Health Bill

Lord Scriven Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Baroness Merron (Lab)]

I would be very happy to do that.

[Lord Scriven (LD)]

I have been listening very carefully and, in answer to my noble friend, the Minister has just said that secondary legislation will be for all NHS services by choice. What stops that being put on the face of the Bill?

[Baroness Merron (Lab)]

This is the point I have just raised: we feel that secondary legislation is the better place to put it for flexibility and future-proofing; it is not appropriate, in a static way, for primary legislation.

[Lord Scriven (LD)]

As I am sure the Minister agrees, that would make sense if you were putting the operational services down. If you were making a commitment in Clause 5 that all NHS services in secondary, primary and community services will be accessible for choice, it would then give discretion within that boundary. I do not understand what stops the Government putting those principles on the face of the Bill, rather than making the operational amendments, which the Minister said were too restrictive.

[Baroness Merron (Lab)]

I think we just have a difference of approach to and opinion about the roles of primary and secondary legislation. I respect what the noble Lord is saying and I will of course review the points that have been made, as I always do; however, the position is exactly as I have described.

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[Lord Kamall (Con)]

My Lords, let me make it clear that I recognise that what I am asking for does not need to be in the Bill and does not need legislation. However, my frustration at the lack of progress, both when I was the relevant Minister and as shadow Minister, has forced me to table this probing amendment.

I often meet entrepreneurs and tech companies who claim that they have an innovative product or solution that could transform healthcare. They ask me how they can have a conversation with the relevant person within the NHS. When I was a Minister and I asked my officials about this, they would give me an email address I could share. However, two things stayed with me. First, why was this email address not widely advertised and known by more people? Secondly, when I asked such entrepreneurs whether anyone from DHSC or NHS England had replied, the answer was no.

In opposition, I began thinking, “How can I help more innovators into the NHS?” It was suggested that I meet the Health Innovation Network, which told me that it is the front door for innovation. However, once again, many tech entrepreneurs have never heard of it. I was surprised to read on the Health Innovation Network’s LinkedIn page that it has “501-1K employees”. How about that for precision? Speaking to noble Lords and others interested in health innovation, I have heard a range of opinions about the local networks—that some are good, some are bad and some are in the middle. While some regional health innovation networks are good, others are not so good and coverage is patchy. This brings me to my question. What is the Health Innovation Network’s remit, and what assessment have the Government made of local networks’ effectiveness? What plans do the Government have for the networks in the reorganisation?

I recognise that there is a fantastic clinical entrepreneurs programme led by Tony Young, an NHS surgeon and clinical entrepreneur. He has always been very open and has encouraged me to send on to him clinical entrepreneurs who have approached me, in order to have further conversations. The question relating to this amendment is: what about entrepreneurs who are not clinicians, but who have an innovative solution that could transform health or social care? For them, there is no obvious front door to the NHS or one-stop shop. What do they do? They spend ages trying to get into the system at primary care, trust or ICB level, sometimes wasting their time but also clinicians’ precious time. Sadly, they then give up or go abroad, meaning that the UK loses out on British innovation.

In July, during an Oral Question, I asked the Minister to ask the DHSC Minister for technology and innovation to create such a front door or one-stop shop to triage those who approach it. That front door could distinguish those salespeople who have no minimum viable product, telling them what they need to come back with to be taken seriously. Secondly, what about those who have a solution but need more support, so that they can be signposted to someone who can advise them on coming up with a more feasible approach? Thirdly, there are those who have potentially a fantastic solution that could transform healthcare and need to be piloted as quickly as possible.

I was grateful when noble Lords from all Benches later told me that they agreed that this was a practical idea. Has any progress been made since I asked that question in July. If not, what are the reasons why? Time and again I hear the same concerns from entrepreneurs, researchers and businesses: the system is difficult to navigate, and numerous organisations are involved in supporting innovation, all with different remits, processes and points of entry. Expertise clearly exists throughout the system, but identifying the right door to knock on can be a challenge in itself.

