Health Bill

Baroness Merron Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, the Committee will undoubtedly be grateful to the noble Lord, Lord Hunt, and the noble Baroness, Lady Tyler, for bringing forward these important amendments and for highlighting the vital contribution that unpaid carers make to our health and care system.

It is an obvious truth, but a truth worth stating, that carers are the people who know the person they care for best. They provide not only practical support but continuity, reassurance and an understanding of individual needs that can make a real difference to the quality of care. I very much welcome the recognition of the key role that carers play and the need to ensure that they are, first, identified—as many noble Lords have emphasised—and then listened to and appropriately involved in decisions about the people they support, while at the same time respecting the wishes and rights of patients themselves.

Carers are often family, friends and neighbours, and they usually do not foresee the duty happening upon them. They demonstrate the most admirable qualities in fulfilling that duty. The pressures that caring responsibilities can place on individuals and families are frequently very considerable, which is why we must never lose sight of the need to support carers’ own health and well-being, including opportunities to take a break from caring, as the noble Baroness, Lady Pidgeon, mentioned.

Amendment 21 would enshrine the right of carers to be involved in patients’ decisions, which seems eminently sensible and right. Carers, with patient consent, already have the right to be involved in discussions with clinicians. At the same time, clinicians will always need to make a judgment according to the situation, because it is just as important to go back and check the wishes of the patient and to make sure, for example, that they have privacy when they want it. Without wishing to downplay in the slightest the value of these amendments, it would be helpful to have confirmation from the Minister that a patient has the right to withhold from a carer sensitive information in their medical records that they might not want shared.

We will be debating the Government’s proposals for a national care service in a later group, but I wonder whether the Minister can give us a sense of how the Government view the position of unpaid carers in the context of those proposals. In what way do they think a national care service could or should affect the status of family carers? I ask because, with the concerns that noble Lords have raised during the debate, it seems doubly important that we do not inadvertently sideline or devalue the extraordinary contribution to society, and indeed to the economy, that unpaid carers make, or overlook the practical support and respite that carers need.

Unpaid carers are the backbone of so much of our health and social care system. Carers can be of any age. My noble friend Lord Young of Cookham rightly emphasised the role of young carers. Their contribution is immense, as are the burdens they carry, yet so often those things go unseen. Caring is a profoundly challenging role that, over time, will undoubtedly affect a person’s mental and physical health. The support for carers that noble Lords have so often called for can come in different forms: the noble Baroness, Lady Watkins, referred to the vital importance of respite and the part that care homes play in providing it. My noble friend Lady Morris has just reminded us that there are many great charities operating in this field. I wonder whether the Minister could give us a sense of what the Government’s vision is for how such support and respite should be delivered: whether they see it as primarily a role for the state or whether there is a broader palette of provision that is right and sensible to avail of.

Whatever the future structure of our care system, we must not lose sight of the people who give so much to care for others. Their voices and needs must be recognised.

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

My Lords, I am most grateful to my noble friend Lord Hunt and the noble Baroness, Lady Tyler, for initiating this important debate about carers, and indeed health and care partners. The points that have been made in the debate on this group were well made and well heard, and I know they are very much rooted in personal as well as professional experience. I too pay tribute to the vital work that carers, friends, families and neighbours all do to support their loved ones, often in the most challenging circumstances. I particularly note the reference to young carers by the noble Lord, Lord Young, the noble Earl, Lord Howe, and my noble friend Lord Hunt.

I turn first to Amendments 21, 214, 173 and 174, in the name of my noble friend Lord Hunt. Integrated care boards have an existing duty to promote the involvement of patients, and their carers and representatives, in decisions relating to their care or treatment. To the point the noble Earl, Lord Howe, has just raised, carers are the patient; they are the key person and they have control, as long as they are able, to make decisions about what is appropriate and what is not, as is usual. In addition on these particular amendments in this group, local authorities are required by the Care Act to have regard to the importance of people participating in decisions and being provided with information. I point out that the Health Bill also introduces a duty on integrated care boards to promote opportunities for visiting and a duty for local authorities to have due regard to the importance of individuals being able to involve other people in decisions about their care and about being able to receive visitors.

Regulation 9A already provides legal protections by placing a duty on care home, hospital and hospice providers to facilitate visits and accompaniment in a way that meets the person’s needs. As I just said, at the centre of all this are the needs of the individual. To clarify, a visit includes somebody providing physical support or companionship in person, and encompasses the support envisaged from a health and care partner.

My noble friend Lord Hunt and the noble Baroness, Lady Finlay, raised this matter in the earlier part of the discussion. The existing legislation intentionally avoids establishing a distinct term of “health and care partner”, simply because a single definition may not appropriately reflect the range of relationships that there may be and those that apply across different health and care settings. Also, the reference in Clause 57 to “other people” encompasses family, friends and carers and would already include a health and care partner.

The proposed amendments may inadvertently constrain how contact and support are provided and would inadvertently fail to provide for exceptional circumstances where offering support becomes a significant risk to the health, safety or welfare of a person using the service or on the premises. Instead, we are building on existing protections through non-legislative measures, including through the development of the NHS health and care partner policy. I hope that will meet the intentions behind these amendments.

Amendments 89, 175 and 176 tabled by the noble Baroness, Lady Tyler, relate to unpaid carers. The existing legal framework already requires the system to support carers. The Care Act 2014 places requirements on local authorities to assess and meet eligible needs. Carers are also explicitly referenced in the NHS constitution, and local authorities and NHS bodies have a duty of co-operation.

As for Amendments 175 and 176, existing legal duties establish a framework where needs assessments and subsequent care planning focus on the individual and their circumstances, rather than prescribing a particular service or solution such as respite care—something to which the noble Earl, Lord Howe, referred.

Amendment 88 tabled by the noble Baroness, Lady Tyler, raises a point that a number of other noble Lords have spoken to, including the noble Baroness, Lady Pitkeathley. It is of course important that carers are properly recorded and identified in the system. However, we do not believe that setting explicit requirements is appropriate for legislation, important though that is. We are making clear commitments in the 10-year health plan and are taking practical steps to improve identification, recording and support.

My noble friend Lady Nargund asked specifically about the single patient record. The Bill contains powers that will enable regulations to make patient information available to people other than patients on the patient’s behalf, if that is required. That can include all carers. The main point here is that we want to ensure that carers who act on behalf of those they care for can also get full benefit from the single patient record.

There is also guidance to support general practice to better identify and record which patients are unpaid carers. There is ongoing work to improve identification by promoting more consistent coding of unpaid carers by GPs.

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[Baroness Finlay of Llandaff (CB)]

My Lords, can the Minister confirm that the partner policy that she referred to—which is being developed as guidance and would avoid anything going into statute—will include a requirement that the carer providing principal care for someone when they are discharged from a unit will be assessed for how much they can and are willing to do in providing care and will be taught procedures that may make the care of the person easier? This includes simple things such as how to help someone get up from a chair, how to manage if someone falls on the floor and even how to give injections for breakthrough medication, such as for pain relief if that is indicated—so that carers are not left feeling that they do not know what to do when the person they are caring for comes home.

[Baroness Merron (Lab)]

The noble Baroness makes extremely fair points. The discharge process takes account of whether somebody can be safely and properly discharged. The care that is provided, whether by a professional or an unpaid carer, has to be absolutely right. She is right to make the points and I am sympathetic to them.

[Lord Hunt of Kings Heath (Lab)]

My Lords, in seeking leave to withdraw my amendment, I thank noble Lords who have taken part in this debate both today and last week. I particularly thank the noble Baroness, Lady Tyler, for her amendments.

The noble Baroness, Lady Morris, made an important point for us to consider on respite care for young carers, as did the noble Baroness, Lady Nargund, on the identification of women carers. The noble Baroness, Lady Pidgeon, made the point that intervention before crisis occurs is so important. The noble Earl, Lord Howe, spoke about the pressures facing carers more generally.

My noble friend the Minister is resistant to legislation because of the existing needs assessment framework. On the recording of people, she felt that the 10-year plan, alongside the action plan she mentioned, would meet those needs. One must take that as a positive response.

We have been here before, though, and a huge number of carers, faced with the bureaucracy of the local system, find it very difficult to get support. Respite care, in a sense, is a visible indication of the issues that we face. I am sure noble Lords will wish to come back to that.

On my amendments, I am grateful to the noble Baroness, Lady Finlay, for her support last week, and also to Care Rights UK and to John’s Campaign, which have been campaigning for a long time to see some statutory protection for loved ones and partners who see and have concerns about the way their loved ones are treated in a care home. They have faced vindictive action by the people operating those care homes for raising legitimate concerns.

I take the Minister’s point about definitions; obviously, that is something to reflect upon. I also take the point about the current statutory duties. However, I think that people need some protection against the behaviour of so many care homes, when faced with legitimate questions about their loved ones. I hope, because the noble and learned Baroness, Lady Hallett, produced her recommendation on this only recently, that the Government will consider legislation in the light of it. Having said that, I beg leave to withdraw my amendment.

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[Baroness Pidgeon (LD)]

My Lords, I am grateful for the support for this group of amendments from noble Lords across the Committee. If the health service is to be truly patient-centred, patient choice needs to be a key part of this. Different patients will have different needs. Therefore, choice is a key part in having ownership of their care and treatment.

My Amendment 23 in this group picks up a key issue as we move to greater use of digital health. The NHS app will start to play a greater role. My amendment picks up the potential loophole that if a patient is seen in person, they may be referred for treatment or diagnostics by their GP or other primary care practitioner and given a choice of where to go for their referral. However, if this is done virtually, via an app or online, patients may not have the same choice that they would have received in person. This amendment seeks to ensure that there are no closed lists and that patients are referred to one provider only. Amendment 24 is similar in its aims.

Amendment 67 in my name, Amendment 22 in the names of the noble Lord, Lord Kamall, the noble Earl, Lord Howe, and the noble Baroness, Lady Neville-Rolfe, and Amendment 68 in the names of the noble Lord, Lord Kamall, and the noble Earl, Lord Howe, are similar. My amendment specifically pushes for patient choice for non-consultant-led community services, including optometry-led glaucoma care and community urgent eye care services. The amendment seeks meaningful choice from providers available in an ICB area for out-of-hospital services. We know that waiting lists have increased for community services, yet these are often preventive services. I have raised in this Chamber before that 600,000 people are on hospital waiting lists for eye care services, yet we have optometrists on every high street who could be used to help address this and bring routine treatment nearer to people’s homes, thus leaving specialists able to deal with patients who need their services in a more timely manner.

Audiology, as we have heard, is another really important area. As the noble Earl, Lord Howe, highlighted, NHS community audiology services are commissioned across the whole of an ICB area in just 42% of ICBs. This means that the majority of patients are being denied choice. Often, patients are required to attend hospital-based services and experience long waits for services which could be offered safely and in a more timely manner in the community. This could be nearer to home or to a family member’s home—somebody who helps them get to an appointment and helps them with transport—giving them genuine choice. If we are serious, as we debate the Bill, about shifting care out of hospitals and into the community then patients must be given the same right to choose their provider for community services as they currently have for consultant-led hospital care.

Community waiting lists have now reached record levels, with around 1.25 million people waiting for treatment. Patients should be empowered with clear information on waiting times and location, allowing them to choose the provider that best meets their needs. By placing choice in the hands of patients rather than commissioners, which it too often is, we can improve access to timely treatments and actually deliver on the Government’s ambition of more personalised care closer to home. I look forward to the Minister’s response.

[Baroness Merron (Lab)]

My Lords, I will address the wider principles underpinning Clause 5 and Amendments 22, 23, 24, 67 and 68. I am grateful to noble Lords for their contributions and consideration of matters that are key to patient choice—a concept that is, as I know noble Lords are aware, neither new nor innovative but is absolutely at the core of the Bill.

Clause 5 introduces new duties to require the Secretary of State to promote the involvement of patients, their carers and their representatives in decisions relating to the prevention or diagnosis of illness, care or treatment. This applies where the Secretary of State exercises her health functions. As I said, this is absolutely core to the Bill and I am sure that noble Lords will welcome that.

The clause also requires the Secretary of State to act with a view to enabling patients to make choices about the health services provided to them. I hope that noble Lords are aware that the Government are committed to involving patients and carers in decisions about their care, as we discussed in the last group. One of the reasons is that we know it supports better experiences of care and in many cases leads to a better outcome. It is not just a “nice to have”, but a “necessary to have”.

I refer the noble Baronesses, Lady Manzoor and Lady Coffey, and the noble Earl, Lord Howe, to the new Choice Charter, which will strengthen this approach by setting out—this is key—what patients can expect so that they can make informed decisions about their health and care. There is no point in just expressing a wish to have patient choice if we are not equipping patients to make that choice. That is why we are protecting the patient’s right to choice and the duty to involve them in decisions. As I said, that will remain a central principle of the health system. I was glad to hear noble Lords across the Chamber welcoming the move from hospital to community provision. As the noble Baroness, Lady Pidgeon, set out, many services can be provided better in the community than they can in hospital. I welcome that support.

Amendments 22, 23, 24, 67 and 68 have been tabled by the noble Lord, Lord Kamall, and the noble Baroness, Lady Pidgeon. These amendments would go further than Clause 5 currently does by expanding patients’ right to choice to a wider range of out-of-hospital services and onward referrals by virtual and integrated health services, and by prescribing how this must operate in practice. I reconfirm our commitment to strengthening patient choice as part of our wider agenda to improve access to care and reduce waiting times. It might be helpful to remind your Lordships’ House—the noble Earl, Lord Howe, might be particularly interested in this—that existing choice rights already apply to some consultant-led out-of-hospital services where the regulatory conditions are met. These include dermatology, pain management services, gastroenterology and diabetes services.

