Health Bill

Baroness Manzoor Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

I do not believe this needs to be set out in legislation, but it is necessary to get this clarity as well as the timeline. Regarding the population health improvement plans, how will resources be allocated to ensure that inequalities are addressed and that there will be a joint system with local authorities as well as local stakeholders?

[Baroness Manzoor (Con)]

My Lords, I thank the Minister very much. I am absolutely delighted that the Government have listened with regards to Healthwatch and HSSIB, which are two very important legs of the NHS in terms of independence, patient safety and patient voice. I welcome that and thank the Minister; I know that she is also passionate about those areas.

I thank my noble friend Lord Howe and others who have spoken on his amendment. Irrespective of what one feels about NHS England—I will certainly share my views—it is right that there is an operational plan and a transitional plan. No business would move to such a major reorganisation without having such plans and risk assessments, with key performance indicators and clarity around outcomes in relation to budgets and finance.

My key question is that if savings are to be made, when will they made and how will they be reinvested into direct patient care? With all these changes, what does it mean for the patient? How do they benefit, so that we are not just talking round and round to ourselves about reorganisations?

I have been involved with the NHS for nearly over 40 years—the noble Lord, Lord Hunt, and I have been around a long time. I chaired a health authority when I was in my 20s, and I chaired one of the eight regional offices of the NHS. My region was northern and Yorkshire, and we had a budget of £3.5 billion. I have some experience of transformation and of the difficulties, challenges and risks that will be involved. If we do not have these plans or clarity, things will go wrong. That will adversely affect patient care, when trying to improve patient care is what the Bill is really about.

I do not like to see lots of duplication in services. I like direct and simplified governance structures in the NHS. We had them when we had the regional offices. I recollect—it was a Labour Government at that time—that the eight regional chairs rocked up to the Department of Health, I think quarterly although the memory has faded a bit, and sat down with the Secretary of State, the Permanent Secretaries and the chief executive of the NHS Executive. We went round to find out what the finances were within our regions, which hospitals were performing well and which were not, and where there were real issues about waiting lists. It really concentrated the mind. Then we went back and fed it to all the 60 or 80 chairmen within our regions and their respective chief executives. I am not too worried and concerned that there will be a lot of haters, but we must have very clear plans to enable this to happen.

Last but not least, I want to talk about the governance structures; I mentioned them in my speech previously. If we do not have clarity around governance structures and accountability, we really will not deliver. If there is one plea that I can make, can it be that? I totally support the amendment tabled by my noble friend Lord Howe.

[Baroness Gerada (CB)]

My Lords, one of the people who I have most admired over the years is the American paediatrician, Professor Don Berwick—some of your Lordships may know him—who is an international expert on healthcare and a great advocate of the NHS. In fact, he led the Mid Staffs review in 2013. In the States, he led Medicare and Medicaid under President Obama. It always struck me that Don Berwick wrote us a birthday card on the NHS’s 60th birthday. It was a long card and I urge your Lordships to read it one day. He offered a simple prescription for the NHS: “Stop restructuring”. He warned that successive reorganisations drained the workforce’s “energy and confidence” and argued that stability makes improvement easier. Does the Minister agree that his advice would be well taken?

--- Later in debate ---

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Baroness, Lady Tyler, and the noble Lord, Lord Patel, made some important points about cross-government working. I was thinking back to what the noble Lord, Lord Patel, said, basically that what started under Tony Blair was continued under Gordon Brown. It was backed up by, first, a specific Cabinet committee, which underpinned the inequalities work, and, secondly, by what were called PSA targets, which tied different departments in. I think that was a good mechanism. In defence of the Government, though, the important work that is being undertaken in relation to health inequality by Alan Milburn, working with different government departments, is going to be pivotal because it embraces the terrible outcomes for so many people who come under the NEET category. It is also looking at the dreadful mental health support for children and adolescents, which goes to the heart of many of these issues. If we can pull this off, we can start to achieve some of the equality issues that we have been talking about.

