King’s Speech

Lord Dodds of Duncairn Excerpts

Wednesday 20th May 2026 Lords Chamber

[Lord Dodds of Duncairn (DUP)]

It is a pleasure to follow the noble Baroness, Lady Wheatcroft, and I entirely agree with what she said about social care and the need for a timetable—that is a glaring omission from the Government’s programme.

I will speak mainly about health. The NHS modernisation Bill in the gracious Speech promises to reduce inefficiency and place power and resources in the hands of front-line NHS organisations. The review of the noble Lord, Lord Darzi, which has just been mentioned, describes the system as too rigid and complex, overcentralised, and having unclear lines of accountability.

The Government’s intention is to transfer NHS England’s functions into the Department of Health and Social Care and the wider system to reduce bureaucracy and free up resources to be reinvested in the front line. Here I compare what has happened in the devolved arrangements in Northern Ireland, just by way of illustration. Many of the same criticisms led the then DUP Health Minister in Northern Ireland, Simon Hamilton, to announce in 2015 the abolition of the Health and Social Care Board, which was responsible for regional commissioning of services, managing resources and performance management. Responsibility for the Stormont health portfolio has now passed on to other parties, and the board eventually closed in March 2022.

There has been reference to a 50% target for reduction in staff from merging when NHS England closes, but, unfortunately, that has been far from the outcome we have seen in Northern Ireland. Inexplicably, the health department in Northern Ireland now has more than 1,200 staff at Stormont, exceeding the combined number across both the Department of Health and the Health and Social Care Board prior to the board’s dissolution. The department’s new strategic planning and performance group alone comprises an extraordinary 500 people, administrative costs of £305 million and management costs of £264 million—both from two years ago. Each exceeds the respective totals for the HSC board and the department jointly in 2021-22 and previous years prior to the closure of the board.

Much of the rationale for removing the Health and Social Care Board was to reduce and streamline bureaucracy, which we heard the Government talk about in relation to their plans for NHS England. Yet the process in Northern Ireland and the same kind of approach have somehow ended up in a situation where the number of staff and the costs have grown. It is worth people keeping an eye on this and seeing what lessons can be learned from that devolved experience. Certainly, if lessons can be learned, they should be communicated back to the Northern Ireland Executive.

The Government are proposing, as we have heard, that the NHS harnesses digital technology and unlocks the value of health data with a new single patient record, bringing individuals’ information together into one place to improve patient safety and experience. In Northern Ireland, we have a single digital care record for every citizen, created via the encompass programme, which went live in the final two trusts, the southern trust and the western trust, 12 months ago. This provides patients and service users the ability to view and update their health information online wherever and whenever they like, via My Care, the patient portal. This makes it much easier for health and social care staff to view key information about their patients, both in a clinical setting and while out working in the community.

Bringing together health and social care records has maybe proven somewhat simpler in Northern Ireland, given our integrated trusts, compared with the local government responsibility for social care here in Great Britain. Unfortunately, however, the Northern Ireland electronic record does not incorporate GP and primary care data, so we will watch with interest the progress that His Majesty’s Government make on this front. Clearly, integrating primary care data would present a significant further step forward.

I want to see the Government, in this parliamentary Session, do more on fixing end-of-life and palliative care. All older people should be able to die with dignity, comfort and choice. We are now at a crucial point, given where we are with attempts to introduce the assisted dying Bill. We must see a government commitment to really change the provision for palliative and end-of-life care.