NHS 10-Year Plan

Lord Kamall Excerpts

Wednesday 9th July 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, before I begin, it is the first opportunity for me from these Benches to wish the noble Baroness, Lady Merron, a speedy but restful recovery over the summer. I look forward to seeing her back after recess. I thank the Minister for repeating the Statement. As she will appreciate, for many questions that have been asked on health in this House in the last few months, the answer has often been, “You have to wait for the 10-year plan”. As the 10-year plan is here, now is the time to have some constructive debate. We will ask questions but also perhaps suggest some improvements. It gives us a chance to scrutinise and, I hope, to work constructively to make sure that the Government can deliver on the plan.

Let me be clear that the Government welcome aspects of this plan—sorry, the Opposition; it has been a year now and I am still getting used to it. I am sure that the Government welcome it too, but we have many questions. First, I know there is the Casey review, but surely, we have to understand that we must get social care right if we are to unblock many of our beds. Some 13% of NHS beds have patients waiting for discharge. It is not about the financing of social care; it is about making sure people can go into the community.

Secondly, we completely agree on the use of technology. I was the Minister for Technology in the Department of Health and Social Care, and we will support pushing through technological change as quickly as possible, but we also want to make sure we can save both time and cost and improve the patient experience. Far too many functions are duplicated, but, at the same time, if you fall off your bike in an area where you do not live, surely it ought to be easy for the clinicians and paramedics there to pull up and view your record. We still have not quite got there.

How will the single patient record link with the NHS summary care record and the National Care Records Service? Will there be duplication, or will the Government be merging the SCR and the NCRS into a single patient record? The plan rightly places a lot of emphasis on the NHS app. I am proud that a Conservative Government introduced that app and welcome the fact that the Government are going to build on it.

Page 121 talks about wearable medical technology being integrated into the app, which is very welcome. We know that many people already have these wearables and that they integrate them with apps other than the NHS app, but what about the concerns of some patients who worry about where else their personal data will be shared when they share it with the app? How will the Government reassure those people that the data from their wearables will not be shared elsewhere? Will patients be able to see who has accessed their records and when, so that they can have greater confidence in the idea of data sharing?

Turning to the shift from the hospital to the community, which is something that we also agree with. On page 36 it says:

“Our aim is to establish a Neighbourhood Health Centre … in every community”,


and on page 32 it says that a neighbourhood will consist of 50,000 people. However, in his answers on the Statement, the Secretary of State said:

“We aim to go for 250 to 300 new neighbourhood health centres by the end of this plan and 40 to 50 over the course of this Parliament”.—[Official Report, Commons, 3/7/25; col. 449.]


If the Government create 300 neighbourhood health centres that each serve 50,000 people, the total served by these neighbourhood health centres will be 15 million people. England has a much larger population of about 57 million people, so, far from there being one in every community, simple maths suggests that there will be 42 million people without one.

To help noble Lords understand, can the Minister explain some of the maths behind this assertion about neighbourhood health centres and what this really means? There needs to be some clarification. If they do not serve the whole population and we are not going to have neighbourhood health centres everywhere, on what basis will they be set up? Who decides where they will be? How do we make sure that they are located on the basis of need or deprivation rather than the politics of a local area? Will they complement existing GP practices and surgical hubs, and how do we make sure that there is no duplication?

On prevention, we all know that we must tackle the obesity crisis and the ill-health crisis. The problem is that quite often we are tempted to go for top-down solutions. We like to say, “Let’s ban this and let’s ban that”, but when I speak to local community civil society organisations, which work with people in local communities to encourage them to eat healthily, they are very sceptical of a lot of these top-down measures. I think of a project like BRITE Box, near where I live in south London, which goes into family homes and delivers healthy ingredients and an easy-to-read menu that children can enjoy and teaches families to cook healthily together. Surely we need to get healthy eating, healthy cooking and the sharing of meals into family homes, particularly those in deprived communities, rather than adopt a top-down solution from Whitehall or Westminster. I would have liked to see more about how we engage the power of the community and civil society at local-community level to tackle many of these issues.

