Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026

Lord Kamall Excerpts

Wednesday 15th April 2026 Grand Committee

[Lord Addington (LD)]

My Lords, this is one of those debates where you think, “Who do I disagree with?” I am afraid that I have not disagreed with anything from anybody. As I speak for my party, it is important for me to restate that things went wrong with the treatment of the Manchester Arena disaster. We should do something about it—that would be great.

The problem here is that we seem to have gone far too wide. As the noble Baroness, Lady Finlay, asked, how far down do you go when covering an event? For instance, for small rugby union clubs—my own sporting background—you are lucky if there are three men and a dog watching. That is your crowd, but a local cup game could have a couple of thousand. Where does that support structure kick in? That is something that all amateur sport will confront from time to time. This is merely the first opportunity for the Minister to correct these perceptions. We need to have some cut-off points, going from when it is enough simply to have a first-aider within earshot to when we need better medical support and structure. When that changes and how they interact is really what the discussion here is about.

When it comes to sport, please let us not do anything that stops sporting events happening. There is a fear that we will do so inadvertently by providing a greater bureaucratic burden on providing help. We hope that the Government will not do that. I hope that the Department of Health will not do something that will make the country intrinsically less healthy. That is really what we are looking at.

Let us look at other specialist events. This is not an interest, but I live in the village of Lambourn so, even if I did not want to be, I am very aware of things to do with equestrian sport and particularly races. Anything to do with horses is intrinsically dangerous; indeed, we have a rehabilitation centre for neck and back injuries in Lambourn. When it comes to racing, as my wife has often pointed out to me, there are not many events when an ambulance follows you down the course as you are taking part—so there are structures there. If something that organised is raising concerns—it is not because they want it to be there but because it has to be there—there might well be something worth listening to. We must make sure, when we deliver this, that we do not throw the baby out with the bathwater and that good intentions are erased out. We should go through all those things.

The Government need to start doing something to get better information out there about exactly what they are doing, where the barriers are and what will happen. A series of meetings might help—possibly with parliamentarians and certainly with larger groups—and they should get the information out quickly. It will dramatically help to let the information out in dribs and drabs—as and when they see fit as they go forward—setting out their intentions, and we will bring in stuff behind it. That way, if there is a real fault-line here, as opposed to a fear of one, we will find out. Then we can start to do something about it.

Can the Government give us something that reassures us on our worries about the extra bureaucratic burden, given that people are terrified? They are one newspaper report and a few tweets away from people having a panic about everybody being sued every time anybody gets cuts in an amateur football game. What are they doing? Where are the structures going? That is what is required here.

We all want the big events to be safer, but they will have got it wrong if they apply this to an open mic night at a pub and a Sunday league football game at the same time. We must make sure that people know where those fault-lines are. The exemption for people taking part in sports events is a no-brainer. Can we make sure that this happens and that people know about it? It is clear that they do not, at the moment, and that is a fundamental flaw in the Government’s approach.

[Lord Kamall (Con)]

My Lords, as other noble Lords were declaring their interests, I thought, “Oh, that’s good; I have no relevant interests”. But, the last time I thought that, a number of people tweeted at me for not declaring my interests, so I will bore all noble Lords with them. I am a professor of politics and international relations at St Mary’s University, Twickenham. I teach an MBA module on healthcare policy and strategy. I also work with the medical school that it is starting and have started co-operating with colleagues in the Faculty of Sport, Technology and Health Sciences. I also teach at the University of Buckingham, but I have no contact with its medical school. I just wanted to touch all the bases.

I thank the Minister for setting out these draft regulations in her usual clear manner. Obviously, they arise from the tragic events of the Manchester Arena attack and the subsequent inquiry. Like other noble Lords, my heart goes out to those who were affected; we offer our condolences to the victims and their families, some of whom are probably still in a state of bereavement. Clearly, that inquiry called for a review of healthcare provision at events, as well as clearer standards for public safety, which I think everyone who has spoken is in favour of.

