Health Bill

Debate between Baroness Pidgeon and Baroness Finlay of Llandaff

Committee stage
Monday 9th November 2026 Lords Chamber

[Baroness Pidgeon (LD)]

My Lords, the number of people diagnosed with cancer in the UK continues to grow. For the first time, the number of new cancer diagnoses each year has passed 400,000. Almost one in two of us in our lifetime will have cancer, and I am sure it has affected all of us in this Chamber.

The commitments made in the national cancer plan to improve cancer outcomes are welcome. Driving up survival rates and increasing earlier diagnosis will transform the experience of people affected by cancer. Amendment 41 in my name, to which the noble Baroness, Lady Morgan of Drefelin, and the noble Lord, Lord Patel, have added their names, focuses on outcomes. Over the past five decades, cancer survival has more than doubled due to life-saving research, earlier detection and cutting-edge treatments. But over time the rate of improvement has slowed, with the 10-year cancer survival index for all cancers rising nearly three times faster in the early 2000s compared with the early 2010s. There is, of course, a substantial variation between different cancers.

The Health and Care Act 2022 included a requirement for the Secretary of State to include cancer outcome objectives in the annual mandate set by the Secretary of State for NHS England, and that those outcome objectives explicitly took priority. The current Health Bill abolishes the mandate, including the prioritisation of cancer outcomes, and a similar duty has not been replicated elsewhere in the Bill. In publishing the national cancer plan, the Government have shown that they are committed to transforming patient outcomes. However, with the removal of the current requirement, there is a very real concern that progress on cancer outcomes risks being deprioritised amid competing priorities. I am sure that this is not the Government’s intention, and I hope the Minister will be able to reassure us today and will consider tabling a government amendment on Report to ensure cancer outcomes are on the face of the Bill.

On the other amendments in my name in this group, Amendment 217 would require the Secretary of State to introduce regulations requiring the Government to co-ordinate research into cancers with the lowest survival rates. This is a long-standing failing in our approach to some of the deadliest forms of cancer. While welcome progress has been made in treatment and outcomes for many cancers, those with the lowest survival rate, which can include cancers such as pancreatic, brain, liver and lung, continue to receive disproportionately less research focus. Greater co-ordination would help identify gaps in knowledge, avoid duplication, encourage collaboration and ensure that our scarce research resources are directed where they can have the greatest impact. If we are serious about improving outcomes and reducing cancer mortality, we must focus on where survival rates remain stubbornly low.

Amendment 228 would give patients a right under the NHS constitution to start cancer treatment within 62 days of referral. There is an inconsistency in the NHS constitution between the rights to treatment and actual waiting times. There is a right to elective care within 18 weeks, but there are other pledges for other waiting times. Cancer does not simply stop while a patient waits for their treatment. Research shows that every four weeks of delay reduces patient survival by an average of 10%. That is why I have tabled this important amendment—so that there is a focus on starting treatment and that it is reported to Parliament.

Finally, Amendment 250 from the noble Baroness, Lady Finlay, addresses the important issue of radiotherapy. This is an area which can often be overlooked in terms of cancer care, facing the longest waiting times and significant problems with access, particularly in rural areas. I understand that England has fewer radiotherapy machines than comparable European countries, and thousands of people are having to travel over 45 minutes for their treatment. With around half of all cancer patients needing radiotherapy, it is important that access to this service is improved. This is a really important group of amendments, and I look forward to the debate. I beg to move Amendment 41.

[Baroness Finlay of Llandaff (CB)]

My Lords, I have two amendments in this group, and I am grateful to the noble Baroness, Lady Pidgeon, for having referred to one of them.

My Amendments 247 and 250 would address genomics and radiotherapy, because there are fundamental weaknesses in how diagnostic genomic services and radiotherapy treatment services are planned and improved across England. In both areas, rapid advances are altering survival and avoiding toxicity from poorly planned treatments. Current international comparisons by the OECD place the UK 31st out of 43 countries for five-year lung cancer survival and 26th for colon cancer survival. Overall cancer mortality data place the UK 26th out of 36 countries. Following on from the questions from the noble Baroness, Lady Pidgeon, I ask the Minister two specific questions. First, why is the UK no longer submitting information to the OECD on cancers? Secondly, will we be renegotiating for our cancer research to become part of the EU4Health programme again?

Diagnostic delays and inadequate radiotherapy services are largely responsible for our poorer outcomes. In cancer genomics, only 3% of pathologists are always meeting the 14-day national target for lung cancer genomic testing. Pathology personnel shortages are particularly severe in genomics and genetics, causing delays, which are compounded by high sample volume workload, administrative inefficiencies, delays in sample processing, and outsourcing, as well as inadequate equipment.

Recently, almost half of healthcare professionals had to start urgent treatment before biomarkers were available. Around 1,000 cancers are diagnosed a day, but delays compromise timely treatment decisions, patient safety, access to targeted therapies and eligibility for time-sensitive clinical trials, while precious time is wasted by fragmented reporting pathways, poor IT interoperability and outdated laboratory information management systems, or LIMS.

Yet genomics is one of the major strategic transformational priorities for the NHS to improve cancer outcomes. Innovation in genomics is advancing very rapidly, and AI advances in analysing and interpreting large-scale sequencing data need digital infrastructure. Although many local pathology laboratories can deliver results within clinically useful timeframes, whole-genome sequencing at genomic laboratory hubs becomes essential for complex cases and inherited cancer syndromes. In addition, it supports research and new biomarker assay development when integrated with tissue pathology and imaging.

