Neighbourhood Health Services

Debate between Baroness Merron and Lord Hunt of Kings Heath

Tuesday 10th November 2026 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord comes forward with a good example; digital diagnosis is a huge support in the improvements that we seek to make for patients, so we are investing in digital diagnostic transformation through NHS England’s diagnostics digital capability programme. That will ensure that networks have that core set of digital capabilities so that care can be improved in quality, safety and productivity. Those are all outcomes that we seek in neighbourhood healthcare.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord, Lord Lansley, has underpinned the importance of general practitioners. My noble friend will be aware that there is a big variation in the number of GPs per patient up and down the country. Can she say a little about what the Government are doing to deal with these under-doctored GP areas?

[Baroness Merron (Lab)]

It is true that general practice is a cornerstone of neighbourhood health. I am glad that people will now find it easier to access their doctor and have more choice in how and when they book appointments. With reference to digital access, I believe that will greatly help in accessibility to GPs, but we are improving capacity. We are employing more GPs; there are now 2,800 more fully qualified full-time equivalent GPs employed compared with July 2024. That is the highest number since 2015. We have also made changes to the GP contract so that PCNs and practices can hire more GPs and introduced a practice-level GP scheme. We are focusing our efforts on the more under-doctored areas that my noble friend describes.

Health Bill

Debate between Baroness Merron and Lord Hunt of Kings Heath

Committee stage
Monday 9th November 2026 Lords Chamber

[Baroness Merron (Lab)]

I think the bigger question that the noble Baroness is asking is about politicisation; I heard what she and the noble Lord, Lord Stevens, said about the situation elsewhere. I have to remind myself that, if there were, for example, a different Government with whom I did not agree—goodness me—it would be their right to make decisions and bring forward legislation. So, with the best will in the world, whatever we do here, we have to be realistic about what we can achieve. It is also important to note that checks and balances, which I have referred to, are already in the system. We are doing the opposite of tearing them up: we are continuing to apply them.

[Lord Hunt of Kings Heath (Lab)]

In the case that the noble Baroness raised, the issue is that of course we have an Independent Reconfiguration Panel but, ultimately, it should be the Secretary of State’s decision. Otherwise, we would have a situation where a decision to close a service in a locality would be made not by those elected by local people but by an appointed board. Surely, in the interests of democracy and accountability, the Secretary of State must in the end have that intervention power.

[Baroness Merron (Lab)]

My noble friend has put it very clearly and I most grateful. I think the public believe that the Secretary of State has that power already, but in fact she does not, which is a point my noble friend has made on many occasions.

Turning to Amendment 40, I should also draw attention to the distinction we have made between the more routinely used power of direction and the powers specifically reserved for use in cases of significant failure or risk of significant failure. Retaining the distinction between types of direction is important, as is the recognition of when an intervention is undertaken to protect patients, the public or taxpayers. I note the alternative proposal to appoint commissioners from the noble Lord, Lord Scriven, in Amendment 40. My concern is that this approach would likely be more cumbersome and would slow Ministers’ ability to intervene where significant failure was occurring—something that I know noble Lords would not want. Amendment 40 also touches on outcomes frameworks. I assure the noble Lord that I share the sentiment about the importance of outcomes frameworks, and, if necessary, we can complement existing frameworks by using directions.

I will now briefly touch on Amendments 76 and 77, which relate to Clause 21. The clause transfers the requirement to conduct annual assessments of ICBs from NHS England to the Secretary of State and focuses the assessment on the statutory functions of these organisations rather than a narrow list of duties. Currently, the position is that NHS England assesses ICBs annually, using data and local insight to review their performance against their functions, including a list of duties prescribed by the current legislation. The results are published online and they inform the oversight relationship between NHS England and each ICB. However, this list of duties forms a static list of requirements which are already part of the ICBs’ statutory functions. Performance assessments need to adapt to the evolving role of ICBs as strategic commissioners, and evening out the focus across all ICB duties supports that, making assessment more flexible and meaningful as ICBs adapt.

These clauses enable the Secretary of State to support the system, respond to unforeseen challenges and uphold the standards that patients expect and deserve, while ensuring that we have fairness and impartiality at the heart of the National Health Service.

Health Bill

Debate between Baroness Merron and Lord Hunt of Kings Heath

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[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.

People with Learning Disabilities: Acute Illness

Debate between Baroness Merron and Lord Hunt of Kings Heath

Monday 20th July 2026 Lords Chamber

[Baroness Merron (Lab)]

There are financial sanctions for providers that could be brought into play. On accountability, delivery is monitored through NHS governance and assurance processes. This includes the NHS operating framework, annual assessment of ICB performance, regional oversight and review of local delivery plans.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the tragedy is that Lord Rix many years ago pointed out the same problems and no progress has been made. My noble friend is putting faith in ICBs, but she knows that their resources will be reduced in terms of headcount. Going back to the question by the noble Lord, Lord Harper, does she not think that accountability needs to be placed with NHS trusts? They need to be required to establish specialist teams, which we know lead to better outcomes, and have a response in relation to communications. Should we not be putting responsibility where it actually lies, rather than relying on ICBs to commission this?