Finally, there is one omission in this plan: fracture liaison services. There is only one mention of it, on page 165. That is rather disappointing, because I remember in June last year, before the last election, the current Secretary of State for Health said that he would take “immediate action” on fracture liaison services. Of course, we had to give the Government time to bed in, but it has now been a year, and we have got the 10-year plan, and there is nothing concrete on fracture liaison services. This is an easy win for the Government, because the savings to be gained from the rollout of fracture liaison services will be realised in two or three years—easily within the political cycle and easily before the next general election.

If the Minister does not have the answer to all these questions, she can write to us and deposit a letter in the Library. We look forward to her replies.

[Lord Scriven (LD)]

My Lords, we on these Benches welcome the Minister to her place. I know that, when I say that we hope that she is not too long in her place and that the noble Baroness, Lady Merron, is with us again soon, she will understand that I say it in the nicest possible way.

From these Liberal Democrat Benches, our unwavering commitment to the NHS remains absolute. We welcome any stated ambition to improve the health service, particularly with a focus on prevention, leveraging technology and moving care closer to people’s homes. However, our support is contingent on plans being genuinely deliverable, properly funded and, crucially, addressing the interconnected crisis in social care. We have long championed that you cannot fix the NHS without fixing social care.

I confess that, as I read the Government’s new 10-year plan, a familiar echo resonated through my mind. Having started my career in the early 1990s as a manager in the health service, much of what is proposed sounds eerily familiar. This plan speaks of a network of new neighbourhood-based care that provides services between general practice and traditional general hospitals. This mirrors strikingly similar initiatives from previous governments—echoing, for example, the advocacy of the noble Lord, Lord Darzi, for polyclinics in 2007.

What does history teach us about such wholesale shifts of care from hospital? It tells us that this inevitably involves running the old and new systems simultaneously, which is, without exception, expensive. Hospitals will continue to perform their essential functions, and their fixed costs will remain. The new community service demands significant new investment in buildings, staff and technology, and there are no immediate savings to fund the shift. Let us not forget the stark reality: we currently lack the capital simply to repair our existing crumbling health estate, let alone build numerous new hubs.

Crucially, for any plan that speaks of shifting care out of hospitals, the most frequent users of the NHS are our elderly population. Keeping them well and out of acute settings profoundly depends on effective social care, yet this essential pillar remains largely absent from this new plan. We search in vain for a decade-long funding and development road map for social care, or for a stand-alone, fully resourced social care strategy. This is a crucial strategic failure, undermining the very foundation upon which this shift to community is based.

Moreover, while the enthusiasm for digital transformation is understandable, the detailed implementation plan of how to do it is absent. The app is a diagnostic tool; it does not provide direct care, it does not give the jabs and it does not provide the treatment. The King’s Fund has shared its concern on this:

“AI scribes can only transform the productivity of the NHS if staff don’t need to spend 30 minutes every morning logging into multiple out-of-date IT systems”.


The fundamental question remains unanswered: how will this be delivered? The plan is ambitious, but it has been launched into an incredibly chaotic delivery environment marked by significant structural change within the health system bureaucracy. The key question for the Government is how this will be delivered. I therefore have a few questions for the Minister.

What precise funding strategy is embedded within the 10-year plan to deliver the necessary reform and integration of adult social care? Given the dual running costs of new neighbourhood health facilities, can the Minister provide a year-by-year financial breakdown of expenditure and demonstrate how these investments will lead to overall system efficiencies and net savings? Will the Minister commit to publishing within the next four months a comprehensive, independently overseen delivery road map for this 10-year plan that details specific year-by-year objectives and names leads and mechanisms for public reporting on progress? While we wish the ambitions well, the key challenge for this Government is how they will deliver and being open and transparent on that.

[Baroness Blake of Leeds (Lab)]

My Lords, I also start by sending my very best wishes to my noble friend Lady Merron. No one more than me is looking forward to her making a very speedy recovery. I am very pleased to hear from her that she is making good progress, so we look forward to her return. I think it is appropriate that I declare an interest: my son is a GP, which I think is perhaps slightly relevant to the debate before us today.