The NHS workforce plan, which we have already discussed, must consider training and workforce development in genomics and genetics, cellular pathology, clinical biochemistry, and molecular pathology; otherwise, a bottleneck in cancer and precision medicine pathways will continue to compromise cancer diagnosis and will eventually leave us with even worse outcomes.

Radiotherapy is crucial for cancer treatment. It is the second most widely used cancer treatment. It is needed by half of cancer patients and is key to 40% of cancer cures, and there is also palliative radiotherapy. Yet radiotherapy has the worst waiting times of the main cancer treatments, with significant inequalities in access. The latest NHS figures show that wait times for radiotherapy are far worse than for surgery or cancer drug treatments. Only 42% of patients receive their first radiotherapy treatment within 62 days. In some ICBs, this is as low as 10%, so only one in 10 patients receives their treatment on time—far away from the target of 85%.

Delays to radiotherapy are worse in the east of England, the Midlands and the north-east. Delays jeopardise survival. For some cancers, every four-week delay in treatment, as we have heard, brings a 10% increase in the risk of death. That is very serious. Government data shows that access to radiotherapy among lung cancer patients was as low as 11% in some areas. As the noble Baroness, Lady Pidgeon, said, the UK has only five radiotherapy linear accelerators per million people, compared with more than seven in France, Italy, and the Netherlands. International estimates suggest that 53% of cancer patients could benefit from radiotherapy, yet in England only 35% received it as part of their primary treatment.

Improving this requires a new approach. I, like everyone, welcome the national cancer plan, but a previous error in it highlights the need for this amendment. The cancer plan claimed that 28 replacement radiotherapy machines would enable an additional 27,500 patients to be treated annually, but the now corrected figure is for 27,500 treatments, not patients. Patients can receive dozens of treatments, so this could be a tenfold overestimate in capacity increase. It shows why radiotherapy expertise must be involved in policy, particularly horizon scanning advanced technology.

Radiotherapy services do not map neatly within ICB boundaries and operate within in the wider operational delivery networks. Most ICBs have no named lead, having only one or two radiotherapy centres in their area. So the ICBs lack the necessary specialist knowledge. Secretary of State support to ICBs would improve access to modern techniques, including stereotactic radiotherapy and proton beam therapy. The financial case is compelling.

Radiotherapy is our most cost-effective curative cancer treatment. A curative course costs around £3,000 to £7,000, and palliative treatment is a few hundred pounds. It accounts for just 7% of cancer expenditure in England, despite being second to surgery for cure rates. Radiotherapy investment makes clinical and economic sense for the treatment of cancer patients. We must improve. I suggest that these amendments are practical, complementary to the Government’s cancer plan, and essential.

Health Bill

Debate between Baroness Pidgeon and Baroness Finlay of Llandaff

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

I will be very brief in supporting that suggestion from the noble Lord, Lord Scriven. When I was listening to the debate, I was thinking about people who have told me about feeling discriminated against. They often do not declare their racial, religious or whatever view, because they are terrified of being further labelled and discriminated against. The noble Lord, Lord Shinkwin, spoke about the history of this for the Jewish people; there were lists of who was Jewish, particularly in the Netherlands, which were rapidly exploited to round them up with speed and persecute them further. That is a very deep-seated fear in a lot of these people.

The other fear is that, if they disclose that they have been discriminated against, they will be undermined in other forms that make their lives even harder. I can again think of other specific examples that have been brought to my attention. I commend this solution as a way forward.

[Baroness Pidgeon (LD)]

My Lords, this group of amendments is incredibly important. I thank the noble Baroness, Lady Gerada, for tabling most of them and for her powerful words about Jewish staff and patients, and their experiences in the data that she also presented. In different ways, all these amendments are trying to ensure that all parts of the NHS stamp out antisemitism and racism, and provide the right training on it, as recommended by the review from the noble Lord, Lord Mann.

I completely agree with the neutrality point that the noble Lord, Lord Hunt, raised about the uniform that staff wear. I recall that, several years ago, the Metropolitan Police had a huge issue with badges that officers started to wear as part of their support for charities such as Help for Heroes. That was ruled out of order, and they were not allowed to wear them. I think this is a similar thing, and there has been a sort of creep in uniforms over the years in what is acceptable or not. We need to make sure that all staff are seen to be neutral and behave neutrally.

The amendment on assessing the performance of ICBs is important in ensuring that trusts have a duty to prevent this and respond to it; it would ensure that that is integral to these organisations. The noble Lord raised a point about leadership. We on these Benches fully support the Mann review and the implementation of its recommendations, and my noble friend Lord Scriven’s practical suggestion about the NHS constitution is certainly a good idea worthy of consideration by the Minister. I hope the Government will look at how best to implement these amendments—as worded or in a different way—and I look forward to the Minister’s response.

Health Bill

Debate between Baroness Pidgeon and Baroness Finlay of Llandaff

Committee stage
Wednesday 28th October 2026 Lords Chamber

[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?

[Baroness Pidgeon (LD)]

My Lords, we welcome these Government amendments, which ensure that the devolved Administrations’ boundaries are protected and that there is proper consultation and agreement. But devolution must be integral to any legislation from the start, rather than an afterthought. Granted, there has been consultation with the devolved Governments, but these amendments were tabled very late and this is a worrying sign. It is an indication that aspects of the reorganisation and its governance implications had not been properly thought through at the start—through the lens of the devolved Administrations, rather than simply through that of Whitehall and civil servants centrally. The Minister’s words have provided some assurance, and I look forward to the devolved Administrations being at the start and the heart of legislation such as this in the future, rather than an add-on at a late stage.