Health Bill

Baroness Pidgeon Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Baroness Pidgeon (LD)]

My Lords, we have had a really good debate on this group of amendments. My Amendment 216 addresses one of the most persistent inequalities in our healthcare system: the growing number of communities that simply cannot access an NHS dentist. For too many people, finding an NHS dental appointment has become an impossible task, with entire areas effectively becoming dental deserts. Other amendments in this group are very much in the same place.

Amendment 216 would require the Secretary of State to establish a scheme specifically designed to tackle that problem, ensuring that integrated care boards can guarantee emergency access to NHS dentistry and provide free dental check-ups to children, mothers within one year of having given birth, pregnant women and low-income households. The amendment recognises the current state of access to NHS dentistry across the country, and that preventive care is better for patients and more cost-effective for the NHS than treating advanced dental disease later.

However, my amendment would go further by recognising the critical importance of dental health for patients facing serious medical treatment and guaranteeing dental appointments for those about to start chemotherapy or undergo transplant procedures. It would help ensure that necessary treatment was not delayed because of untreated dental problems and would support those patients at a time of great need.

In this debate, we have heard of how dentists are remunerated. My amendment would require the publication of a reformed dental contract before the scheme was introduced, because the current contractual arrangements have contributed significantly to the workforce shortages and access problems that we see today.

My amendment is practical and targeted at ending dental deserts, improving access to dental care and ensuring that NHS dentistry is once again available to the people who depend on it. The noble Lord, Lord Patel, and the noble Baroness, Lady Coffey, have given clear examples of the different needs of coastal and rural communities and the importance of access to transport for access to services, which too often gets forgotten in these debates.

The amendment from the noble Lord, Lord Hunt, to which I have added my name, would ensure the publication of an important, regular report on the state of NHS dentistry and a debate in Parliament, which would keep a focus on this issue. There is so much going on in the health space that this can easily get lost, which in some ways has led to the situation we are in today.

We mentioned children in our debate. More than for any other reason, children attend A&E because of tooth decay. That is extraordinary. We can talk, and we have talked, about how we are tackling the issue—we have programmes teaching children how to brush their teeth properly—but what are we doing in nurseries and other early care settings? Only 10 years or so ago, my son was in nursery. That nursery had an NHS dentist who came in every six months and did check-ups with the children, and you got a note sent home. Why are we not looking at some of that preventive work? This report would allow the wider debate that we have started today, as well as discussion of some of the other important points and links to other health issues. I hope the Minister will respond positively and pick up the issue of that regular report.

[Lord Mawson (CB)]

My Lords, I support the amendment from the noble Lord, Lord Hunt. I will share a practical experience. In Tower Hamlets, a large proportion of the residents are Bengali and eat betel nut, which produces all the symptoms and serious health impacts that the noble Lord, Lord Kakkar, has well described. I have previously mentioned the street we rebuilt following some very difficult health circumstances. We ended up building a health centre, a school, 600 homes, and now a primary school, and we joined it all up with a multidisciplinary team. When you bring the headteacher, the GP, the pharmacist and the housing practitioners together, you start to learn things about the community in which you are based, and we began to discover this serious health implication among the Bengali community.

Because we had a very good working relationship with Queen Mary University, which is up the road and which became a partner in this development, there was an opportunity to bring a dental school, with a brilliant professor of dentistry, on to the street. We could then connect it to the pharmacy, the school and the science programme—which we have been running for 14 years with Professor Brian Cox—and create a whole joined-up situation that would not only improve the dental health of people but, if we connected it properly into the school, might well produce more dentists. It would mean that, instead of the health centre being overwhelmed by these issues, the dentists could start to deal with patients and the detail of all this. My point is that, if we began to think of neighbourhood health centres not as a box but as a street and a campus, and of the connections between these things, it would begin to throw up interesting innovations and solutions to issues that arise particularly in places such as Tower Hamlets, which are very much to do with dentistry.

I have to say that this was one of our health failures, because all that was coming together; everyone was in favour of it, and the professor of dental health was brilliant, but it sadly fell because of the politics going on in the medical school. I am illustrating it because, if we create a culture on the ground in neighbourhoods and build the relationships, these kinds of innovations around these very serious issues, which deal with the very serious medical conditions that the noble Lord, Lord Kakkar, rightly described, can start to happen.