Most of the people who have contacted us said that they support the principle that those attending sporting and cultural events should have access to safe, high-quality medical care—there is no disagreement there—but the question before your Lordships is one not of principle but of implementation and delivery. It is right, therefore, that the detail be scrutinised carefully.

In removing the previous exemption and requiring providers of event healthcare to register with the CQC, the SI clearly extends the CQC’s regulatory remit to a sector that is complex and, in many cases, heavily reliant on volunteers and small providers. You cannot just transplant knowledge from the hospital or mental health sectors into sports events; noble Lords have referred to the range of events that would be covered. This removal, while understandable, has given rise a number of concerns—I am sure that the Minister has heard them—among, but not limited to, small organisations and volunteer-run sports clubs. Like the noble Lord, Lord Addington, I share the concerns of the noble Lords on different Benches who have spoken. There is no disagreement here.

The department’s own impact assessment acknowledges the increased costs associated with registration and ongoing compliance, but one of my concerns arose when I saw the estimate for the registration fee. It said that, for newly regulated providers, it will be between—

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[Lord Kamall (Con)]

A number of noble Lords have raised concerns, and I am going just to outline or repeat a few of them. The first is that the department’s own assessment acknowledges that the costs associated with registration and ongoing compliance are estimated, for newly regulated providers, as being between £99,400 and £994,000 per annum. They are quite accurate figures, but let me rephrase that: it could be nearly £100,000 or nearly £1 million. We know that most forecasts are wrong, but a factor of 10 is rather a wide range. I have to admit that that raises concerns about the understanding of these regulations.

But more concerning is the evidence from the Faculty of Sport and Exercise Medicine suggesting that many clinicians working in event medicine may reconsider their involvement if these regulations are implemented as proposed—as the noble Baroness, Lady Grey-Thompson, raised. As other noble Lords have said, events medical providers support the principle of these regulations but warn that they could lead to a reduction in workforce capacity, with the potential unintended consequence of reducing safety. My noble friend Lord Herbert referred to that unintended consequence.

There are also concerns that, where providers withdraw from delivering this regulated medical care, events may instead have to rely on first aid provision, as we have heard from a number of noble Lords. That falls outside the scope of CQC regulation. Well-run events such as Wimbledon, Royal Ascot, the Silverstone Grand Prix and the Glastonbury Festival currently manage most medical incidents on-site. But we could see a shift away from properly staffed medical provision, which risks increasing demand on already stretched NHS services off-site.

Stakeholders, including the Sport and Recreation Alliance, have highlighted a lack of comprehensive engagement with the sector to date. Given the unique characteristics of event medicine, it is essential that any regulatory framework be developed in close consultation with those who deliver care on the ground. However, I have been told by some medical professionals that the CQC is being selective in who it wants. I was told a similar story to that told to my noble friend Lord Markham: when three or four CMOs asked for a joint meeting, the CQC person refused and insisted that they wanted to meet only one of the CMOs. When I hear this, frankly, it gives me no confidence in the CQC or its consultation process. Let me be clear: I do not use those words lightly, but the CQC should be doing proper consultation and not refusing meetings.

I recognise the efforts by the previous and the current Government and the CQC to fix its previously poor reputation. Last year, in the mental health debates, these Benches supported the Government in resisting the appointment of a separate mental health commissioner, because we agreed that the mental health part of the CQC was getting its house in order. Indeed, I met today with some people from the CQC on transitional care, and I was very impressed with them.

However, when I am told that for this regulation the CQC suggested that an additional 36 organisations would require registration, compared to an estimated 25,000 in the survey by the Faculty of Sport and Exercise Medicine, this, as my noble friends Lord Lansley and Lord Markham, and the noble Baroness, Lady Grey- Thompson, said, demonstrates a massive gap in understanding that needs to be addressed. Once again, I am sorry when I say this, but it gives the impression of the CQC being out of its depth.

I am sorry if that is not exactly the ringing endorsement that the Minister was hoping for, but I also know that she has been willing in the past to meet to discuss legislation, and we have worked constructively together in the time we have both been on our respective Front Benches. So, in that constructive spirit, I will make three suggestions, which in fact touch upon those that that were made by other noble Lords.

