Neighbourhood Health and Social Care

Baroness Watkins of Tavistock Excerpts

Tuesday 15th September 2026 Lords Chamber

[Baroness Merron (Lab)]

My noble friend is right to identify that, if we are going to deliver neighbourhood healthcare and make improvements in social care, we have to join up the NHS and local government. That is key to our whole approach to neighbourhood health. That is why health and well-being boards, which are responsible for drawing up the local plans for what the locality needs, will bring together and have on them local authority representation and voice, along with the NHS and others. We will manage this only by doing so, because, in order to reduce health inequalities and deliver locally, it cannot just sit with one. I am grateful to local government for what it is doing.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Minister explain how health and social care will be planned to ensure intergenerational input, in particular from young carers and young people, who often have very good innovative ideas about how to provide such services?

NHS: Agency Medical Staff

Baroness Watkins of Tavistock Excerpts

Wednesday 9th September 2026 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord has welcomed our emphasis on the continuity of care. It is the best form of healthcare that we can offer. The only way to do that properly is through an established NHS workforce. The reality is, as noble Lords will be very aware, that there are times that we need to use some type of temporary cover in order to secure patient safety. The main thing is that we are committed—and it will be delivered through the workforce plan—to a more settled workforce and a workforce that can properly provide the care that we need. We are not yet in that place, but the steps that we are taking will get us there.

[Baroness Watkins of Tavistock (CB)]

My Lords, the Minister quite rightly said that retention is one of the most important things, both for our own staff and the advantage to patients. Yesterday, the Health APPG heard evidence from senior staff in Georgia, USA, who explained that by starting to pay off student loans between three and five years of continuing service, they had managed to retain and get a much more stable workforce. When will the department look at the cost-benefit analysis of such an approach?

[Baroness Merron (Lab)]

The noble Baroness has not asked me to make a commitment, and I am glad that she did not, because I could not give that commitment at this stage. However, in addition to the action that we are taking, which I referred to earlier in this Question, we are looking broadly at how we can retain people. The cost to individuals is a key matter. The noble Baroness will be aware of the constraints upon us. It is a matter of seeing what else we can do. We are undertaking targeted retention work, not least to understand why staff have left. There are a variety of reasons: some obvious and some less obvious. They all need to be tackled, and we are taking a multifaceted approach.

Integrated Care Boards: Access to Services

Baroness Watkins of Tavistock Excerpts

Tuesday 8th September 2026 Lords Chamber

[Baroness Merron (Lab)]

The patient’s voice is absolutely key, and that is why the Health Bill, which is currently in the Commons and will be introduced in your Lordships’ House tomorrow, is very focused on that. There will be much discussion in here. I can assure the noble Lord that patient safety, patient voice and patient experience are absolutely key, and that will be the case as we move forward to develop and further improve the NHS.

[Baroness Watkins of Tavistock (CB)]

My Lords, there is increasing evidence that access to senior nursing staff in care homes and in the community keeps people out of A&E and therefore reduces many of the problems there. What responsibility will ICBs have to ensure that they purchase district nursing and community mental health training so that we have sufficient district nurses and admiral nurses to support the elderly population?

[Baroness Merron (Lab)]

Getting the right staffing mix is key, and the noble Lord, Lord Kamall, just spoke about what was described as a hierarchy. I am more interested, as I know noble Lords here are, in the team. The noble Baroness raised a very correct point about the role of nursing staff. These are decisions to be made locally. However, the requirement is on ICBs, and they will be measured—as will be contained in the national guidance—on getting the right staffing mix and the right people in place to meet the move to community health services and reduce unnecessary attendance and bed occupancy within hospitals.

National Maternity and Neonatal Investigation

Baroness Watkins of Tavistock Excerpts

Monday 6th July 2026 Lords Chamber

[Baroness Merron (Lab)]

My noble friend allows me to say how grateful we are to the Royal College of Obstetricians and Gynaecologists for its continuing work, as we are grateful to our many partners who are committed to driving through change. We are working particularly closely with RCOG in developing routes forward. I agree with the points that my noble friend made. Most NHS maternity staff—and other staff, but we are talking about maternity staff—are providing exceptional care. It must be very difficult for them to hear about and read these findings. Our job is to support them with the right culture and leadership, and to equip them and support them to listen and learn. It is important that we have the right skills mix among consultants, to whom my noble friend refers, and retain them, because they are absolutely key. We will continue to work with RCOG accordingly.

