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

Baroness Merron Excerpts

Wednesday 15th April 2026 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026.

Relevant document: 54th Report from the Secondary Legislation Scrutiny Committee

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, this statutory instrument makes an important change. It will amend the 2014 regulations so that the treatment of disease, disorder or injury, known as TDDI, is brought within the regulatory scope of the Care Quality Commission. This change will be for the treatment of disease, disorder or injury provided in sports grounds or gymnasiums, or under temporary arrangements at sporting or cultural events, where it is delivered for the benefit of those taking part in or attending those activities.

Let me start by clarifying what this is and what it is not. This regulated activity relates not to the task being carried out but to who is doing it. It is the assessment and treatment of physical or mental state when provided by a specifically defined list of healthcare professionals, as per the CQC’s website. The scope of this activity requires those carrying it out to be listed healthcare professionals registered with the appropriate professional body, such as the General Medical Council, the Nursing and Midwifery Council or the Health and Care Professions Council. When a healthcare professional uses their professional title, qualification and skills to assess and treat a person for a disease, disorder or injury, they must be registered with or employed by a company registered with the CQC.

Providers carrying out the treatment of disease, disorder or injury at events may include independent ambulance services that employ paramedics, doctors and nurses, and which are commissioned to attend an event such as a music festival, marathon or football match and be on hand in case anyone there experiences a medical emergency.

Perhaps I can give some context. Members will recall the tragic events of 22 May 2017, when the Manchester Arena bombing killed 22 people and injured more than 1,000 others. The subsequent inquiry uncovered serious failings, including inadequacies in the provision of healthcare services at the arena. The inquiry noted that these shortcomings may have been present at other venues across the country, in part because of the absence of appropriate regulation. A central finding of the inquiry was absolutely clear: the Department of Health and Social Care should consider changes to the law to enable the CQC to regulate healthcare delivered at events. The CQC has itself outlined additional concerns about the quality of care provided at events. It has heard serious allegations of unregulated provision resulting in severe patient harm.

The Government, as noble Lords would expect, are committed to acting on the inquiry’s recommendations and strengthening public safety. I recognise that these changes are overdue, but it was important that they be carefully considered in order to understand the impacts. I am pleased that they have now been laid before us.

To turn to what the amendment will do, the 2014 regulations exempted the treatment of disease, disorder or injury provided at sports venues or gymnasiums or under temporary arrangements from regulation. This SI removes this exemption. It will bring the provision of this treatment at events into line with provision in hospitals, clinics, ambulances, GP surgeries, community services and care homes where it is already registered. This means that any provider delivering the treatment of disease, disorder or injury at an event must register with the CQC and must comply with the same robust regulatory standards that apply elsewhere in the health system. Of course, some of the providers will already be registered to provide this treatment in other settings, which will make the process quicker for them.

I should say to noble Lords that there has been some misunderstanding about what is covered by

“the treatment of disease, disorder or injury”.

It includes a wide range of treatments, from emergency interventions to ongoing care for long-term conditions. I wish to be clear that the treatment of disease, disorder or injury does not include first aid. First aid remains outside the scope of CQC regulation.

By making these changes to the 2014 regulations, the Government will make true our commitment to fulfilling the recommendations of the Manchester Arena inquiry and the drive to improve patient safety. I beg to move.

[Lord Lansley (Con)]

I shall speak briefly to this statutory instrument and ask a number of questions, if I may, to which I hope the Minister will be able to respond. I think that I understand the structure of what is proposed and the exclusion of first aid so that it is not covered, but when I look at the providers that are likely to be affected, I am trying to work out carefully which are the providers concerned. I am assisted by a friend who is part of the Faculty of Sport and Exercise Medicine and who said that it had undertaken a survey.