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[Baroness Finlay of Llandaff (CB)]

My Lords, I shall address Amendments 219 and 229, tabled by the noble Baroness, Lady Pidgeon. I have already had a brief discussion with her, because I would have liked to have signed Amendment 229, except for a bit of the wording. She is absolutely right that corridor care is one of the scandals of our time. In fact, it was on the news at lunchtime today, with patients being filmed in corridors still. We also still have social care problems arriving in emergency departments. These are people who really need to be looked after; they cannot just be sent out.

One thing about emergency departments is that people arrive, attend and then, after they are assessed, there is a decision about whether they are to be admitted. There is a clear line in the way that the figures are collected. That becomes important because roughly 25% of the people who attend are actually admitted. We have to be really careful that there is no gaming around these figures, which can happen by managers if targets are put in that become difficult to reach for one reason or another.

There are terribly long trolley waits at the moment. In each of the past three years, over half a million patients have been waiting on trolleys. As we touched on at Oral Questions yesterday, the flow through hospitals is a problem, with very high bed occupancies. We have far fewer beds in our NHS than the average across the EU—we have below half of that average. Also, the countries that have lower bed numbers often have other services in place. For example, in the Netherlands, the numbers of beds in hospitals are not that high but it has the discipline of nursing home medicine, with a large number of beds and staff trained to a very high level.

One problem that we face is the flow through hospitals —in, through and out of them. In simply addressing the front door, we are not addressing the problem properly, because there are a number of patients who are deemed to be medically fit for discharge but remain in hospital. That number is estimated at nearly 13,000 patients a day, which is huge. These patients are deemed to have been medically optimised but no longer need to remain in the hospital.

The design of our emergency departments does not help in relation to corridor care or other care. I had the privilege of spending some time in Groningen in the north of the Netherlands and was astounded at its emergency department, which was superbly laid out. There were two direct resus rooms from the ambulance bay, fully equipped so that they could be turned into emergency operating theatres for very major trauma, with CT scanners in them. They had moved from the open front door, which we have, to being able to move major trauma and other problems straight into much more appropriate environments than we have been providing.

I commend the Government for taking on the problem of modernisation, but I hope that we look at the whole issue of patient experience and patient flow and recognise that, unless we do something about our emergency departments, the more than 90% of staff who feel that they cannot cope in the longer term will be on their knees and we will have more problems going forward.

[Baroness Pidgeon (LD)]

My Amendment 219 addresses the deeply concerning and increasingly common practice of corridor care. No patient should be left receiving treatment, assessment or prolonged care in a corridor simply because there is nowhere else for them to go. A friend of mine only a couple of weekends ago showed me a picture of a relative in hospital, who was in a corridor. This is absolutely unacceptable. As we heard from the noble Baroness, Lady Finlay, it was on the news again today. Corridor care undermines patient dignity, compromises privacy, increases clinical risk and places additional strain on hard-working NHS staff who are trying to deliver safe care in environments that were never designed for that purpose.

We all recognise the immense pressures our hospitals are facing, from rising demand to workforce shortages and delayed discharge, but corridor care must never become normalised, as I fear it has, as an acceptable feature of our health service. Dr Ian Higginson, president of the Royal College of Emergency Medicine, has described corridor care as

“dangerous, undignified, and a source of national shame”.

Survey data published by the royal college only on 20 July shows that 61% of clinical leads in England said that their trusts did not even capture corridor care accurately, with many saying that patients who were on chairs and in waiting rooms waiting for admission were not counted towards their corridor care figure.

There is significant variation in reporting between hospitals and emergency departments. Consultants are concerned about patients who wait on chairs in waiting rooms, off-the-clock assessment units and the repurposing of space as “non-corridor” places, where they put chairs so that patients can wait and not be counted. I have even been told of somebody being sat on a chair in a cupboard because that would not count towards corridor care figures. This is also not counting patients waiting in ambulances or on corridors on the way into departments. It is simply unacceptable. This amendment would help shine a light on the true scale of the problem and support genuine efforts to ensure that patients are treated in appropriate clinical settings with the dignity, safety and respect that every person deserves when they turn up to their hospital in their time of need. We need this to lead to the end of this practice.