[Baroness Watkins of Tavistock (CB)]

My Lords, like others I recognise the kindness and compassion that the majority of staff in our health service deliver, but as the Secretary of State for Health and Social Care rightly said:

“We must break the cycle of recommendations sitting on a shelf gathering dust”.


The Minister has already made it clear that the reviews currently planned will continue. I wondered whether they might be postponed or cancelled, but, as they are not going to be, will we ensure that we stop looking further and actually implement what is necessary now, in particular more senior midwives on duty at night? As well as employing more midwives, can we look, through the NHS workforce plan, at putting both general nurses and mental health nurses on fast-track midwifery courses so that we have experts in other areas working in midwifery?

[Baroness Merron (Lab)]

I know that the noble Baroness, Lady Amos, made the kind of comments to which the noble Baroness refers. The National Maternity and Neonatal Taskforce will certainly look at all these areas and, as I mentioned, those reviews will continue. I emphasise that we have to bring this cycle to a close. That is exactly why the former Secretary of State commissioned the noble Baroness, Lady Amos, so that we would bring together a coherent, fully informed list of national recommendations. That is indeed what we have, and we have already actioned a number of them. To the points that the noble Baroness made, that work will continue and will not be held up.

Cancer Outcomes in the UK

Baroness Watkins of Tavistock Excerpts

Tuesday 21st April 2026 Grand Committee

[Baroness Watkins of Tavistock (CB)]

My Lords, I congratulate my noble friend Lord Patel on securing this important debate, to which it is a pleasure to contribute. I declare my interest as a fellow of the Royal College of Nursing, and I am delighted that I will be followed by a previous president of the same organisation—making at least three in the Room. I intend to cover elements of the themes identified in the plan on community services, the value of screening, the workforce necessary to deliver for patients and the worried well, and an emphasis on psychological support, as well as the protection of patient data and the control of its use for UK-led research and prevention of cancer.

I join others in welcoming the ambitious plan, which will require cultural change across the workforce to improve the communication between assessment, diagnostic and treatment teams, as well as the use of AI and digital information. The aim is to provide seamless delivery of care closer to patients’ homes. This, of course, should be cost effective. The plan has been described as a revolution, and it is vital that the strategy for implementation and delivery is clearly led and monitored to ensure that the change actually happens. With the emphasis on community-based care, the current workforce will, in many instances, need the opportunity to refresh and enhance its skills and knowledge for delivering care outside acute hospital settings. As many people know, I help lead some of that, closing a large mental hospital into community care. The challenge may be similar to achieve this plan—not that I am suggesting we can shut the Royal Marsden.

Clinical staff often work alone in the community, which can be challenging for staff who spent most of their careers with easy access to other multi-professional team members for support and guidance, particularly when a patient’s condition suddenly rapidly deteriorates. Staff must be confident and skilled to provide care in the community, which will call for professional development and dedicated preparation time. The King’s Fund argued that a persistent shortage of radiologists, pathologists and severely overstretched nursing teams often results in haphazard organisation and innovation, rather than planned organisational change. The cancer plan highlights some excellent examples of innovation from the Humber and North Yorkshire Cancer Alliance pilot, using nursing and pharmacy teams to introduce home-based delivery of some subcutaneous chemotherapy drugs. The Christie supportive oncology services demonstrate the value of integrated care provision, from psychology support to dietary advice and symptom management.

The issue at hand is how such innovation can be rapidly and efficiently scaled up nationwide. One patient using the Christie service said:

“The cancer treatment helped, but it was the wider support that”


the service

“gave and continue to give that had the most impact on my quality of life … The team saw me as a whole person, not just as someone with cancer”.

Yet age-standardised premature cancer mortality is twice as high in some areas of the UK than in the best performing ones. The plan acknowledges the need to increase investment in research and open clinical trials more widely, so that patients who want to do so can have the opportunity to participate. Patients from deprived areas, particularly in rural and coastal parts of the country, such as where I live, are less likely to be offered the opportunity to be in trials, as are those from Black, Asian and other ethnic minority groups, who remain underrepresented.