Like the noble Baroness, Lady Tyler, I am here to say a few words about coastal health because the noble Lord, Lord Patel of Bradford, told us we must. Five years ago, the Chief Medical Officer devoted his 2021 annual report to health in coastal communities. He identified high levels of poor physical and mental health, an ageing population with increasingly complex needs and serious challenges in recruiting and retaining the healthcare workforce. The noble Lord, Lord Patel, basically has three asks, on which I want to reinforce what the noble Baroness, Lady Tyler, said. Five years after the CMO’s report, we have no strategy. First, will the Government publish a substantive account of progress against his recommendations? Secondly, how will the Government ensure that coastal populations are separately identified? Unless we do that, we do not have the data on which to plan and strategise and see whether improvements can be made. Thirdly, will the department work across government to develop and test commissioning prevention workforce models suited to the distinctive geography and needs of coastal communities? I would be very grateful if my noble friend would agree to meet the noble Lord, Lord Patel of Bradford, to discuss this further, because it is an important consideration.

My Amendment 11 relates to the terrible distribution of GPs in England currently and asks for a much more equitable distribution. I am grateful to the noble Baronesses, Lady Gerada, Lady Hodgson and Lady Manzoor, for their support. Last week I was very fortunate to have a meeting with Minister Dame Diana Johnson and her officials, which I found extremely helpful, and I was grateful to her officials for the way they have been prepared to communicate on this.

This morning, the RCGP published the State of General Practice 2026 report. Chapter 4, about fair and sustainable general practice care—equitable care—makes clear that action is needed. One area where I believe we need action is what the noble Lord, Lord Darzi, described as

“huge and unwarranted variations in the number of patients per GP”.

Data from the NHS general practice workforce team shows that the national average list size of fully qualified full-time equivalent GPs hovers at around 2,200 patients. John Gooderham, a retired civil servant who once worked for me, undertook a number-crunching exercise showing that the differences in average list sizes are almost unbelievable. His evidence, which was published by the Institute of Health and Social Care Management, showed at least 20 areas with an average list size ranging from 8,300 to 4,400 patients, almost four times as many as the national average. All of them are clearly severely underdoctored. At the other end of the scale, there are 20 areas with an average list size ranging from 1,000 to 1,444 patients.

The trouble is that there seems to be no approach or system to rectify this. We used to have the Medical Practices Committee, which was set up by Nye Bevan in the 1946 Act and lasted until 2001. I have to confess that I took through the legislation abolishing the MPC. Mea culpa—it was a mistake. At the time, the line that I took—I looked it up—was that area health authorities would sort it all out. Where are area health authorities? They did not, and none of their successors has. I think we need to go back to a system that identifies areas that are overdoctored or underdoctored to consider how we can justify this situation. It cannot be allowed to continue. I know that officials feel that the kind of MPC system we had is not fit for today’s more modern circumstances, but one way or another, either through financial incentives or through some restrictions, we have to do something about this. I hope the Government will be sympathetic.

[Baroness Manzoor (Con)]

Noble Lords will know that I am passionate about improving the health of all. The National Health Service is the National Health Service, not the ill service. So many disadvantaged, marginalised groups are not receiving the care or the health that they need. I will not go back into the disparities and the health inequalities. I have put my name to the amendment from the noble Lord, Lord Patel, who spoke very clearly. It is a simple amendment but would be a pivotal, key amendment to the Bill.

I also support the amendment in the name of the noble Lord, Lord Hunt, because without having the first line of defence of GPs, marginalised groups do not have the access to doctors that they desperately need. Everybody knows the effects of inequalities on the economy, the NHS and individuals. The Government have a great opportunity to enhance the Secretary of State’s power and strengthen it, rather than transfer the current power.