To recap before I go into more of the details, I emphasise that this plan is different in so many ways to the NHS plans that have come before it. As we have heard, it is a road map for radical reform that is built on three fundamental shifts. Those of us that have been around the health agenda for a while recognise the past aspiration for some of these measures, but there was never a bold, innovative, collaborative plan to take our ambitions forward.

From hospital to community care, bringing care closer to home and making access to GPs faster and simpler is absolutely fundamental, particularly in the current climate—and from analogue to digital, giving staff modern tools and patients the kind of convenience and control they expect elsewhere in their lives. All of us have heard heartbreaking stories of patients who go from one specialist to another, and there is not that join-up. This has to be changed. There is no reason why this cannot apply across all the experiences the public have, regardless of where they are seeking services.

Many of us have been talking about the need to move to prevention in so many areas of life. Where better than people’s health, looking at the root causes of poor health and making healthy choices? It is the easy choice, but at the moment it is not that easy.

The new NHS has patients at its heart, will deliver equity and quality, is devolved and decentralised so that we are more responsive to local community needs and the front line is freed up to harness innovations, and the rules and incentives in the system support clinicians and lead us locally to be able to make the right decisions. This means that there is no simple chapter or section within the plan for individual conditions or groups setting top-down actions. The impact on particular services and outcomes will be through successfully transforming how our health ecosystem works. As we will come on to with the more specific questions, this is very much a work in progress. I am delighted by the reach the consultation has had over the last year. That has informed the debate and the outcome that is seen in the plan, so there have been no surprises. Many people who have been involved recognise what is in the plan.

The plan is backed by £29 billion per annum of extra investment by the end of the review period and, crucially, by a drive to cut unnecessary bureaucracy and empower front-line staff, giving them the tools to do what they do best: caring for patients.

I thank the noble Lord, Lord Kamall, for his very constructive comments; they were exceptionally helpful. Across the House, we all look forward to taking this extremely seriously and moving forward.

Turning to the comments of the noble Lord, Lord Scriven, on social care, he and I share a very positive background in local government, and nothing could be closer to our hearts than working out how we are going to bring the two together. That is fundamental. Both noble Lords made the point very clearly, and we welcome that.

Over the next three years, we will focus on the neighbourhood health approach to those most let down by the current system. That includes older people with frailty and those in care homes. Social care professionals will work alongside NHS staff in local teams, supporting recovery, rehabilitation and independence. We have examples from around the country where this is already happening: services are joined up and the cultural differences between the NHS and local government have been successfully broken down. We need to make sure this is replicated and spread to every part of the country. We need to enable care professionals to take on many more health-related responsibilities, such as blood pressure checks and reducing avoidable hospital administrations. Of course, pay terms and conditions have to be improved through fair pay agreements.

In the longer term, the noble Baroness, Lady Casey, will produce an interim report next week, but it is very much a work in progress.

[Lord Kamall (Con)]

It will be next year.

[Baroness Blake of Leeds (Lab)]

Sorry, I meant next year—I was just testing that everyone was still with us—in anticipation of the in-depth work she is already involved with. There will be cross-party discussions and a real engagement with stakeholders.

On the single patient record, I will have to write to the noble Lord about how the merging of the different systems will be achieved, but it will very much be about the patient being in control and giving a full picture for staff moving forward. The digital red book for children is absolutely fantastic.

On the shift to the community, as we have made clear, we will initially prioritise those living in areas of greatest deprivation. We will be opening neighbourhood health centres in places where life expectancy is low. There will be principles that we will follow, bringing all the multidisciplinary teams together.

On the fracture liaison service, I will have to respond in writing. I am sorry but I do not have the specific details in front of me.

Returning to the noble Lord, Lord Scriven, and his comments about social care, it is critical that we get this right and make sure that local leaders are right in there, responsible for delivery, proactive, providing a co-ordinated response and building on the work already being done.

On the funding, £29 billion is quite a significant amount of resource to work from. We recognise that there are challenges, and it would be wrong of me to pre-empt the work of the noble Baroness, Lady Casey. But I know she has been encouraged to work with the best of the best, and I look forward to the outcomes.