It seems to me that many of the people who responded to that as healthcare professionals may well be working in registered providers already, so they may be concerned about the need to register in relation to the services that they provide at events but in fact they do not need to register. However, the event organisers themselves may need to register if they bring healthcare professionals on site in order to provide services that go beyond first aid at their event. I am trying to understand how, when the department went out and identified 89, or whatever the number was, potential providers that were not already registered, it ended up with a figure of 36, which seems very low. It certainly bears no comparison to what those who are working in the sector believe would be the number of presently unregistered providers. We need to understand who these 36 are, the character of those providers that the department has identified and why there is such a discrepancy between that and what others have been saying. I would be grateful if the Minister would tell us much more about that.

As a practical example, are all football clubs, or the major football clubs in the Premier League, the Championship and so on, already registered with the CQC? Clearly, they, as organisations, provide continuing healthcare to their players. Do we not need to worry about any of that? Is an event like one of the big festivals that take place already registered, because it has put a team together in order to provide more than simply first aid? Perhaps we are worrying about a need for registration when actually we do not need to worry so much.

I have only one other question. An essential part of the follow-up to the Manchester Arena inquiry was the preparation of an event healthcare standard. Would the Minister be kind enough to update us on that process? Where does it stand and when might we see its publication for consultation?

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[Lord Kamall (Con)]

A number of noble Lords have raised concerns, and I am going just to outline or repeat a few of them. The first is that the department’s own assessment acknowledges that the costs associated with registration and ongoing compliance are estimated, for newly regulated providers, as being between £99,400 and £994,000 per annum. They are quite accurate figures, but let me rephrase that: it could be nearly £100,000 or nearly £1 million. We know that most forecasts are wrong, but a factor of 10 is rather a wide range. I have to admit that that raises concerns about the understanding of these regulations.

But more concerning is the evidence from the Faculty of Sport and Exercise Medicine suggesting that many clinicians working in event medicine may reconsider their involvement if these regulations are implemented as proposed—as the noble Baroness, Lady Grey-Thompson, raised. As other noble Lords have said, events medical providers support the principle of these regulations but warn that they could lead to a reduction in workforce capacity, with the potential unintended consequence of reducing safety. My noble friend Lord Herbert referred to that unintended consequence.

There are also concerns that, where providers withdraw from delivering this regulated medical care, events may instead have to rely on first aid provision, as we have heard from a number of noble Lords. That falls outside the scope of CQC regulation. Well-run events such as Wimbledon, Royal Ascot, the Silverstone Grand Prix and the Glastonbury Festival currently manage most medical incidents on-site. But we could see a shift away from properly staffed medical provision, which risks increasing demand on already stretched NHS services off-site.

Stakeholders, including the Sport and Recreation Alliance, have highlighted a lack of comprehensive engagement with the sector to date. Given the unique characteristics of event medicine, it is essential that any regulatory framework be developed in close consultation with those who deliver care on the ground. However, I have been told by some medical professionals that the CQC is being selective in who it wants. I was told a similar story to that told to my noble friend Lord Markham: when three or four CMOs asked for a joint meeting, the CQC person refused and insisted that they wanted to meet only one of the CMOs. When I hear this, frankly, it gives me no confidence in the CQC or its consultation process. Let me be clear: I do not use those words lightly, but the CQC should be doing proper consultation and not refusing meetings.

I recognise the efforts by the previous and the current Government and the CQC to fix its previously poor reputation. Last year, in the mental health debates, these Benches supported the Government in resisting the appointment of a separate mental health commissioner, because we agreed that the mental health part of the CQC was getting its house in order. Indeed, I met today with some people from the CQC on transitional care, and I was very impressed with them.

However, when I am told that for this regulation the CQC suggested that an additional 36 organisations would require registration, compared to an estimated 25,000 in the survey by the Faculty of Sport and Exercise Medicine, this, as my noble friends Lord Lansley and Lord Markham, and the noble Baroness, Lady Grey- Thompson, said, demonstrates a massive gap in understanding that needs to be addressed. Once again, I am sorry when I say this, but it gives the impression of the CQC being out of its depth.