As I indicated earlier, in my region we had a duty to bring down inequalities in a deprived area. I worked closely with Alan Milburn and other Ministers, including the then Prime Minister, Tony Blair. It worked when that key emphasis, monitoring, duty and strategy were put in place. We need a health strategy, as the noble Lord, Lord Patel, indicated. I leave the question on the table for the Government. This is a fantastic opportunity. It is not about all the structural change that we have been talking about; this is about making a real difference to people’s lives and to the health of our nation.

Neighbourhood Health and Social Care

Baroness Manzoor Excerpts

Tuesday 15th September 2026 Lords Chamber

[Baroness Merron (Lab)]

I certainly can give that reassurance to my noble friend. I am glad she recognises that our move towards neighbourhood health is not just a shift on paper but a real turnaround in how we see people and services. Coproduction is required for neighbourhood health plans, which would be all the poorer if we did not include the voices to which she refers.

[Baroness Manzoor (Con)]

My Lords, integration is harder than colocation. For instance, housing and social isolation are key detriments to health, yet they sit outside the NHS. Therefore, a social worker sitting next to a GP may be helpful, but the reality is that this social worker will not get extra money, extra access to health beds in the community or extra staff. What will the Government do to erase these difficulties, particularly when the health needs of the population are growing and the workforce has not kept pace with the complex needs of the ageing population?

Neighbourhood Health Services

Baroness Manzoor Excerpts

Monday 7th September 2026 Lords Chamber

[Baroness Merron (Lab)]

First, we are investing where it is needed, particularly on new estates and on improvement support. We are also asking ICBs to refocus their existing resources. This is not just tinkering; it is a fundamental shift—one of the three main shifts—to deliver neighbourhood health, which people very much welcome. We are also creating financial incentives. We are creating—the national evaluation will assist us more with this—funding flows and payment mechanisms, which means that savings from improved quality of care will then go into investment in new services. I say to the noble Lord that that has not always been the case in the past.

[Baroness Manzoor (Con)]

My Lords—

[Baroness Hussein-Ece (LD)]

My Lords, we know, and it is very well researched, that people with learning disabilities face enormous barriers in access to primary health care and have lower life expectancy as a result. Can the Minister assure me that these neighbourhood health services will ensure that screening and support for people with learning disabilities will be embedded in this service?

Nottingham Maternity and Neonatal Services

Baroness Manzoor Excerpts

Monday 29th June 2026 Lords Chamber

[Baroness Merron (Lab)]

I will be pleased to raise that with my ministerial colleague in the Cabinet Office. I agree that an oversight mechanism is very important. On the Bill—which will, of course, become an Act—it is key to note that it will establish a new duty of candour and assistance at inquiries, inquests and other investigations. To the point that we are discussing here, the Bill will also allow for that duty of candour to be applied to health investigations by regulation. That is crucial, and it is by using that power that we will ensure that the Leeds and Sussex reviews, which are live, are included through secondary legislation.

[Baroness Manzoor (Con)]

My Lords, I align myself with the comments that have been made by the noble Lord, Lord Kamall, and the noble Baroness, Lady Pidgeon. This a totally devastating outcome. I pay tribute to the families that have been affected in this way.

I am just absolutely disturbed by the quality of the governance at the trust. I am shocked. I have chaired a number of trusts. To not put patient safety first and to not have the data available to make that judgment is absolutely appalling. Therefore, in terms of accountability, will the Minister assure me that the chief executive, the chair or, indeed, any members of the board who have been given honours as a result of their service to their trust are stripped of them? It is not an honour; it is absolutely devastating, and there has been a lack of duty in what they have achieved.

[Baroness Merron (Lab)]

I completely understand the noble Baroness’s point. I am grateful for her sensitivity on this subject. I do not feel qualified to comment on honours and their removal, but I will raise it with the appropriate ministerial colleague to say that this is a view—exactly as the noble Baroness said. I know that she is not alone in feeling that.