With NHS digital systems advancing and patients’ individual records stored in their NHS app, protecting personal data is crucial. Data should be used only for British research to drive new knowledge and enhance care. The future workforce plan aims to equip managers and clinical and support staff for effective delivery. Staff need dedicated time for training and research, particularly in fields such as nursing. This protected time would support professional growth, boost morale and help retain staff.

Action 23 states that

“every patient will have a clinical nurse specialist or other named lead to support them through diagnosis and treatment”.

As such, clinical nurse specialists will need to be more central in workforce models and must be adequately trained in psychological support for patients with long-term physical and mental health care needs, because people now live with cancer for long periods. Many people who live with cancer fear recurrence, so it is important to focus on living happily and productively for the best quality of their lives, including working, where it is feasible to do so, as the plan states.

The NHS is, rightly, free at the point of delivery for screening, diagnosis and treatment, yet there is little mention in the plan of the need to consider withdrawing some screening programmes at a certain age—for example, for breast cancer over the age of 70—because the cost benefit, many would argue, is unjustifiable. A small cohort would of course benefit, so the NHS allows an opt-in mechanism. However, that has the potential to increase health inequalities, with the worried well requesting the service, which the private and contributory healthcare systems of many other countries would not pay for as a benefit.

Withdrawal of treatment is always a difficult issue and requires delicate conversations between the patient, their family and significant others and the clinical team involved. Such withdrawal must be decided on sound guidance based on relevant research knowledge. British universities are central to cancer research, but there is very little information about their role in this plan.

It is estimated that nearly 40% of cancers are preventable by reducing tobacco and alcohol use, increasing exercise, improving diet and lowering obesity. The Government must be congratulated on the Tobacco and Vapes Bill but, as the noble Lord, Lord Patel, said, the plan makes no reference to the fact that a minimum unit price for alcohol could make inroads too.

Will the Government consider mandating protected time for continued professional development for clinical healthcare staff to support their adoption of the new technologies, the faster treatments and the vision of this plan? Can the Minister say whether screening programmes will be reviewed to ensure cost-effective investment for specific cohorts, and whether appointing a named national lead for screening innovation should be considered? In addition, can she confirm that the use of patients’ clinical records for research will be led by British universities, in partnership with the NHS, using clinical trials that recruit from the whole country, and that they will not be sold for commercial use?

Terminally Ill Adults (End of Life) Bill

Baroness Watkins of Tavistock Excerpts

Committee stage
Friday 20th March 2026 Lords Chamber

[Lord Wolfson of Tredegar (Con)]

My Lords, we have focused in this debate on the role of the independent advocate, but of course many of the underlying concerns arise with regard to protections for various vulnerable groups and people in situations that expose them to coercion or abuse. It is clear that the text of the Bill as drafted does not specifically address protections for groups such as those with Down syndrome or those subject to coercion.

In fairness to the noble and learned Lord, Lord Falconer of Thoroton, he could reasonably argue that the drafting of the Bill should be wide enough to encompass all of these groups on a generic basis without specifically referencing them. If the Bill is drafted with too much specificity, almost certainly somebody will be left out and we would have to come back at a later stage. That is presumably why the noble and learned Lord has introduced his regulation-making power in Amendment 549A, which I will come back to in a moment.

That said, I would suggest that it is not enough just to say that the drafting of the Bill is broad and that, therefore, we cannot debate its impact on specific vulnerable groups. I would be interested if the Minister could take time in her response to set out how the Government have taken into account the specific needs of the groups mentioned in the various amendments. That seems to me to be part of the work to deal with the practicalities of implementing the Bill.

How, for example, in practice does a person with Down syndrome who might have both speech and hearing difficulties communicate that they wish to die? How will medical practitioners and independent advocates assess that that person has come to an informed choice that they wish to die? Assessing the true wishes of people in that situation can be exceptionally challenging, and many such people rely on loved ones or carers to interact between themselves and medical professionals. How, therefore, do these family members or carers fit into the architecture of the Bill? How do they fit in, for example, with the independent advocate? What is the relationship between family members, carers and the independent advocate within the system of the Bill? Those are general questions which I hope the Minister will be able to respond to.