This amendment seeks to address that problem through a simple but important principle: that there should be a single national point of access through which innovators and other organisations can obtain co-ordinated support. The purpose is not to create another bureaucratic layer; on the contrary, it is intended to reduce complexity, improve co-ordination and ensure that innovators spend less time navigating the system and more time developing solutions that could benefit patients. The principle behind the amendments mirrors one that the Government have embraced elsewhere in the health service. The concept of a single point of access, or a single front door, is designed to simplify routes into services, triage inquiries effectively and direct people to the most appropriate expertise at the earliest opportunity. Rather than forcing patients to navigate multiple pathways, the system assumes responsibility for guiding them to the right destination.

My Amendment 27 applies precisely that same logic to innovation. Instead of requiring innovators to work their way through a maze of organisations and programmes, a single front door would provide a clear route into the system, supported by intelligent triage to the most appropriate person in the Department of Health and Social Care or the NHS. It could be, but not necessarily, one of the 501 to 1,000 people who work for the Health Innovation Network. I beg to move the amendment.

[Lord Scriven (LD)]

My Lords, I thank the noble Lord, Lord Kamall, for moving this amendment and for the very short debate that has followed. I believe that the frustration is real, but the Committee deserves answers to two questions: what is in place now and would the proposed new clause make it better?

As the noble Lord, Lord Kamall, said, there are 15 health innovation networks, each serving its own region, but there is already a national point of access. The NHS Innovation Service, as the noble Lord, Lord Kamall, said, has been running since 2022, when it was set up by a very forward-thinking junior Health Minister—the noble Lord, Lord Kamall. NHS England describes it as a single entry point. An innovator completes one record. Experts from within the network review it within 10 working days, give tailored advice and can refer the innovator to one or more local networks. More than 2,000 innovations have had support through that service.

Proposed new paragraphs (a) and (b) of proposed new subsection (2) in this amendment largely describe something that already exists. Does it work? As a front door, it appears to do so in some regions for some people. The problem is that if the amendment from the noble Lord, Lord Kamall, was accepted, it would create two front doors for people to come through, which would probably not be a wise thing to do.

I believe that the front door is not the main problem here; the problem is spread. Adoption is one trust taking up a good idea; spread is that everything gets to the patient, no matter where they live. The Health Innovation Network’s own evidence to Parliament says adoption is

“slow, uneven and overly dependent on local early adopters”.

It describes what it calls

“a postcode pattern of spread”,

and warns that

“proven technologies do not spread through evidence alone”.

An innovation proven in one place can face the same hurdles all over again in the next, so I do not believe that we have a front door problem.

Therefore, I must be honest. As drafted, this proposed new clause would help only at the margins and it could hinder. It could create a second door beside the one we have, unless it simply puts a statutory label on the existing service. It would write an operational arrangement into primary legislation, when the way innovators are supported should be one that changes quickly. It would place duties around networks that neither the Bill nor the proposed new clause define.

There are two parts that I welcome. Proposed new subsection (3) would require published information on performance, and we should be told how many innovations spread beyond their first site and how far. Proposed new subsection (2)(c), on co-ordinated support across regions, goes closer to the real issue, but the network says that spread needs systems with

“the resource to redesign pathways, train staff and evaluate impact in practice”.

A referral service does not provide that.

The amendment’s most important contribution is the question it raises. NHS England runs the innovation service. The network’s national commission comes from NHS England, with the Office for Life Sciences. However, the Bill abolishes NHS England. Clause 6 gives the Secretary of State a duty to promote innovation and a power to award prizes, but it says nothing about the networks. A prize will not help a company stuck between a successful pilot and its second trust.

I have a few questions for the Minister. Who will run and fund the innovation service, and commission the networks, once NHS England has gone? Can she guarantee that there will be no gap? Will the Government publish performance data, including on adoption and spread, which is lacking, whether this amendment is accepted or not? Who, after abolition, will be responsible for making sure that proven innovation spreads across the whole NHS, not just to the early adopters?

A single door is a reasonable aim and we largely have one. What patients need is for it to work in one part of the NHS and then to reach all of it. I look forward to the Minister’s reply.

