Health Bill

Baroness Nargund Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thought it would be appropriate for those of us who have been involved in this for the last 15 years or so to join in the debate a little. The noble Lord, Lord Lansley, is quite right: this is about transition. It is about a transition that affects two groups of people: patients and people who work in the NHS.

I am a veteran of the transitions that we have had so far, because I was abolished in 2020. I became a member of my local CCG, which I very much enjoyed serving on, having worked on the 2012 legislation that created it. I then took refuge as a non-executive director in my local hospital. I helped to create our local ICB, which is now being abolished with a super-ICB being created. I feel as if I have been at the governance coalface of the reorganisations for the last 15 years. This is an important debate, and I am in favour of the abolition of NHS England.

I intend to involve myself in Committee mostly with equality, social care, patient records and so on, but I have a question for my noble friend the Minister about the arrangements for the people who will move from NHS England into the department and where they stand right now. Those people are very precious to us, and many of them are very experienced. I would like to know how the TUPE arrangements are progressing, what the dates are for those arrangements and when we are likely to see some documentation about how that will actually happen.

[Baroness Nargund (Lab)]

My Lords, I understand and support the general thrust of this amendment. I have worked in the NHS for nearly 40 years and have worked very closely with NHS England. Having experienced all the transitions that have happened with local health boards, PCTs, CCGs and ICBs, and having worked with CCGs and ICBs across England as a provider and doctor and with NHS England, as I said at Second Reading, I wholeheartedly support the abolition of NHS England. It will cut the bureaucracy and the unnecessary layer. I support the Secretary of State taking back the power to give it away to ICBs where patients are treated. It also fits in with the neighbourhood health plan, because they are best placed to develop and deliver that.

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[Baroness Nargund (Lab)]

My Lords, it is an honour to follow my noble friend Lady Royall. I support Amendment 18 from the noble Baroness, Lady Tyler, to publish a cross-governmental strategy to reduce health inequalities in England. This debate has been extremely humanitarian because addressing health inequalities is a matter of social justice and human dignity.

Health is not created in hospitals or GP clinics; it is created in homes, workplaces and our communities. Health is so fundamental, as Martin Luther King said:

“Of all the forms of inequality, injustice in health is the most shocking and the most inhuman”.


That is what we are talking about—addressing something of a humanitarian nature by addressing health inequalities around our country.

The noble Baroness said about the NHS being criticised. It has often been criticised as not being a national health service but a national sickness service. If we really want to transform our NHS to become a national health service, we have to address health inequalities. These do not lie within hospitals or clinics but in our society and the social determinants of health.

I declare an interest as a founder and trustee of the charity the Health Equality Foundation which works in this area. I also have had the honour of working with Sir Michael Marmot in helping to address the social determinants of health. One of the greatest challenges we face is this nearly 20-year gap in healthy life expectancy, and this cannot be addressed by one department alone nor simply by hospitals. Like the child poverty strategy, we need a whole-government approach to tackling the wider determinants of health—where we are born, how we live and the conditions in which we grow up—which account for 80% of health outcomes.

After having served in the NHS for nearly 40 years, with over 30 years as an NHS consultant, I have treated the consequences of inequality, but I was not able to address the causes of inequality. We have a huge opportunity to address that. I welcome the Government’s manifesto commitment that my noble friend Lady Royall mentioned and the 10-year plan commitment to address health inequalities and the wider determinants of health around our country. The commitment to address health inequalities—not that I know previous Health Bills well—has never been stronger.

The economic case is as compelling as the moral one. If the north of England achieved the same health outcomes as the rest of the country, it could add £18.4 billion to our economy each year. Poor health reduces productivity, increases welfare spending and constrains growth. We know if we want good growth in every postcode, we need good health in every postcode, not just good healthcare in every postcode, which we all know is also essential.

I support this amendment from the noble Baroness, Lady Tyler, because of the need for a cross-government strategy. I have previously spoken in this Chamber about the need for a cross-government taskforce or board; I have also written about that. I believe a cross-government strategy and a taskforce are needed to address our health inequalities and that that taskforce would go beyond this to tackle wider and general determinants of health.