The noble Lord, Lord Patel of Bradford, made a number of key points. Community services are by their very nature designed differently from hospital services. I assure him that those who need help to exercise their choice will get it around what their needs are. They will not simply be expected to manage with one size fits all. The points that have been made are fair and I take them on board but, as a point of principle, we do not think that this level of operational detail, important though it is, is appropriate for primary legislation. Our preference is to use secondary legislation to set out the services covered by choice rights and the detailed requirements for offering choice. The key thing is that that will allow that framework to be updated as services, evidence and system capability develop, because we are not going to be stuck in one place and healthcare will develop as we go along. I say to the noble Lord, Lord Patel of Bradford, that we will continue to look at the scope of the choice rights and ensure that we are provide the most effective offer to patients.

I say to the noble Baroness, Lady Coffey, and the noble Earl, Lord Howe, that we are taking the practical actions they seek, as set out in the elective reform plan. We are empowering people to take control of their health by making the NHS App and the “Manage Your Referral” website the default route for patients to choose their provider. To enable patients to make an informed choice, we are improving the information available to them, following the point I made earlier, including on waiting times. The noble Lord, Lord Patel, was right to say that not everybody can use online access. We completely understand that, and I emphasise that online tools are in addition to traditional channels. We will ensure that people who need help to make a choice receive that support and information in the way that suits them, as raised by the noble Baroness, Lady Pidgeon.

On the point made by the noble Baroness, Lady Neville-Rolfe—this might also be helpful to other noble Lords—patients will continue to be able to choose any provider that holds a contract to deliver NHS services. As I said in my letter to the noble Baroness, that includes independent sector providers, within set circumstances. It is the responsibility of ICBs to ensure that their processes comply with the right to choose. That includes any qualifying contract requirements, clinical appropriateness and eligibility criteria. There is guidance for the use and implementation of indicative activity plans and activity management plans. That is detailed in the NHS standard contract technical guidance. If the noble Baroness would like more information, I will be happy to ensure that it is there.

The noble Baroness, Lady Manzoor, talked about the need for real choice to be strengthened. The government guidance on choice makes it clear that GPs, dentists and optometrists have clear duties to ensure that patients are offered a choice of where they go to their first out-patient appointment. I totally agree with her that a right is only as good as the information and confidence that you have. That is why we are taking these steps.

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[Baroness Pidgeon (LD)]

Before the Minister sits down, she mentioned that the Government are minded to use secondary legislation rather than amendments to the Bill. Are the Government minded to include the non-consultant community services we have been discussing in the Chamber today in such secondary legislation, for genuine patient choice?

[Baroness Merron (Lab)]

Secondary legislation will ensure patient choice across all NHS services, so that will be included.

[Baroness Neville-Rolfe (Con)]

I think the Minister’s answer showed that this local variation is a problem, partly because of the standards, contracts and framework that she described. Some of this may be in future secondary legislation, as the Minister has just said. I would like to pursue this a bit further to see if one can tap the capacity that could reduce waiting times in these important community areas of medicine. I am worried that the existing system is not providing the incentive for that. I would like to understand a little more detail, perhaps in a meeting before we get to Report.

[Baroness Merron (Lab)]

I would be very happy to do that.

[Lord Scriven (LD)]

I have been listening very carefully and, in answer to my noble friend, the Minister has just said that secondary legislation will be for all NHS services by choice. What stops that being put on the face of the Bill?

[Baroness Merron (Lab)]

This is the point I have just raised: we feel that secondary legislation is the better place to put it for flexibility and future-proofing; it is not appropriate, in a static way, for primary legislation.

[Lord Scriven (LD)]

As I am sure the Minister agrees, that would make sense if you were putting the operational services down. If you were making a commitment in Clause 5 that all NHS services in secondary, primary and community services will be accessible for choice, it would then give discretion within that boundary. I do not understand what stops the Government putting those principles on the face of the Bill, rather than making the operational amendments, which the Minister said were too restrictive.

[Baroness Merron (Lab)]

I think we just have a difference of approach to and opinion about the roles of primary and secondary legislation. I respect what the noble Lord is saying and I will of course review the points that have been made, as I always do; however, the position is exactly as I have described.

[Earl Howe (Con)]

My Lords, I am most grateful to the Minister for her response and, indeed, to all noble Lords who have contributed to this debate. This has been a valuable opportunity to explore how we can give patients greater choice while making better use of the resources and expertise available across our wider healthcare system. In particular, services such as optometry and audiology have been highlighted.

I was encouraged by much of the Minister’s response, particularly her reference to the need to empower patients, not least to optimise patient outcomes. She is right that there are already several consultant-led NHS services delivered in the community. It would be helpful, though, if she could reflect on the issues I raised about audiology, which is not consultant-led. Perhaps she could consider what could be done to increase audiology provision in the community. As I said at the outset, our intention is not to undermine the NHS but to support it. Where independent charitable and community providers can deliver high-quality care closer to home and more efficiently, we should be making full use of that capacity.

My noble friend Lady Coffey rightly said that politicians of every colour all too easily make declaratory statements about choice, but that we do not do enough to bring meaningful choice to the attention of patients. I confess that I worry sometimes that the absence of choice in certain situations may, in part, not be wholly unintentional. As we heard from my noble friend Lady Neville-Rolfe, it sometimes seems to suit NHS commissioners not to bring down waiting times. The primary reason for that, I suspect, is the way commissioners channel and direct their commissioning budgets. It is important, though, to keep in mind, and perhaps remind commissioners, that out-of-hospital services can often be less expensive to provide than services delivered in hospital.

Having said that, I hope the Government will take these points away and give further consideration to how patient choice can be strengthened as this Bill progresses. For now, I beg leave to withdraw Amendment 22.

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[Lord Kamall (Con)]

My Lords, this has been an important and timely debate, coming not long after the Terminally Ill Adults (End of Life) Bill and the Prime Minister’s remarks. While these amendments address a range of issues, they all point to the same conclusion: palliative and end-of-life care must have a central place in this conversation.

If the Government are serious about shifting care from hospitals into communities, supporting people to remain closer to home—notwithstanding the comments from the noble Baroness, Lady Barker—and delivering truly patient-centred care, palliative care must be part of that vision from the outset. The need for action is clear. Marie Curie estimates that each year around 170,000 people in England die with unmet palliative care needs, equivalent to almost one person every three minutes. We must ensure that those approaching the end of their lives can access the support they need, when and where they need it. This is closely linked to my noble friend Lady Coffey’s amendment. She spoke movingly of her mother’s experience and the need to ensure that patients have access to high-quality palliative care, wherever they happen to live and choose to die.

If the Government’s proposed national care service is to succeed, it cannot simply be a discussion about structures, responsibilities and reorganisations. It must be about the experience of those who rely on care. No group demonstrates that more clearly than people approaching the end of their lives. Palliative care is perhaps one of the clearest examples of where health and social care are inseparable. While clinical support may be provided by the NHS, the ability of a person to remain at home or close to home, to maintain their dignity and spend time with loved ones, often depends just as much on the availability of social care. For many families, social care provides the day-to-day support on which good end-of-life care depends. Evidence shows that when effective support is available in the community, people are more likely to be cared for and pass away in a place they choose, rather than in hospital. As the noble Baronesses, Lady Finlay and Lady Hollins, said, this will also reduce hospital deaths, save the NHS money and make more beds available.

Palliative care does not begin and end with the NHS; it depends upon social care providers, community services, carers, local authorities, hospices and voluntary organisations working together around the individual and their family. When those services are joined up, people are more likely to receive care in the setting they choose and with the support they need. When they are not joined up, it can profoundly affect those approaching the end of their lives.

In that context, I welcome the amendment from the noble Baroness, Lady Finlay, which recognises that good palliative care depends not on any single organisation but on effective collaboration across the NHS, adult social care and the voluntary sector. Too often, services that support people approaching the end of their lives are commissioned, funded and delivered separately, despite the fact that patients and families experience them as part of a single journey. The amendment would help to ensure that integrated care boards take active steps to bring those services together, whether through access to specialist hospice care, shared equipment, medicines, workforce development or closer collaboration between providers.

Crucially, the amendment recognises the vital contribution of hospices and charitable organisations to the delivery of palliative and end-of-life care. These organisations are not peripheral to the system; they are an essential part of it. If the Government are serious about creating a national care service and a neighbourhood health service that are genuinely joined up for patients, the expertise and capacity of the voluntary sector must be properly integrated into the way care is planned and delivered.

Indeed, some of the most important services available to people at the end of their lives are delivered by hospices and charitable organisations. For decades, as the noble Lord, Lord Hunt, said, the voluntary sector has not merely supplemented statutory services but has been fundamental to the provision of specialist palliative care. But too often it is forced to operate at the margins of the system, dependent on local arrangements, local funding decisions and local fundraisers, and subject to tax rises, such as employers’ national insurance, from which state providers are understandably exempt. The noble Baroness, Lady Bennett, shared examples of recent hospice closures.

If the Government wish to build a neighbourhood health service and develop a national care service, integration must mean integration not only within the NHS but between the NHS, adult social care and the voluntary sector. Ultimately, the measure of success will not be the structures we create but whether individual patients receive seamless support at one of the most difficult moments of their lives and for their families.

The issue of patients having a conversation about their end-of-life care, addressed in the amendment in the name of the noble Baroness, Lady Pidgeon, was illustrated by the very moving stories from the noble Lord, Lord Patel, the personal experience of the noble Baroness, Lady Barker, and the concerns raised by the noble Baroness, Lady Grey-Thompson. These amendments seek to move us towards that goal. I hope that the Minister will give careful consideration to the issues that have been raised during the debate.

[Baroness Merron (Lab)]

My Lords, I can certainly confirm to the noble Lord, Lord Kamall, that I will give complete consideration to the points raised.

As other noble Lords have acknowledged, I thank the noble Baroness, Lady Barker, and the noble Lord, Lord Patel, for bringing their loved ones’ stories into the Chamber for the benefit of others, and for their willingness to share with us such a painful but realistic time. I believe that many people will identify with what the noble Baroness and the noble Lord said, and it will mean so much to so many.

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[Lord Stevens of Birmingham (CB)]

Conditionally.

[Baroness Merron (Lab)]

The noble Lord says “conditionally”. I would I expect it always to be conditional, but I thank him for clarifying.

To address the concerns of the noble Baroness, Lady Coffey, as we have already discussed in Committee, Section 1C of the NHS Act 2006 states:

“In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service”.


This is a deliberately overarching duty that applies across the whole of the health service, so we do not consider it appropriate to create separate versions of that duty for individual services. That would risk duplication and make the legislative framework overly prescriptive.

The much talked about modern service framework for palliative care and end-of-life care was referred to as a “trick or treat” test by the noble Lord, Lord Stevens —I will leave him to conclude, when I finish. I also assure the noble Baroness, Lady Coffey, that no one in this Chamber wants her to feel grumpy, and I am sure that nobody in the department wishes her to feel grumpy.

The modern service framework will focus on reducing inequalities. It will identify, measure and reduce inequalities, and reduce unwanted variation in access, experience and outcomes—I say to the noble Baroness, Lady Grey-Thompson, that that absolutely includes in respect of disability. The modern service framework is indeed anticipated in the autumn, which we remain in. I know that we are all keen to ensure that everyone can receive high-quality and personalised care in the right place at the end of life. I look forward to the modern service framework giving us the best way forward on that.

I turn to Amendment 78, also in the name of the noble Baroness, Lady Finlay. As per Clause 21, the Secretary of State is already required to undertake an annual performance assessment of each ICB in discharging its statutory functions. Again, that was spoken to by my noble friend Lord Hunt. I say to the noble Baroness, and to the noble Baroness, Lady Hollins, that the latest report for 2024-25 was published on 17 December last year. Future assessments will continue to consider how ICBs are discharging their statutory palliative care duties. I very much understand the calls from noble Lords across the Chamber and their emphasis on how important this is.

The modern service framework will indeed build on the ambitions set out in the neighbourhood health framework, which includes increasing the identification of those approaching end of life by 10% and reducing non-elective admissions and hospital bed days by 10% for those at end of life. I take the point that the noble Baroness, Lady Hollins, made about measurement and ambition in particular. On the NICE guidance in this area, in keeping with all NICE guidance, although it is not statutory or legally binding, as local healthcare professionals need autonomy to make clinically appropriate decisions in relation to their patients, there is an expectation that commissioners and service providers take it into account when they make those decisions on how to meet the reasonable needs of their populations.

On Amendment 230, tabled and spoken to by the noble Baroness, Lady Pidgeon, alongside the existing statutory framework that I have already outlined, the already published universal principles for advance care planning promote opportunities for individuals, including those with a terminal diagnosis, to discuss their wishes, their preferences and the clinical recommendations. Health and care professionals are expected to provide appropriate opportunities for individuals to engage in advance care planning. This area was spoken to by the noble Lords, Lord Kamall and Lord Patel, as well as the noble Baroness, Lady Barker.

These principles explicitly recognise the importance of involving a person’s family, carers and those who are important to them. I emphasise the point that those who are important to us do not always come neatly packaged. They are to be involved in discussions, including through the nomination of a named spokesperson. The outputs of these discussions may include one or more of the following: an advance statement —I have heard how helpful that is, along with the importance of an advance decision, where it is to refuse treatment—context-specific treatment recommendations and lasting power of attorney, where it is appropriate, in line with the Mental Capacity Act 2005.

Additionally, for those nearing the end of their life, the Government’s priority is to provide people with financial support quickly and compassionately. The noble Lord, Lord Patel, and the noble Baroness, Lady Barker, both spoke to the absolute importance of compassion being at the core of everything that is done. In a practical sense, the main way that this is done is through the special rules for end of life, which apply to five key benefits, including the personal independence payment.

I move on to the points on medicines access raised under Amendment 242, tabled by the noble Baroness, Lady Finlay. The pharmacy quality scheme forms part of the community pharmacy contractual framework. The scheme’s palliative and end-of-life care domain aims to ensure sufficient arrangements are in place so that patients, relatives, carers and healthcare professionals can obtain medicines in a timely manner—again, something spoken to very clearly by the noble Lord, Lord Patel. ICBs commission out-of-hours dispensing arrangements where there is a need for patients to access medicines outside core pharmacy hours.