First, we need to see meaningful CQC engagement with sector representatives, our national governing boards, the chief medical officers in sports groups, the Faculty of Sport and Exercise Medicine and the Faculty of Pre-Hospital Care to ensure that any inspection framework is sector-specific and not simply lifted from the hospital sector. Imposing a CQC regulatory framework suitable for hospitals is inappropriate for pop-up clinics at park runs, cycle races or pitch-side at rugby. Let us be frank: the CQC does not have any existing knowledge of working in these sectors at that level, and it should be listening rather than seeking to impose.

Secondly, we should consider expanding the current employer/employee CQC exemption to athletes, performers and officials whose healthcare providers meet strict occupational health standards regardless of the patient’s contractual arrangement, as other noble Lords suggested.

Thirdly, although I understand that the Secondary Legislation Scrutiny Committee has raised concerns about the time taken to bring forward these regulations, given that the CQC is not exactly inspiring confidence from those who organise sports and other events, could the Government possibly ask the CQC to wait until the event healthcare standard being led by the Faculty of Pre-Hospital Care has been published? In addition, if and when it becomes apparent that the CQC has indeed underestimated the size of this and the cost to the sector, would they be prepared to perhaps extend that December 27 deadline, if appropriate?

However, really to emphasise the point that the Government are listening, I know we have asked for individual meetings, but a much better suggestion would be a round table with interested noble Lords, with the relevant Minister from the department—obviously we would love to have the noble Baroness, Lady Merron, there as we always enjoy her consultations— and the CQC, so it can stop being selective about who it speaks with and can actually listen to CMOs and other medical experts from across the sector. They are not doing this to score points; none of us is doing this for that reason. We agree with the principle, and we want this to work, whichever party and whichever Bench we work on, but we are concerned that the CQC’s approach will lead to the unintended consequence of the withdrawal of appropriate medical provision at these services.

It is quite clear that all noble Lords support the goal of improving public safety at events. All noble Lords have heard the concerns from public events medical experts, and all noble Lords hope that the Minister has listened to their concerns and will agree to the modest requests they have made in today’s debate.

[Baroness Merron (Lab)]

My Lords, I am most grateful for the debate today. I will make a few general points.

I very much welcome the points and the concerns that noble Lords have been willing to outline. I also want to acknowledge that I have heard the understanding of why we are doing this. I know that we all understand the intent, and I understand the numerous questions— I make that as a comment, not as any criticism—trying to understand the workability. I very much welcome them. What I take from this debate and what I will share with Minister Ahmed as the Minister for Patient Safety is that clearly there is considerable concern. To refer to what the noble Lord, Lord Addington, said about fault lines, I think this is about fear of fault lines, but even fear of fault lines is fear enough, so I absolutely take that point.

Let me say at the outset that, if noble Lords had not asked for it, I would have suggested having a round table for interested Peers. It will indeed include officials from the department and the CQC. Ministerially, because it is Peers, I would want to be there in any case. I am sure that Minister Ahmed would want to be there too, but my anxiety is to get on with the meeting, so I will happily have a discussion with him, but I certainly want to be there. If noble Lords remain concerned about a lot of the points, we can tease them out there.

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[Lord Kamall (Con)]

I can add to that. What is the process for notifying those who will come under this regulation? That would be helpful to know as well.

[Baroness Finlay of Llandaff (CB)]

If I may add to the list of questions, I think it might be helpful for the Minister to explain how the decisions over the size relate to the Purple Guide that the Health and Safety Executive produced, because I understand from page 114 of volume 2 of the Manchester Arena inquiry report that the Purple Guide for an event of that size set things out quite clearly, but was not adhered to at all. I have a slight concern from the responses that we have had that we may have two completely separate things going on. The Minister may not be able to answer that now, but it would be helpful in this meeting that we are all anticipating if there is a cross-reference to the Purple Guide and if the discussions could include how that would impact and be used by the CQC in regulating.