Health Bill

Baroness Watkins of Tavistock Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank the Minister for the meeting that she has arranged and for the progress we have made, and I hope that we will continue to do that as we debate this issue. However, I too am concerned about the costs and benefits in the timetable that is currently set out.

There are two questions that I want to ask. First, has the strategy—which I firmly believe in; we should move away from NHS England—been looked at against the NHS charter? I ask this because Principle 6 says:

“The NHS is committed to providing best value for taxpayers’ money. It is committed to providing the most effective, fair and sustainable use of finite resources. Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves”.


How much this is costing and when it will be paid back are fundamental in terms of the charter.

The charter also talks about staff rights, and although I am not working in the health service, I have many friends and colleagues who are. This feeling of uncertainty has been going on for 18 months, and I can say as a mental health nurse that one of the worst things for mental health promotion is uncertainty. This amendment really is important in trying to move us forward on the real timetable. Can the noble Baroness say whether there is, as some rumours are implying, a kind of back-pedalling? Now that we have asked the noble Baroness, Lady Casey, to move forward faster, are we trying to get to a point where we have some of the care service strategy in our mind? What could be worse than making a lot of very capable people redundant, and then needing to re-employ them? The costs to society and the taxpayer would be enormous. I just wanted to make those points, and I welcome what the Minister has to say.

[Baroness Royall of Blaisdon (Lab)]

My Lords, I agree that it is absolutely necessary to have clarity on the transition to the new system, and I add my voice to those noble Lords who have talked about the need for clarity for the staff. Successful reform, which we must have, both for patients and all staff, absolutely depends on retaining the expertise, experience and commitment of the staff. If we expect that commitment, we have to give them some security and knowledge of what will happen to their careers and their families—of whether they are going to be made redundant.

This is of course about the systems and cost, but it is also about the networks—the cancer network mentioned by my noble friend Lady Morgan. It is about the consultants, the doctors and nurses, and the people who keep the hospitals going: the cooks and cleaners, many of whom have been contracted out. Those contracts are bound to change as well. The clarity we are all asking my noble friend the Minister for is critical if we are going to ensure the success of this new enterprise.

Health Bill

Baroness Watkins of Tavistock Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Pitkeathley (Lab)]

Noble Lords will not be surprised to know that I give my enthusiastic support to the amendments on unpaid carers in the name of the noble Baroness, Lady Tyler. As she clearly said, one of the great difficulties about the carers’ movement is that people do not identify themselves as carers. That is partly because you become a carer in different ways: sometimes it creeps up on you, and you start by doing your dad’s shopping and then gradually do more for him until you are in a caring situation; or your mum has a stroke and there you are, suddenly in the carer role. Either way, you do not prepare for it, you do not discuss it with anybody, and you certainly do not identify yourself as a carer. That is why having somebody else identify you is of huge importance, and the only way that you are going to identify yourself as a carer and therefore have access to any kind of services at all.

Ironically, although carers have rights with local authorities under various other Acts in the past, they have no rights as far as health services are concerned, and yet it will probably be with their GP that they make initial contact. We did at one point have a duty on GPs to identify carers, but, sadly, that fell by the wayside during a different Government.

Identifying carers should be a duty, to help them and to support that huge workforce. Similarly, that applies to promoting the health and well-being of carers, because, as we have heard, 72% of carers report a long-term condition compared with 60% of people who are not carers. They do not take care of and neglect their own health because they are too busy caring.

As ever with unpaid carers, there is an economic as well as a moral case for supporting them. Here we have this huge workforce of 5 million people providing care worth, as the noble Baroness reminded us, the equivalent of another health service. It is in everybody’s interest to keep them well and doing what they want to do—they do so lovingly and willingly, usually—and to support them as much as possible.

[Baroness Watkins of Tavistock (CB)]

I support the amendments in the name of the noble Baroness, Lady Tyler. I have little to add to what the noble Baronesses, Lady Tyler and Lady Pitkeathley, have said, except to say that, for young carers, regular respite is essential. That might be going to a club once a week, to get out of the house and maintain other connections outside of school, for example. We know how important that is in preventing mental health problems.

There is huge inequality. For three years, I was a carer for my mother, who had Alzheimer’s disease. When I had had enough, I could afford to pay, along with her, to put her into a really nice nursing home for two weeks—which is in fact where she ended up for the last eight months of her life. It is not difficult if you have the money to plan it, but there are lots of people who do not. I cannot emphasise that enough. It kept me well and, in her moments of lucidity, made my mother feel independent, since she was paying to give me a break. We need to think about how difficult it is for people who cannot do that.

Particularly for people with dementia, admiral nurses should be able to identify those carers who are in need of respite. For many people, two weeks may not be what they need; what they need is 24 hours, once a week. Again, the care home that my mother was in is now offering that, and managing to have three people twice a week. That enables other people to go off. I am pleased to say that some of the beds in that nursing home are now paid for by the local authority, so things may be a bit more equitable than they were then.

There is clear evidence that, if you give respite to foster carers, foster carers can go on. Let us learn from that and see how we can apply that to carers right across the country, but with a particular emphasis on those who cannot fund anything to help themselves.

Corridor Care

Baroness Watkins of Tavistock Excerpts

Tuesday 20th October 2026 Lords Chamber

[Baroness Merron (Lab)]

We are putting in specialist teams to work with those particular hospitals. The Secretary of State has made it quite clear that ending corridor care for children is an absolute priority. As I said to the noble Baroness earlier, we are ensuring that best practice is applied. Because of the additional funding, we have been able to and will be able to extend capacity. The noble Lord will have looked at the areas that are receiving targeted financial support. Where we have greater levels of corridor care, our teams are working with those hospitals to say, “Why is this the case? This is how to sort it out”, and make sure that they can. The small number of trusts means that there is greater reliance in some areas than others, and that is not all right.

[Baroness Watkins of Tavistock (CB)]

My Lords, what additional support are the Government going to give to the healthcare staff in accident and emergency departments, who are feeling very demoralised following a difficult summer and now face a difficult winter? Most importantly, in preventive terms, is it not time that we linked care in the community by subcontracting some beds in care homes, so that patients who could be discharged immediately if that was available can be, to enable things to be a bit better for staff and patients this winter?

[Baroness Merron (Lab)]

I share the views of the noble Baroness, as I do the comments of the right reverend Prelate about the role that our healthcare staff play. The noble Baroness is right about the connection with social care. Better patient flow and discharge actually rely on that, and that is why we have published the Model Emergency Department, the Model Acute Pathway and the Model Discharge Pathway, so that we can see earlier assessment, timely senior clinical review, improved discharge and better patient flow, because it is down to beds and also to pressure. If there is one thing we are promoting in terms of prevention, it is for everybody to get a flu jab who is eligible, because we want to prevent people unnecessarily presenting at hospital. That will assist us greatly.

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.