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[Lord Kakkar (CB)]

My Lords, I support the amendment in the name of the noble Baroness, Lady Shawcross-Wolfson. It is an important amendment raising two fundamental questions, which I hope the Minister will be able to answer. The first is this: ultimately, in preparing a workforce plan that will enjoy broad confidence, there must be external scrutiny of that plan. It would be most helpful if the Minister could confirm how His Majesty’s Government’s healthcare workforce plan will be independently scrutinised. Also, how will His Majesty’s Government be able to reconcile potential differences generated as part of that independent scrutiny with what they consider to be deliverable at this particular moment in time?

The second issue is how a mechanism will be secured—now that the functions independently exercised in NHS England will become the responsibility of the Secretary of State for Health—in respect of long-term workforce needs and short-term financial pressures. As we have heard, investment in the workforce is a long-term investment, and Ministers will always be faced with short-term financial problems and crises. Historically in the NHS, the education and training budget has been periodically sacrificed when there have been other service, access and delivery demands on NHS institutions.

In providing an opportunity now with this Bill, how will the Government address that fundamental tension and secure a mechanism both for independent scrutiny and to ensure—with all the powers now lying in the hands of the Secretary of State for Health—that the education and training budget that secures the long-term development of the workforce cannot be sacrificed for short-term exigencies?

[Lord Scriven (LD)]

My Lords, I will speak mainly to Amendment 252 in the name of the noble Baroness, Lady Hollins. I apologise for not putting my name to it; I wish I had.

But I wish to speak first on two other amendments. The amendment from the noble Baroness, Lady Shawcross-Wolfson, is useful, and I thank her for the way that she presented it. An independently verified assessment and a 10-year plan is exactly what is needed. But I do have a word of caution. Publication within one month of Royal Assent could be a real challenge, even considering the amount of time that we have been waiting. Also, a plan that is produced that quickly risks being inaccurate, and an inaccurate workforce plan is worse than none at all, because people will make training and funding decisions on it. The amendment from my noble friend Lady Pidgeon offers a better timescale of 12 months from Royal Assent as well as an assessment of the staff needed, a funded plan to close the gap and an annual report to Parliament.

Amendment 252 matters because it names people who are easily forgotten in workforce planning: that is, the staff who care for people with a learning disability. Let me start with why that matters. The latest—in fact the last ever—national LeDeR report found that the median age at death for adults with a learning disability was 62.8 years, compared with 81.8 years for the general population. That is a gap of 19 years. Many noble Lords will know that my own wonderful nephew, Myles, who was 31 years old, is part of that terrible, tragic statistic. Some 39% of deaths of these adults were judged to be avoidable, against 21% for the general population. No workforce plan can fix that alone, but no plan that ignores it is worth having.

Health Bill

Lord Scriven Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Lord Scriven (LD)]

My Lords, I just have a very quick practical suggestion to deal with some of the issues the noble Lord, Lord Blencathra, and others raised about staff neutrality, because that is what we are talking about. Would it not be wise, rather than going through a long process, to make it part of the NHS constitution that staff have to be neutral in how they deal with fellow staff and patients with whom they come into contact? I ask the Minister to consider that seriously when she reports back not just today but on Report. It is just a practical suggestion.

[Baroness Finlay of Llandaff (CB)]

I will be very brief in supporting that suggestion from the noble Lord, Lord Scriven. When I was listening to the debate, I was thinking about people who have told me about feeling discriminated against. They often do not declare their racial, religious or whatever view, because they are terrified of being further labelled and discriminated against. The noble Lord, Lord Shinkwin, spoke about the history of this for the Jewish people; there were lists of who was Jewish, particularly in the Netherlands, which were rapidly exploited to round them up with speed and persecute them further. That is a very deep-seated fear in a lot of these people.

The other fear is that, if they disclose that they have been discriminated against, they will be undermined in other forms that make their lives even harder. I can again think of other specific examples that have been brought to my attention. I commend this solution as a way forward.

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I thank the noble Lord, Lord Scriven, for raising consideration of staff neutrality, as was also spoken to by the noble Baronesses, Lady Finlay, Lady Pidgeon and Lady Cash. We are clear that staff must demonstrate the core values of the NHS and demonstrate neutrality in the workplace. I would go further. I do not know that I would use “neutrality”; it is an issue of fairness, and “without fear or favour” might be the other expression.