If we want to seriously address this, we must have a cross-government strategy. I recognise the important work already undertaken by the Government in this Bill and the 10-year health plan, but given that many of the underlying causes of poor health sit outside our health service, has the Minister given any consideration to developing a cross-government strategy and potentially a taskforce similar to the one created in respect of the child poverty strategy to address the wider determinants of health? Are there any lessons from that approach that could be applied to tackling wider health inequalities? I am really honoured to have spoken in this debate.

[Baroness Lister of Burtersett (Lab)]

My Lords, I am honoured to follow my noble friend Lady Nargund. I have added my name to a number of the amendments in this group calling for a clear duty on the Secretary of State to take action to reduce health inequalities and produce a cross-government health inequalities strategy. I also support the other amendments on this theme, including that in in the name of the noble Baroness, Lady Bennett of Manor Castle. As we have heard, her amendment makes specific reference to inclusive health groups, including Gypsy, Roma, and Traveller communities, who experience some of the poorest health outcomes of any group in England, as the noble Baroness, Lady Jones of Moulsecoomb, spelled out.

As Just Fair points out, there is a right to health under the International Covenant on Economic, Social and Cultural Rights. In its 2025 concluding observations, the UN Committee on Economic, Social and Cultural Rights raised a number of concerns about the provision of health services in the UK, including inequalities in access to care, as we have heard about.

At Second Reading, I and a number of other noble Lords spoke in favour of a clear duty on the Secretary of State to tackle health inequalities and a cross-government health inequalities strategy that would underpin the preventive approach that the Government, rightly, initially favoured and, indeed, that the Chancellor referred to in his Budget speech today. Our interventions reflected calls from a wide range of health and other bodies, many of which support the Health Equals campaign to put tackling health inequalities on a statutory footing and to reboot the Government’s emphasis on a preventive approach. It also reflected the position of the Health and Social Care Committee in its scrutiny report on the Bill.

The Government themselves have emphasised the importance of addressing health inequalities in their child poverty strategy, as I pointed out at Second Reading. Indeed, the strategy declares that addressing healthcare inequality is at the heart of their health mission. Moreover, in September, the Minister for Women and Equalities, in announcing the establishment of a new class unit, described it as

“a pivotal step in embedding a focus on socio-economic inequality into the heart of government”,

as part of their drive to tackle entrenched inequality. Given all that Ministers have said about inequalities, I am puzzled as to why they seem so reluctant to translate this commitment to tackle entrenched inequality into a statutory duty in this key legislation.

In the Commons, Minister Smyth failed to give a convincing explanation as to how mere empowerment is more effective than a duty to address health inequalities, which she herself said remained a government priority. However, it might not be a priority for a future Government, so warm words are not enough. In the Second Reading debate in your Lordships’ House, my noble friend the Minister reiterated the Government’s commitment to working for greater equality but did not engage with the arguments put by a number of us and explain why a power is better than a duty to achieve this. I therefore hope that she has been able to reflect on what was said and on the growing pile of evidence on health inequalities, especially among children, some of which we have heard about today, and that she will be able to respond more positively and commit to bringing forward a government amendment on Report that meets the objectives of the various amendments debated today.

Fracture Liaison Services: National Coverage

Baroness Nargund Excerpts

Tuesday 27th October 2026 Lords Chamber

[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.

Neighbourhood Health and Social Care

Baroness Nargund Excerpts

Tuesday 15th September 2026 Lords Chamber

[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.

Patient Data: Research

Baroness Nargund Excerpts

Thursday 10th September 2026 Lords Chamber

[Baroness Nargund (Lab)]

My Lords, it is a great pleasure to follow the noble Lord, Lord Patel. I congratulate him on securing this very important debate and on his insightful and excellent introductory speech.

The National Health Service is one of Britain’s greatest institutions. After 30 years as a front-line NHS consultant in women’s health, I believe it can be more than a healthcare provider. The NHS holds the richest longitudinal health dataset in the world. It can help to improve outcomes, accelerate innovation, create intellectual property, patents and high-value jobs, and attract global investment. The new Health Data Research Service presents a significant opportunity. Our ambition should go further, to create the high-quality representative datasets needed to develop and validate AI safely.