Finally, I will address Amendment 26, tabled by the noble Baroness, Lady Finlay, on which we heard a number of contributions. Funding for palliative and end-of-life care is available through existing NHS funding arrangements and, as I have outlined, ICBs have statutory responsibility for commissioning. Indeed, as we have discussed on a number of occasions, local commissioners are best placed to determine how funding should be allocated according to the population need, local service provision and the best use of available resources. The ring-fenced fund proposal, which would mean establishing it in primary legislation, would, we believe, risk being overly prescriptive and would limit the flexibility of local commissioners to determine how resources are best used.

On the point about hospices and funding, I very much recognise, as have noble Lords, the absolutely vital part that voluntary sector organisations, including hospices, play when providing support to people at the end of life, but also to their loved ones. It is also worth noting that the majority of palliative and end-of-life care is provided by NHS staff and services, to whom and for which we are also most grateful. It is true that the amount of funding for each charitable hospice will vary but, by definition, that depends on the demand in local areas and on the type of palliative care provision. My noble friend Lord Hunt made the point that hospices value their operational independence—that is something that I have found in my discussions with them—and they are great innovators. I understand the point about funding, as I do in this whole area. However, when I have looked at this and spoken with hospices, that ability to operate independently is one that they really value.

The modern service framework will ensure that palliative care and end-of-life care is well within a strategic commissioning model. Importantly, there will be clear and transparent contractual arrangements, which I hope noble Lords will welcome.

[Baroness Finlay of Llandaff (CB)]

My Lords, I am extremely grateful to all noble Lords who have spoken in this debate, particularly my noble friend Lord Patel and the noble Baroness, Lady Barker, for sharing recent experiences, and my noble friend Lady Hollins and the noble Baroness, Lady Coffey, who have also drawn on their experiences. Everybody in this Chamber has experienced being bereaved: it is a universal experience, and we all carry with us the mark of whatever happened.

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[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Lord, Lord Kamall, for bringing this debate before the Committee. I commend his honesty that this is born out of frustration and a wish to improve things, rather than seeking a legislative response—something the noble Lord, Lord Scriven, also observed in looking at the amendment. I agree with the noble Lord, Lord Scriven, that the amendment raises important points to be considered more broadly, so I assure the noble Lord, Lord Kamall, of that consideration.

I will make a few points that may be helpful. The NHS Innovation Service already provides a wide national point of access. The way it works is that an innovator makes one request, creates one product record and is referred according to product type, maturity and location. More than 2,200 products have been registered with and have received support through the service, including 710 innovations in the 2025-26 financial year. All health innovation networks participate alongside 11 other organisations. That means that innovators have access to a broad range of expertise through a single service. Almost all products reach at least one health innovation network and are referred to four organisations on average. Innovators may also approach a network directly. Support can span several networks and regions, with onwards referral requiring no new application. Uptake is already reported at a high level while, of course, protecting commercial confidentiality.

I hope that the noble Lord, Lord Kamall, will understand that funding a second route—or, as I believe the noble Lord, Lord Scriven, said, a second front door, which would confuse us—where an effective national service is already in place may not exactly represent what we might call the most effective use of public resource. The amendment’s core aims are therefore already met. Prescribing an operating model in legislation could limit its ability to evolve—something I know the noble Lord understands.

The noble Lord, Lord Kamall, asked about health innovation networks. I can confirm they are subject to performance and impact monitoring. They also produce impact reports to show what their local impact is. The noble Lord, Lord Scriven, asked what would happen following the abolition of NHS England. Nationally funded health innovation networks’ work will continue and will be overseen by the Secretary of State. I will look at the other points that have been raised, because they are all certainly relevant and will be drawn to the attention of my colleague, the relevant Minister, Chris McDonald.

[Lord Kamall (Con)]

My Lords, I am grateful to the very many noble Lords who queued up to speak in this debate—I obviously raised a very important point. I am also grateful to the noble Lord, Lord Scriven, for reminding me how innovative I was when I was the Technology and Innovation Minister. In fact, I set up the very service that I am now asking for many years later. It does beg a question, because even I, as the person who set it up, still did not know that this service existed. When I speak to people in NHS England and elsewhere and say, “You know what you need? You need a front door for innovators”, they say, “You’re absolutely right; we haven’t got one”. So even people in NHS England do not know that this exists.

I was up front that I knew this was not meant to be in the Bill. I just wanted to get discussion. It probably helped to prompt my memory as well—my thanks to the noble Lord, Lord Scriven—but it is really important that more people know about the NHS Innovation Service. Perhaps the Minister could write to me and the many other noble Lords who are interested in this topic to let us know what the Government intend to do to promote the NHS Innovation Service, so that more people are aware and so I do not ask for the same thing next time we have a health Bill.

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[Baroness Merron (Lab)]

My Lords, I am grateful for the debate we have just had. Unsurprisingly, but not exclusively, a lot of it focused on the promised workforce plan, so I will address that straight off. There has been lots of thought about why it is “in due course”, and that is the situation. I am glad that the noble Baroness, Lady Coffey, appreciated the impact, without blame, of a new Secretary of State: she is well placed to speak to that point.

Let me say that, first, our absolute commitment to the workforce plan for the NHS remains. There is no shift in that. I also say that, as I mentioned, the reason we await it and it is “in due course” is that, as is absolutely reasonable and right, a new Secretary of State has to be allowed to provide views; that is the situation. I hope that clarifies the position.

With permission, I will address Amendments 28, 92, 240, 252, 253 and 279J together. Amendments 28 and 253 have been tabled by the noble Baronesses, Lady Shawcross-Wolfson and Lady Pidgeon. I absolutely agree that the health and care workforce is fundamental. It is fundamental to everything we are doing and to this entire debate, and it is fundamental to the interests of patients, which is why we will publish the 10-year workforce plan. As most noble Lords spoke to the plan, I will emphasise that the Secretary of State already has duties to ensure effective planning and the delivery of healthcare, education and training—as has been called for, rightly—and also has a duty to report on the system for assessing and meeting NHS workforce needs.

To the noble Lords, Lord Kakkar, Lord Stevens and Lord Kamall, I can say that an expert panel of external stakeholders has scrutinised the 10-year workforce plan approach to workforce planning. To the noble Baroness, Lady Hollins, I can confirm that sickness absence is indeed factored in to the workforce planning process. I heard the noble Lord, Lord Stevens, talking about the way in which the workforce has changed; that is absolutely right and, again, the plan will reflect that.

The noble Lord, Lord Kakkar, and the noble Lord, Lord Stevens, raised points about short-termism versus long-termism in workforce planning, and so on. I am sure noble Lords will understand that decisions about the education and training of healthcare professionals will continue to be driven by data, based on evidence and intelligence led. That will be through the new restructured system. The point here is to make sure that we have the right people in the right places, with the right skills, to care for patients when they need it.

The noble Baroness, Lady Hollins, asked about a bottleneck in medical training pathways. I can say on that point that noble Lords will recall the passage of what became the Medical Training (Prioritisation) Act, and we are easing competition for medical training by prioritising UK-trained graduates for foundation specialty training places, alongside some other groups. The recently agreed 2026 resident doctors deal also significantly expands specialty training places by up to 4,500 over three years, including 1,000 next year.

The noble Baroness, Lady Gerada, made a very strong, and correct, point about the role of district nurses, borne out by the noble Baroness, Lady Barker. Through NHS England, we are actively monitoring future nursing and midwifery student numbers and will continue to assess the 2025-26 graduate guarantee as a mechanism. There is a wide range of measures to support students, educators and universities with the transition into employment, including Student Hub, which offers guidance and resources for students and newly qualified practitioners.

To the point made by the noble Baroness, Lady Barker, I will be pleased to speak to colleagues in the Home Office about the supply of district nurses, if not directly then through the appropriate Minister.

The noble Baroness, Lady Shawcross-Wolfson, in her opening comments made reference to numbers of GPs. We have committed £292 million for GP recruitment this year, which translates to 1,600 GPs, and there are 4,100 more GPs than a year ago. It is important to note that, while we wait for a workforce plan, we have not waited in taking action. For example, we have resolved the long-running doctors’ dispute and we have published a set of core NHS staff standards.

On adult social care, and the point made by the noble Baroness, Lady Harding, that was another point I pushed when we last debated this matter and when we were in Opposition. There was also a comment about legislating on planning duties. That would pre-empt the vital work to develop a national care service which will follow from the recommendations of the noble Baroness, Lady Casey, which we will receive in the summer. That work will have important implications for the shape and skills of the future adult social care workforce. I agree with noble Lords: it is inextricably linked with the NHS workforce, which is a point I have made over a number of years. In the meantime, we will commit to publishing a workforce plan and we will set out immediate action to further support and develop the adult social care workforce.

My noble friend Lady Rafferty tabled Amendment 279J on continued professional development for nurses and midwives. I agree that that is critical for patient safety and outcomes. That is why we are investing in their professional development, with £181 million of continued professional development funding allocated for nurses, midwives, nursing associates and allied healthcare professionals in 2026-27 as part of a three-year cycle and to support equitable access to professional development. To respond to her questions, I can tell my noble friend that organisations are responsible for the planning and governance of their CPD, to ensure that staff have a fair opportunity to benefit from the funding. We expect employers to provide support, supervision and guidance, and to foster a culture of continuous learning, which, again, we would expect throughout the NHS.

Health Bill

Baroness Merron Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Baroness Cash (Con)]

My Lords, this looked like a very serious group of amendments on paper but, until we had this debate, quite how grave the current gaps are in the NHS did not really emerge. I thank the noble Baroness, Lady Gerada, for tabling her amendments and the noble Lords who spoke to them. I also pay tribute to the noble Lord, Lord Mann, for his review and to the Government for accepting the recommendations that Members from all Benches in the House appear to accept unreservedly.

I sympathise with and support the intent of every amendment in the group. I particularly support Amendments 79, 258 and 259, given the gaps they highlight and the urgent need to close them. Even in light of what the Government have accepted, it is quite apparent that shocking levels of antisemitism are continuing, and there need to be some urgent interventions to stop that.

I spoke quite recently in this House on Sir David Bell’s review of the levels of antisemitism in schools. It is really quite sad, and a shame for this country, that the review by the noble Lord, Lord Mann, shows the same pattern in the NHS. There is clearly a major problem and it is racism, plain and simple, directed at Jews. Too many institutions are tolerating it in a way they would never tolerate against any other group.

The facts are devastating. Community Security Trust recorded 3,700 antisemitic incidents in 2025—the second-highest total ever recorded. In the 2025 NHS staff survey, as we have heard, 13% of Jewish staff recorded discrimination from their own managers or colleagues. That is intolerable in your workplace. How can anyone possibly feel safe going about their day-to-day interactions? We have heard from a number of noble Lords this evening that Jewish people are the only religious group, the only ethnic group, for whom discrimination from colleagues is more common than discrimination from patients. The hostility is coming from inside the institution, and it is therefore beholden on us, debating this Bill, not to miss the opportunities to address this and close the gaps.

The Commission on Antisemitism found Jewish patients considering whether they should remove their religious symbols before treatment. Imagine feeling so unsafe in a healthcare setting, when you are at your most vulnerable, that you may have to consider concealing that about your identity. Patients who feel they have to hide who they are to be treated have lost trust in the NHS; they have lost faith that their doctors will do no harm—the first and basic premise of healthcare—and they have lost confidence that they will be safe.

The regulator has not done its job, which is why I support these amendments, even though the Government have actions in progress and even though they have accepted the recommendations of the review by the noble Lord, Lord Mann. Around 70% of completed appeals by the GMC against tribunals have succeeded, and we know that if the regulators are succeeding seven times out of 10, there is something fundamentally wrong in the disciplinary decisions.

I will not repeat what has been said by noble Lords in support of their amendments, but we should give serious consideration to the proposal from the noble Lord, Lord Scriven, so that we can address the fundamental issue here: a loss of neutrality and an overt willingness to attack colleagues and patients on the basis of their Jewish identity. My noble friend Lord Blencathra goes even further in his Amendment 279C, and I look forward to hearing the Minister’s response to that. He outlined the very serious reasons why he has asked for that, and those reasons and facts need to be addressed.

On Amendment 29 and training, I support the recommendation of the noble Lord, Lord Mann, that it is needed, but he was very specific in what he asked for. He called for the mandatory module, used by 1.5 million staff already, to be updated with quality assured content on antisemitism and anti-Muslim hostility. He added that subject experts should be consulted and that the training be monitored and reported on publicly to ensure it has the desired impact, but I have real reservations about the training that would be possible under Amendment 29, because as drafted it does not contain any of the noble Lord’s safeguards. That does not mean we should not consider or expedite the training that is needed.

The record of equality training in the public sector gives a good reason for us to take care. In 2020, the Government phased out unconscious bias training in the Civil Service after a review found no evidence that it changed behaviour, and some NHS anti-racism training has left out antisemitism entirely. Moorfields Eye Hospital’s compulsory anti-racism seminar was reported last year to have made no mention of Jews at all. Training built on theories of privilege has too often placed Jews among the privileged and therefore outside the protection it claims to offer. So, there are lots of types of training that will make the problem a lot worse. I would like to hear from the Minister what types of training and suppliers will be used, and what accountability and monitoring there will be for anything currently being developed.

It is very important to note that the noble Lord, Lord Mann, recommended mandatory training for the chairs and chief executives of NHS trusts within six months of his review, but the Government’s same statement in response to his review said that senior leaders would be invited to complete it by March 2027. I hope that the Minister will explain to noble Lords why a recommendation for mandatory training became an invitation to train, and when that training will be completed by all chairs and CEOs of NHS trusts, as recommended.