[Lord Scriven (LD)]

My point about the important value of neutrality is this, and let me give an example. You might not be discriminatory: you have somebody who is Jewish, somebody who is Muslim, somebody who is Christian and somebody of no faith, and you treat them all equally, but you might have something on your body which is not neutral to two of them. You are therefore possibly treating that person differently, from their perspective. If neutrality and fairness is such an important value for the NHS, can the Minister go away and look seriously at making it a key component in the NHS constitution, because it is not there at the moment?

[Baroness Merron (Lab)]

I take that point and I certainly accept the spirit in which the noble Lord suggests it. I will take all the points that have been discussed away to see whether there is any way that we can work with it, rather than extending a debate on what neutrality means, because I know what the noble Lord is getting at. It is helpful that he has given thought to that.

On Amendment 258, NHS bodies are already subject to clear legal duties to prevent and address discrimination and racial harassment, alongside established responsibilities to tackle extremism and safeguard patients and staff. In a technical fashion, I certainly caution against adding further legal duties here because it would risk confusion about what we expect ICBs and trusts to do. I know that is not something that any of us would wish to do.

On Amendment 259, we have accepted the recommendation from the noble Lord, Lord Mann, to consider amending the performers lists regulations, which would enable conditions to be imposed on suitability grounds. We intend to amend the regulations, subject to consultation. The amendment is unnecessary as the Government are already taking forward the substance of it. It would also impose a six-month statutory deadline before the necessary consultation and consideration have taken place, whereas we have to allow sufficient time to make sure that any changes are legally robust, proportionate and workable. Nor would we wish to pre-empt consultation by committing in this moment to how particular forms of conduct should be addressed in the regulations.

On Amendment 279C, under NHS staff standards—which, as I referred to on the comments from the noble Baroness, Lady Manzoor, were launched on 6 July—employers must take sustained and meaningful action to prevent and root out racism. NHS organisations will be measured on this through the national oversight framework. In addition, I say to the noble Lord, Lord Blencathra, that regulatory processes are already in place to which all registered healthcare professionals are subject. Regulatory fitness to practise processes allow concerns about misconduct to be investigated. They allow evidence to be considered and the appropriate regulatory action, which could indeed include removal from the register, to be determined in each case. The Professional Standards Authority for Health and Social Care acts as an independent body in this regard to make sure that regulators apply the right sanctions. Where it considers that a decision does not provide sufficient public protection, it has the powers to refer the decision to the courts for consideration.

In drawing this together, I assure the noble Baroness, Lady Gerada, the noble Lord, Lord Patel of Bradford, and your Lordships’ Committee that we are ensuring that ICBs and providers are fulfilling their duties. The key means to do that is through performance assessments. I gently caution against adding additional criteria to the current approach, because it is important that assessments have sufficient flexibility to adapt to the evolving role of ICBs as strategic commissioners, which, after all, is at the heart of the Bill.

Health Bill

Lord Scriven Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

We have fantastic staff in these lovely hospitals where we have been treated, but they are given a management that I do not think often works. This is the opportunity we have to grasp. We have to deal with it and not be the sort of people who are always very difficult and behave like turkeys that do not want Christmas to come.

[Lord Scriven (LD)]

My Lords, I thank noble Lords who have spoken in this rather revealing debate. I particularly thank the noble Earl, Lord Howe, for introducing this amendment in his normal calm and measured way. Importantly, he has given us all the chance to ask the most basic question of the Bill: where is the plan? It is pleasing that the Minister and the Government have been in listening mode, particularly regarding the Health Services Safety Investigations Body and Healthwatch. I hope that during Committee the Government will continue to listen and make other important changes to the Bill.

At Second Reading, I said the Bill was a power grab. The Nuffield Trust’s October briefing for this Committee puts it more politely. It describes new powers for the Secretary of State as being well beyond those that NHS England holds, which it says enables “more political control” and limits real devolution. The Government are entitled to decide whether they want NHS England’s functions in the department, under political hands. We on these Benches would caution on that, but the Nuffield Trust accepts that some duplication between the department and NHS England is real; the Minister must specify exactly what that duplication is. But if that is the aim, it has to be planned and costed.