AI can analyse data at a large scale in a way that humans cannot, predicting risk, promoting early detection, accelerating drug discovery and clinical trials, and enabling the much-needed shift from treatment to prevention. However, AI is only as good and equitable as the data it is trained on. We need richer data points—not simply age and sex, but ethnicity, disability, socio-economic deprivation, postcode and wider determinants of health—to identify who is missing out and why, why outcomes differ and how to address them. Diseases do not care about borders, and nor should any medical research. The UK should ensure regulatory interoperability with international standards and lead global research with our data. This is essential in particular for rare diseases and cancers, and for ethnic minority communities who are underrepresented in research.

Public trust must be the foundation. Patient consent, privacy, security, transparency and appropriate safeguards must be embedded from the outset. If the challenges my noble friend Lord Patel described are addressed, the NHS patient database can become a powerhouse for health research and AI-driven innovation, and economic growth. Can the Minister say whether the Government will ensure that the Health Data Research Service develops representative datasets for AI research and also pursue international data interoperability, so that Britain can lead in equitable and rare diseases innovation, while driving economic growth? Good patient data can drive good medical research and help deliver good health and good growth together.

Integrated Care Boards: Access to Services

Baroness Nargund Excerpts

Tuesday 8th September 2026 Lords Chamber

[Baroness Merron (Lab)]

One of the major shifts for the NHS now and in the future is about moving services from hospitals to communities; we had a Question on that just yesterday. It is important to say that the fundamentals of oversight, which we are improving, will be through the NHS oversight framework, which will be clear about delivery and approach. I should add that NHS England will be able to focus on helping the most challenged organisations with their performance and capabilities. If there are problems such as those that the noble Baroness described, they will be identified.

[Baroness Nargund (Lab)]

My Lords, access to women’s health services varies significantly across the country, with women from deprived areas and some ethnic-minority communities facing particular barriers. Therefore, what steps are the Government taking to ensure that ICBs not only commission but deliver equitable women’s health services in all regions, so that a woman’s ability to access timely diagnosis and treatment is not determined by her postcode, ethnicity or social deprivation?

[Baroness Merron (Lab)]

My noble friend makes an important set of observations. I can reassure your Lordships’ House that reducing inequalities is absolutely hard-wired throughout our renewed women’s health strategy. For example, we are redesigning clinical pathways for the most common women’s health conditions, and that will standardise and improve care across the country.

Childbirth-related Post-traumatic Stress Disorder

Baroness Nargund Excerpts

Wednesday 2nd September 2026 Lords Chamber

Asked by

[Baroness Nargund]

To ask His Majesty’s Government what assessment they have made of the study published in the British Journal of General Practice which found that thousands of women have undiagnosed post-traumatic stress disorder after childbirth every year.

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

My Lords, we take the findings of this study seriously and recognise the significant impact that PTSD after childbirth can have on women and families. Postnatal appointments provide opportunities for identification of PTSD and specialist perinatal mental health services are available nationwide to support diagnosis, treatment and professional training. The national maternity and neonatal action plan will provide further opportunities to strengthen prevention and postnatal support for those affected by birth trauma.

[Baroness Nargund (Lab)]

My Lords, I thank my noble friend for her reply and her ongoing commitment to improving women’s health and mental health. This new evidence highlights that thousands of women with post-traumatic stress disorder following childbirth may be going undiagnosed. Will the Government use this evidence to raise awareness about childbirth-related post-traumatic stress disorder and work with NICE and other stakeholders to implement screening tools for diagnosis and a pathway for specialist referral in primary care so that women can receive timely diagnosis and treatment?

[Baroness Merron (Lab)]

The key thing here is identification, because without that we cannot have treatment. Prevention of PTSD is really our starting point. I certainly agree with my noble friend that early identification is crucial and that women should be routinely asked about their mental health and birth experiences during postnatal contact. That is why training resources have been developed to support this. I can assure my noble friend that I am very keen that we continue to work with clinicians, charities and, crucially, women with lived experience, because further improvements are needed, including on how women can be identified earlier and referred for appropriate support.

Healthcare Sector: Clinicians

Baroness Nargund Excerpts

Wednesday 22nd July 2026 Lords Chamber

Asked by

[Baroness Nargund]

To ask His Majesty’s Government what steps they are taking to support clinicians to become innovators and entrepreneurs in the healthcare sector.