Midwives: Graduate Guarantee

Baroness Manzoor Excerpts

Tuesday 21st April 2026 Lords Chamber

[Baroness Merron (Lab)]

Through NHS England’s student movement tool, forecasting on the workforce and national analysis are being undertaken to assess the areas of risk—my noble friend is right to raise those concerns. That is shared with NHS England’s regional teams so that they can manage and monitor workforce positions directly with providers.

[Baroness Manzoor (Con)]

My Lords, I welcome the comments made by the Minister. However, she will be aware that, as well as having a shortage of midwives in place—and we have seen the terrible effects of poor service delivery in antenatal and postnatal care—we have a significant shortage of health visitors, who give advice regarding immunisations, development, feeding and so forth. Some of those health visitors have caseloads of up to 1,000 families. That is not sustainable and, frankly, is quite dangerous. What are the Government going to do to address this?

[Baroness Merron (Lab)]

Again, I refer to the forthcoming 10-year health and care workforce plan, which will take a multidisciplinary approach. I certainly share the noble Baroness’s views about the value of health visitors. As we move services into the community and develop the neighbourhood health service, that will require the greater use of roles such as health visitors. Ultimately, this is a local matter about local employment of staff to meet local need.

Migraine Care: 10-year Health Plan

Baroness Manzoor Excerpts

Monday 23rd March 2026 Lords Chamber

[Baroness Merron (Lab)]

We constantly review and discuss with pharmacists the range of conditions they cover. It has been one of the highly successful ways of making community-based care available, and we certainly want to continue to work with pharmacists. It is also important to note that more modern treatments are available now on prescription, which will all also support people to manage their condition and will reduce unnecessary A&E admissions.

[Baroness Manzoor (Con)]

My Lords, as has already been mentioned, over 10 million people in the UK suffer from migraine, and it is highly prevalent in women. It is also linked to anxiety and depression. I welcome what the Government are doing in extending women’s health hubs and emphasising mental health in the 10-year plan but, unfortunately, there are no systematic gateways for migraine care in the 10-year plan. How can the Government address this in the light of the significant problem that there is? I am also sorry to hear that the noble Lord, Lord Londesborough, suffers from migraine.

[Baroness Merron (Lab)]

It is important that we acknowledge that this is a debilitating condition. The noble Baroness is right that it is one of the most common neurological conditions, affecting one in five women and one in 15 men. Indeed, it is a major cause of disability. The 10-year plan sets out the main pillars. For example, there will be an updated adult neurology service specification, which will come into being just next month. It was published in August, and I believe it will take account of the points the noble Baroness rightly raises.

GP Contract

Baroness Manzoor Excerpts

Tuesday 17th March 2026 Lords Chamber

[Baroness Merron (Lab)]

The right reverend Prelate is right to raise this. We have been very concerned for some time about the inequalities in coastal areas and areas of greatest need, where healthy life expectancy is the lowest. That includes communities with higher deprivation levels. That is why we began our reforms last year with an independent review of the outdated Carr-Hill formula. That is about the distribution of GP funding, which is fundamental to the point the right reverend Prelate makes. It is based on data that is around 25 years old in some cases, and clearly our population has changed. I look forward to updating the House when that review is concluded.

[Baroness Manzoor (Con)]

I welcome some of the criteria that are going to be used, particularly for deprived communities, in relation to access, but there remains a postcode lottery in terms of access to GPs, particularly in deprived communities. My concern is that, with some of the algorithms and IT being used as a postbox, patients are being referred directly to A&E departments. Will the Government assess in A&E departments which people are being referred that way so, that we can ensure that that loophole is addressed?

[Baroness Merron (Lab)]

It is important to say that online access does not sit alone. There is also in-person access, including telephone access if people prefer that. The intention is not—and it is not the practice—that they are just postboxes. They are dealt with. We constantly keep those approaches under review. Our expansion is about access to GPs. That includes, for example, in answer to some of the points that have been raised today, including by the noble Baroness, repurposing £292 million from primary care network incentive scheme moneys to fund additional GP sessions to create more capacity, because that is necessary whatever way people make contact. That was based on feedback from the BMA, which said this would be a more effective use of funding.