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

My Lords, I am most grateful to noble Lords across the House for their sensitive consideration of something that is very insensitive: antisemitism and other forms of racism. I know that the words spoken today—the sentiments and the commitments—will resonate across communities in a way that will make a difference, and I personally am most grateful for that. I also am grateful to my noble friend Lord Mann for his review and, indeed, to the former Secretary of State, Wes Streeting, for listening to the voices of those for whom the situation they have to live with day in, day out, is quite intolerable, and for commissioning that review. That set the tone.

As the noble Baroness, Lady Gerada, observed from the outset, we have accepted in full the recommendation of my noble friend’s review, and we are taking action to deliver. As was referred to, we provided our latest update last month. This work is continuing, and I understand that noble Lords are asking for more to be done. Indeed, there is no let-up, but we want to get this right, of course.

I will address Amendments 29, 79, 258, 259 and 279C together. We have all said this, but it always bears saying: there is no place for discrimination, antisemitism or racism in our NHS. As noble Lords have said, patients and staff and those associated with them must be free from all forms of racism and religious hatred—and, indeed, from the fear of that, as well as the actuality. That is at the core of these amendments and this debate.

I say to the noble Lord, Lord Shinkwin, that Ministers have asked all NHS bodies to adopt the IHRA definition of antisemitism. We are receiving a good response and will continue on that.

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[Lord Scriven (LD)]

My point about the important value of neutrality is this, and let me give an example. You might not be discriminatory: you have somebody who is Jewish, somebody who is Muslim, somebody who is Christian and somebody of no faith, and you treat them all equally, but you might have something on your body which is not neutral to two of them. You are therefore possibly treating that person differently, from their perspective. If neutrality and fairness is such an important value for the NHS, can the Minister go away and look seriously at making it a key component in the NHS constitution, because it is not there at the moment?

[Baroness Merron (Lab)]

I take that point and I certainly accept the spirit in which the noble Lord suggests it. I will take all the points that have been discussed away to see whether there is any way that we can work with it, rather than extending a debate on what neutrality means, because I know what the noble Lord is getting at. It is helpful that he has given thought to that.

On Amendment 258, NHS bodies are already subject to clear legal duties to prevent and address discrimination and racial harassment, alongside established responsibilities to tackle extremism and safeguard patients and staff. In a technical fashion, I certainly caution against adding further legal duties here because it would risk confusion about what we expect ICBs and trusts to do. I know that is not something that any of us would wish to do.

On Amendment 259, we have accepted the recommendation from the noble Lord, Lord Mann, to consider amending the performers lists regulations, which would enable conditions to be imposed on suitability grounds. We intend to amend the regulations, subject to consultation. The amendment is unnecessary as the Government are already taking forward the substance of it. It would also impose a six-month statutory deadline before the necessary consultation and consideration have taken place, whereas we have to allow sufficient time to make sure that any changes are legally robust, proportionate and workable. Nor would we wish to pre-empt consultation by committing in this moment to how particular forms of conduct should be addressed in the regulations.

On Amendment 279C, under NHS staff standards—which, as I referred to on the comments from the noble Baroness, Lady Manzoor, were launched on 6 July—employers must take sustained and meaningful action to prevent and root out racism. NHS organisations will be measured on this through the national oversight framework. In addition, I say to the noble Lord, Lord Blencathra, that regulatory processes are already in place to which all registered healthcare professionals are subject. Regulatory fitness to practise processes allow concerns about misconduct to be investigated. They allow evidence to be considered and the appropriate regulatory action, which could indeed include removal from the register, to be determined in each case. The Professional Standards Authority for Health and Social Care acts as an independent body in this regard to make sure that regulators apply the right sanctions. Where it considers that a decision does not provide sufficient public protection, it has the powers to refer the decision to the courts for consideration.

In drawing this together, I assure the noble Baroness, Lady Gerada, the noble Lord, Lord Patel of Bradford, and your Lordships’ Committee that we are ensuring that ICBs and providers are fulfilling their duties. The key means to do that is through performance assessments. I gently caution against adding additional criteria to the current approach, because it is important that assessments have sufficient flexibility to adapt to the evolving role of ICBs as strategic commissioners, which, after all, is at the heart of the Bill.

[Baroness Barker (LD)]

I thank the noble Baroness, Lady Merron, for that very detailed and thorough answer. Can I just check that, in the midst of what she said, she made it clear that NHS staff and NHS providers are under a legal obligation to ensure that all the protected characteristics under the Equality Act are treated properly and with respect?

[Baroness Merron (Lab)]

They should absolutely have regard to the law in respect of protected characteristics. That is the fullest answer I can give at this moment.

[Baroness Gerada (CB)]

My Lords, I am grateful to noble Lords who have spoken and to the Minister for her assurances. I just want to make a few very brief comments, because I am aware of the time.

I was struck by the noble Lord, Lord Shinkwin. If I heard him correctly, his orthopaedic surgeon was on the last Kindertransport out of Prague. Our own noble Lord, Lord Dubs, was also on the last Kindertransport from Prague, as was my father-in-law. Such are the coincidences that happen in this life.

I am not Jewish, but I have been subject to antisemitism. I suspect that is because people assume I am Jewish. I have been left fearful, hurt and angry, with all those emotions and not knowing where to take them. If I experience that, I can see that my Jewish colleagues experience it in spades. I work in the NHS, and I can tell noble Lords that antisemitism has become normalised. Although the figures we have seen—13% and 11%—are pretty awful, I suspect it is considerably higher than that. It has become almost de facto that one can abuse Jewish colleagues, although not necessarily Jewish patients because you are subject to greater regulatory forces. Certainly, in the last 12 to 18 months Jewish staff have been subjected to quite appalling behaviour from colleagues with whom they work. Antisemitism has been normalised and almost accepted.

Nevertheless, I thank the Minister. I hope that the training does not become a tick-box exercise and includes the issues that we heard about from the noble Lord, Lord Shinkwin. I may wish to return to this issue on Report, but at this stage I beg leave to withdraw the amendment.

National Brain Cancer Lead

Baroness Merron Excerpts

Tuesday 3rd November 2026 Lords Chamber

[Baroness Paul of Shepherd’s Bush]

To ask His Majesty’s Government what progress they have made towards appointing a national lead for brain cancer, and what measures are in place to ensure that the role supports improvements in research funding, clinical care, treatment pathways and patient outcomes across the United Kingdom.

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

My Lords, last month the Government confirmed plans to recruit a national brain tumour lead, with details to follow. As announced by the Prime Minister, the national lead will co-ordinate action and drive forward work to improve outcomes for brain tumour patients, supported by our rare cancer clinical and research leads and working with the National Cancer Board.

[Baroness Paul of Shepherd’s Bush (Lab)]

My Lords, I congratulate 25 year-old Archie Goodburn, the Commonwealth medallist living with a currently incurable brain tumour, on securing this commitment from the Prime Minister for a clinical lead on this devastating disease. Brain tumours are the biggest cancer killer of children and young people under 40, but despite this, there has been no change or progress in treatment in over 40 years. Does the Minister agree with me that the only way to change outcomes is to accelerate at pace the number and range of clinical trials taking place so that there is a chance of a cure for Archie and other patients?

[Baroness Merron (Lab)]

I know how much the Prime Minister appreciated his meeting with Archie. Indeed, the Prime Minister has acknowledged that enough progress has not been made in this area and committed, as my noble friend said, to a number of actions. I certainly would agree with my noble friend’s view on the importance of clinical trials. I can say to my noble friend that, as we set out in the national cancer plan, we are committed to ensuring that the UK supports new clinical trials for brain cancer and boosting participation in research. Both of these really need to be pushed forward, and we are fast-tracking clinical trial set-up times to 150 days to ensure that more patients can access innovative treatments in our country.

[Baroness Pidgeon (LD)]

My Lords, I pay tribute to the swimmer, Archie Goodburn, for his courage in campaigning for people affected by brain cancer. I welcome the Government’s commitment to commission an expert review. Will they ensure that it will set out clear, time-bound recommendations, with named bodies responsible for delivery in this area, and that progress against them is published?

[Baroness Merron (Lab)]

We are keen to be open about this. The immediate expert review, which will take just three months, will be led by Professor Anthony Chalmers. It will examine progress since the 2018 brain tumour research report. I look forward to that review being published within three months. A national action plan, which I am sure will refer to the points that the noble Baroness made, will then help us to move discoveries from the laboratory into treatments and clinical care much more quickly. That is where we need to be.

[Baroness Finlay of Llandaff (CB)]

My Lords, what powers will the appointment have, given that 74% of patients are diagnosed in A&E because of delays in diagnosis in primary care? This results in 45% of patients being told in A&E that they have a brain tumour. Even when they have a biopsy, there are inadequate freezing facilities for biopsies to be taken and kept so that personalised medicine can be developed and entered into studies.

[Baroness Merron (Lab)]

On the point about brain tissue freezing, NHS England has, as the noble Baroness may be aware, just completed a freezer capacity gap analysis and is in the process of working with sites to ensure additional capacity. I share her view that identification in an emergency setting is not the best place, although that will sometimes be the case. All this movement is to reduce that incidence.

[Baroness Mattinson (Lab)]

My Lords, I want to pick up two aspects of this very welcome new appointment. The first is the degree to which the patient’s voice—so often overlooked in this area—will be heard, and that listening to it will be part of the remit. The second is about timing. Can the Minister reassure us on the speediness of the appointment, given that most brain cancer patients have 12 to 18 months to live after diagnosis? They do not have the luxury of time on their side.

[Baroness Merron (Lab)]

I think that has been acknowledged by the Prime Minister in this review being so rapid—delivered within three months—and in the fact that he is taking personal oversight of this work. Again, that is to be welcomed. On the patient’s voice, one of the outcomes from discussions is that the Secretary of State will be convening researchers, clinicians and charities to identify practical ways to increase participation in brain cancer trials. Certainly, the Prime Minister has asked patients, families and charities to work with us to help raise awareness and support participation in clinical trials. For me, the patient’s voice is absolutely critical and I know that it will be at the heart of this.

[Lord Patel (CB)]

My Lords, we recognise that outcomes for people with brain tumours and cancers, particularly children, is a survival time of no more than 13 months to five years. Although it is important to do clinical trials using drugs, the problem we have is the blood-brain barrier, which protects the brain from being affected by these drugs. We need to find novel ways of treatment. Some are being researched; for instance, focused ultrasound, micro-RNA treatments and personalised vaccines developed for particular patients for each of their tumours. We need to support these novel ways of finding treatments for brain tumours that do not apply to other diseases.

[Baroness Merron (Lab)]

The noble Lord is right. That is why we have to work so much more quickly to move discoveries from research into treatments and clinical care. That has been sadly lacking, which is why the points that the Prime Minister announced include an accelerated review by the MHRA of the regulatory arrangements for rare disease medicines, known as orphan drugs—I mention that just as one example—that would see that work completed in two years rather than three. We understand the need for speed and acknowledge that we are in a position, sadly, where not enough progress has been made in this area.

[Lord Kamall (Con)]

My Lords, I too welcome the Government’s commitment to establishing a dedicated national brain cancer lead. My question is about accountability, going back to the question from the noble Baroness, Lady Pidgeon. Will the Government publish a set of measurable objectives for the national lead, particularly for access to treatment and patient outcomes, so that this House and others can assess whether the role is achieving the real progress that patients and families want to see?

[Baroness Merron (Lab)]

I mentioned a national action plan that will be informed by the three-month review, and I confirm that the Government will publish that national action plan. I would expect to see the markers that the noble Baroness and the noble Lord have called for within that.

[Baroness Linforth (Lab)]

My Lords, I am very pleased that my noble friend Lady Paul asked this Question today as our great friend Baroness McDonagh died of a glioblastoma in 2023. I understand that the NHS is currently running 35 clinical trials related to brain cancer, of which nine are related to glioblastoma, the most aggressive form of brain tumour. Will the Minister either tell the House today or write to me setting out how many patients have been recruited to each of those trials?

[Baroness Merron (Lab)]

I am grateful to my noble friend for honouring the memory of Baroness McDonagh, as other noble Lords have done, and Baroness Jowell. I know that many noble Lords are affected directly or indirectly by this and will be feeling the weight of that as we discuss this matter. To answer my noble friend’s question, the number of glioblastoma patients who have been recruited into specific trials is not centrally held. There is a reason for that. It is because many studies enrol patients who have more than one type of brain cancer, and the data is managed by study teams and sponsors. I also note that some data for commercial trials is considered commercially sensitive. Each trial will have its own inclusion and exclusion criteria that are set out by the study team. Having said that, if there are particular things with which I can assist my noble friend, of course I will be pleased to do so.

Health Bill

Baroness Merron Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

Moved by

[Baroness Merron]

1: Clause 2, page 1, line 16, at end insert—
“(1A) The Secretary of State may not make a transfer scheme transferring anything to—(a) a Scottish public body, without the consent of the Scottish Ministers;(b) a Welsh public body, without the consent of the Welsh Ministers;(c) a Northern Ireland public body, without the consent of a Northern Ireland department.”Member's explanatory statement
This amendment would require the Secretary of State to seek the consent of the appropriate devolved nation before making a transfer scheme which transferred property, rights and liabilities from NHS England to a Scottish public body, Welsh public body or Northern Ireland public body.

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

My Lords, as I said at Second Reading, the abolition of NHS England is being taken forward with the interests of patients firmly at its core. It will provide greater clarity for the system. It will restore democratic accountability and free up resources to be reinvested in the front line. It will also bring greater clarity about where responsibility lies, ensuring that Ministers are accountable for national decisions while devolving more power to local NHS organisations. Patients will benefit from faster and clearer decision-making, with less duplication and red tape, with staff being allowed to spend less time navigating bureaucracy and more time focused on care and delivery.

I will address the government amendments to Clauses 2 and 28 together. Amendment 1 and consequential Amendments 2 and 3 make additions to Clause 2, which empowers the Secretary of State to establish transfer schemes. These clauses provide a structured and transparent means of moving property, staff, rights and liabilities from NHS England to the Department of Health and Social Care, integrated care boards and other relevant bodies.

