King’s Speech

Baroness Thornton Excerpts

Wednesday 20th May 2026 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I am, as ever, honoured to be speaking in the debate on the gracious Speech today and I want to address two issues which I think are related: social care and the procurement of people-focused services. They are both central to the delivery of the NHS 10-year plan and the future of social care. I need to declare some interests: I am honoured to be the chair elect of SCIE—the Social Care Institute for Excellence; I am a patron of Social Enterprise UK; and a senior associate of E3M, working with the leadership of social businesses currently delivering public services.

I think we must all welcome the commitment of the proposed NHS modernisation Bill to ensure that the voices of people using care and support directly inform the services they receive. We need patients and those who have lived experience to be the voices in the design and delivery of neighbourhood health and the national care service. My first question to my noble friend the Minister is: how will the Government ensure that people’s lived experience shapes service design, improvement and accountability? Importantly, if they do that, how will they do it if Healthwatch is abolished? Although Healthwatch is not the only means of capturing lived experience—SCIE, among others, is expert at this—surely the abolition of an independent, separate body to gather and report patient, carer and care user experience, however uncomfortable that may be from time to time, smacks of the NHS marking its own homework. I think I am reflecting the concerns of many organisations, and we can predict this as a matter for some discussion when we reach that part of the legislation.

My second question concerns the importance of social care as an equal partner in the health and social care infrastructure. Given the moving feast of NHS reorganisation, the Casey review and local government reorganisation, this is important. Can my noble friend the Minister explain—I am happy if this is in a letter—how the Government will ensure that social care is treated equally within NHS reform and, before the Casey commission’s report, how they will ensure action to strengthen social care’s role in prevention, independence and community support? How will it otherwise be possible to deliver neighbourhood health?

The commissioning of community services to support vulnerable people should surely be vastly different from buying marketised goods and commercial services. I thank E3M, Stone King and, particularly, Sandra Hamilton for their research and thinking about this. Today, 80% of social services contracts are delivered by private for-profit actors and 50% of the children’s residential system is dominated by six private equity actors, with profits in excess of £45,000 per child per annum. This cannot be a good use of taxpayers’ money. The key words in people-focused procurement should surely be collaboration, not competition, on an open-book basis with predetermined reasonable profit margins. There is no reason why any purpose-aligned private company cannot do this too, as much as a social enterprise or a charity.

My question to the Government is: while some are working to maximise the significant yet little-used flexibilities available under the light-touch regime, how will the commissioning regime change? There is a need for a new and distinct regulatory regime for people-focused services, since 75% of local authority budgets are spent on those services, using market purchasing processes that are not fit for purpose. Caring for our most vulnerable citizens is not a market opportunity to exploit; it is a statutory public service system desperately in need of some long-term stewardship.