I would also caution the noble Lord, Lord Hunt of Kings Heath, and the noble Baroness, Lady Harding, for suggesting that putting NHS England’s functions in the department will bring accountability to the Secretary of State. When we get to Clause 11, we may see that the accountability is missing but the powers are about to be transferred.

Noble Lords will know the architect’s maxim that form follows function, but not here—

[Lord Hunt of Kings Heath (Lab)]

Is the point not that at the moment, parliamentarians can raise issues with Ministers only to be told that something is the responsibility of NHS England? I accept what the noble Lord says about how this is going to work but, ultimately, now the finger is absolutely pointed at Ministers for everything that happens.

[Lord Scriven (LD)]

When we get to Clause 11, the noble Lord, Lord Hunt, will see that some of the powers that the Secretary of State now takes, beyond NHS England, will not come before this Parliament. They will just be at the signature of the Secretary of State’s pen.

In this Bill, form comes first and function will follow in due course. We have the demolition notice but are still to see the drawings of the new structure. Let me say how far behind the Government are. The Nuffield Trust, working with the Institute for Government, compared past public sector reforms and NHS abolitions. It found that the key factors for success are not in place here. The abolition was announced without plans to explain its goals to staff and without redundancy funding, which led to months of delay. Detailed planning for the new department began only in early 2026, almost a year after the announcement. Nuffield’s verdict is that the process has been “poorly handled”.

We are still short of very basic information. At Second Reading and in this Committee, the noble Lord, Lord Stevens, who I admit must know something about running the NHS, pointed out that the costs and benefits in the impact assessment are still marked as “not available”. There are also still a number of questions about the timing of when this reform will come in. We have the Government’s estimates that redundancy exits—across the department and NHS England, ICBs and the commissioning support units—will cost between £1 billion and £1.3 billion, to be met from existing allocations, but we must ask which allocations. Which services pay?

Then there is the timetable. On 15 October the Health Service Journal reported that abolition will have to be formally delayed beyond April 2027 unless decisions on future national structures are made within days. Have those decisions been made? Are staff now aware of where they will be transferred? The new operating model has been waiting for ministerial sign-off for months. Ministers are still weighing whether thousands of staff will go to the department or potentially, as we read, into a new stand-alone agency. This Bill sends nearly every function of NHS England to the Secretary of State, yet the Government have not decided where the people who will perform those functions will sit. The department says that it continues to plan for 1 April 2027, but planning a date is not the same as being able to meet it.

The planned 50% job cuts in the department appear to require moving the large majority of central policy and analytical staff. Or is it about cutting operational staff? As the noble Lord, Lord Crisp, said, we need clarity about which staff and which functions will be in the department. It is not clear that the figure is rested on rigorous assessment of who is needed and why. History tells us how this ends: after previous reforms that moved managers from commissioning bodies, the department consultancy spend peaked at over £600 million a year and the number of managers within five years was higher than going into the reorganisation. I fear that this will be another case of “cut first, rehire later and call it efficiency”.

As the noble Earl, Lord Howe, has said, we need not simply rely on the words of noble Lords in this debate. The Darzi review, commissioned by the Government and updated in May, concluded that a top-down reorganisation of NHS England and ICBs is “neither necessary nor desirable” and added:

“Constant reorganisations are costly and distracting”.


We have had six statutory major reorganisations in 30 years, none with clear evidence that the restructure has brought about improvement. The Government commissioned that review; they should read it and learn from it.

I have six questions for the Minister. When will the target operating model be published, and will that be before Report? Is the latest thinking to put transferred NHS England functions and staff into the department, or will the Government set up a stand-alone body? Will the Government publish a full, costed impact assessment, including benefits, and explain where the £1 billion to £1.3 billion comes from? What are the expected costs of disruption, and how will any further delay be limited? Are the Government confident that the 50% cut will not drive up consultancy spending by the end of this Parliament? If the Government do not accept the amendment from the noble Earl, Lord Howe, will they commit to laying a transition plan before Parliament and before Report? In substance, that is what this amendment is asking for.