Following engagement with the devolved Governments, these amendments have been tabled to require the consent of the relevant devolved Government should a transfer be made to a Welsh, Scottish or Northern Ireland public body. Amendment 1 does not change the purpose of Clause 2 but provides assurance to devolved Governments that any transfers to their bodies can take place only with their agreement. I emphasise that there are currently no plans for transfers to be made to devolved Governments’ public bodies, but this amendment provides a proportionate safeguard if such circumstances arise in the future.

Likewise, Amendments 103 and 104 are technical amendments to Clause 28, this time in response to engagement with the Welsh Government. They make clear the territorial limit of the clause to ensure it could not be used to establish, or delegate functions to, a Welsh special health authority. I believe these to be sensible and proportionate amendments, and I beg to move Amendment 1.

[Baroness Finlay of Llandaff (CB)]

My Lords, I welcome the Minister’s discussions with the devolved Governments and her saying that nothing is going to be potentially imposed on them, particularly having had those discussions. But can she clarify what will happen to some of the prevention agendas that have been in place—such as the Couch to 5K programme, for which I understand no outcomes have been collected, but which has been part of NHSE and the department’s promotion of exercise—and whether these programmes will be increasingly promoted across England as part of the prevention agenda, and in discussion with the devolved Governments, so that we get consistency in prevention across the United Kingdom?

[Earl Howe (Con)]

My Lords, it is a pleasure to begin our Committee consideration of the Health Bill, and I look forward to the discussions over the coming days. I am grateful to the Minister and to the Government for bringing forward these amendments, which we understand to be principally technical in nature, although there are questions we shall want to ask in later groups about cross-border patient referrals and related issues. We welcome the clarification these amendments provide regarding the consent of the devolved Administrations and the exercise of powers by devolved health bodies, and we are content to support them.

I hope the Committee will allow me to take this opportunity to acknowledge the letter sent by the Minister this morning concerning Healthwatch. Noble Lords across the House will welcome the Government’s decision not to proceed with its abolition, and I am grateful to the Minister for listening to the concerns raised in this House and elsewhere. This is a very positive example of the Government engaging constructively with the scrutiny of this Bill and showing a willingness to reconsider their proposals where legitimate concerns have been raised. That is precisely the spirit in which I hope we can continue our consideration of this legislation, and I welcome the approach the Government have taken on this occasion. I look forward to the Minister’s response.

[Baroness Merron (Lab)]

My Lords, I am grateful for this brief but important debate, and in particular for the support for these amendments. As the noble Earl, Lord Howe, says, they are technical amendments. I say to the noble Baroness, Lady Pidgeon, that this is absolutely nothing to be worried about: we work closely with the devolved Governments, and this is an extra layer of reassurance to them that we felt was helpful, because it is what they sought. These technical amendments are brought forward not as an afterthought but because that is what conversations have led us to think is the right thing to do. I know they very much welcome this, and I am grateful for their assistance.

I hear what the noble Earl, Lord Howe, said about the letter I sent out and the announcement in respect of Healthwatch. I am most grateful to noble Lords for their engagement as we have approached this point in the Bill. As the noble Earl acknowledged, we are always keen to listen. We cannot always do exactly what every noble Lord would want, but I am glad that the noble Earl welcomes the way in which the Secretary of State and the Prime Minister have approached this.

On the point raised by the noble Baroness, Lady Finlay —who also gave her support—about particular programmes, I am very happy to look into that. However, as I have set out, we intend for the programmes to which we are committed to be transferred to the department. What happens in the longer term on the prevention agenda is another consideration. We work very closely with the devolved Administrations on prevention, but, ultimately, healthcare is a devolved matter. I commend the amendment to the Committee.

Amendment 1 agreed.

Moved by

[Baroness Merron]

2: Clause 2, page 2, line 14, leave out subsection (4)
Member’s explanatory statement
This is consequential on my amendment to Clause 2, page 2, line 21.

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[Lord Scriven (LD)]

When we get to Clause 11, the noble Lord, Lord Hunt, will see that some of the powers that the Secretary of State now takes, beyond NHS England, will not come before this Parliament. They will just be at the signature of the Secretary of State’s pen.

In this Bill, form comes first and function will follow in due course. We have the demolition notice but are still to see the drawings of the new structure. Let me say how far behind the Government are. The Nuffield Trust, working with the Institute for Government, compared past public sector reforms and NHS abolitions. It found that the key factors for success are not in place here. The abolition was announced without plans to explain its goals to staff and without redundancy funding, which led to months of delay. Detailed planning for the new department began only in early 2026, almost a year after the announcement. Nuffield’s verdict is that the process has been “poorly handled”.

We are still short of very basic information. At Second Reading and in this Committee, the noble Lord, Lord Stevens, who I admit must know something about running the NHS, pointed out that the costs and benefits in the impact assessment are still marked as “not available”. There are also still a number of questions about the timing of when this reform will come in. We have the Government’s estimates that redundancy exits—across the department and NHS England, ICBs and the commissioning support units—will cost between £1 billion and £1.3 billion, to be met from existing allocations, but we must ask which allocations. Which services pay?

Then there is the timetable. On 15 October the Health Service Journal reported that abolition will have to be formally delayed beyond April 2027 unless decisions on future national structures are made within days. Have those decisions been made? Are staff now aware of where they will be transferred? The new operating model has been waiting for ministerial sign-off for months. Ministers are still weighing whether thousands of staff will go to the department or potentially, as we read, into a new stand-alone agency. This Bill sends nearly every function of NHS England to the Secretary of State, yet the Government have not decided where the people who will perform those functions will sit. The department says that it continues to plan for 1 April 2027, but planning a date is not the same as being able to meet it.

The planned 50% job cuts in the department appear to require moving the large majority of central policy and analytical staff. Or is it about cutting operational staff? As the noble Lord, Lord Crisp, said, we need clarity about which staff and which functions will be in the department. It is not clear that the figure is rested on rigorous assessment of who is needed and why. History tells us how this ends: after previous reforms that moved managers from commissioning bodies, the department consultancy spend peaked at over £600 million a year and the number of managers within five years was higher than going into the reorganisation. I fear that this will be another case of “cut first, rehire later and call it efficiency”.

As the noble Earl, Lord Howe, has said, we need not simply rely on the words of noble Lords in this debate. The Darzi review, commissioned by the Government and updated in May, concluded that a top-down reorganisation of NHS England and ICBs is “neither necessary nor desirable” and added:

“Constant reorganisations are costly and distracting”.


We have had six statutory major reorganisations in 30 years, none with clear evidence that the restructure has brought about improvement. The Government commissioned that review; they should read it and learn from it.

I have six questions for the Minister. When will the target operating model be published, and will that be before Report? Is the latest thinking to put transferred NHS England functions and staff into the department, or will the Government set up a stand-alone body? Will the Government publish a full, costed impact assessment, including benefits, and explain where the £1 billion to £1.3 billion comes from? What are the expected costs of disruption, and how will any further delay be limited? Are the Government confident that the 50% cut will not drive up consultancy spending by the end of this Parliament? If the Government do not accept the amendment from the noble Earl, Lord Howe, will they commit to laying a transition plan before Parliament and before Report? In substance, that is what this amendment is asking for.

We on these Benches are not defenders of the status quo. I started in the NHS in the early 1990s and lived through more reorganisations than I care to count. Every one promised less bureaucracy and a freeing up of the front line; none delivered it. If the Government want to put NHS operational matters into political hands, that is their choice, but they owe this House a plan and then a price and then a Bill, in that order. At present we have a Bill and we are still waiting for the other two. I look forward to the Minister’s reply.

[Baroness Merron (Lab)]

My Lords, I am most grateful to the noble Earl, Lord Howe, for moving this amendment, and to the noble Lord, Lord Kamall, for tabling it. As other noble Lords have observed, it is comprehensive and thorough. It makes the point, which a number of noble Lords have made, about the importance of ensuring that the right processes and assessments are undertaken as we move towards the abolition of NHS England—one of the key things in the Bill. As we are at the beginning of our deliberations, I say to noble Lords that I listen, and have listened, very carefully to the points that are made. I will endeavour to answer a number of points, but I will take some away and write to noble Lords. As ever—and as noble Lords will recall from previous Bills—those letters will be available to all Peers, because I want to do justice to those points.

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[Lord Scriven (LD)]

I asked one specific question, which the Minister may not be able to answer at this moment, but perhaps she could put it in writing. As the Minister has just pointed out to the noble Lord, Lord Stevens, is it the Government’s intention to transfer all the staff into the department or is a stand-alone body being looked at as a potential route for those staff?

[Baroness Merron (Lab)]

The intention is the former, but I will gladly write further to the noble Lord on this point.

[Earl Howe (Con)]

My Lords, I am grateful to the Minister for her wide-ranging response, and to all noble Lords who have contributed to this important debate, which has been very useful.

The Committee has spoken with one voice in underlining the scale and complexity of the task which lies ahead and the importance of ensuring that the abolition of NHS England, or its transformation, as the noble and right reverend Lord, Lord Sentamu, put it, is managed carefully, transparently and with proper accountability.

As I said at the outset, we are not opposed to efforts to reduce bureaucracy or to improve efficiency in the health service. However, we have to be confident that the Government have a clear understanding of the costs involved, the savings which can realistically be achieved and the risks associated with a reorganisation on this scale. Above all, we must not lose sight of the people whom these reforms are intended to serve. The ultimate measure of success must be whether patients receive better, safer and more timely care, rather than simply whether we have succeeded in changing the administrative structure of the NHS.

Despite what she said, I hope the Minister recognises that my amendment was put together as a giant probe of the Government’s transition plans, rather than as a model form of words to be written into the Bill. I therefore welcome her assurance that she will reflect carefully on the concerns that have been raised today, particularly around the need for a clear and independently assessed transition plan. We will consider the Minister’s response ahead of Report. However, for now, I beg leave to withdraw my amendment.

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[Lord Scriven (LD)]

My Lords, I speak for these Benches on this short but important group. I thank the noble Earl, Lord Howe, for the amendment on Supply Chain Coordination Ltd and the noble Lord, Lord Hunt of Kings Heath, for his important amendment on value-based procurement.

These amendments may look technical, but they go to something that matters in every clinic and every operating theatre: how the NHS buys what it needs and who is accountable when things go wrong. NHS Supply Chain manages an estimated £8 billion a year of NHS spending on products, and, since 2022, it has carried out the department’s PPE programme. Yet under Clause 2, its shares can be moved by a transfer scheme at the Secretary of State’s discretion. There is no requirement to tell Parliament where they are going, who will exercise the shareholder role, or how continuity of supply will be protected.

Asking for a plan first seems modest. If the pandemic taught us anything, as the noble Lord, Lord Hunt, suggested, it is that supply chain resilience is first and foremost a patient safety issue.

However, a report is not a safeguard in itself. The real risk is that the transfer happens in the middle of a reorganisation, cutting the central headcount by half. The very people who understand how the company works may be gone before the scheme is made. The National Audit Office found that Supply Chain Coordination Ltd was meeting only seven of its 18 key performance indicators and that trusts spend more than £3 billion outside it. A company with that record needs careful handling, not a transfer done in a rush.

On value-based procurement, we welcome the direction of travel. As the noble Lord, Lord Lansley, just pointed out, this is not novel. We do not even have to take his experience of Unipart as an example. We can look at value-based procurement elsewhere: in Denmark, Canada, Italy and even Indonesia. There are models which the Government could use to look at how it is done.

The national guidance published in June is a genuine step forward, asking what delivers the best outcome across the whole patient pathway, rather than simply what the cheapest price is. But with NHS financial pressures, the temptation will always be to grab the lowest price today, without the skills, the capacity, and a finance regime that rewards long-term value. So I ask the Minister: what thinking is being done, not just for the pilots but as part of the new powers that the Secretary of State will have from the transfer of NHS England, on rewarding long-term value in the financial regime? What changes, if any, will the Government make to the financial regime?

There is a wider point that both amendments expose. NHS procurement still sits apart from the rest of the public sector. When the Procurement Bill passed through this House, my noble friend Lady Brinton, with support from all sides, including from the noble Lord, Lord Hunt, asked why the NHS should be treated differently. She warned that the NHS arrangements were not visible and that they were

“SIs at the discretion of any Secretary of State for Health”.—[Official Report, 28/11/22; col. 1578.]

Today, we have one regime for healthcare services and another for goods. NHS buyers are told to take legal advice on how the new value guidance fits both. With NHS England abolished, all that discretion will sit with the Secretary of State, and my noble friend’s warning has become even more relevant.

Therefore, I ask the Minister four simple questions. First, where will the shares in Supply Chain Coordination Ltd go, and when, and will Parliament see the plan before the transfer is made? Secondly, what independent assurance has been commissioned on the continuity of supply during the transition? Thirdly, after NHS England’s abolition, who will own value-based procurement and make sure that it is built into national service frameworks? Fourthly and finally, will the Government now review whether two separate procurement regimes for NHS services and goods still make sense, or will they at least publish how the boundaries between them will be policed, once the Secretary of State holds the pen on both? These are modest amendments, asking for sensible things, and I hope the Minister can give the Committee reassurance.

[Baroness Merron (Lab)]

My Lords, I most grateful to noble Lords for their observations and the way they have dealt with this. At the outset, I pick up the point that my noble friend Lord Hunt started with and others, including the noble Baroness, Lady Finlay, developed further. We are particularly concerned with personal products and products that need to be personalised. The illustrations that noble Lords have given have been most helpful. The reason for the changes is to see more of that.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Baroness, Lady Jones, for opening the debate on this group, starting with the amendment laid in the name of her noble friend, the noble Baroness, Lady Bennett. I am grateful to all noble Lords for their consideration on a topic that is key to this Bill and to all our work. I will return to this, but it includes the 10-year health plan, which provides the framework for all that we do.