My Amendment 229 seeks to address another visible symptom of the pressures that our National Health Service faces: the growing difficulty in securing timely admission from accident and emergency departments into appropriate hospital beds. When patients have been assessed and a clinical decision has been made that they require admission, prolonged waits in A&E not only are frustrating but can lead to poorer outcomes, increased risk to patient safety and greater distress for patients and their families. These delays also contribute to serious overcrowding in emergency departments, making it harder for clinicians to deliver care to all those who come through their doors. While we know that the causes are complex—bed capacity, workforce shortages, which we talked about earlier, and the difficulty of discharging medically fit patients into the community and social care settings, as we heard from the noble Baroness, Lady Finlay—we should be clear that long waits for admission are just not acceptable.

This amendment would provide greater transparency and accountability and help ensure that the health system focuses on reducing delays and delivering the safe, timely and dignified care that patients have every right to receive. Putting this right in the NHS constitution would focus efforts and make sure that we address this serious issue. We do not want patients avoiding A&E because they fear endless hours of waiting. We know that is happening; we hear about it. Sorting out admissions and ending corridor care would transform the patient experience and, most importantly, patient outcomes.

The amendment tabled by the noble Lord, Lord Patel of Bradford, on prohibiting minimum waiting times is important. We discussed this in a group only last week. We need to see waiting times minimised and patients receive the diagnostics and treatment that they need in a timely manner—one that is led clinically rather than by budget rationing, which we see too often today. The amendment from the noble Baroness, Lady Coffey, talks about ambulance services. I commend the recent work by the Public Services Committee, which looked at the response and reaction between ambulance services and emergency departments, but it only scratched the surface of that issue. A lot more could be done with that workforce and those teams to ensure that patients get to the right door for further clinical care. I look forward to the Minister’s response to this important group, as this is really on the minds of the public today.

[Earl Howe (Con)]

My Lords, I shall speak only briefly on this group of amendments, not because I am in any way lukewarm about their content—quite the opposite—but for the practical reason that, as a Committee, we are being urged to make faster progress, bearing in mind the number of debating hours allocated to us. Let me say how impressed I was by the speeches from the noble Baroness, Lady Finlay of Llandaff, and the noble Lord, Lord Patel of Bradford. I hope the Minister will take their very powerful points back to officials in the department. I also agree fully with all that the noble Baroness, Lady Pidgeon, said about the unacceptability of corridor care.

I will make a couple of points on my noble friend Lady Coffey’s amendment on equitably available ambulance services. This is a tremendously important issue. As she will remember, I had to grapple with it as a Health Minister, not least as regards services in her then constituency. It is sadly the case that the category 1 response target of seven minutes has not been met nationally since April 2021. The Government have made big investments in emergency response services since coming to office; that is excellent, but since July 2024 the dial on category 1 and category 2 response times has not moved appreciably, if at all. That is not meant as a criticism but simply as another indication of how difficult a challenge this is.

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[Baroness Merron (Lab)]

My Lords, I am most grateful to noble Lords for their contributions. Indeed, we all share a determination to ensure that patients receive safe, timely care in the right place. I am grateful to the noble Earl, Lord Howe, for his brevity; I will also seek to focus on amendments, and I hope noble Lords will appreciate that the reason for that is so we can deal with the content of the Bill.

Amendment 50 in the name of the noble Baroness, Lady Coffey, raises the important issue of rural access to ambulance services. I confirm that ICBs already have a statutory duty to meet the needs of their local population and to have regard to the need to reduce health inequalities, with respect to both ability to access health services and outcomes. I can assure your Lordships’ Committee that the funding that ICBs receive for commissioning ambulance services is based on factors such as age and deprivation and is adjusted to reduce health inequalities. To the point on rural areas, this includes adjustments for longer emergency ambulance journeys. We have heard some statistics, but I confirm that the category 2 mean ambulance response time is, as of July of this year, three minutes and 35 seconds faster than in July 2024. That is not the end of the story; I am simply indicating progress that is being made. I recognise, as always, the challenge of the situation that we are dealing with.

On Amendment 229, tabled by the noble Baroness, Lady Pidgeon, I certainly share her determination to reduce long waits in A&E. Trusts are already expected year on year to improve four-hour performance and to reduce waits of 12 hours or more from arrival. There is no complacency about what we have to do to improve performance, which is why the Secretary of State recently announced £140 million of investment in urgent and emergency care schemes across England, including urgent treatment centres, same-day emergency care, emergency department upgrades and additional ambulance capacity.