We on these Benches are not defenders of the status quo. I started in the NHS in the early 1990s and lived through more reorganisations than I care to count. Every one promised less bureaucracy and a freeing up of the front line; none delivered it. If the Government want to put NHS operational matters into political hands, that is their choice, but they owe this House a plan and then a price and then a Bill, in that order. At present we have a Bill and we are still waiting for the other two. I look forward to the Minister’s reply.

[Baroness Merron (Lab)]

My Lords, I am most grateful to the noble Earl, Lord Howe, for moving this amendment, and to the noble Lord, Lord Kamall, for tabling it. As other noble Lords have observed, it is comprehensive and thorough. It makes the point, which a number of noble Lords have made, about the importance of ensuring that the right processes and assessments are undertaken as we move towards the abolition of NHS England—one of the key things in the Bill. As we are at the beginning of our deliberations, I say to noble Lords that I listen, and have listened, very carefully to the points that are made. I will endeavour to answer a number of points, but I will take some away and write to noble Lords. As ever—and as noble Lords will recall from previous Bills—those letters will be available to all Peers, because I want to do justice to those points.

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I am most grateful to noble Lords who have engaged with me, through round tables and directly, and who have received the correspondence that I sent. I will be glad to continue to do that as we go through Committee and beyond. I reassure noble Lords that we remain committed to parliamentary scrutiny throughout the transition, and we will continue to publish updates as we move forward.

[Lord Scriven (LD)]

I asked one specific question, which the Minister may not be able to answer at this moment, but perhaps she could put it in writing. As the Minister has just pointed out to the noble Lord, Lord Stevens, is it the Government’s intention to transfer all the staff into the department or is a stand-alone body being looked at as a potential route for those staff?

[Baroness Merron (Lab)]

The intention is the former, but I will gladly write further to the noble Lord on this point.

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[Lord Lansley (Con)]

My Lords, I want to speak briefly in support of Amendment 211, in the names of the noble Lord, Lord Hunt of Kings Heath, and the noble Baroness, Lady Finlay.

I declare an interest in that I am an officer of the All-Party Parliamentary Group on Access to Medicines and Medical Devices, which has held meetings on the value-based procurement of medical devices. I chair a group looking at breakthrough implantable devices, which has taken an interest in the procurement of just the kinds of devices that the noble Baroness, Lady Finlay, was talking about and in the importance of clinical input to understanding the potential value of such innovative devices.

Some Members of the Committee will know that I have been an advocate of value-based procurement and, where medicine is concerned, value-based pricing as an approach in the National Health Service. There is some good work being done in the department on promoting value-based procurement; we just need to make sure that it is understood and implemented correctly. I have been worried by evidence from some early tenders that the attitude is that the assessment of value should be conditional upon the achievement of a pricing threshold. Sometimes the pricing threshold is set at a point where the calculation of potential value is effectively nullified. If we are serious about understanding value-based pricing, we cannot put in a pricing threshold. You may well attach greater or lesser weight to the pricing element, but you cannot attach a threshold and believe that you are implementing value-based pricing. Quite often, part of the value assessment is to look at issues of patient experience, the outcomes that are to be achieved, the long-term life of a product and how it is used, to arrive at the overall value of a product. This is perfectly normal in commercial procurement. I do not think we are talking about something that should be regarded as exceptional to the NHS. It should be something that is regarded as normal and best practice in procurement.

It is slightly dispiriting in a sense, as I have seen an awful lot of progress on procurement in the NHS. Some 30 years ago, I was working with Unipart—before I came into Parliament—in trying to encourage the NHS, for example, to have just-in-time delivery and barcode-based procurement. That was an awfully long time ago and we have progressed a long way. It seems to me that, if we are keeping pace with the best procurement practices —and I hope the NHS will do that—we should be looking at a value-based system. I very much support what the noble Lord, Lord Hunt, said about that.

[Lord Scriven (LD)]

My Lords, I speak for these Benches on this short but important group. I thank the noble Earl, Lord Howe, for the amendment on Supply Chain Coordination Ltd and the noble Lord, Lord Hunt of Kings Heath, for his important amendment on value-based procurement.

