Healthcare Services: Acute, Primary and Community

Lord Evans of Rainow Excerpts

Thursday 25th June 2026 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, I thank the noble Baroness, Lady Janke, for securing this important debate. There is broad agreement across the House on one central point: if we are to build an NHS that is sustainable for the future, we cannot rely solely on treating people once they arrive at hospital. We need strong primary care and early intervention that prevents illness escalating in the first instance.

That principle is not new. Successive Governments, including the Conservatives, have spoken about shifting care closer to home. The current Government have made it one of the central pillars of their health strategy through the proposed neighbourhood health service and the commitment to move from hospital- to community-based care. The question, however, is not whether we support that ambition, but whether the Government are delivering it.

The figures set out in the House of Commons Library briefing are striking. Between 2015-16 and 2023-24, spending on acute services increased by £14.3 billion, while primary medical care increased by only £1.7 billion and community services by £3.1 billion. Those figures illustrate the scale of the challenge in rebalancing the system; they also demonstrate why simply announcing a shift is not enough. Resources must genuinely follow patients into community settings if the policy is to succeed.

These Benches welcome the Government’s stated commitment to shift care out of hospitals into communities. We also recognise the potential benefits of neighbourhood health centres in bringing diagnostics, rehabilitation, mental health services and primary care together and closer to where people live.

However, there are legitimate questions to be asked about pace and delivery. Before the election, Ministers spoke about increasing the proportion of NHS funding allocated to primary and community care by 2029. That objective has now been pushed further back to 2035. For many patients and practitioners, that will feel like a significant delay.

These Benches also have concerns about whether primary care is being given the tools it needs to succeed. The Opposition have consistently raised concerns regarding changes to the GP funding formula and the expectations placed on GPs through the advice and guidance system. Community care cannot become simply a mechanism for managing demand that would previously have gone elsewhere in the system. If primary care is expected to do more, it must be properly resourced to do so.

I turn briefly to mental health, where the relationship between acute and community services is particularly important. Community support and accessible treatment can prevent deterioration early and reduce hospital admissions. It is therefore concerning that the share of NHS spending devoted to mental health has fallen in each of the last three years—from 9% in 2023-24 to a projected 8.4% in 2026-27. At the same time, local systems are no longer required to increase mental health spending in line with overall NHS spending. These developments appear difficult to reconcile with the principle of parity between mental and physical health.

In closing, I therefore have four questions for the Minister. What specific milestones will the Government use to demonstrate that the promised shift from hospital to community care is taking place? What assessment has been made of the impact that recent GP contract changes will have on primary care capacity? How do the Government intend to ensure that mental health services do not lose out as NHS resources are distributed across the system? In the case of eye care, there is already a workforce and infrastructure in the community to treat patients effectively, yet access depends on where you live, which pushes avoidable demand into hospitals. What steps are the Government taking to ensure equitable access across England?

Strong hospitals will always be essential, but an NHS fit for the future also requires strong community services and effective early intervention. The challenge for the Government is not setting out that vision but delivering on it. I look forward to the Minister’s response.