I have to finish—I am sorry; there is never enough time. Our health system is in crisis, and we need to act now. We must make sure that the NHS continues as a publicly funded service free at the point of use. We need to seize the opportunities provided by all the new technologies and medicines outlined in the plan, go forward with innovation and make sure that the patients are at the heart of everything we do.

Emergency Planning

Lord Kamall Excerpts

Monday 20th February 2023 Lords Chamber

[Baroness Neville-Rolfe (Con)]

DLUHC is working with the local resilience forums to work out what we should be doing in the light of the latest developments. I agree that the focus on the website is not always great, particularly when websites go down during emergencies, which has been my own experience. I have dealt locally with people who deal with emergencies, notably on Covid. The voluntary effort that comes forth when emergencies take place and all the good things that are done are really impressive. We have to learn from that and put that into the system, as it were, for the future. I take the point about making sure that people know, by leaflets and so on as well as by websites, what they need to do in the case of an emergency.

[Lord Kamall (Con)]

The noble Lord opposite talked about the website for resilience. For the benefit of noble Lords who are not yet aware of this website, can my noble friend the Minister share the URL for that website so that we can evangelise about it on her behalf?

[Baroness Neville-Rolfe (Con)]

I will certainly take forward my noble friend’s idea. I have also been impressed by the system that the mobile phone operators have that you can ring if your electricity goes down. These things exist, but the point—as expressed so powerfully on the other Benches—is that we need to make sure that people know what to do when flooding comes or there are other local difficulties. That is why we have put in a new head of resilience within the Cabinet Office and have published the risk framework. We are open to new ideas, both on substance and on communication, as I hope that I have shown.

Civil Service: Digital Skills

Lord Kamall Excerpts

Monday 20th February 2023 Lords Chamber

[Baroness Neville-Rolfe (Con)]

I think that is a matter for the House authorities, but I will happily pursue it for the noble Lord.

[Lord Kamall (Con)]

My noble friend the Minister is absolutely right to say that countries such as Estonia and Latvia were able to leap-frog—they did not have the encumbrance of legacy technologies. Can she tell us the thinking around how legacy technology—not only the technology itself but the processes around that technology—can often hold back progress?

[Baroness Neville-Rolfe (Con)]

I can tell my noble friend a lot about what we did at Tesco on this matter. We had a spaghetti junction of old technology and what we did—I am sure noble Lords will be interested in this—was bring in systems that were compatible with one another. We gradually got rid of the spaghetti junction of technology and moved to new technology across the board. It is about those sorts of principles. Alex Burghart, the very energetic Minister concerned, heads at ministerial level the Central Digital and Data Office. It is these sorts of issues that we are looking at, so as to make sure that the transformation to digital that we need is efficient, smooth and speedy, and does not cause lots of legacy problems. I think we all know of experiences in different government departments where these already exist.

Public Services: Workforce (Public Services Committee Report)

Lord Kamall Excerpts

Friday 16th December 2022 Lords Chamber

[Lord Kamall (Con)]

I begin by congratulating the noble Baroness, Lady Armstrong, not only on getting through those 15 minutes with a cold but on the report. I also congratulate and thank the members of the committee, as well as the staff who the noble Baroness mentioned.

One of my passions is local civil society. I first became interested in this area as a PhD student, when I read a book by David Green, a former Labour councillor, called Reinventing Civil Society: The Rediscovery of Welfare Without Politics. He wrote about the country’s rich history of civil society organisations, such as mutuals, friendly societies and trade unions, which used to provide adult education, insurance, medical and other services; what we would today call public services. Since then, I have taken a real interest in local civil society, an interest shared by noble Baroness, Lady Armstrong, and the noble Lord, Lord Collins.