These amendments may look technical, but they go to something that matters in every clinic and every operating theatre: how the NHS buys what it needs and who is accountable when things go wrong. NHS Supply Chain manages an estimated £8 billion a year of NHS spending on products, and, since 2022, it has carried out the department’s PPE programme. Yet under Clause 2, its shares can be moved by a transfer scheme at the Secretary of State’s discretion. There is no requirement to tell Parliament where they are going, who will exercise the shareholder role, or how continuity of supply will be protected.

Asking for a plan first seems modest. If the pandemic taught us anything, as the noble Lord, Lord Hunt, suggested, it is that supply chain resilience is first and foremost a patient safety issue.

However, a report is not a safeguard in itself. The real risk is that the transfer happens in the middle of a reorganisation, cutting the central headcount by half. The very people who understand how the company works may be gone before the scheme is made. The National Audit Office found that Supply Chain Coordination Ltd was meeting only seven of its 18 key performance indicators and that trusts spend more than £3 billion outside it. A company with that record needs careful handling, not a transfer done in a rush.

On value-based procurement, we welcome the direction of travel. As the noble Lord, Lord Lansley, just pointed out, this is not novel. We do not even have to take his experience of Unipart as an example. We can look at value-based procurement elsewhere: in Denmark, Canada, Italy and even Indonesia. There are models which the Government could use to look at how it is done.

The national guidance published in June is a genuine step forward, asking what delivers the best outcome across the whole patient pathway, rather than simply what the cheapest price is. But with NHS financial pressures, the temptation will always be to grab the lowest price today, without the skills, the capacity, and a finance regime that rewards long-term value. So I ask the Minister: what thinking is being done, not just for the pilots but as part of the new powers that the Secretary of State will have from the transfer of NHS England, on rewarding long-term value in the financial regime? What changes, if any, will the Government make to the financial regime?

There is a wider point that both amendments expose. NHS procurement still sits apart from the rest of the public sector. When the Procurement Bill passed through this House, my noble friend Lady Brinton, with support from all sides, including from the noble Lord, Lord Hunt, asked why the NHS should be treated differently. She warned that the NHS arrangements were not visible and that they were

“SIs at the discretion of any Secretary of State for Health”.—[Official Report, 28/11/22; col. 1578.]

Today, we have one regime for healthcare services and another for goods. NHS buyers are told to take legal advice on how the new value guidance fits both. With NHS England abolished, all that discretion will sit with the Secretary of State, and my noble friend’s warning has become even more relevant.

Therefore, I ask the Minister four simple questions. First, where will the shares in Supply Chain Coordination Ltd go, and when, and will Parliament see the plan before the transfer is made? Secondly, what independent assurance has been commissioned on the continuity of supply during the transition? Thirdly, after NHS England’s abolition, who will own value-based procurement and make sure that it is built into national service frameworks? Fourthly and finally, will the Government now review whether two separate procurement regimes for NHS services and goods still make sense, or will they at least publish how the boundaries between them will be policed, once the Secretary of State holds the pen on both? These are modest amendments, asking for sensible things, and I hope the Minister can give the Committee reassurance.

[Baroness Merron (Lab)]

My Lords, I most grateful to noble Lords for their observations and the way they have dealt with this. At the outset, I pick up the point that my noble friend Lord Hunt started with and others, including the noble Baroness, Lady Finlay, developed further. We are particularly concerned with personal products and products that need to be personalised. The illustrations that noble Lords have given have been most helpful. The reason for the changes is to see more of that.

NHS: Agency Medical Staff

Lord Scriven Excerpts

Wednesday 9th September 2026 Lords Chamber

[Baroness Merron (Lab)]

Agency staff can cost the NHS more, which the noble Lord referred to. That is why we now have the agency price cap, which did not exist when agency spending rose completely out of control—for example, it stood at around £3.7 billion in 2015-16, because there were limited national controls. The agency price cap is the maximum amount that an NHS trust would normally pay for an agency worker. I do not quite recognise the situation that the noble Lord referred to on NHS staff, but I will take it away and check the situation.