I am sorry if that is not exactly the ringing endorsement that the Minister was hoping for, but I also know that she has been willing in the past to meet to discuss legislation, and we have worked constructively together in the time we have both been on our respective Front Benches. So, in that constructive spirit, I will make three suggestions, which in fact touch upon those that that were made by other noble Lords.

First, we need to see meaningful CQC engagement with sector representatives, our national governing boards, the chief medical officers in sports groups, the Faculty of Sport and Exercise Medicine and the Faculty of Pre-Hospital Care to ensure that any inspection framework is sector-specific and not simply lifted from the hospital sector. Imposing a CQC regulatory framework suitable for hospitals is inappropriate for pop-up clinics at park runs, cycle races or pitch-side at rugby. Let us be frank: the CQC does not have any existing knowledge of working in these sectors at that level, and it should be listening rather than seeking to impose.

Secondly, we should consider expanding the current employer/employee CQC exemption to athletes, performers and officials whose healthcare providers meet strict occupational health standards regardless of the patient’s contractual arrangement, as other noble Lords suggested.

Thirdly, although I understand that the Secondary Legislation Scrutiny Committee has raised concerns about the time taken to bring forward these regulations, given that the CQC is not exactly inspiring confidence from those who organise sports and other events, could the Government possibly ask the CQC to wait until the event healthcare standard being led by the Faculty of Pre-Hospital Care has been published? In addition, if and when it becomes apparent that the CQC has indeed underestimated the size of this and the cost to the sector, would they be prepared to perhaps extend that December 27 deadline, if appropriate?

However, really to emphasise the point that the Government are listening, I know we have asked for individual meetings, but a much better suggestion would be a round table with interested noble Lords, with the relevant Minister from the department—obviously we would love to have the noble Baroness, Lady Merron, there as we always enjoy her consultations— and the CQC, so it can stop being selective about who it speaks with and can actually listen to CMOs and other medical experts from across the sector. They are not doing this to score points; none of us is doing this for that reason. We agree with the principle, and we want this to work, whichever party and whichever Bench we work on, but we are concerned that the CQC’s approach will lead to the unintended consequence of the withdrawal of appropriate medical provision at these services.

It is quite clear that all noble Lords support the goal of improving public safety at events. All noble Lords have heard the concerns from public events medical experts, and all noble Lords hope that the Minister has listened to their concerns and will agree to the modest requests they have made in today’s debate.

[Baroness Merron (Lab)]

My Lords, I am most grateful for the debate today. I will make a few general points.

I very much welcome the points and the concerns that noble Lords have been willing to outline. I also want to acknowledge that I have heard the understanding of why we are doing this. I know that we all understand the intent, and I understand the numerous questions— I make that as a comment, not as any criticism—trying to understand the workability. I very much welcome them. What I take from this debate and what I will share with Minister Ahmed as the Minister for Patient Safety is that clearly there is considerable concern. To refer to what the noble Lord, Lord Addington, said about fault lines, I think this is about fear of fault lines, but even fear of fault lines is fear enough, so I absolutely take that point.

Let me say at the outset that, if noble Lords had not asked for it, I would have suggested having a round table for interested Peers. It will indeed include officials from the department and the CQC. Ministerially, because it is Peers, I would want to be there in any case. I am sure that Minister Ahmed would want to be there too, but my anxiety is to get on with the meeting, so I will happily have a discussion with him, but I certainly want to be there. If noble Lords remain concerned about a lot of the points, we can tease them out there.

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[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.

[Baroness Merron (Lab)]

On all these areas, as I said, I am happy to meet with noble Lords in person. To be honest, I think that that would be more helpful, not least because we are talking about scenarios and we have a note of the questions that noble Lords are raising. I would be delighted to go through them. Again, in the responses today, I am probably going to be repeating some of what I said earlier and I am not sure that that will take us forward, so I would rather that we held those points for a meeting, if noble Lords are agreeable.

With that, I thank noble Lords. This has been a very valuable debate. It shows the work that needs to be done and we will be pleased to do that. I thank all noble Lords for their considered contributions and support of the principle of why we are here.

Motion agreed.