Health Bill

Lord Lansley Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

Moved by

[Lord Lansley]

54: Clause 12, page 9, line 8 at end insert—
“(za) in subsection (1), after paragraph (j) insert—“(k) such other services and facilities as are required for persons with a primary health need arising from a progressive or deteriorating disease which is reasonably expected to continue for the remainder of the person's life, including where the person's condition is intermittent or fluctuating, and without regard to the rate of such progression or deterioration or whether a person is entering a terminal phase of their life.””Member’s explanatory statement
This amendment would ensure that a wider range of serious chronic diseases, such as severe dementia, would qualify for NHS Continuing Care and not have eligibility restricted on grounds that the condition is fluctuating or is not deemed to be in a terminal phase.

[Lord Lansley (Con)]

My Lords, this group is essentially about the processes of commissioning. Other groups will touch on these issues, but Amendment 54 raises the commissioning of NHS continuing care. It is grouped with amendments that relate to other aspects of specialised commissioning.

I thank the Minister for her letter earlier today saying that she will be able to tell us quite soon what the division of responsibilities for commissioning between the national and the ICB level will be. She expects it to be broadly similar to the practical distribution of commissioning responsibilities now. That is a comfort to some of us in understanding how this will work in future. She was also kind enough to tell us, in the spirit of “the more things change, the more they stay the same”, that, following the disbandment of the commissioning support units, we will have the office of pan-ICB commissioning—which sounds awfully like the recreation of commissioning support units.

I am in favour of having commissioning support units. I was originally in favour of having an opportunity for independent support to commissioning, not just NHS-delivered support for commissioning and competition between commissioners in who provided them with that expertise. I will not get that, obviously, but having the ability to provide support to the commissioners collectively is clearly the right thing to be doing.

I do want to just say that, from my point of view, there is an issue about specialised commissioning, which the Minister’s letter touched on: the question of standards. When we took the responsibilities for some specialised commissioning away from primary care trusts, we found that there was substantial variability in what was being commissioned, how it was being commissioned and the standards to which it was being commissioned. One of the most expensive aspects of the reforms that we had to undertake was that we brought them to the same standard, the highest standard, which over recent years has been guided by the publication of the National Institute for Health and Care Excellence’s guidance and standards.

I hope that when we come to debate specialised commissioning in more detail, we will also look at ensuring that we continue to meet those high standards, notwithstanding that there is a difficulty in reconciling that with the budgetary decisions on commissioning that must be made by individual ICBs if they are responsible for specialised commissioning. We will have to find out precisely how that divides itself.

I do not want to say any more about specialised commissioning. I want to focus on Amendment 54, which is intended to deliver a very specific question to Ministers that I hope we will follow through. A couple of weeks ago, we all agreed during Oral Questions that this Bill is a big opportunity to improve social care. The Minister herself said that. Well, it is. There will be two or three debates, of which this is the first, at which I hope to bring forward ways in which this Bill can be used to undertake essential aspects of the future shape of what a national care service looks like.

I do not have to go into all the aspects of what a national care service is, but one building block in making it happen is for the NHS to take a greater and more substantial responsibility for providing continuing care to people who have a primary health need. Noble Lords may say, “But does it not do that now?” The point is that, presently, two-thirds of access to NHS continuing care essentially comes through the fast-track route. That pathway tool is very much focused on those who are reaching what is described as a rapidly deteriorating condition leading to a terminal phase of life. Unfortunately, this means there are very many who have a condition that I think NHS continuing care was, and is, intended to provide for, where the NHS takes responsibility for a person who has a primary health need which arises from a progressive or deteriorating disease expected to continue throughout their life. That is the fundamental definition, but that is not what the NHS is presently doing.

The Prime Minister himself gives us the classic illustration: he says, and said again on 1 September this year, that the NHS should support people with dementia as well as it supports people with cancer. This is precisely what does not happen. NHS continuing care is often available to people with a terminal diagnosis of cancer who are rapidly deteriorating, but, for a variety of reasons, somebody with severe dementia does not get it. They do not get it because it cannot be established: there is no prognosis in the way there often is for cancer. They do not get it because they are often in a situation where, from the point of view of the assessment, there is less clinical intervention, even though a primary health need gives rise to the condition; it is often intermittent, fluctuating and not predictable; and there are often episodes when somebody who is undertaking assessment will say, “Well, at the moment, this is manageable without all the clinical interventions that would be required if this were a cancer diagnosis”.

So I think we have a serious issue. This is why my Amendment 54 says that we should construct the legislation in a form that requires the persons using this decision support tool for NHS continuing care to have regard to whether it is a primary health need that gives rise to a patient’s condition and whether it is a long-term condition they will have throughout the rest of their life, in which case the NHS should therefore take on the responsibility.

Given the hour, I do not want to dwell on any further details or examples, but I think the comparison is very straightforward. It is increasingly clear that the reason people do not get access is because of the failure to observe the principle that the NHS should take responsibility where a primary health need gives rise to that social care requirement; in practice, principally for budgetary reasons, that has been narrowly confined. If the Prime Minister, as I understand it, is looking towards the state taking a greater responsibility, a very good starting point for that to happen would be for the NHS to take responsibility for those people whose social care requirement arises from a primary healthcare need. That is the principle of purpose of Amendment 54, which I beg to move.

--- Later in debate ---

Finally, on Amendment 54, in the name of the noble Lord, Lord Lansley, which the noble Earl, Lord Howe, also spoke to, regarding eligibility for continuing healthcare, I say that it depends on primary health needs. Assessing this will consider the nature, intensity, complexity and unpredictability of the condition, including the challenges created by fluctuating needs. So, eligibility will not depend on deterioration, nor on terminal status. Therefore, we believe that this amendment is not necessary, although we understand the intent, as patients with serious, chronic conditions are already eligible for continuing healthcare, and it is not linked to whether they have a named, particular diagnosis or condition.

[Lord Lansley (Con)]

My Lords, there have been so many good speeches that I have listened to, on so many important issues. I know we will return to them on Report, so, specifically with that in mind, I beg leave to withdraw Amendment 54.

Amendment 54 withdrawn.