Under-16s Energy Drinks Ban

Baroness Manzoor Excerpts

Tuesday 10th February 2026 Lords Chamber

[Baroness Merron (Lab)]

I understand the noble Lord’s point. We are focusing on those energy drinks that contain 150 milligrams of caffeine per litre as the way of making the greatest impact to children aged under 16. When I think that over 100,000 children aged 11 to 15 consume at least one high caffeine energy drink per day, I believe that that is the right thing to do, as some of those drinks are equivalent to four cans of Coke or two espresso shots. That is how seriously we need to take this. I hear his point about going further, but it is important that we focus on the absolute immediate.

[Baroness Manzoor (Con)]

The Government introduced voluntary guidelines for manufacturers to reduce salt and sugar in baby food and milk food products for ages up to 36 months. How has that gone? Will they introduce statutory guidelines after the first 18 months? Have companies complied with the guidelines?

[Baroness Merron (Lab)]

We were glad to introduce the voluntary measures. To be proportionate and evidence-based, they will in the first instance be voluntary. We will review along the way how we are getting on and whether there is a need for statutory action, as the noble Baroness asks.

Better Start Longitudinal Programmes

Baroness Manzoor Excerpts

Tuesday 10th February 2026 Lords Chamber

[Baroness Merron (Lab)]

I think I heard what my noble friend said: I got the gist. What matters is not just that we are in a position where children’s health and well-being is not where it should be but that we are pulling together all the best examples of practice, including Sure Start and family hubs, and investing in provision, services and information. This will take us forward to a situation where we genuinely have the healthiest generation ever. That is not something we have now, particularly in the more disadvantaged areas.

[Baroness Manzoor (Con)]

My Lords, I am sorry if I sound like a broken record, but what are the Government doing to ensure that we retain the health visitors and midwives that we have? There are not sufficient midwives or health visitors in the service and they play a vital role in supporting young mothers and fathers in the care of their babies and children.

[Baroness Merron (Lab)]

They do: I completely agree. That is why they are very much part of our delivery plan. It is part of the move from hospital to community: part of the neighbourhood service model. We will be publishing the workforce plan in the spring; that will take account of it. This is a multidisciplinary approach. We are seeing more midwives. We are also seeing more consultants in obstetrics, for example, although I know that the noble Baroness was not referring particularly to that. We are also developing stronger health visitor teams. They all matter, because they bring the care closer to home in a way that will make the greatest impact.

NHS: Corridor Care

Baroness Manzoor Excerpts

Wednesday 4th February 2026 Lords Chamber

[Baroness Merron (Lab)]

On social care, we are making progress on building a national care service. Around £4.6 billion of additional funding has been made available for adult social care by 2028-29. Along with other matters, including funds to improve and provide adaptation so that people can return home when they would not have been able to otherwise, we are providing funding of over £1 billion for adult social care with local authorities. This can be used to expand capacity. Of course, we have an independent commission chaired by the noble Baroness, Lady Casey.

[Baroness Manzoor (Con)]

My Lords, in a recent survey 78% of physicians reported undertaking corridor care. It is becoming almost the norm all the year round. It affects patients’ dignity, health and safety, and patient outcomes, because there are greater infection rates. I welcome the Minister’s points on the action that the Government are taking, but it is rather long-sighted and there is a real urgency to do something now.

[Baroness Merron (Lab)]

I agree with the noble Baroness. Corridor care is perhaps one of the most visible and distressing symptoms of an NHS that the noble Lord, Lord Darzi, described as broken. We have to fix a number of the processes. I welcome that we are expanding urgent care access, for example, in primary, community and mental health settings, which will reduce demand on services. However, without publicly available data and the clinical operational standards that we are setting, the change will not be made as quickly as we would all like. There are immediate actions, as well as medium and long-term actions.