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[Noble Lords]

Order!

[Baroness Nargund (Lab)]

I thank my noble friend the Minister for her reply and welcome the Government’s commitment to innovation, but the actual programme has supported only a small fraction of the NHS workforce so far. I have met so many doctors, nurses and other healthcare professionals in my career with innovative ideas that could improve patient care, reduce costs and improve productivity. Yet too often, these ideas get nowhere because there are no clear, accessible pathways to develop them, and we are losing out on so many innovators and innovations that would benefit not only our patients but the Treasury. Does my noble friend the Minister agree that we now need an NHS entrepreneurship workforce strategy that could truly make our NHS the Silicon Valley of health innovation? If so, what steps could the Government take to give every NHS staff member protected time, training, mentoring incentives and accessible, clear pathways to develop and scale their innovative ideas?

[Baroness Merron (Lab)]

I certainly agree with my noble friend that there is a rich seam of intellectual capital among the 1.5 million NHS staff in our country. I am glad to say that the clinical entrepreneur programme is already a world leader in healthcare entrepreneurship, as my noble friend looks for. It has supported over 1,800 NHS staff and 690 start-ups, and it has raised more than £1.2 billion. We have now doubled the baseline annual funding for the programme. Yes, I agree that a clear pathway to adoption is vital, so we are expanding the health innovation networks, because they will provide the necessary support.

Modern Service Framework for Dementia and Frailty

Baroness Nargund Excerpts

Thursday 9th July 2026 Grand Committee

[Baroness Nargund (Lab)]

My Lords, I am grateful to the noble Lord, Lord Weir of Ballyholme, for securing this important debate, and I welcome the Government’s commitment to delivering the modern service framework for dementia and frailty. Dementia is not gender neutral. We may not have a cure at the moment, but we can cure the inequity in access to research, clinical trials, early diagnosis and effective treatments.

In England, more than 500,000 people now have a recorded diagnosis of dementia, and nearly two-thirds of them are women. Dementia and Alzheimer’s disease have been the leading cause of death for women in England and Wales since 2011. Almost two-thirds of unpaid carers for people with dementia are also women. Women live longer, but longevity alone does not explain this disparity. The APOE4 gene increases women’s risk of Alzheimer’s disease more than men’s.

The emerging evidence suggests that the hormonal changes associated with menopause may increase vulnerability. The hormone oestrogen is vital for memory formation, as it is essential for effective communication between neurons in the part of the brain involved in memory. The link between dementia and menopause extends beyond misdiagnosis, yet until recently, the relationship between menopause and dementia received remarkably little scientific attention. We need more research about the risks of developing dementia in women who undergo early or premature menopause. As the noble Lord, Lord Weir, mentioned, we need to work on reducing risk and, where possible, identify who is at high risk of developing dementia. Part of that involves identifying the risk in women going through early or premature menopause.

This has a human cost. Karen Barber from Essex devoted more than a decade of her life to public service at HM Passport Office and HMRC. In her 50s, her memory and organisational skills began to deteriorate. Her symptoms were repeatedly attributed to menopause and stress. She was repeatedly told that her symptoms were “in her mind”. Without a diagnosis, she was dismissed from her job for poor performance. More than 10 years later, and only after paying privately for a specialist assessment, she was finally diagnosed with young-onset dementia. Karen’s story is not simply one of illness; it is a story of delayed diagnosis, lost employment, financial hardship for the family and a system that failed to recognise the disease at the time.

For too long, medicine has been built around a male standard. Women’s underrepresentation in research and the failure to analyse differences between the sexes have left important gaps in our understanding of dementia. As we have known for a long time, studies show that women are underrepresented in dementia clinical trials relative to the burden of disease they bear. One review found that, among 118 dementia trials, only eight reported outcomes separately for women and men. In several studies, treatment benefits appeared greater in men, reminding us that biological sex may influence how medicines work. If we do not measure these differences, we cannot deliver gender-based care and the truly personalised, precision medicine that everyone deserves. I therefore warmly welcome the framework’s commitment to expanding dementia clinical trials, which is absolutely necessary and urgent, and the confirmation that participation will increase to 2,000 people over the next five years.