There is one specific point I ask the noble and learned Lord to consider which arises from his Amendment 549A, which would introduce a new clause after Clause 22. This point was prompted by a comment made by the noble Baroness, Lady O’Loan. If one looks at subsection (2)(b), the regulations must

“require a specified person to instruct an independent advocate to represent and support a person”

if the section applies. In subsection (2)(b)(ii), it says that it applies if

“the person has not indicated that they do not want an independent advocate”.

I was just comparing that to Clause 20 of the substantive Bill, which deals with the situation of when a person who has made either a first or second declaration wants to cancel the declaration as they have decided they do not want to die. In those situations, the person

“may cancel it by giving oral or written notice of the cancellation (or otherwise indicating their decision to cancel in a manner of communication known to be used by the person)”.

On the face of it, therefore, we are requiring much more from a person—oral or written notice—to cancel if they do not want to die than what is needed if they do not want an independent advocate. If we are going to go down the route of Amendment 549A, instead of saying the person has not indicated they do not want an independent advocate, it really should be that the person has confirmed—by written notice or by some sort of firm confirmation—that they do not want an independent advocate. What does “indicated” mean? It is a very loose word and, I would suggest, a very light test. What is happening here is that a person who would otherwise have an independent advocate to protect them is now not getting one; if that person is not going to get one, then we need more than a mere indication from them that they do not want the protection because, ultimately, this is all about protecting people. The contrast with Clause 20 seems to be somewhat stark, so I look forward to the noble and learned Lord’s response.

[Baroness Watkins of Tavistock (CB)]

I just wanted to stress, particularly for Hansard, that the people we are talking about are ultimately going to die from the illness they have had. Therefore, when the noble Lord has referred to them not wanting to die, he means that they do not want an assisted death.

[Lord Wolfson of Tredegar (Con)]

We all know what we are talking about here, but yes, absolutely.

This all goes back to the fundamental point of the Bill. I am addressing this point because the hypothesis is that the person has less than six months to live but, notwithstanding that, we are making sure that this particular group of people have an independent advocate. My point is simply that, if we are going to go down this road, there needs to be consistency: if they are not going to have an independent advocate, they really need to confirm it rather than merely indicate it. I apologise for my slightly loose language; the noble Baroness was quite right to pick me up on that. I hope the noble and learned Lord will consider my point as to whether “indicating” is actually the right test in subsection (2)(b)(ii) of his proposed new clause.

--- Later in debate ---

We should not allow the Bill’s six-month prognosis to become, in effect, an early death sentence. Patients do not know that the odds are not definitive and are sold misinformation by being told, “You’ve got six months to live”, when it is a bit more complicated than that.

[Baroness Watkins of Tavistock (CB)]

My Lords, we have already had extensive discussion about the multidisciplinary team involvement. In 50 years of nursing—not all in clinical—I have never heard a doctor come out with, “You’ve definitely got six months to live”. There are much more subtle conversations.

I accept that people with MAID sometimes want to discuss it and say, “If I come off the support that you’re giving me, how long would I live?” Some of the answers can be very straightforward and we still enable patients to stop treatment when they want to.

I am also delighted that the noble Lord is alive and that he clearly understands statistical formulae.

[Baroness Fox of Buckley (Non-Afl)]

I just want to ask the noble Baroness for one clarification. I agree that most doctors are not brutal and do not say, “You’ve got six months and that’s it”. I asked whether the Bill, which requires you to have a six-month prognosis to access the service, will encourage doctors to feel that they have to be more definitive to allow people to access this service.

[Baroness Watkins of Tavistock (CB)]

I do not think so. I have greater faith in the medical profession and the multidisciplinary team.

NHS: In-house Software Capabilities

Baroness Watkins of Tavistock Excerpts

Monday 16th March 2026 Lords Chamber

[Baroness Merron (Lab)]

My noble friend is right to point out the history. The NHS previously relied very heavily on large, outsourced IT systems that, in some cases, led to inflexibility, high long-term costs and limited NHS control over core platforms and data. I was glad to arrange for my noble friend to meet the chief data and analytics officer at NHS England last Wednesday. I hope that, like me, he was reassured that NHS England has very much shifted its model towards building and operating critical digital services in-house, in line with the standards that I referred to in my initial Answer.

