Health Bill

Debate between Baroness Gerada and Baroness Hodgson of Abinger

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Gerada (CB)]

My Lords, I rise to support Amendments 11 and 14 in the names of the noble Lords, Lord Hunt and Lord Patel of Bradford, who also asked me to speak to this amendment.

First, I want to say that I find it helpful—and, in listening to this debate, even more helpful—to separate out health inequalities and healthcare inequalities. Health inequalities are due to the social determinants of ill health, as we have heard, such as housing and employment, which require cross-government involvement to address—the lowering of the unwanted teenage pregnancy rate was a fabulous cross-government initiative that had fabulous outcomes—while healthcare inequalities are due to the distribution of healthcare services, which is what I am going to address. I get very confused if I do not separate out those two, and I think sometimes we get in a muddle, because it is not for the NHS to deal with housing. I take the point about Bromley-by-Bow, but the NHS is there to deal with health, ill health, prevention and so on, although of course it should be involved in cross-government work.

I shall start my speech with a GP. In 1971, Julian Tudor-Hart, a fabulous Welsh GP who worked in a mining village in south Wales, wrote a pivotal paper in the Lancet. In it, he described what he called the inverse care law: the availability of good medical care tends to vary inversely with the need for it. Put simply, those who need care are least likely to receive it. That was some 50 years ago, and I would love to tell the House that it was now a historical curiosity, but it is not. If anything, that situation is getting worse. I shall talk about two particular places where we see that most clearly, general practice and our coastal towns.

I shall start with general practice. The noble Lord, Lord Hunt, has given some figures, and I am going to highlight a few more showing why it is so important to have an equitable distribution of general practitioners. Many of the indices of ill health are due to the drop in numbers of GPs. If noble Lords want to debate with me about that claim, I can show that there is an absolute line towards that.

As the noble Lord said, this week the Royal College of General Practitioners published—the first time it has ever done so—its State of General Practice Report 2026. We have to take its findings very seriously if we are going to address our population’s needs. To pull out just one figure from the report, which the noble Lord mentioned, as of September 2026 there were only 36 more full-time equivalent GPs than in September last year—so slightly better than when I made my speech at Second Reading, but not much. British Medical Association data shows that in the same period the number of hospital doctors has grown by nearly 50%. Those figures are reflected in the number of patients GPs care for, such that the average number of patients per full-time GP has gone up by 12% and at the same time, according to data in the British Medical Journal, the number of patients per consultant has fallen by 18%.

GPs are doing their best to meet the demand. Over the last 12 months, approximately 388 million appointments were carried out in general practice—by the whole team, but largely by GPs. Some 45% of those appointments were booked for the same day, 82% of them within two weeks, and 60% of them were face to face, excluding home visits. That is tens of millions of appointments more than before the pandemic.

The Government have rightly said that care should move out of hospital and into the community, but we have moved the patients without moving the resources. So it is perhaps not a surprise that the Royal College of General Practitioners survey showed that three-quarters of GPs say their workload is compromising patient safety, while the GPs themselves have the highest burnout rates of all the professional groups.

Here is the part I find difficult to understand. Thanks to government initiatives, we now have over 5,000 doctors in general practice training, the highest figure for years, but BMA analysis shows that half of those who finished training between 2018 and 2024 were not working in a GP practice a year later. It is not that the practices do not want them; they just cannot afford to employ them. This is the contradiction at the heart of the problem: demand is rising yet the workforce has not kept pace. As Tudor-Hart predicted, those who lose out most are those in most need.

According to the Health Foundation, after accounting for increased workload and higher health needs in poorer communities, practices in deprived communities receive roughly 7% to 10% less funding than those in affluent areas—and I now know where, in a way, that has come from, and I thank the noble Lord, Lord Hunt. We are not just failing to tilt the playing field towards needs; we are tilting it the wrong way. That is the case for Amendment 11. If we are serious about reducing healthcare inequalities, general practice distribution must reflect the population’s needs.

That brings me to Amendment 14. As we have heard, the Chief Medical Officer’s report on coastal communities found that those living in seaside areas have shorter lives and spend more of those years in poor health. We have heard about the challenges they have—poor transport, geographical isolation, older population. Noble Lords might expect the health service to send more staff to areas with higher levels of illness, such as coastal areas, but too often it is the opposite. In Hastings, a lovely place, each GP cares for more than 3,700 patients, the highest number in England. In Kingston upon Hull, which again is a lovely place, there is roughly one GP for every 3,000 patients, but in Kingston upon Thames the figure is roughly 1,900—similar names but very different experiences.

The GPs and nurses who work in those places describe it vividly. In Skegness, an area where I spent many of my childhood holidays, staff told researchers about constant firefighting, burnout and isolation, and about patients who could not get their appointments because of poor transport. The problem extends beyond general practitioners to community nursing, where recruitment and pay parity have fallen even further than for GPs.

The evidence is clear that reducing healthcare inequalities requires services and workforce planning to reflect the needs of the communities they serve. That is why Amendment 14 matters. It would explicitly place the need to reduce healthcare inequalities between coastal and inland communities within the Secretary of State’s duties under the Bill. Funding must reflect the health needs of the population, not merely the number of patients on a practice list. As care moves out of the hospital and into the community, staff and resources must move with it.

These amendments are not seeking preferential treatment for GPs. They are seeking fair treatment according to need. Robust evidence spanning more than 50 years shows that more GPs per head of population means better health outcomes, fewer premature deaths, a better patient experience, more preventive work and a lower cost to the NHS.

I hope the Minister will recognise that these amendments would give practical effect to the Bill’s ambitions to reduce healthcare inequalities. The inverse care law was identified 50 years ago but we should not accept that it remains patients’ experience today. They did not choose to live in the deep end, but we can choose whether to leave them there.

[Baroness Hodgson of Abinger (Con)]

I too put my name to Amendment 11. I do not want to repeat everything the noble Lord, Lord Hunt, and the noble Baroness, Lady Gerada, have said, but it is so important that people have access to a GP. Too often we hear that people cannot get to see their GP. That is one reason why A&E departments in hospitals are becoming overwhelmed—because people then go there. I too am concerned that GPs are being asked to see far too many patients. Many patients cannot be dealt with in just 10 minutes, and the stress of all this is creating burnout for GPs, as we have heard. So please can we ensure that everyone has access to their GP without having to wait weeks or fight with the receptionist?

Patients need continuity of care. We all know that, when GPs know their patients, the outcomes are hugely better. I am not medical, but it is common sense that if a patient can get to see a GP quickly, things can often be resolved sooner and conditions picked up earlier, making treatment easier. We need to ensure equality of access. If we can get the GP system functioning better everywhere, that will help to deal with some of the enormous strain placed on other parts of the national healthcare system at the moment.