We are also taking action across the urgent and emergency care pathway to reduce excessive waits and to improve patient safety and flow through hospitals, which the noble Baroness, Lady Finlay, spoke to. I assure your Lordships’ Committee that this will continue following the abolition of NHS England. It is our view that a legal time limit in itself would not address the underlying pressures on capacity and patient flow that contribute to long waits, and establishing a new statutory scheme would risk distracting from the crucial work that is already under way.

On Amendment 219, also tabled by the noble Baroness, Lady Pidgeon, I could not agree more that corridor care must not—not even should not, but must not—be normalised. I am reiterating some of the points that I made in a recent Oral Question, which I believe was from the noble Baroness, on this very important point. Our priority is sustained action to address the causes by improving patient flow and discharge, expanding urgent care capacity and supporting the most challenged hospitals. We have introduced a consistent national definition and reporting arrangements, and we have improved transparency and enabled support to be focused where it is most needed.

The Secretary of State has also asked NHS England to bring forward urgent plans aimed at eliminating corridor care for children. I can say that one in six trusts consistently reported no corridor care across their emergency departments or the wider hospital over the summer. I particularly make the point about the summer because of the extreme pressure due to the weather—not something we usually say, but we are increasingly seeing it. The pressures were immense, and that was their report to us.

The noble Baroness, Lady Finlay, made the strongest case for exactly what we are doing with the neighbourhood health service, which is about moving the focus from hospital to community. I spoke earlier this week in the Chamber about the movement of savings accruing from timely discharge that can be directed to neighbourhood health. We are trialling that, because it is a very clear and practical way to make the move that the noble Baroness rightly identifies.

[Baroness Pidgeon (LD)]

My Lords, may I tease something out that the Minister was saying about corridor care? She quickly moved on to another thing, and I wanted to come back in.

Yes, this is similar to a discussion we had only last week or the week before in answer to a Question I had tabled, but two-thirds of medics working in emergency departments are saying that their trusts are not accurately reporting the data on corridor care. The Minister keeps saying that we have this new definition or whatever; it was decades ago that I worked in the NHS, but we had a way to make sure that people were not counted as being on a trolley: you took the wheels off and it became a bed. Trusts are very creative at finding ways around to meet their definitions. If two-thirds of those surveyed by the Royal College of Emergency Medicine are reporting that their trusts are not accurately calculating this, what are the Government doing to try to get under the data, to make sure that the Minister and the department are getting accurate data to be able to deal with this serious problem?

[Baroness Merron (Lab)]

I feel quite sure that the noble Baroness herself never did such a thing.

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[Baroness Pidgeon (LD)]

No, obviously not, but trusts do that.

[Baroness Merron (Lab)]

I take very seriously the point that the noble Baroness made. I am sure it is already being looked into, but I will personally make sure that that is the case.

On corridor care and children, one example of the practical action taken is our recent announcement that the NHS is rolling out a standardised system to spot when a child’s health is deteriorating, so that early warning signs are caught earlier and there is faster action. The paediatric early warning system will be introduced in all emergency departments by the end of 2027-28, with an ambition to also roll this out in ambulance and community settings in the future. This is broader than just corridor care, but I know that that is a particular concern, as I said, when it comes to children. I cannot confirm often enough that we remain committed to fully eliminating corridor care before the end of this Parliament.

Finally, on Amendment 72, in the name of the noble Lord, Lord Patel of Bradford, I can give the reassurance that there is no national policy supporting blanket minimum waits. Indeed, patient safety always comes first. If a commissioner puts capacity measures in place, urgent referrals must be excluded, minimum waits must not be set above 18 weeks and providers must continue to triage patients according to clinical priority.

At the start of the year, it is important and expected that commissioners plan to balance service delivery with their yearly budgets while prioritising patient safety and clinical need. I remind your Lordships’ House that it is due to our approach to financial planning that the NHS stayed in line with its budget in 2025-26 while also cutting waiting lists by over 250,000 between July 2024 and August 2026. Removing the use of tools to support planning could drive unplanned activity and overspending, which would of course undesirably divert resources from other patients.