I approach the report and this debate based on my experiences. First, when working as academic and research director at an economic think tank, it was clear to me that we needed to think about demographic changes and their impact on public services. I should refer noble Lords to my register of interests. Secondly, this is based on my recent experience of being a Health Minister, however briefly, faced with the current and future challenges of our system of health and social care. I am grateful to many noble Lords across the House for conversations and advice on addressing these challenges during my time at the Department of Health and Social Care, particularly the noble Baroness, Lady Pitkeathley, who I see here and who helped me many times. Thirdly, when I was a Member of the European Parliament for London, I was inspired by and helped to publicise local community and neighbourhood civil society projects across London. They addressed many of the issues found in local communities; for example, training NEETs or using sport to help teach children who had been excluded from school due to behaviour problems. There were local charities helping the homeless, including a fantastic project helping former drug dealers to turn their entrepreneurial skills to becoming sandwich dealers—I will not say what was in the sandwiches—projects working with ex-offenders, anti-radicalisation projects and many more. When in October the current Prime Minister decided that my services as Minister for Civil Society, my dream job, were no longer required, I was able to return to my passion projects. One of these is to help local community champions set up neighbourhood non-state civil society projects.

Having read the report, I found myself agreeing with a number of its recommendations, but today I will focus on two or three. During my time at the Department of Health and Social Care, it was obvious that we have so much more to learn about health and well-being and so much research to do. One example is our increased awareness and understanding of mental health conditions—I look to the noble Lord, Lord Davies, who often raised this issue—compared to even 30 years ago, when the response used to be something like, “Stiff upper lip!” or “Pull yourself together.” Think about PTSD, which was recognised only in the 1980s. Looking back, we realise that shell shock from the First World War was a form of PTSD. I remember preparing for a debate on neurological conditions. When I rather naively asked my officials to send me a list of all the neurological conditions they knew of, I received the answer, “But Minister, there are more than 600”—600 conditions, many of which will require more research to understand and more resources to address.

While people are living for longer physically, they are not always living in good mental health for as long, so demand for these services, as well as existing services, is increasing. As the report says, our ageing population means that

“The proportion of the population with multiple and complex needs will rise further, even as the labour market available will be smaller.”


In simple terms, the number of people paying into the Government’s piggy bank will get smaller, as the number of people receiving public services paid out of it increases.

As the noble Baroness alluded to, contributors to the report argued that

“long-term thinking must consider different ways to boost workforce numbers, such as UK training routes and immigration”,

efficiency, data, and flexible and creative deployment of staff. The report argues that we need all of these, but advances in technology and flexibility alone will not solve the skills gap. We will need some immigration.

After the war, when the UK faced a workforce shortage, it was immigrants from mainly Commonwealth countries who saved our public services. Take my own family. My father came here to work on the railways and as a bus driver; his brother came to work as a postman; his sister as a nurse. We will need more immigration, especially from those countries that train more people than they have jobs for domestically and that see receiving overseas remittances as far more effective than receiving foreign aid. I hope we can change the debate on immigration from one of numbers to one of filling the skills gaps and vacancies.

The third important point that stood out was the recognition that public services do not always mean state-provided services. On more than one occasion, the noble Baroness, Lady Armstrong, has reminded the House that the state cannot do it all. It has to work with civil society and the private sector. The report rightly recognises that

“The voluntary sector can add immense value to public service delivery”.


I have seen and worked with a number of projects. I think of a local mosque offering IT training to its congregation; the local council partnered with it to offer wider, more cost-effective delivery for the council and a bit of income for the local charity—a win-win situation. But while this is a win-win situation, we have to be careful and not expect all charities to become social enterprises and support public services. I have also seen projects fail when they have turned their attention to government contracts as opposed to growing organically and helping local people. I remember an owner of a gym who said that the people who worked there did not need qualifications but social skills. They needed to turn up on time, smile, be clean and learn not to say, “Computer says no.” He said that that was what he had to do. Sadly, this is one of those projects that expanded too quickly and failed, in anticipation of government contracts. While we should encourage social enterprises to bid for public contracts, they still face a number of barriers, as the report rightly says. It says that we need

“a fundamental shift in how the public sector works with voluntary partners”

and the private sector.

There are many other points which I could address, but I will leave that to other noble Lords. It is an excellent report. I cannot cover all the points, but I will end with a question for my noble friend the Minister. Can she tell noble Lords what the Government are doing across departments to include civil society, and indeed private sector partners, in better delivering public services so that we all gain?