patients, it was not quite as much: it was £6,500 in cost savings, but with that same improvement in quality of life.

One of the problems has already been alluded to: although the faster diagnostic standard had been met, the delays from the decision to treat, and indeed from referral to start treating, has meant that targets have not been met to date. Almost half of young people later diagnosed with cancer attend three or more GP appointments before receiving a referral to cancer services for diagnosis, meaning that teenagers have the longest time to diagnosis, with 67% diagnosed as an emergency. This puts huge pressure on parents in particular, who have to provide emotional support and take time off from work, and it of course has an enormous financial drain on the whole family.

At this point, I point out that some of these young people have very rare tumours. If we look at ocular melanoma, which is a very rare tumour, there is a subgroup of patients who will respond extremely well to some treatments that are not yet NICE-approved and not available on the NHS, even though they have been used and developed for over 20 years. Therefore, families—here I declare an interest as having a family member involved—are having to support their treatment, because the dramatic response means that they are living, rather than having already died, leaving young families.

As well as putting pressure on NICE to review the way it looks at the management of some rare cancers, will the Minister also look at the workforce training needs? Sadly, there is evidence that, even though over 90% of those dying will have some palliative care needs at some level—which is often adequately provided by generalist services when they have back-up from specialist services—the electronic staff record of nursing staff in the community shows that only a small number have actually had palliative care and end-of-life role training. The problem is that this means that about 78%—over three-quarters—of home care workers report insufficient training in pain management or anticipatory prescribing, while two-thirds have never received formal training and do not have access to palliative care services during their shifts out of hours.

There is much to be done, but much that can be improved. I hope that this plan will move us forward with better integration. The evidence shows that where we have better integration of services, it costs less and the clinical outcomes are improved.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026

Baroness Finlay of Llandaff Excerpts

Wednesday 15th April 2026 Grand Committee

[Lord Markham (Con)]

My Lords, I declare my interest as the founder and director of Cignpost Express Test, which did a lot of Covid testing for sports events and currently does health screening at PGA golf events and Mercedes Formula 1 testing, so I have quite a bit of experience in health screening. As other noble Lords have said, what we are trying to do here is very well intentioned. Ours hearts go out to all those affected by the Manchester Arena bombing. This is designed to try to correct many of those ills. The fact that we have two Ministers here shows the important stress that the Government put on this, and I know that Minister Ahmed has been engaged on this, too.

There are good intentions here but, as other noble Lords have pointed out, the devil is in the detail and implementation. Everyone thinks of big events in this context but, as the noble Baroness, Lady Grey-Thompson, mentioned, the small events are the real concern. I have had volunteers at mini rugby tournaments asking, “How are we going to cope with this?” There is a confusion, which perhaps the Minister can clear up, about doctors who are currently CQC-registered through their practice and volunteer at, for example, weekend point-to-point racing events or mini rugby tournaments, who feel that they will no longer be able to do that without being CQC-registered separately for those events, which costs almost £1,000 a time. That drives a lot of the discrepancies we seem to have in the numbers: are we talking about 36 events or many thousands? It would be helpful to get an understanding of that because there is a lot of concern out there.

As a former Health Minister, I know that the CQC already has a lot on its plate. The 1,000 limit on new registrations was mentioned earlier, and this could be the straw that breaks the camel’s back, to be honest. I am very concerned about this. Event organisers and chief medical officers have told me that if it becomes too burdensome, we will employ first-aiders instead of having volunteer doctors, because they do not have to be CQC-registered. That, of course, will mean that the care is less good. They gave an example: apparently, during Wimbledon, 4,000 people saw the medical support services during the whole tournament, and only 1% of them ended up being referred onwards to the NHS or hospital services, because good volunteer doctors and medics were there. Clearly, if they were just first-aiders, a lot more of those people would have been pushed straight on down to Kingston Hospital or wherever, which would have put a large burden on the local NHS services, which I am sure we all want to try to avoid.

I have three suggestions, if I may, the first of which is an athlete exemption. Will athletes be exempt from this, since their medical treatment is quite different, as the noble Baroness, Lady Grey-Thompson, said? Secondly, there is a feeling among the chief medical officers that it would be useful to get the event healthcare standard finalised in the way that the noble Baroness, Lady Harding, talked about, before we do this. It would be useful to have this standard, but it is hard to talk about implementation until we know exactly what that standard will be.