Innovation reduces inequalities only if it is designed for everyone. This is not only a health challenge for women, it is also an economic one. Women already face a substantial gender pension gap, and many leave the workforce prematurely because of caring responsibilities or their own ill health. For women with young-onset dementia, like Karen Barber, years of lost earnings, delayed diagnosis and interrupted careers compound lifetime financial disadvantage. Preventing dementia becoming a pathway into poverty should be part of our national ambition. Women bear a double burden when it comes to dementia, as I said earlier—I repeat it. They constitute the majority of those living with dementia and the majority of those caring for people with dementia. Too often, they also constitute the majority of those overlooked by research, clinical trials and clinicians.

If this modern service framework is truly to be once in a generation, it must place women not at the margins but at its very heart when it comes to clinical trials and early diagnosis. As the noble Lord, Lord Weir, said, this is a huge opportunity to achieve that. Can my noble friend the Minister assure the Committee that sex and gender differences will be embedded throughout the modern service framework, from research funding and clinical trial design to the adoption of new diagnostics and treatments with proportionate representation of women? That includes ethnic minority women, because there are some differences in clinical trials and mandatory reporting of sex-disaggregated outcomes. If we are serious about precision medicine, which we should be, it must be precision medicine for all women.

Pharmacy Closures

Baroness Nargund Excerpts

Wednesday 1st July 2026 Lords Chamber

[Baroness Merron (Lab)]

As I have said, we keep this constantly under review, but it is the case that GPs can provide dispensing services in a number of situations. That particularly helps if people live further away from a community facility than is ideal.

[Baroness Nargund (Lab)]

My Lords, I thank my noble friend the Minister for her reassuring reply about the closure of local pharmacies. However, research published in 2025 shows that access to local pharmacies has declined almost four times faster in England’s poorest communities. What assessment have the Government made of the impact of this on health inequalities? What steps will they take to integrate pharmacy services within neighbourhood health centres?

[Baroness Merron (Lab)]

That comes into the category of underserved areas, particularly if there are fewer pharmacies. I disagree with my noble friend about the overall picture in terms of pharmacies; we are supporting them to do more work, and a bigger range of work strengthens their position. It is not necessary to live right near a pharmacy, because of provision by online pharmacies. Finally, I repeat that local authorities can also seek to open pharmacies where there are underserved areas.

IVF Treatment

Baroness Nargund Excerpts

Wednesday 1st July 2026 Lords Chamber

Asked by

[Baroness Nargund]

To ask His Majesty’s Government what assessment they have made of The Lancet article Is IVF treatment heading in the right direction?, published on 23 June, indicating that many IVF add-ons do not work; and what consideration they have given to giving regulators the power to ban them.

[Baroness Nargund (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I declare my interests as the lead author of the Lancet insight paper on IVF add-ons and as a board member of the Human Fertilisation and Embryology Authority.

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

My Lords, we are aware of the issues raised in the Lancet article regarding the effectiveness of IVF treatment add-ons. The regulator, the HFEA, provides information to patients on the effectiveness of fertility treatment add-ons through its website. In most cases, there is insufficient evidence to demonstrate that they improve treatment outcomes. The Government are considering a range of proposed reforms to fertility regulation, including the scope of regulator powers to regulate add-ons effectively.

[Baroness Nargund (Lab)]

I thank my noble friend the Minister for her reply. The concern about IVF add-ons is not only that many are unproven and ineffective but also that some can pose serious health risks to patients and unnecessary emotional and financial harm. The HFEA’s current traffic light system is guidance only and the regulator has no enforcement powers, which means that some add-ons with a red rating continue to be offered in clinical practice. Will she consider granting the HFEA interim enforcement powers for the use of red-rated IVF add-ons to protect patients from harm while the wider reforms to the fertility regulatory framework are being developed and implemented?

[Baroness Merron (Lab)]

I recognise the situation that my noble friend describes and note that, while the relevant Act has provided a strong framework for over three decades, the fact is that treatment, science and societal expectations have all evolved very significantly since the last major reform in 2008. It is the case that the Act does not currently provide powers to ban add-ons. We are constantly looking at what we can do while we await and consider legislative change, but that really is the best way forward to tackle this.