Health Bill

Debate between Lord Lansley and Baroness Royall of Blaisdon

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Lord Lansley (Con)]

My Lords, I may be the first speaker not to have signed any of these amendments, but that does not mean that I do not agree with them; a great deal has been said with which I agree. The importance of this debate can hardly be overstated.

I just want to contribute one thought, which is that in taking all these issues and understanding how they relate to this Bill, we have to put it in the context of what is already in the National Health Service Act. I want very quickly to outline that.

The Bill before us is an improvement on what is in the NHS Act as far as the Secretary of State’s duties are concerned, because it extends the duty from equal access to healthcare services and facilities to seeking to reduce inequalities and securing equity in outcomes from healthcare services. That is what is in the Bill; I think that is a significant improvement. The Bill focuses at this point on what the National Health Service is doing to secure the prevention of illness and the promotion of successful treatment. It is not about the improvement of public health at that point.

The noble Baroness, Lady Tyler of Enfield, talked about the Bill transferring a duty to the Secretary of State. In fact, the NHS Act has the same duty on both the Secretary of State and NHS England: they are concurrent duties. Therefore, we are not transferring the duty; this is not part of a transfer from NHS England to the Secretary of State.

Under Section 2A of the NHS Act, the Secretary of State has a duty for the protection of public health, which are all those things to do with vaccination, immunisation, et cetera. Section 2B, which was inserted by the 2012 legislation, as my noble friend on the Front Bench will recall, inserted into the Act a duty as to the improvement of public health, and that is on both local authorities and the Secretary of State. It is not, I think, phrased as we would want it to be; more needs to be done to look at that.

I suggest—and this picks up the point made by the noble Baroness, Lady Royall of Blaisdon—that when we talk about wider determinants of health, we are looking at a strategy that relates not only to the Secretary of State—i.e. to the Government—but to local authorities, and she made that point very rightly. But it is in the NHS Act. Local authorities have a duty to improve public health in their area and take such appropriate steps as they can to achieve that, and the Secretary of State has such a duty to improve public health in Section 2B—unaffected, as I understand it, by this Bill. Therefore, when we come to look at it on Report, I hope that those who are thinking about how we might create the right strategy for the improvement of public health do not just think that it is done by attaching it to the responsibilities of the Secretary of State in relation to the NHS but also look at Section 2B.

[Baroness Royall of Blaisdon (Lab)]

My Lords, I am grateful to the noble Lord for giving way. I recently read Section 2B of the NHS Act. I think one would find that it states that local government and strategic authorities “must” improve health and reduce inequalities, but the Secretary of State only “may” improve health. I think that is very interesting to look at. Perhaps that is a wrong that we ought to right.

[Lord Lansley (Con)]

The noble Baroness is absolutely right: local authorities “must” take such steps as they consider appropriate; the Secretary of State “may” take such steps as they consider appropriate. I think I was right in saying—and she has illustrated it—that we can improve what is in Section 2B. I would just make the point that, when we come to Report, it is necessary not only to look at what is in this Bill but to look at how the improvement of public health is promoted through the NHS Act, including Sections 2A and 2B.