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

Lord Markham Excerpts

Wednesday 15th April 2026 Grand Committee

I assure the Minister that the industry is ready to help. It wants to get this right and provide appropriate care, but there is more that we need to do to make sure that that happens.

[Lord Markham (Con)]

My Lords, I declare my interest as the founder and director of Cignpost Express Test, which did a lot of Covid testing for sports events and currently does health screening at PGA golf events and Mercedes Formula 1 testing, so I have quite a bit of experience in health screening. As other noble Lords have said, what we are trying to do here is very well intentioned. Ours hearts go out to all those affected by the Manchester Arena bombing. This is designed to try to correct many of those ills. The fact that we have two Ministers here shows the important stress that the Government put on this, and I know that Minister Ahmed has been engaged on this, too.

There are good intentions here but, as other noble Lords have pointed out, the devil is in the detail and implementation. Everyone thinks of big events in this context but, as the noble Baroness, Lady Grey-Thompson, mentioned, the small events are the real concern. I have had volunteers at mini rugby tournaments asking, “How are we going to cope with this?” There is a confusion, which perhaps the Minister can clear up, about doctors who are currently CQC-registered through their practice and volunteer at, for example, weekend point-to-point racing events or mini rugby tournaments, who feel that they will no longer be able to do that without being CQC-registered separately for those events, which costs almost £1,000 a time. That drives a lot of the discrepancies we seem to have in the numbers: are we talking about 36 events or many thousands? It would be helpful to get an understanding of that because there is a lot of concern out there.

As a former Health Minister, I know that the CQC already has a lot on its plate. The 1,000 limit on new registrations was mentioned earlier, and this could be the straw that breaks the camel’s back, to be honest. I am very concerned about this. Event organisers and chief medical officers have told me that if it becomes too burdensome, we will employ first-aiders instead of having volunteer doctors, because they do not have to be CQC-registered. That, of course, will mean that the care is less good. They gave an example: apparently, during Wimbledon, 4,000 people saw the medical support services during the whole tournament, and only 1% of them ended up being referred onwards to the NHS or hospital services, because good volunteer doctors and medics were there. Clearly, if they were just first-aiders, a lot more of those people would have been pushed straight on down to Kingston Hospital or wherever, which would have put a large burden on the local NHS services, which I am sure we all want to try to avoid.

I have three suggestions, if I may, the first of which is an athlete exemption. Will athletes be exempt from this, since their medical treatment is quite different, as the noble Baroness, Lady Grey-Thompson, said? Secondly, there is a feeling among the chief medical officers that it would be useful to get the event healthcare standard finalised in the way that the noble Baroness, Lady Harding, talked about, before we do this. It would be useful to have this standard, but it is hard to talk about implementation until we know exactly what that standard will be.

Thirdly, I, too, would like to be involved in the meeting, if I may, but a round table with the CQC and all the chief medical officers would be useful. I know that Minister Ahmed said that he was in favour of that and suggested to the CQC that it should meet with all four chief medical officers. However—I appreciate this is hearsay—I have heard from the chief medical officers themselves that the CQC refused to meet them all together and wants only to meet them separately. I do not know why that is, but the meetings would be more valuable as round tables, with everyone in the room, so that the CQC can get the full flavour of the things we are hearing about today.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare an interest, in that I am president of the Chartered Society of Physiotherapy, so it is partly with that hat on that I am asking these questions.

The Manchester Arena inquiry makes harrowing reading, and I expect that there will be some bereaved people watching this debate, because they are aware that these regulations have come out following that inquiry. The deficits that the reports highlighted are really worrying, but I was struck that many of them are in the domain of so-called first aid: the failure to use tourniquets when people were bleeding, and the fact that the tourniquets were locked up in a first aid room anyway, compound the distress and the memories with which people who lost somebody in that event have to live.

So, one of my questions relates specifically to where the boundary defining first aid sits. The initial response of qualified doctors and physiotherapists may be first aid, but they may also start to instigate longer-term treatment for whatever happened at the event that could not be instigated by somebody who was trained in first aid only as a volunteer from a charity or group. I was thinking about the Glastonbury Festival, an event that is extremely well organised for medical emergencies. It is set up to do a lot of treatment on site, but some things mean that people have to be airlifted out sometimes. They go from the very minor—the joke is rashes from all the wellies rubbing on people’s legs—right through to life-threatening adverse reactions to the most bizarre cocktails of drugs. That needs a highly specialised knowledge. If emergency medicine consultants had not been working there, lives would have been lost because this is so complicated.

One of my other questions relates to the people who are to be used or employed. A level of first aid could happen anywhere, but what is needed at a sporting event may be very different from that at a large event where a lot of illicit substances are being used and the expertise required to avoid loss of life will be quite different.

My other main question relates to the boundaries around an event. How big and organised does an event have to be to qualify, or how small not to qualify? What about a local children’s football league that happens on a Saturday morning with lots of different clubs competing? The kids are traveling around with parents, and may cross from Wales to England, England to Wales, into Scotland or wherever. As amateur participants, their risk of a really bad injury is no lower —in fact, it may even be higher—than if they were playing as fully trained professionals with a full support team.

I am also slightly concerned about where the boundaries are around the person. For some of these smaller events, people will have volunteered as doctors. I know one who volunteers to work at football matches: he is employed by a large hospital and is not a sports medicine person, but he brings a lot of experience that you could say all falls within the realm of first aid, or you could say is tipping over the boundary, because general medical emergencies arise from time to time.

Both the national boundaries and the size of the event concern me. I am not quite clear where those physiotherapists sit who are in private practice—possibly solo private practice—but who are then providing support at a sporting event. If they are to register with CQC as a single worker, it might be quite a lot of money out of their practice pocket. They may therefore feel that they are not incentivised to carry on but they have a great deal of skills. The danger is that the skills available on-site at an event might, inadvertently, be lower than one is anticipating. I realise that there have been a lot of questions to the Minister, but we look forward to the answers.

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[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.

[Lord Markham (Con)]

If I may, I hope this may be helpful: the confusion that I have heard is over whether a doctor, for a CQC registration at their GP surgery, can use that to volunteer on a point-to-point racecourse, as an example, or whether they have to separately register with the CQC to be a volunteer on the racecourse and pay the £1,000. Again, if that comes in the letter, that is fine, but that is one of the main points of confusion.

[Baroness Merron (Lab)]

On all these areas, as I said, I am happy to meet with noble Lords in person. To be honest, I think that that would be more helpful, not least because we are talking about scenarios and we have a note of the questions that noble Lords are raising. I would be delighted to go through them. Again, in the responses today, I am probably going to be repeating some of what I said earlier and I am not sure that that will take us forward, so I would rather that we held those points for a meeting, if noble Lords are agreeable.

With that, I thank noble Lords. This has been a very valuable debate. It shows the work that needs to be done and we will be pleased to do that. I thank all noble Lords for their considered contributions and support of the principle of why we are here.