I start with Amendments 6 to 11 and 13 to 20. I assure your Lordships of our commitment to tackling inequalities. We have debated this several times in this Chamber and rightly so. I certainly agree with the comments made, including those from the noble Baroness, Lady Cash. This is about people’s ability not just to access services but to achieve the right outcomes for them regardless of who they are, their background or where they live.

I turn to Amendments 8 to 10, tabled by the noble Baroness, Lady Walmsley, and spoken to by the noble Baroness, Lady Tyler, and Amendment 7 in the name of the noble Lord, Lord Patel. These test whether the duty on the Secretary of State is strong enough. It is right to discuss that point. I appreciate the intention—which was emphasised by my noble friends Lady Royall and Lady Lister, and the noble Lord, Lord Lansley—to ensure that we are taking action, because that is ultimately what we are here to do. However, I would caution against amending the Bill in the way that the amendments seek to do. As a number of noble Lords will be aware, the “have regard” formulation in legislation has a number of precedents across the statute book, and it is familiar to government departments and to decision-making in the public sector.

There was an exchange between the noble Lord, Lord Lansley, and my noble friend Lady Royall over Sections 2A and 2B of the NHS Act. I tread with some trepidation at this stage, but we do not believe that it is necessary to change “may” to “must”, certainly for the duty in Section 2B. This is for the reason I have just outlined about risking confusion because it is moving away from the usual way of doing things. It would also potentially reduce the ability of Ministers to make decisions about priorities. There is no practical intention to reduce the importance of tackling inequalities. The noble Baroness, Lady Gerada, has moved from her place.

[Baroness Gerada (CB)]

It was cold down there.

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[Baroness Merron (Lab)]

I am sorry to hear that it is cold, but I am glad the noble Baroness is here. I appreciated the useful distinction that she drew regarding what we are talking about when we talk about inequalities.

Amendments 18 and 19, tabled respectively by the noble Baroness, Lady Tyler, and the noble Lord, Lord Patel, have regard to new strategies for tackling health inequalities. I know that your Lordships’ Committee is aware, but it is worth saying again that we remain absolutely committed to our comprehensive 10-year health plan. It was drawn up with a very wide range of input and, importantly—as has been referred to on this group and elsewhere—it was underpinned by the independent investigation of the NHS by the noble Lord, Lord Darzi. Tackling inequalities is at the very core of the 10-year health plan, which dictates everything that we do. It is therefore important that we focus on practical action rather than diverting towards developing new strategies. To assure noble Lords, I repeat that tackling inequalities is what I call core business; it is not an add-on or a sidecar—it is absolutely key.

The noble Lord, Lord Patel, put a number of observations to me and asked whether I agreed with them. My answer is that I appreciate them all and agree with most. I particularly welcome the acknowledgement by the noble Lord, Lord Patel, the noble Baroness, Lady Manzoor, and a number of my noble friends, of the achievement of the last Labour Government—which was somewhat exceptional in the period we have been talking about. The only point I would make to the noble Lord, Lord Patel, is that when he was running off a list of Ministers at the time, I hoped he might mention me—but I am doing so.

[Lord Patel (CB)]

I was going to do so after I heard the Minister’s response.

[Baroness Merron (Lab)]

I was very proud to have been part of that as Public Health Minister, working with Andy Burnham. But it is not enough to just rest or delight on one’s memories; we must take what worked and bring it into the current time.

I agree with the noble Lord, Lord Patel, that tackling health inequalities is key to not just the NHS but the broader economy—and, of course, the well-being of people. I agree with all noble Lords who said that a cross-government approach is crucial. That is why we are taking that approach, underpinned by the 10-year health plan. Tackling inequalities, for example, informs the key initiatives of the 10-year health plan, such as neighbourhood health centres. On that, we are starting in the most deprived communities. We are not going to the communities that are easier to work with; we are starting where there is the most challenge. I welcome that radical approach.

I believe accountability is extremely important. I assure noble Lords that the department will continue to report on action taken to address health inequalities as part of its annual report, alongside a whole range of published metrics, including the health inequalities dashboard. The dashboard’s measures cover 20 indicators, including—I will give noble Lords a couple of examples —the prevalence of adult and childhood obesity, and healthy life expectancy at birth.

My noble friend Lady Nargund supported the call for a cross-government strategy, which we are already working on. Recent cross-government action in this area includes the warm homes plan, the Keep Britain Working review and the homelessness strategy—all of which speak to the points that noble Lords are calling for. That is one of the reasons why I caution against putting in the Bill a duty to develop some independent strategy, when in fact it is core to what we are already doing.

Amendments 13 and 14 were tabled respectively by the noble Lords, Lord Patel and Lord Patel of Bradford. My noble friend Lord Hunt asked whether I would meet the noble Lord, Lord Patel of Bradford; I would be very pleased to do so, and I open that meeting up to other noble Lords who are interested in coastal and rural areas. Amendment 20 was tabled by the noble Baroness, Lady Pidgeon. These amendments are concerned with tackling health determinants and inequalities in coastal and other areas.

Health is determined not just by our health and care system but by our wider environment. We know that geographical variation has grown over a number of years, and this Government seek to tackle it. That variation runs from housing and employment to education and our local high streets, to name just some. It has informed the content of our 10-year health plan and the overall guiding aim that we pursue: to halve the gap in healthy life expectancy between the richest and the poorest—to which noble Lords referred. That is why we are introducing the neighbourhood health centres, to which I referred, where they are needed most. We are now going further by devolving power to local communities so that those who know their areas best can make sure that the services are there for them. I remind noble Lords that ICB funding allocations, for example, are already adjusted for health inequalities and take account of factors such as an ageing population and deprivation. The Core20PLUS5 approach gives ICBs a range of tools to tackle inequalities, and we will—and do—hold ICBs to account for their progress.

I am grateful to my noble friend Lord Hunt for tabling Amendment 11 on accessing GP services—an area raised by other noble Lords, including the noble Baroness, Lady Gerada. I agree that equitable distribution of GPs is crucial to ensuring that people in all areas get timely access to care. When I say that, I mean not that every area should have exactly the same number but that the distribution should be sensitive to the needs of an area. Progress is being made: there are 2,600 more GPs than in July 2024—the highest figure since 2015; the average number of patients per GP practice is improving; and we continue to boost recruitment through the practice-level GP reimbursement scheme in 2026-27. Because GPs—like other professions —are more likely to practise where they trained, we are delivering 1,000 more GP training practices by 2028, targeted towards the areas of greatest need. We are also reviewing the Carr-Hill funding formula because, to reduce health need, we have to ensure that resources are allocated much more accurately—as noble Lords expect.

The noble Baroness, Lady Hodgson, also commented on this area. We are uplifting the GP contract by £601 million for 2026-27, which builds on last year’s £1.1 billion of additional investment. In the year to August 2026, 15.8 million additional appointments—including Covid vaccinations—were delivered, compared with the previous 12 months. This is the way we are going. When I make these points, I am not saying that the job is done, but I am showing movement and improvement.

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[Lord Patel (CB)]

The Minister did what I thought she would do: point to areas in the legislation that might help reduce inequalities in health and in outcome, and therefore inequalities in healthcare provision. She mentioned the 10-year health plan, but she was not able to point to where it says the gap is, which is around cross-government action. Neither did she mention examples in the Bill that demonstrate that there is cross-government action. She said she did not agree with me in one area—maybe it was that one.

[Baroness Merron (Lab)]

Oh, no—I agree with the noble Lord about the need for cross-government action. I simply part company with the idea that it needs to go into primary legislation. That would not be usual, because that is a process. I also referred to examples of where we already have cross-government action to deal with health inequalities, as distinct from healthcare inequalities—the noble Baroness, Lady Gerada, referred to that.

[Lord Patel (CB)]

Why not, when, as she mentioned, the Minister was previously so successful as part of the Government who demonstrated how they could implement cross-government action and reduce inequality?

[Baroness Merron (Lab)]

I am not sure we are that far apart on this. I am just picking up the point about primary legislation, rather than the intent of the noble Lord, which I agree with.

[Baroness Jones of Moulsecoomb (GP)]

I will stand up before anybody else does.

I thank the Minister for her replies; I really admire the positivity in there. I have been using the NHS since 1949, and it is absolutely amazing. My working-class parents were incredibly delighted by its introduction, but I rather suspect that my age cohort has had the best of it—I hope that that is not true. I would love to respond to a lot of the points, including on coastal communities, which often suffer from huge environmental pollution in rivers, along seashores and so on. This has been a fascinating debate, and I can see an exciting Report stage in the offing. In the meantime, I beg leave to withdraw my amendment.

Health Bill

Baroness Merron Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, I too am grateful to the noble Lord, Lord Rennard, for bringing forward these amendments and for drawing the Committee’s attention to the important issue of diabetes prevention, treatment and care. I particularly welcome the focus in these amendments on innovation, because this is an area in which we see some genuinely promising developments. One example, mentioned by the noble Lord, Lord Rennard, and the noble Baroness, Lady Pidgeon, is the emergence of hybrid closed-loop systems. For people living with type 1 diabetes, this technology has the potential to make an enormous difference.

In April 2024, NHS England began a five-year programme to roll out this technology to eligible children, young people and adults living with type 1 diabetes. That was a very welcome development, and I hope we will continue to see the programme expanded so that more patients who would benefit from the technology are able to access it. It would be helpful to hear from the Minister about that, and about how the rollout of the programme is progressing and how many patients have received the technology so far. As with any issue like this, improvements in accessing the technology are always forefront of commissioners’ minds, so it would be helpful if the Minister can say anything about that. I would also be interested to hear what assessment the Government have made of the availability of specialist staff to support this rollout. Developing an effective new technology is one thing; ensuring that patients can access it, and that clinical teams have the resources and expertise to provide it, is another.

More widely, these amendments raise an important question about the future scale and impact of diabetes in this country. The noble Lord, Lord Rennard, highlighted the statistics and predictions from the International Diabetes Federation. Those predictions present a considerable challenge for not only patients and their families but for the health service. They also reinforce the importance of prevention, particularly in relation to type 2 diabetes, where earlier intervention can make a considerable difference. Can the Minister tell us what steps the Government are taking to strengthen prevention and early diagnosis and to support the wider adoption of new technologies?

Finally, I want briefly to touch on Amendments 225 and 226, which raise a wider point about the abolition of NHS England and the continuity of existing national diabetes programmes. During our consideration of the Bill, we have discussed at some length the importance of ensuring that the abolition of NHS England does not disrupt the delivery of essential services or lead to the loss of programmes and expertise that are already delivering benefits to patients. The noble Lord is absolutely right to raise that concern in the context of diabetes. I am not necessarily persuaded that we need to place each of these requirements in statute, but he raises some entirely legitimate questions. I would welcome assurances from the Minister that these programmes will continue to receive the attention and support they require throughout the transition. I look forward to what the Minister has to say.

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

My Lords, I am most grateful to the noble Lord, Lord Rennard, for tabling this amendment, and to other noble Lords for their contributions. The Government recognise the importance of high-quality diabetes prevention, treatment and care services, and I believe that our actions on this reflect that. Programmes such as the NHS Diabetes Prevention Programme, the NHS Type 2 Diabetes Path to Remission Programme and the National Diabetes Audit all play an important role in improving outcomes for people living with diabetes.

I turn specifically to Amendments 225 and 226. The Bill allows for the transfer of functions and responsibilities from NHS England following its abolition—that means a transfer that will not impact service provision. I say to the noble Earl, Lord Howe, that the Government support effective diabetes services and innovations in various ways, but that includes ensuring the continued commissioning, monitoring and improvement of these programmes without the need for disease-specific provisions in primary legislation. Moreover, specifying programmes at this level of detail would restrict our ability to adapt to new and changing evidence on effective treatments and technologies; I know that is something noble Lords would not want to restrict. Similarly, a diabetes-specific reporting clause would duplicate existing monitoring and oversight arrangements that provide additional assurance without adding administrative burden and additional bureaucracy.

To turn to Amendment 12, improvement of outcomes for people with diabetes absolutely includes reducing health inequalities, which we debated in an earlier group. That is already captured in the general duty to reduce health inequalities set out in Clause 4. Furthermore, the modern service framework for cardiovascular disease, which was published in July, advocates a holistic cardiovascular/kidney/metabolic approach, including finding those with undiagnosed or unmanaged diabetes, initiating treatment and increasing the number of people whose treatment is optimised, with a strong focus on reducing inequalities.

On Amendment 25, I reassure your Lordships that the Secretary of State and the NHS already have powers to promote innovation across the health service. The risk of singling out diabetes technologies in primary legislation is that it would create inconsistency with the approach taken for other conditions. Rollout of glucose monitoring and automated insulin delivery technologies is already supported through NHS implementation arrangements, based on established NICE guidance. Therefore, listing specific technologies in legislation could reduce the flexibility of the NHS to be as truly innovative as we would all want, as new technology emerges.

[Lord Rennard (LD)]

My Lords, I thank the Minister for her sympathy on these issues, and I thank all the people in her department, who I know are sincerely committed to trying to help people with diabetes, to help prevent its occurrence and to provide the best possible care and treatment. But at the heart of the problem, as the noble Lord, Lord Hunt of Kings Heath, said, is a dilemma: as people try to treat medical conditions such as diabetes differently and say there should be a localist approach, there is a fundamental problem for the whole of the country in that, if we fail to deal with this, the cost is on all of us. The costs to taxpayers, the costs of people not working, the costs of not paying to HMRC and the costs of drawing down on the DWP are growing enormously. This is such a huge problem that, as we have said at many points today, we have to look across all government sections at how we work together on all these issues. On that note, I beg leave to withdraw my amendment.

LED Lighting: Health Effects

Baroness Merron Excerpts

Wednesday 28th October 2026 Lords Chamber

[Lord Davidson of Glen Clova]

To ask His Majesty’s Government what assessment they have made of the developing science on the adverse health effects of LED lighting.