Thirdly, I, too, would like to be involved in the meeting, if I may, but a round table with the CQC and all the chief medical officers would be useful. I know that Minister Ahmed said that he was in favour of that and suggested to the CQC that it should meet with all four chief medical officers. However—I appreciate this is hearsay—I have heard from the chief medical officers themselves that the CQC refused to meet them all together and wants only to meet them separately. I do not know why that is, but the meetings would be more valuable as round tables, with everyone in the room, so that the CQC can get the full flavour of the things we are hearing about today.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare an interest, in that I am president of the Chartered Society of Physiotherapy, so it is partly with that hat on that I am asking these questions.

The Manchester Arena inquiry makes harrowing reading, and I expect that there will be some bereaved people watching this debate, because they are aware that these regulations have come out following that inquiry. The deficits that the reports highlighted are really worrying, but I was struck that many of them are in the domain of so-called first aid: the failure to use tourniquets when people were bleeding, and the fact that the tourniquets were locked up in a first aid room anyway, compound the distress and the memories with which people who lost somebody in that event have to live.

So, one of my questions relates specifically to where the boundary defining first aid sits. The initial response of qualified doctors and physiotherapists may be first aid, but they may also start to instigate longer-term treatment for whatever happened at the event that could not be instigated by somebody who was trained in first aid only as a volunteer from a charity or group. I was thinking about the Glastonbury Festival, an event that is extremely well organised for medical emergencies. It is set up to do a lot of treatment on site, but some things mean that people have to be airlifted out sometimes. They go from the very minor—the joke is rashes from all the wellies rubbing on people’s legs—right through to life-threatening adverse reactions to the most bizarre cocktails of drugs. That needs a highly specialised knowledge. If emergency medicine consultants had not been working there, lives would have been lost because this is so complicated.

One of my other questions relates to the people who are to be used or employed. A level of first aid could happen anywhere, but what is needed at a sporting event may be very different from that at a large event where a lot of illicit substances are being used and the expertise required to avoid loss of life will be quite different.

My other main question relates to the boundaries around an event. How big and organised does an event have to be to qualify, or how small not to qualify? What about a local children’s football league that happens on a Saturday morning with lots of different clubs competing? The kids are traveling around with parents, and may cross from Wales to England, England to Wales, into Scotland or wherever. As amateur participants, their risk of a really bad injury is no lower —in fact, it may even be higher—than if they were playing as fully trained professionals with a full support team.

I am also slightly concerned about where the boundaries are around the person. For some of these smaller events, people will have volunteered as doctors. I know one who volunteers to work at football matches: he is employed by a large hospital and is not a sports medicine person, but he brings a lot of experience that you could say all falls within the realm of first aid, or you could say is tipping over the boundary, because general medical emergencies arise from time to time.

Both the national boundaries and the size of the event concern me. I am not quite clear where those physiotherapists sit who are in private practice—possibly solo private practice—but who are then providing support at a sporting event. If they are to register with CQC as a single worker, it might be quite a lot of money out of their practice pocket. They may therefore feel that they are not incentivised to carry on but they have a great deal of skills. The danger is that the skills available on-site at an event might, inadvertently, be lower than one is anticipating. I realise that there have been a lot of questions to the Minister, but we look forward to the answers.

--- Later in debate ---

[Lord Kamall (Con)]

I can add to that. What is the process for notifying those who will come under this regulation? That would be helpful to know as well.

[Baroness Finlay of Llandaff (CB)]

If I may add to the list of questions, I think it might be helpful for the Minister to explain how the decisions over the size relate to the Purple Guide that the Health and Safety Executive produced, because I understand from page 114 of volume 2 of the Manchester Arena inquiry report that the Purple Guide for an event of that size set things out quite clearly, but was not adhered to at all. I have a slight concern from the responses that we have had that we may have two completely separate things going on. The Minister may not be able to answer that now, but it would be helpful in this meeting that we are all anticipating if there is a cross-reference to the Purple Guide and if the discussions could include how that would impact and be used by the CQC in regulating.

[Lord Markham (Con)]

If I may, I hope this may be helpful: the confusion that I have heard is over whether a doctor, for a CQC registration at their GP surgery, can use that to volunteer on a point-to-point racecourse, as an example, or whether they have to separately register with the CQC to be a volunteer on the racecourse and pay the £1,000. Again, if that comes in the letter, that is fine, but that is one of the main points of confusion.