Health Bill

Debate between Baroness Manzoor and Baroness Coffey

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Baroness Manzoor (Con)]

My Lords, I support the amendments in the group, particularly Amendments 22 and 24, in the names of my noble friends Lord Kamall and Lord Howe. I say to the Minister that patient choice needs to be significantly strengthened, particularly in three important areas.

Currently, there is choice, but we need to make choice much more meaningful, rather than simply theoretical, by giving patients greater control over access to services and their care pathways and ensuring that choice is available across the whole of the NHS and the health ecosystem, not just elective hospital treatment, as was clearly outlined by my noble friend Lord Howe. Patients are not always aware that they can choose which hospital or provider they attend. In practice, patients may simply accept the hospital suggested by their GP or referral system, without being told about alternatives.

How do we improve this? I passionately believe that GPs should have a duty to routinely explain patients’ rights to choose, and patients should be offered a meaningful range of clinically appropriate providers. They should be provided information about waiting times, quality, outcomes and location, as Amendment 22 suggests. Patients should be supported to make informed decisions, rather than being directed towards a single provider. The NHS England guidance recommends currently that referrers should shortlist an average of five provider choices where it is practical, clinically appropriate and preferred by the patient.

Choice is particularly relevant in relation to NHS 111 and A&E attendance. Patients contacting NHS 111 are often given a recommended pathway, but their ability to access alternative services may be limited. For example, a patient might be advised to contact their GP, attend an urgent treatment centre, access a community pharmacy, receive a telephone or face-to-face clinical assessment, or attend A&E if clinically necessary. The problem is that a recommendation is not necessarily a genuine choice if the alternative service is unavailable.

Improvement is needed. There needs to be better access to same-day GP appointments, wider choice in the NHS and wider health ecosystem, more accessible urgent treatment centres, greater availability of evening and weekend services, better integration between NHS 111 and local urgent care providers, and much greater transparency about where patients can receive treatment. The key principle should be that patients are given practical alternatives, not simply redirected from one service to another—audiology has already been mentioned. Amendments 22, 23 and 24 would enable this. I know that this can happen, because, back when we had regions, we had the ability to refer patients to other providers where waiting times could be reduced, and it worked very well. Of course, we must not allow cherry-picking, which is a danger, and we must clearly define what outcomes are to be expected.

[Baroness Coffey (Con)]

My Lords, I agree with the amendments. The original duty included by the Government feels a bit lightweight and almost declaratory, rather than anything of substance. That it is why it is proving a useful debate, through the variety of amendments, to look at putting more substance to this.

In the real world of the NHS, in my experience as a patient and previously as an advocate, what is convenient for the NHS is more important. We will come to this in a broader sense later in the Bill, but it is vital that we try to help patients, as with the earlier duty in the clause that is not being changed, to have more involvement in their healthcare. As my noble friend Lady Manzoor just said, patients are often not aware of the availability of other services. It would be useful to get an understanding of how the Secretary of State intends, through this clause, to make patients more aware.

At the same time, as my noble friend Lady Neville-Rolfe points out, in effect, probably due to budget constraints, rationing has started by not allowing patients to take advantage of provision in the interests of trying to manage budgets. I am not saying that the NHS is a bottomless pit—it is not—but we have to come back to what the NHS is there for. The constitution is quite clear that patient choice is a key element. That is reasonable in order to try to make sure that we have a healthier society. As my noble friend pointed to, quite a lot of illnesses are stopping people working, or working to their full potential. That is no good. A lot of illnesses mean children are not allowed to reach their full potential and are spending time out of school.

We need to consider such factors when carefully considering the amendments tabled by my Front Bench and that of the Liberal Democrats to beef up what it means to ensure that other provision can be readily accessed to have a healthier society. I hope that my noble friends will bring this back on Report if we do not have any satisfaction today.