On the points made by the noble Lord, Lord Patel, about autism and ADHD assessment, expectations have already been set out for ICBs and providers to reduce those long waits and to improve experience, quality and productivity in ADHD services over the next three years. We are moving to a needs-led support model that means earlier access to information and support and appropriate interventions that are individually based, without and before a diagnosis.

On the question about ICBs imposing minimum waits and whether we will publish which ICBs are doing this, there are no plans to publish this information. The data is held locally and that is right, because these are decisions for local areas. To restate what I said before, commissioning decisions are for ICBs to make.

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[Baroness Pidgeon (LD)]

My Lords, I am grateful to the noble Baronesses, Lady Hayman and Lady Boycott, and all noble Lords who have put their names to these amendments, including my noble friend Lady Sheehan.

The central question is straightforward: as the Bill proposes changes to the organisation of the health service, how do we ensure that its responsibilities for climate change, environmental protection and—from all that—patient safety are strengthened rather than simply diminished and reduced?

We absolutely support Amendment 52. As the noble Baroness, Lady Hayman, has clearly set out, in 2022 the House established climate and environmental duties for NHS England integrated care boards and trusts but not for the Secretary of State. As functions move into the department, responsibilities for this must not disappear. The amendment is modest; it talks about “have regard” to the duty. It would not prevent the Minister balancing competing priorities but would make sure climate change was absolutely on the agenda.

Can the Minister explain who will report progress to Parliament once NHS England’s annual reporting responsibilities are lost? How will Parliament be able to scrutinise this in future? Just because there is an organisational change—and we see that a lot in the NHS—it should not then lead to a huge accountability gap and a potential reduction in work in this area.

We also support Amendment 248 and its requirement for each NHS trust and foundation trust to publish an assessment of climate risks to its premises, workforce and services, together with plans to address them. This is a practical and proportionate requirement; we should not wait until wards are overheating or hospitals flood before asking whether there was a plan and doing something about it. Adaptation is about patient safety, as we have heard, and, given the extreme weather that we are now living through, it is essential. It is about resilience, as the noble Lord, Lord Crisp, said.

The final point made by the noble Lord, Lord Hunt, was important: this is about investing to save in terms of tackling sustainability issues. That is spot on. Years ago, there was an “invest to save” fund. We need to look at that if we are going to be able to make savings in the future to invest in the capital works that are needed. I hope the Minister will be able to respond positively to this group.

[Earl Howe (Con)]

My Lords, again, if the Committee will forgive me, I will speak only briefly. I start by expressing my support for the remarks made by the noble Baroness, Lady Hayman, in speaking to her Amendment 52. It seems impossible to argue that the Secretary of State for Health and Social Care should be exempt from a duty to be mindful of the climate change agenda in everything they do, especially as we remember that the Secretary of State for Health and Social Care presides over an organisation with a very large carbon footprint. It was very much with that in view that Section 9 of the Health and Care Act 2022 included duties on NHS England to have regard, in the exercise of its functions, to the Climate Change Act 2008. Therefore, the noble Baroness was entirely right that the duties that apply currently to NHS England in this area should now logically apply to the Secretary of State.

Having said that, I would be surprised if the Minister did not respond by saying that the first part of Amendment 52 is unnecessary, for the very dull reason that Section 15 of the Climate Change Act 2008 already places a duty on “the Secretary of State”, in exercising his or her functions, to have regard to

“the need for UK domestic action on climate change”;

the section spells out what that means in practice. It has long been drummed into me that an Act of Parliament conferring duties on “the Secretary of State” should be read in law as applying to any Secretary of State. That is a very legalistic point, and I do not think that it constitutes a sufficient reason for the Minister to resist this amendment, for all the reasons set out so well by the noble Lord, Lord Crisp.

Personally, I feel the need for something declaratory and specific in this area. The duty to issue detailed guidance seems a very definite omission from the Bill. As we heard the Minister say in response to the previous group of amendments, climate change is becoming a highly relevant factor for ICBs and trusts in the planning of service delivery. As the noble Baroness, Lady Boycott, was right to emphasise, it is equally relevant in the public health context and to the design of buildings, including hospitals. With all that in mind, I hope that the Minister will feel able to give the noble Baroness’s amendment a positive response.