King’s Speech

Baroness Tyler of Enfield Excerpts

Wednesday 20th May 2026 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, my remarks today focus mainly on health and its poor relation, social care, which had no mention in the gracious Speech. I will also comment briefly on some defence and national security issues, which will be centre stage tomorrow.

As we have heard, the modernisation Bill will abolish NHS England, make changes to the duties of integrated care boards and create the framework for a single patient record. In essence, it will pull many of the functions back into Whitehall, including transferring some powers directly to the Secretary of State. While recognising the improvements that the Minister set out when opening the debate, I have to admit to some disappointment at what feels like a largely technocratic Bill, focusing on structural and digital reform and accountability arrangements rather than on improving patient care and outcomes.

With the exception of data integration, there is very little focus on improving social care or mental health provision, which are both badly needed. As we said throughout debate on the Mental Health Bill, we need to see major investment in preventive and community services if the three big shifts in the 10-year plan are to be realised. The absence of social care from the legislative programme, referred to by so many speakers, reinforces my view that the Government give this low priority and fail to recognise the need for a fully joined-up health and social care reform programme. We cannot just wait for the Casey commission’s final recommendations; we need action now.

We also urgently need a new mental health strategy with a strong focus on community services and early intervention. The Government have recently issued a call for evidence, which I welcome; indeed, they are more than welcome to borrow from the wealth of ideas and evidence in the Liberal Democrats’ recent policy paper, Whole-Person Mental Health. This includes a new offer for young people, protecting by law the share of the NHS budget spent on mental health and the introduction of mental health check-ups for adults going through major life events.

While I welcome in principle, as so many others have today, the move to join up health and social care records to avoid the frustration of patients in having to keep repeating their medical history, many questions remain about how this is to be done and how privacy concerns will be addressed and trust built with patients. The proposed abolition of Healthwatch is a matter of huge concern to me and one that I shall be following very closely. In short, any successor arrangements must have a strong independent element to ensure that an authentic patient voice is heard.

Where Healthwatch worked well, it also provided unsolicited feedback on matters of real concern to patients and helped bridge the gap where trust between local communities and the healthcare system is fractured. The current proposals for ICBs and local authorities to take over the local responsibilities of Healthwatch feel unworkable to me. Can the Minister please explain how that will deal with the much-needed co-ordination between health and social care? In my book, it will simply exacerbate the divide. I am also concerned that the very large footprint of ICBs will make them disconnected from local communities.

As I said, at the heart of the Bill lies the abolition of NHS England. But I sense a real disconnect between a narrative saying, “You can’t run the NHS from Whitehall and need to devolve decision-making”, which I agree with, and simultaneously bringing more powers back to the centre and the Secretary of State. Two quick examples of this are the proposed new cap on NHS foundation trust spending limits and the need for appointments of all chairs and non-executive directors of these trusts to have Secretary of State approval. The rhetoric and the reality of this Bill do not add up.

On health inequalities, I am sure we are all deeply concerned by the widening and deepening inequalities in healthy life expectancy between the most affluent and deprived areas. It is scandalous that there are now, broadly, 20 years separating these two extremes. Yes, the Bill contains a duty on the Secretary of State to reduce disparities in health, but where is the programme of action to tackle the wider social determinants of health inequality and improve the nation’s health? The Bill should be seen as an opportunity to do just that and improve support for unpaid carers.

Finally, a healthy population is essential if we are to protect our shores effectively, strengthen our national security against the growing number and severity of threats that we face and increase our national resilience. This was all set out very cogently in the recent report by the Joint Committee on the National Security Strategy, on which I serve. Given the rising global tensions and rapidly changing geopolitics, we urgently need to see the Government’s long-overdue defence investment plan and far more detail on the target to spend 1.5% of GDP on security and resilience. I hope that relevant Ministers will respond to both these points in tomorrow’s debate.