[Baroness Watkins of Tavistock (CB)]

My Lords, cyber security is an essential element in any system, but nowhere more so than when people’s health records are being maintained. Many security breaches are attributed, at least in part, to human error. What investment are His Majesty’s Government making to train front-line staff in the new systems and provide continuous professional development to achieve the 10-year digital healthcare plan?

[Baroness Merron (Lab)]

The straightforward answer is that we are doing exactly that. It is important to say that our front-line digitisation—our move from analogue to digital—is not something for the sake of it; we are doing it because it is improving efficiency and outcomes. For example, a 94% coverage of electronic patient records is expected by the end of this month, and the digitally mature trusts show a 13% lower cost per admission. That is a prize worth having, but we can do it only through the systems and training that the noble Baroness seeks.

NHS: Violence Against NHS Staff

Baroness Watkins of Tavistock Excerpts

Monday 2nd March 2026 Lords Chamber

[Baroness Merron (Lab)]

That is a terrible thing that the noble Lord reports, and I appreciate him drawing your Lordships’ House’s attention to it. I can only reiterate the unacceptability of growing violence, bullying and harassment towards staff. Our work is to retain, recruit and get the best out of staff—I know this is a matter of interest to noble Lords—but we cannot do that in this environment. It is absolutely key that staff do not just feel safer but are safer in the workplace.

[Baroness Watkins of Tavistock (CB)]

My Lords, when working as a district nurse in 1981, I worked with an elderly male patient who had a rat in a cage as a pet. I made a rookie mistake that I would not make now: I said I was frightened of it. The next time I visited, when I drew back his bedclothes to give him a bed bath, the rat leapt out at me. I just draw attention to that, but can the Minister explain how and what statistics are kept on the sickness and absence of healthcare workers who work in the community as a result of physical and psychological aggression from patients?

[Baroness Merron (Lab)]

Again, I am very sorry to hear of the experience that the noble Baroness had and should not have had. Sadly, I am sure that she was not—and is not—alone in having had such experiences. We have zero tolerance towards violence, bullying and intimidation, and I would regard that as being an instance of that. We need to improve our data and our recording. We are developing a common reporting framework for violence prevention and reduction which will support the adoption of more consistent approaches to dealing with it and improve comparability across not just systems but services. The noble Baroness’s point about community-based violence is as valid as points about hospital-based violence: violence is unacceptable wherever it is.

Terminally Ill Adults (End of Life) Bill

Baroness Watkins of Tavistock Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[Lord Carlile of Berriew (CB)]

My Lords, I will raise a practical problem, which I urge the noble and learned Lord to address, in connection with care homes and nursing homes. The problem has been drawn to my attention—and, I think, that of other noble Lords—by a letter received today from the charity Mission Care, which has 300 staff in and around London and looks after 230 residents, some of whom might wish to apply for assisted death. The point that Mission Care makes is that its staff, by reason of the fact that Mission Care is a committed Christian organisation, en bloc would not be willing to take part in assisted death under the Bill. The effect of that, says Mission Care, is that it would have to close, thereby depriving people of the quality care that they have in those institutions.

I know that the noble Lord, Lord Blencathra, has a visceral opposition to anything arising from the European Convention on Human Rights. However, I have known the noble Lord long enough, and have enough affection for him, to know that he is very practical and that if the European Convention on Human Rights will assist his argument, he will be very ready to adopt it—so I ask him to be patient with me. These amendments, particularly Amendments 110 and 112, which I support, would take the process out of nursing homes and residential homes and into the hands of outsiders.

It is not just a question of Mission Care. Among all the many residential and nursing homes up and down the country, there will be very large numbers of staff who would wish to take advantage of Clause 31(1), which says:

“No person is under any duty to participate in the provision of assistance in accordance with this Act”.


It is the opt-out, and a very important opt-out that I know the noble and learned Lord is committed to as part of his Bill.

If we find that, in nursing homes and residential homes around the country, a significant proportion of staff wish to take advantage of Clause 31(1)—or Section 31(1) if the Bill becomes an Act—it will cause real difficulties for residential and nursing homes. There will be division among their staff, and it may be that those divisions make it very difficult for them to play any part whatever in this scheme if it is made law. I invite the noble and learned Lord to consider this issue further to ensure that those staff are not put in a very difficult position in the exercise of their consciences.