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

My Lords, the risk to the general population is considered low. Potential health risks from lighting are not unique to LED lighting. The Government continue to monitor evidence on the health impacts of LED lighting, publishing guidance on flicker reduction and healthy lighting environments. The UK Health Security Agency contributes to international research and standards and works with experts to better understand how light exposure affects health and to promote good lighting design.

[Lord Davidson of Glen Clova (Lab)]

I thank my noble friend the Minister for her response. I congratulate the NHS on the new Moorfields hospital, which will open next year. However, given the cutting-edge research that has been carried out at UCL on the link between daylight and health effects, can my noble friend assure the House that the new hospital will avoid the problems of 100% LED lighting?

[Baroness Merron (Lab)]

I too very much welcome the new Moorfields hospital which, as my noble and learned friend says, is to open next year. The architecture integrates national daylight with 100% LED lighting. I can assure the House that it has been developed in accordance with applicable net-zero design standards, approvement requirements, technical standards and assurance processes, as I am sure noble Lords would expect. We are seeking confirmation from the trust about any daylighting studies or assessments that have been undertaken as part of the design process. When I get that information, I will be very pleased to write to my noble and learned friend.

[Lord Robathan (Con)]

My Lords, what research is being done on the effects of high-visibility headlights on cars? I am not sure whether they are LED, but they are causing people to have accidents.

[Baroness Merron (Lab)]

The DfT is undertaking independent research and is approaching this with regulatory changes and through international safety standards. The noble Lord raised the question of why glare is a problem. The Which? report on this, published only yesterday, talked not just about brighter LED but the height of vehicles and beam alignment. The DfT has just this week updated driver advice in the Highway Code on this very point, encouraging people to get it checked.

[Baroness Pidgeon (LD)]

My Lords, the Advertising Standards Authority upheld a complaint in June about an LED face mask that claimed it was clinically proven it could reduce wrinkles in four weeks.

[Baroness Pidgeon (LD)]

Exactly. Given there are numerous adverts for at-home LED beauty devices in the run-up to Christmas, will the Government urgently assess whether existing regulation adequately protects consumers in terms of product safety and the evidence supporting claims about health benefits?

[Baroness Merron (Lab)]

This is ongoing work. If it was a true claim, I am sure that many noble Lords would have been very keen to benefit—me included.

[Noble Lords]

No!

[Baroness Merron (Lab)]

How kind. But quite seriously, it is good that the Advertising Standards Authority is looking into this. We have regulations to ensure that people are not misled and are protected. Tangentially but linked, I am sure that the House would welcome our recent work on cosmetic surgery regulations, which really strengthens this point.

[Baroness Rafferty (Lab)]

My Lords, does the Minister agree that the practice recently put in place by King’s College Hospital of exposing intensive care patients to daylight has promoted their earlier recovery and should be adopted by other NHS trusts?

[Baroness Merron (Lab)]

My noble friend is absolutely right to highlight the fantastic King’s critical care roof garden. I was very pleased to see the media coverage of it earlier this year. Not only are the team providing full life support to the patients, staff and families, allowing them to feel the therapeutic effects of being outside and in nature, but they are using the spaces they have developed for research on whether it gives the right support and enhances people’s health. I am very much looking forward to what they come up with. It is very impressive on top of their medical excellence.

[Lord Evans of Rainow (Con)]

My Lords, given the growing evidence that exposure to artificial light at night can disrupt sleep and the circadian rhythms, does the Minister agree that the Government should do more to ensure that the public are aware of these potential health risks? Will the Minister commit to updating existing public health guidance to reflect the latest scientific evidence?

[Baroness Merron (Lab)]

If there are particular things the noble Lord thinks the Government are not doing, I would be very pleased to receive details. I am glad that he did not refer specifically to LED lighting. As I have said, there is no evidence that it is directly harmful in normal use in the general population. However, through the Committee on Medical Aspects of Radiation in the Environment, we are developing an evidence-based review programme on artificial light and health, just as he asks, and gathering evidence and identifying gaps. We are also supporting research and working internationally. I would be very pleased to give further details if the noble Lord would like.

[Baroness Hayter of Kentish Town (Lab)]

I will revert to the question of headlights that people know I have been campaigning on. With LED lights, there are questions both about the luminance—that is, the strength —and about it being a blue light rather than the softer yellow of halogen lights. Would my noble friend agree to put the expertise at the Department of Health together with that at the Department for Transport, which is doing good research on this, so we can make sure these two lots of expertise tie up together?

[Baroness Merron (Lab)]

The policy for lighting is shared across a number of departments—not just the Department for Health and Social Care but the Department for Transport, as my noble friend says, as well as the Department for Energy Security and Net Zero, the Department for Business, Innovation, Science and Trade, and a number of arm’s-length bodies. We do all indeed co-ordinate and, as I mentioned earlier, work internationally, particularly with the UN Economic Commission for Europe, because we need to ensure that we update international vehicle lighting to meet the point that my noble friend is concerned about.

[Lord Patel (CB)]

My Lords, the Minister referred to blue light and its effect on children, which is correct, but a similar biological effect occurs in the retina of children based on the amount of time they spend on screen usage, particularly at night, because, as mentioned already, it disrupts melatonin production, which disrupts sleep. The same effect happens based on the length of time children use screens as for LED lighting, particularly higher-wavelength LED lighting. I thank the Minister for commenting on that.

[Baroness Merron (Lab)]

The noble Lord is quite right and highlights exactly the point I was making earlier on the first question about cars and lighting. There are a number of factors. Screen use can indeed be harmful, particularly where it replaces sleep, physical activity or leisure time. As the noble Lord will know, we advise families with under-fives to limit screens around bedtime and to ensure that content is age appropriate. I know that our department and the Department for Education will be publishing wider guidance for five to 18 year-olds in January.

Fracture Liaison Services: National Coverage

Baroness Merron Excerpts

Tuesday 27th October 2026 Lords Chamber

[Baroness Murphy]

To ask His Majesty’s Government what progress they have made in developing a delivery plan to achieve national coverage of fracture liaison services in England by 2030.

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

My Lords, the 10-year health plan committed to rolling out fracture liaison services by 2030, and it outlines our vision for a more devolved health service. The 10-year health plan and, more recently, the renewed women’s health strategy highlight community-based models of fracture prevention services. Integrated care boards are responsible for commissioning these services and are best placed to determine how they should be delivered to meet local need, while supporting overall development of fracture prevention outcomes.

[Baroness Murphy (CB)]

My Lords, I am very aware that the Minister has had this Question in almost identical wording, and I think there is another one soon to come from somebody else. So I will move away, if I may, and ask: does the Minister agree that the importance of these fracture liaison services is not simply to pick up fractures of the long bones, which are associated with osteoporosis, and to treat them—the fundamental purpose of the liaison service—but to establish connections between orthopaedic surgeons and geriatric medicine, so that, with other problems such as, for example, older people not getting their operations quick enough after a fracture, which Dr Mark Porter mentioned in the Times today, it will speed up the total relationship between the two departments and get better access to care for frail older people? Does the Minister agree that that is the most vital thing about these liaison services?

[Baroness Merron (Lab)]

I agree with the noble Baroness that that is one of the most important functions, because of course prevention and recovery are also key. As I have mentioned, ICBs are focused on providing services closer to home. Also, we are working with NHS England so that we can improve frailty services in acute settings as a priority, including through same-day emergency care and through comprehensive geriatric assessments.

[Baroness Pidgeon (LD)]

My Lords, what assessment have the Government made of the workforce and funding required to deliver national coverage? Will those requirements be reflected in the delivery plan?

[Baroness Merron (Lab)]

I refer the noble Baroness to the forthcoming 10-year workforce plan, which will make sure that the NHS has the staff that it needs, including in frailty services. Fracture liaison services deploy multidisciplinary teams to ensure prompt diagnosis and appropriate treatment. We have made available, through the Department for Education, loans for living costs to support students from the lowest income families to make sure that they can train and be part of the workforce. That is one area where we are developing recruitment and training.

[Lord Black of Brentwood (Con)]

Can the Minister confirm my understanding that, despite the Government’s commitment to a national rollout of FLS by 2030, the patient assessment rate, which is the key treatment measure, has shockingly increased by only 3% since 2024? At this rate of expansion, it will take 38 years—until 2064, my 100th birthday, incidentally—to fulfil their pledge, with tens of thousands of people dying unnecessarily.

[Baroness Merron (Lab)]

I hope we will all get to celebrate the noble Lord’s 100th birthday with him. As he will recall from just last week, we are taking a whole-pathway approach to fracture prevention, including improving access to diagnosis, adopting effective treatments and encouraging local systems to develop services that focus on those at greatest risk. I am always open to the points the noble Lord makes—he is right to make them—but it is important to acknowledge the actions and improvements taking place and the way we are supporting the development of services, particularly for those who need them most.

[Lord Weir of Ballyholme (DUP)]

My Lords, fracture liaison services is one area in which the three devolved institutions are, in effect, ahead of England; it is provided universally in Scotland, Wales and Northern Ireland and has been of great benefit in those jurisdictions. Can the Minister say what liaison is taking place with the three devolved institutions to learn lessons so that, when rollout happens in England, those lessons can be adapted to make sure we get the best service in England?

[Baroness Merron (Lab)]

I suggest some caution about the situation under the devolved Governments. Without any wish to disregard any improvements that have been made, the situation is not quite as the noble Lord describes, and I would be very pleased to write to him to confirm why. We certainly liaise closely and regularly with the devolved Governments to ensure that we can see progress across the whole of the United Kingdom.

[Lord Kamall (Con)]

My Lords, the Minister has just told the House that decisions on fracture liaison services will be made by local ICBs, yet at the national level the Government have made a welcome commitment to universal coverage in England by 2030. Does she accept that leaving delivery to the discretion of individual ICBs risks creating inconsistencies? Would such disparities be an example of where the Secretary of State could use their power of direction, as proposed in the Health Bill?

[Baroness Merron (Lab)]

I am sure we will discuss that at great length in Committee. While I absolutely accept there is a difference in the service level across the country—that is not acceptable, as I am sure we would all agree—it is not the hands-off approach that is often suggested. We have made, through the medium-term planning framework, the neighbourhood health framework and the 10-year health plan an identification that those at risk of frailty are a priority cohort. Our best practice guide was recently updated to give the NHS and local government joint ownership of delivery. In all these ways and a number of others, we support local decision-making and provision.

[Baroness Nargund (Lab)]

My Lords, osteoporosis disproportionately affects more women at menopause. Tens of thousands of women under the age of 40 who undergo menopause tend to receive a delayed diagnosis, and some end up with fractures before their menopause diagnosis is made. Does my noble friend the Minister agree that the fracture liaison services need to be integrated into women’s health hubs, so that younger women with menopause receive not only an early diagnosis and treatment but advice on fracture prevention?

[Baroness Merron (Lab)]

My noble friend is right to identify that there is a higher incidence of osteoporosis in women than men; it is more common. Some 80% of osteoporotic vertebral fractures are not identified and not managed appropriately, which again is unacceptable. That is why NIHR research has investigated the use of a new questionnaire to improve the diagnosis of these fractures in women. If it is successful—I hope it will be—it will reduce fracture risk and change clinical practice, particularly for older women with back pain.

[Lord Patel (CB)]

My Lords, in response to the question asked about the devolved Administrations, the Minister suggested we should interpret the data with caution. The caution is this: Scotland established one of the world’s first fracture liaison services, which is recognised globally as the most effective. Claims of a 50% reduction in repeat fractures might be exaggerated, but not by much. So what is the caution?

[Baroness Merron (Lab)]

The caution—I am very happy to write to noble Lords with more details on this —is that it has been suggested that it has 100% coverage, but I am advised that that is not exactly the case.

Corridor Care

Baroness Merron Excerpts

Tuesday 20th October 2026 Lords Chamber

[Baroness Pidgeon]

To ask His Majesty’s Government what progress they have made on their commitment to end corridor care.

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

My Lords, corridor care is unacceptable, and we are tackling its causes by preventing avoidable admissions, improving patient flow and accelerating safe discharge. Just this weekend, we announced almost £140 million for 14 urgent care schemes, alongside 25 new or expanded sites, which are due to open for winter. Despite unprecedented summer demand, around 50 trusts reduced corridor care. We are working to end corridor care by the end of this Parliament.

[Baroness Pidgeon (LD)]

My Lords, the Royal College of Emergency Medicine has reported today that two-thirds of clinical leads say their trust does not count as corridor care patients on chairs in corridors, patients who have been put on chairs in waiting rooms or even patients in corridors on the way in. What action will the Government take, and by when, to make sure that every trust counts every patient, so that we have a true picture of corridor care in this country?

[Baroness Merron (Lab)]

We are a lot closer to having a true picture, because in March this year we introduced a consistent national definition of corridor care, which I know the noble Baroness has been very keen on. In addition, for the first time monthly national data has been published since June, which is giving us greater visibility of where corridor care is occurring and, in particular, allowing support to be targeted at the most challenged hospitals.

[Lord Harris of Haringey (Lab)]

My Lords, in the 1990s, when I was a little boy, I was director of the Association of Community Health Councils. Each year, we ran something called National Casualty Watch, which involved local community health council members going into every local casualty department and not only counting the number of people there but asking them how long they had been waiting. Successive Secretaries of State, some of whom are in your Lordships’ Chamber, were not very happy about this, but it had a profound effect on making people realise that this is not a way to run A&E departments. Can my noble friend the Minister assure us that, given that the Government are rethinking their plans to abolish Healthwatch and national Healthwatch, facilities will be available for that sort of thing to continue in whatever new arrangements come forward?

[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.

[Baroness Browning (Con)]

I am sure that the Minister has seen some of the hospitals that have solved this problem. Is there a problem with hospitals that have overcome what is a very difficult problem sharing that information with other hospitals that are struggling? It always amazes me: when you see best practice, you just do not understand why it is not shared. If they do not voluntarily share it, is there anything the Minister can do to make them share it?