[Baroness Merron (Lab)]

I have to vary a bit on that point from my noble friend, who I know brings a tremendous interest to this area. It is right that local services are locally provided, but I do not accept the analysis that this is handing it over to an unaccountable local provision. I outlined to the noble Lord, Lord Harper, the specifics of accountability. All the actions that are identified in the inquiry’s report will make major progress. I assure my noble friend that we will keep this continually under review. I am sure that there are always improvements that we can make, and we are committed to doing so.

IVF Treatment

Debate between Baroness Merron and Lord Hunt of Kings Heath

Wednesday 1st July 2026 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness is quite right to identify that this is not an insurance policy to be relied on to guarantee a baby in the future, no matter what suggestion there may be to the contrary. It is also worth knowing that, while egg freezing is the fastest growing fertility treatment, it is proportionately still small—comprising about 5% of treatments. To her point, there is a responsibility on fertility clinics to ensure that anyone using their services understands the risks—which I must emphasise—as well as the long-term impacts of any treatment decisions that they make. It is quite right and proper that they do that.

[Lord Hunt of Kings Heath (Lab)]

My Lords, with the abolition of NHS England, ICBs will be given many more responsibilities in the future. However, does the Minister agree that their record on IVF, where they are not following the clear, specific guidance that they have been given, does not induce confidence in ICBs’ performance? Inevitably, Ministers will be drawn to make decisions more centrally. Does the Minister think ICBs understand that the kind of rationing that they undertake at the moment in relation to IVF is utterly unacceptable?

Nottingham Maternity and Neonatal Services

Debate between Baroness Merron and Lord Hunt of Kings Heath

Monday 29th June 2026 Lords Chamber

[Baroness Merron (Lab)]

I certainly agree. Every woman, in the case of maternity services, deserves safe and compassionate maternity care. That is why we are so determined to drive urgent improvements in maternity services. It is worth noting that this review—the largest ever of its kind, as the noble Lord, Lord Kamall, said—considered the experience of more than 2,500 families and 830 staff. I think it is important that your Lordships’ House also remembers how many staff have found themselves in situations they would never have wanted to be in. I am sure that the noble Baroness, like me, pays great tribute to the many NHS staff who are in the majority in doing their work in a compassionate way—as the noble Baroness has experienced.

I cannot comment on whether it is specific to society but, from Donna Ockenden’s conclusions, there was something deeply wrong here. Whether it was not listening, culture or racism and discrimination towards women, families and staff, and between staff, we cannot have it.

[Lord Hunt of Kings Heath (Lab)]

My Lords, to continue this theme, the report describes a bullying and toxic culture, with junior midwives not being sufficiently supported when dealing with complex cases. It was a culture that did not allow them to refer such cases up the chain. There was a constant turnover in senior midwifery leadership and those they appointed were not given proper induction, mentoring or even guidance about their roles. In the work that the Minister is taking forward with the Secretary of State, will there be a concerted national programme of training and development for senior midwives so that there is a real opportunity to try to grip these issues?

[Baroness Merron (Lab)]

My noble friend’s analysis is quite right. One of the reasons we are developing an anti-discrimination programme is that cultural change across maternity and neonatal services is much needed. I use that as one example; all NHS trusts are to have completed that programme by 2027, and that is already under way.

I found it absolutely shocking that so many senior people at Nottingham did not give evidence to Donna Ockenden’s investigation. That is why, once the Hillsborough law Bill receives Royal Assent, we will extend the duty of candour to the Leeds and Sussex reviews so that the chair, Donna Ockenden, will have the powers to find the truth from organisations and staff. On the earlier point, it is quite shocking and totally unacceptable that they refused to participate.

Migraine Care: 10-year Health Plan

Debate between Baroness Merron and Lord Hunt of Kings Heath

Monday 23rd March 2026 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, my noble friend the Minister, very welcomely talked in her first response about widening access to treatment. My understanding is that NICE guidelines can be very tight for some of those treatments. As part of the work she has put forward, can my noble friend ask NICE to review its guidelines to make sure they are absolutely up to speed?

[Baroness Merron (Lab)]

As I know my noble friend is well aware, the eligibility criteria are set independently by NICE. They are based on clinical evidence and cost-effectiveness, rather than being set by Ministers. However, it is worth saying that the introduction of oral CGRPs, which do not require specialist initiation, will significantly widen access through primary care and reduce the bottlenecks in the system. We are very keen that people can access effective drugs, and I take on board the point my noble friend made.