[Baroness Watkins of Tavistock (CB)]

I want to draw attention to the fact that I raised this issue two days previously in Committee. It is essential that we retain staff, particularly nursing staff, who would object to anything to do with assisted dying. That can be achieved, as I said earlier, by enabling people, when they do their advance directives, to be very clear if they never want to have this discussed with them, which I think is completely fair. Nursing homes must also be able to be very clear that they want nothing to do with this in their marketing materials. That is a bit of a tough word, but I think it is real. We must respect the faith and choice of healthcare staff as well as patients or, in this case, residents and their relatives.

However, the vast majority of people who are in long-term care homes rather than nursing homes have cognitive disability, which means that they will not be eligible in this event. It is in the very high-tech nursing homes where people who have very complicated issues might want to choose assisted dying—it might be a 52 year-old with complex disease. I can see that noble Lords want me to hurry up, but I just want to be absolutely clear that we need to get this in context.

[Lord Carlile of Berriew (CB)]

I am grateful to my noble friend for that intervention. She has raised three points, and I want to answer all three quickly. On point one, I absolutely agree with her: we have to respect the views of staff, particularly views that are a combination of professional and philosophical principles. Taking this process out of the nursing home, in accordance with Amendments 110 and 112, does exactly that.

Secondly, advance directives are quite an esoteric issue. I echo what the noble Lord, Lord Deben, said, based on his experience as a Member of another place. There are a number of us here who used to go to nursing homes and residential homes at least twice a year, sometimes taking our children with us to add good cheer. We came out with very different impressions of those homes: the good, the indifferent and, in one or two cases, the really bad. We have to take that into account. In some of those homes, there is practically nobody with an advance directive. Advance directives on the whole are a middle-class thing. Probably most of us here have advance directives of some kind or another, which one has to pay one’s solicitor to produce; one has to pay a lot of money in London, happily rather less out in the provinces. Where there are advance directives, that is fine, but not everybody has them.

I have spoken to the third point, which related to the remarks of the noble Lord, Lord Deben. I repeat that I am making an extremely practical point that ought to be addressed. If this responsibility lies with nursing homes, then it will cause immense difficulty. Also, there is always the risk in the really bad residential and nursing homes that people will be subject to undue influence in the unusual atmospheres of such institutions.

NHS: Corridor Care

Baroness Watkins of Tavistock Excerpts

Wednesday 4th February 2026 Lords Chamber

Asked by

[Baroness Watkins of Tavistock]

To ask His Majesty’s Government what assessment they have made of the provision of corridor care in the NHS; and what plans they have to mitigate any issues arising.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, we have introduced new data collection on corridor care, which will be published shortly for the first time. We are taking sustained action to reduce the use of corridor care, ensuring that there are safeguards for patients in the interim to still receive high-quality and safe care with dignity and privacy. We are investing £450 million to expand same-day and urgent care services, and to improve hospital flow, as well as introducing new clinical operational standards.

[Baroness Watkins of Tavistock (CB)]

I thank the Minister for her reply, but I want to understand when a credible long-term delivery plan will be published—rather than “in the near future”—to restore year-round resilience, making whole-system patient flow a core performance priority. Unnecessary stays in hospital are linked to worse patient outcomes, and it should be possible to reduce the nearly 13,000 beds occupied on average each day in 2025 by people medically fit for discharge, in turn reducing the need for corridor care.

[Baroness Merron (Lab)]

Let me say at the outset that corridor care should not be normalised; it is not what we want to see as routine. The reality is that we cannot eliminate it entirely—I think that is understood—but the current situation is not as we would want it to be. In addition to the Urgent and Emergency Care Plan 2025/26, which sets out clear actions to deliver improvements, the most challenged trusts are receiving targeted support. Looking to the future, as the noble Baroness asked about, the medium-term planning framework clearly sets out a trajectory to improve the situation. The introduction of clinical guidelines for the first 72 hours will also increase the proportion of people discharged within 72 hours. I very much recognise the situation the noble Baroness describes.