[Baroness Merron (Lab)]

The noble Baroness is right. While we are very mindful of the need to make more progress, sharing best practice is key to how we are improving things across the whole pathway. The majority of corridor care occurs in a small number of trusts, and that is why we are putting in targeted teams to work with those trusts to do exactly what the noble Baroness suggests.

[The Lord Bishop of Southwell and Nottingham]

My Lords, I pay tribute to the NHS staff who provide vital care under immense pressure. Recent reporting from the Queen’s Medical Centre in my diocese of Southwell and Nottingham has highlighted their compassion and professionalism. Does the Minister agree that the challenge of corridor care is one not only of clinical safety and privacy but of human dignity? Hospital chaplains provide invaluable pastoral and spiritual support to patients and families at moments of vulnerability and distress. What consideration have the Government given to ensuring that access to such support is not diminished when patients are cared for in temporary settings?

[Baroness Merron (Lab)]

I pay tribute to the service provided by hospital chaplains, because they extend support to those of all faiths and none, and that is crucial. Corridor care is not an acceptable normalisation. We want to end it by the end of the Parliament. I agree that dignity is very much part of it. The guidance given to hospitals is that, in exceptions where there has to be corridor care, they must take account of supporting the patient in the best way possible. For example, that can, of course, include support from hospital chaplains.

[Lord Kamall (Con)]

My Lords, the Minister said that the department, or maybe NHS England, has been able to identify the hospitals where corridor care is at its worst levels. What specific targeted support does the Minister’s department or NHS England intend to offer to those particular hospitals in order to reduce the high levels of corridor care?

[Baroness Merron (Lab)]

We are putting in specialist teams to work with those particular hospitals. The Secretary of State has made it quite clear that ending corridor care for children is an absolute priority. As I said to the noble Baroness earlier, we are ensuring that best practice is applied. Because of the additional funding, we have been able to and will be able to extend capacity. The noble Lord will have looked at the areas that are receiving targeted financial support. Where we have greater levels of corridor care, our teams are working with those hospitals to say, “Why is this the case? This is how to sort it out”, and make sure that they can. The small number of trusts means that there is greater reliance in some areas than others, and that is not all right.

[Baroness Watkins of Tavistock (CB)]

My Lords, what additional support are the Government going to give to the healthcare staff in accident and emergency departments, who are feeling very demoralised following a difficult summer and now face a difficult winter? Most importantly, in preventive terms, is it not time that we linked care in the community by subcontracting some beds in care homes, so that patients who could be discharged immediately if that was available can be, to enable things to be a bit better for staff and patients this winter?

[Baroness Merron (Lab)]

I share the views of the noble Baroness, as I do the comments of the right reverend Prelate about the role that our healthcare staff play. The noble Baroness is right about the connection with social care. Better patient flow and discharge actually rely on that, and that is why we have published the Model Emergency Department, the Model Acute Pathway and the Model Discharge Pathway, so that we can see earlier assessment, timely senior clinical review, improved discharge and better patient flow, because it is down to beds and also to pressure. If there is one thing we are promoting in terms of prevention, it is for everybody to get a flu jab who is eligible, because we want to prevent people unnecessarily presenting at hospital. That will assist us greatly.

Neighbourhood Health and Social Care

Baroness Merron Excerpts

Tuesday 15th September 2026 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I draw the House’s attention to my register of interests.

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

My Lords, this Government support the integration of neighbourhood health and social care. Our approach to neighbourhood health brings services together so that people experience more joined-up and person-centred care, including from integrated neighbourhood teams. In March, we published the Neighbourhood Health Framework, promoting joined-up partnership arrangements between ICBs and local authorities and asking health and well-being boards to develop neighbourhood health plans for implementation from 2027-28 at the latest.

[Baroness Thornton (Lab)]

I thank my noble friend for that Answer. I felt moved to put this Question because there seems to be more hope today than for many years that local integration of social care, health and primary care might happen. With so many moving parts in the reform agenda—the Casey review, the 10-year plan and so on—there may be a danger of reform steaming ahead without the voices and views of patients, carers and those with lived experience being properly baked into the design process. I seek reassurance from my noble friend that those voices will indeed be heard and heeded.

[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?

--- Later in debate ---

[Baroness Merron (Lab)]

The noble Baroness is quite right to talk about people having more complex needs, and, indeed, we are also living longer. However, the current health system is organised around institutions and services that are complex, disjointed and difficult to navigate, as she said. On housing, for example, I know that the health and well-being boards, which are the key to this, can design themselves to bring in services. I can think of a number which have already done that and included people from housing in the way that she describes. It is absolutely encouraged and health and well-being boards across the country are already doing that.

[Baroness Pidgeon (LD)]

My Lords, a recent workforce assessment by Skills for Care found that adult social care in England still had around 96,000 vacancies and projected that a further 410,000 posts will be needed by 2040 to meet demand. What are the Government doing to address these shortages and deliver genuine integrated patient services?

[Baroness Merron (Lab)]

We recognise the continuing challenge that we inherited in terms of workforce, but that is why we are investing in the adult social care workforce. In 2028, the first ever fair pay agreement will come in, which will be backed by £500 million of funding. It will improve pay and conditions for the workforce, which is crucial. We are also implementing the first ever universal career structure for the adult social care workforce, as well as investing up to £10 million this year in the learning and development support scheme. This, along with all the other changes, will make a massive difference to the workforce in terms of retention, recruitment and development.

[Lord John of Southwark (Lab)]

My Lords, my noble friend has already mentioned health and well-being boards, in which local government is a key participant and player. Having said that, and with the Government’s commitment to devolution in mind, can she tell us more about the role that local government will play in improvements to health and social care going forward? I am delighted to declare my interest as a vice-president of the Local Government Association.

[Baroness Merron (Lab)]

My noble friend is right to identify that, if we are going to deliver neighbourhood healthcare and make improvements in social care, we have to join up the NHS and local government. That is key to our whole approach to neighbourhood health. That is why health and well-being boards, which are responsible for drawing up the local plans for what the locality needs, will bring together and have on them local authority representation and voice, along with the NHS and others. We will manage this only by doing so, because, in order to reduce health inequalities and deliver locally, it cannot just sit with one. I am grateful to local government for what it is doing.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Minister explain how health and social care will be planned to ensure intergenerational input, in particular from young carers and young people, who often have very good innovative ideas about how to provide such services?

--- Later in debate ---

[Baroness Merron (Lab)]

That is a very good point. Young carers are sometimes left out, to the detriment, as I said earlier, of services and policy. I bring us back to the requirement in the Neighbourhood Health Framework, which we published just in March of this year, and add to that our introduction of neighbourhood health centre schemes across the country. The voices of local people, particularly those in the higher-priority cohorts, which can include young carers, will be heard and be part of the coproduction of how we provide neighbourhood health and social care.

[Lord Kamall (Con)]

My Lords, the noble Baroness said that the health and well-being boards will be responsible for making sure that there are sufficient social care services at the neighbourhood level. Following the question of the noble Lord, Lord John, to whom will they be accountable if they do not deliver sufficient social care at the neighbourhood level?

[Baroness Merron (Lab)]

The Neighbourhood Health Framework published in March, which I mentioned, requires local systems to develop neighbourhood health plans. That will give a very clear basis for measuring impact, which we do not have at the moment. I certainly agree with the noble Lord that it is not about the quality of the plan but about the quality of delivery. That is why the framework empowers local leaders in five minimum national goals that include, for example, as we have discussed many times, improving access to general practice, as well as the join-up with social care.

[Baroness Nargund (Lab)]

My Lords, I declare an interest as a former vice-chair and trustee of the British Red Cross. I have seen at first hand how the British Red Cross delivers health and social care across communities in our country by helping people to transition from hospital to home, giving them independence at home and avoiding readmissions. Does my noble friend the Minister agree that bringing together the voluntary sector with local authorities and the NHS will help to deliver more connected, effective and compassionate social care in every postcode?

[Baroness Merron (Lab)]

I certainly agree with my noble friend on that point. That is why achieving neighbourhood health will rely critically on that strong partnership, which will include civil society, as she says.

[Lord Evans of Rainow (Con)]

My Lords, the noble Baroness did not answer the question from my noble friend the Front Bench spokesman on who will be accountable if this does not work out properly.

[Baroness Merron (Lab)]

All the local systems have their line of accountability, with which I know noble Lords are familiar. Currently, for example, ICBs report to NHS England. Subject to the passing of the Health Bill, that will now come within the department and there will be an accountability mechanism. Transparency will be a key part of that. If noble Lords have any particular concerns, I am always happy to hear them.

Patient Data: Research

Baroness Merron Excerpts

Thursday 10th September 2026 Lords Chamber

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

My Lords, I congratulate the noble Lord, Lord Patel, on securing this debate and on his acknowledgement of the importance of patient data to research and of what the Government have done to date. I also thank noble Lords for their very thoughtful and informed contributions. I very much understand the point about trust, which has been made several times. We will come back to that, but I want to assure all noble Lords of the understanding that it is not always whether people have distrust because of something factual; if they feel distrustful, that in itself is a challenge for us.

We have some of the richest health data in the world, thanks to our diverse population and because we have an NHS that has supported and cared for us for some 78 years; we are fortunate indeed. It is the case that patient data drives life-saving discoveries. The noble Baroness, Lady Brinton, spoke very personally to that point, and I know many noble Lords could also draw on their personal experience to do so. It helps us to understand disease and to develop new treatments, many of which we could never have dreamed of.

This is also essential to improving the nation’s health and prosperity; it is key to our life sciences sector, and to creating jobs, driving investment and powering innovation. Ensuring that benefits flow back to patients and the public, as the noble Lord, Lord Patel, asked for, is also, I agree, essential. That is why we have published a value-sharing framework for NHS data, and also why we will charge organisations for access.

I can assure my noble friend Lord Davies, who asked about an oversight body, that the confidentiality advisory group is the independent oversight body; I feel that is probably what he seeks. It decides whether confidential patient data can be used for research without individual consent. As many noble Lords have acknowledged, we all know that people do want their patient data to be used for research, but I completely agree that this trust is conditional on our keeping the data secure and making that known.

We are committed to moving from a system of data sharing, in which copies of people’s data are sent to researchers, to a system of data access by default, using secure data environments. The noble Lord, Lord Patel, spoke to this very point. Perhaps I can give some further outline and further reassurances and pick up a number of the questions. On any key questions that I cannot answer because of time, I will be glad to write to noble Lords.

The noble Lord, Lord Patel, said that NHS England now uses secure data environments—SDEs—as the default route for accessing data for research. Its network brings together around 300 local and regional datasets that were not available previously. The Health Data Research Service—HDRS—will build on that foundation by developing a much clearer route into the system and more consistent processes. That is important more broadly because, although investment in secure data environments had begun previously, and services were being established, we are now taking the system from where it was—as has been said, it was somewhat fragmented—to a coherent approach. I can say to your Lordships’ House that a simpler, safer and more accountable set-up is where we will get to by the end of this Parliament.

In answer to the point raised by the noble Lords, Lord Patel and Lord Weir, last year we commenced powers to allow us to mandate information standards and to create binding rules across both GPs and trusts. Yes, there is more work to do, but I think that sets us absolutely in the right place. There are some examples of very good practice. We can look to Greater Manchester, where they have linked GP and hospital data. This is not commonplace, because it is GPs who currently decide, on a practice-by-practice basis, how their patient data are used. We are currently running a programme of national engagement with GPs on the use of patient data, and we will use that to work with GPs and other primary care professionals to improve the use of GP data in the future. Our new guidance on enabling safe access to UK human genomic data demonstrates that we expect human genomic data to be accessed through secure data environments—and, I would emphasise, only by approved researchers.

I agree with my noble friend Lady Gill that we have to act swiftly and robustly where things go wrong. Of course, we minimise that possibility, but we have to be realistic.

I am grateful to the noble Lord, Lord Tarassenko, for setting out the facts on Biobank, to which my noble friend Lord Davies also referred. I will not repeat the points he made, because I share his analysis.

On the federated data platform, I say to the noble Baroness, Lady Bennett, that it is not used for research; it supports NHS operations and direct care. This means that opting out of sharing your health data for research and planning will not stop your data being used by the FDP to support your care. That is an important reassurance to those who wish to opt out of sharing their health data. As I mentioned, the FDP contract will be reviewed ahead of the February 2027 break clause.

I say to the noble Baroness, Lady Freeman, that the issue of gaining and maintaining trust is key. That means giving people meaningful choices over their data. So, following public engagement, we are reforming how people can opt out of having their data used for planning and research, and making it clearer and simpler, so that they do not feel bound should they not wish to participate.

As noble Lords have said, it is true that people generally support the use of patient data when they understand who is using it, why it is being used and for what purpose. I accept that awareness remains low, so we have to be transparent about its purpose, as well as maintain strong safeguards and involve the public in decision-making.

On the safeguards about which I have spoken, we want to make it easier for legitimate researchers to access data. The Sudlow review described just how long it can take for approved researchers to access health data. That is an issue. So, through the NIHR, we are investing around £1.7 million a year in research and research infrastructure. Alongside that, the NHS data and analytics academy is developing the workforce of data engineers, analysts and other specialists we need, as per the point of the noble Lord, Lord Patel, in order to turn this into better treatments and care.

Our NIHR reforms mean that clinical trials are being set up some 47 days faster than last year. But we want to go further and faster, which is why we have established the HDRS. I say to the noble Baroness, Lady Murphy, that the question of dementia research will indeed be one for the HDRS.

The noble Lord, Lord Mair, asked about HDRS. Processes will indeed be streamlined. On the matter of funding, I say to him that the future funding model is to be developed and we certainly will take into account the patients and the public. I am sure that is something we will want to develop further.

This has been a helpful debate. We are moving towards a coherent strategy. A number of other questions were raised, including from the noble Lord, Lord Kamall, and others, and I will be glad to follow up on those. For now, I hope this will take us forward and that we can all move to using patient data to better manage how we provide our health services.