Resident Doctors: Industrial Action

Debate between Baroness Merron and Lord Hunt of Kings Heath

Monday 15th December 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness has just made a very good case as to why the offer which has been rejected would have been so helpful. On the issue of pay, our door has remained open to the BMA and to reasonable, realistic solutions to resolving the dispute, on which we have been repeatedly clear. I know the noble Baroness did not say this, but I say more broadly that there can be no suggestion that the BMA was not aware that we can go no further on pay this year. Resident doctors have already had a good deal on pay—an average 28.9% rise over the last three years—but pay expectations have to take account of the fiscal position and the impact across the whole of the NHS and beyond. I am glad to hear that noble Lords are in agreement with that approach.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the BMA pay claim has been ridiculous right from the start, and I share my noble friend the Minister’s outrage at the decision to carry out these strikes at a moment when the health service is on its knees, certainly in Birmingham. We are in a critical situation: the service is working under huge pressure, and ambulances are finding it very difficult to discharge patients at A&E because we cannot get the flow of patients through the system.

Listening to the noble Lord, Lord Kamall, I wondered if my noble friend the Minister shares my view. I remember the 2014 junior hospital doctors’ dispute. Although that was ostensibly about pay, what came through was frustration at the way training and working lives were organised, with inflexible placements and utterly insensitive rota allocations. It made junior doctors’ working lives increasingly difficult. This was 2014. Does my noble friend the Minister think that part of the reason we are here now is that nothing was done to respond to the substantive issues juniors raised at the time, and that at some point, there will be a constructive way forward? I am convinced that tackling the way junior and resident doctors are treated in the health service will have to be at the heart of what we do.

[Baroness Merron (Lab)]

I am grateful to my noble friend, and I share his view. I am sure he will be very familiar with this, but it is worth reminding ourselves that in the Statement we are debating, the Secretary of State said last week:

“On jobs, I have much more sympathy with the BMA’s demands. I have heard the very real fears that resident doctors across the country have about their futures; it is a legitimate grievance that I agree with”.


As the Secretary of State outlined and my noble friend referred to, we have inherited

“training bottlenecks that … leave huge numbers of resident doctors without a job … UK graduates”

used to compete

“among themselves for specialty roles; now, they are competing against”

the rest of the world.

“That is a direct result of the visa and immigration changes made by the previous … Government post-Brexit, and … compounded by the”


then Government’s

“decision to increase the number of medical students without also increasing the number of specialty training places”.—[Official Report, Commons, 10/12/25; col. 429.]

This has not just come about, and I am grateful to my noble friend for reminding us of the history of this.

NHS: Wheelchair Services

Debate between Baroness Merron and Lord Hunt of Kings Heath

Monday 24th November 2025 Lords Chamber

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what assessment they have made of the provision of wheelchair services by the NHS and social care authorities.

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

My Lords, integrated care boards are responsible for the commissioning of local wheelchair services based on the needs of the local population. NHS England has developed policy guidance and legislation to support ICBs to commission effective, efficient and personalised services. This includes a Wheelchair Quality Framework, published in April, which is designed to assist ICBs and NHS wheelchair service providers in delivering high-quality provision that improves access, outcomes and experience.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to my noble friend, but does she recognise that the work by the Wheelchair Alliance and the All-Party Group for Wheelchairs Users would suggest that, if you leave this to local health bodies and local authorities, they simply will not improve the current inadequate and patchy service? The All-Party Group for Access to Disability Equipment has reported that

“63% of carers and 55% of equipment users said that services are getting worse”.

Given what my noble friend said about the quality framework, which I very much welcome, does she accept that nothing will change unless this is enforced from the centre, with strong performance management?

[Baroness Merron (Lab)]

I accept the observations that my noble friend has made; I know he has been a voice on this for many years. I share with him the impatience for change and welcome the work of the APPG and the Wheelchair Alliance. The NHS Medium Term Planning Framework, which was published just in October, requires that, from 2026-27, all ICBs and community health services must actively manage and reduce the proportion of waits across all community health services over 18 weeks and develop a plan to eliminate all 52-week waits. I expect that wheelchair provision and services will improve through this as well as other means.

National Health Service Regulations

Debate between Baroness Merron and Lord Hunt of Kings Heath

Tuesday 16th September 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord makes an important point. There is absolutely no intention that people will be disadvantaged in any way. This is about equalising access, which means keeping all forms of access open. That may be online, but it will also be possible to deal with things in person and on the phone. Obviously, if we can take pressure off phone access, or personal access, through the use of online, that will assist the group to which the noble Lord referred.

[Lord Hunt of Kings Heath (Lab)]

My Lords, my noble friend referred to Community Health Councils. I was one of the first CHC secretaries to be appointed in 1974.

[Lord Hunt of Kings Heath (Lab)]

Wait for it, my Lords—I was also the Minister who got its abolition through your Lordships’ House. Mea culpa; I was mistaken. We should bring it back.

[Baroness Merron (Lab)]

My noble friend does himself credit with his honesty, which I too will take example from .