Health Bill

Debate between Baroness Pidgeon and Earl Howe

Committee stage
Monday 9th November 2026 Lords Chamber

[Baroness Pidgeon (LD)]

My Lords, getting primary care right is absolutely crucial for our health service to work for patients and to ensure that neighbourhood health really delivers. Amendment 61 in my name would ensure that access to NHS sight tests remains nationally protected and is not subject to local variation once integrated care boards take on the commissioning of primary ophthalmic services. The national sight testing service remains the foundation of eyecare across the country and is one of the most effective public health services in the NHS. Primary eyecare in England provides more than 23.6 million appointments every year, covering sight tests, enhanced eyecare services and contact lens care.

Protecting vision means supporting people’s independence and safety, including from falls and accidents, and enables people to live well and work well. It is important, as raised by my noble friend Lord Scriven, for the needs of people with a learning disability. The national contract model is the most cost-efficient way of commissioning the service for the NHS. This is because the funding offered by the NHS, as we have already heard, does not come close to covering the cost of an eye test, and it is feared that any fragmentation of the commissioning route will only add more bureaucratic costs. This is a probing amendment, and I would be grateful if the Minister could confirm whether the national NHS sight testing service provided through this cost-effective national contract model will remain in place under the Bill. I also fully support Amendment 61A from the noble Baroness, Lady Gerada, on access to community-based, urgent and minor eyecare.

Amendment 218 in this group would give patients a new right in the NHS constitution to receive a GP appointment. Patients should be able to access primary care when they need it, and too many people across the country are forced to wait weeks for a GP appointment, only to see their condition deteriorate, which does ultimately place greater pressure on emergency departments and hospital services.

That is why these Benches are proposing a new right in the NHS constitution for patients to receive a GP appointment within seven days or within 24 hours if their need is urgent. This is not merely a target but a commitment to restore confidence in GP services and to ensure that timely access to primary care is recognised as a fundamental patient right.

General practice remains the front door to the NHS. Ensuring prompt access to a GP can lead to earlier diagnosis, more effective treatment and better management of long-term conditions, as we heard from the noble Baroness, Lady Gerada. Ultimately, it can reduce demand on overstretched hospitals. The amendment on continuity of care from the noble Baroness, Lady Neville-Rolfe, and supported by the noble Baroness, Lady Gerada, is really important to consider as part of the Bill.

My noble friend Lady Janke’s amendments on ensuring that community pharmacies are supported is important. Her challenge on the cost of medicines and how pharmacists are reimbursed is an important issue that was raised when the Public Services Committee looked at medicines security. I was quite astonished that pharmacies often provide medication at a loss; it is no wonder so many are going under. This group is really important, so I hope the Minister can assure the Committee.

[Earl Howe (Con)]

My Lords, this has been an illuminating discussion that has elicited some valuable contributions from across the Committee. I do not intend to add much to what other noble Lords have already argued so well, but I will underline how much I agree with my noble friend Lady Neville-Rolfe on all that she said about continuity of care. Continuity of care is something on which patients place enormous value, whether in primary care, in community settings or in hospital. My noble friend’s amendment rightly prompted a wider discussion about how we can strengthen those relationships across the health service.

At a time when many patients feel that their care is fragmented and impersonal, it is worth our looking closely at how the NHS can better support relationships between patients and the professionals who care for them. Continuity of care is not simply about patient satisfaction; as has been said, it undoubtedly contributes to better outcomes, often through earlier intervention and a more personalised experience of healthcare.

I have no doubt that the single patient record, when it is eventually rolled out, will be of huge benefit to the efforts of primary and secondary care clinicians to deliver seamless care to patients. However, the noble Baroness, Lady Gerada, was quite right: seamlessness of care is not the same as continuity of care. I agree with her and with my noble friend that, in this context, the more immediate focus for the NHS is that of primary care. More than 90% of patients’ direct experience of the health service is through primary care and, at the moment, many patients experience an NHS under increasing pressure.

The number of trained GPs has gone up over the last decade but, as we noted in an earlier debate, the number of full-time equivalent GPs has fallen. At the same time, despite GP practices employing more nurses, pharmacists and other healthcare professionals, the rise in patient demand has been unrelenting, especially in areas of the country that could fairly be described as underdoctored. These pressures make continuity of care particularly difficult to achieve within general practice. That is not to say that some GP practices do not still achieve it, but the demand curve does not look likely to flatten in the short or even medium term.

Health Bill

Debate between Baroness Pidgeon and Earl Howe

Committee stage
Wednesday 28th October 2026 Lords Chamber

[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.

[Earl Howe (Con)]

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

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

Health Bill

Debate between Baroness Pidgeon and Earl Howe

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Pidgeon (LD)]

My Lords, these amendments tabled by my noble friend Lord Rennard raise some important points and are intended to safeguard national diabetes services following the planned abolition of NHS England, and to ensure that patients do not lose access to proven programmes during that transition.

This is a point that has come to me time and again from different charities representing different disease groups. They are concerned that the specialism and some of the services that are commissioned will be lost. I am sure we will discuss this again on other Committee days.

As we have heard, diabetes is one of the greatest health challenges facing us all. According to Diabetes UK, over 12 million people in the UK are living with diabetes or prediabetes, and it costs the NHS around £10.7 billion every year. That expenditure is linked to complications that can often be prevented through early intervention, effective treatment and consistent monitoring, as well as routine diabetes care.

The amendments would therefore require the Secretary of State to maintain, at a minimum, the current provision of key national programmes. As we have heard, these include the NHS type 2 diabetes prevention programme, the diabetes path to remission programme, continuous glucose monitoring, the rollout of hybrid closed-loop technology and the national diabetes audit programme. I flag that the type 2 diabetes prevention programme is recognised as a world-leading prevention intervention. We do not want to see that lost with this reorganisation.

The amendments would also strengthen transparency and accountability. Before any transfer of functions, the Secretary of State would be required to set out how continuity of these services would be guaranteed. Annual reports to Parliament would then provide clear information on patient access, waiting times and outcomes, while separate assessments over the first four years following the abolition would monitor the impact on funding, workforce capacity or clinical audits, and access to technologies.

At a time when diabetes continues to rise and the impact felt both by individuals and financially throughout the NHS is so significant, it is essential we have confidence that these vital national programmes will not only survive the organisational change but continue to improve outcomes for people living with diabetes. I look forward to hearing the Minister’s response.

[Earl Howe (Con)]

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

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

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

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