[Lord Scriven (LD)]

My Lords, while the Minister talks about reduced agency spending, which is welcome, total temporary workforce costs remain largely unchanged, seemingly displacing into bank premiums, overtime and other insourcing. Will the Minister commit to publishing the total combined costs of flexible staffing, so that Parliament can judge whether taxpayers’ money is actually being saved or merely reshuffled within budget lines?

[Baroness Merron (Lab)]

I will certainly take away the points that the noble Lord raised, but I do not recognise his description of reshuffling, not least because the requirements on local health providers to reduce agency expenditure are quite clear. They have to report against them and drive further reductions. Those moneys are directed into front-line care. After all, that is what we all want to see.

People with Learning Disabilities: Acute Illness

Lord Scriven Excerpts

Monday 20th July 2026 Lords Chamber

Asked by

[Lord Scriven]

To ask His Majesty’s Government what assessment they have made of the recommendations in the National Confidential Enquiry into Patient Outcome and Death report Acute illness in people with a learning disability, published on 11 June; and whether they intend to ensure those recommendations are implemented by NHS Trusts.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, we welcome the National Confidential Enquiry into Patient Outcome and Death’s report and its recommendations. NHS England has circulated learning from the report across the health and care system for regional teams to share it with integrated care boards. NHS accountability arrangements are in place, and immediate improvement actions are under way, including the reasonable adjustment digital flag. The Government are committed to high-quality care for people with a learning disability.

[Lord Scriven (LD)]

My Lords, enough is enough. Currently, with everything in place, people living with a learning disability still die on average 20 years earlier than their non-learning disabled peers. The key missing part of the jigsaw is a statutory independent review of every such death, legally compelling NHS trusts and other providers to implement the improvements identified. Why are this Government content to rely on the toothless, non-statutory reviews that have changed nearly nothing, and allow this 20-year life expectancy gap to continue?

[Baroness Merron (Lab)]

I certainly accept the point, and I am not quibbling about the number, because 19 years, which is where we are now, is totally unacceptable. In addition, there is the high percentage of avoidable deaths, which I know the noble Lord is very alive to. While I share the view that this is unacceptable, I would not put it all down to reports. I can say that there are strong expectations of ICBs. As I have mentioned, they are kept to account, and we are continually ensuring that the death of every autistic person and those with a learning disability that is notified is reviewed. The new national-level patient dataset will certainly provide what I would call a single point of truth, which has not been there in the past.

--- Later in debate ---

[Baroness Merron (Lab)]

That is the reason for the accountability measures that I have outlined. I should add that transparency is absolutely key to that. The guidance that we have issued about supporting the identification of people with learning disability is important; we are at that basic level. That is where we have started, but it will push this forward. Further to my answer to the noble Baroness, Lady Finlay, the guidance for acute hospital staff, for example, included standardised mental capacity assessment forms; they were not in place previously. Each ICB is required, via statutory guidance, to have an executive lead on learning disability and autism.

[Lord Scriven (LD)]

My Lords, every question that has been asked has shown that the system is failing: people are still dying. The key point is that the accountability mechanism is missing or is too diluted to work. Why do the Government allow this system, which kills people early, to continue? What has the Minister not heard in this debate that assures her that the system is working and that it will somehow change for the better? Evidence and history tell us that the system is broken.

[Baroness Merron (Lab)]

I hope that I have already agreed with the noble Lord and others about the progress that needs to be made in this area. I have certainly not said that it is acceptable—it is far from acceptable—and the questions have been very helpful in identifying that. The learning disability improvement standards support NHS trusts to measure the quality of care that they provide. All the areas that I have suggested and more are taking us forward. I gave the commitment —and I mean it—to keep these things under review and to seek to improve wherever we can. We look forward to working with the noble Lord in doing so.

Pharmacy Closures

Lord Scriven Excerpts

Wednesday 1st July 2026 Lords Chamber

[Baroness Merron (Lab)]

That comes into the category of underserved areas, particularly if there are fewer pharmacies. I disagree with my noble friend about the overall picture in terms of pharmacies; we are supporting them to do more work, and a bigger range of work strengthens their position. It is not necessary to live right near a pharmacy, because of provision by online pharmacies. Finally, I repeat that local authorities can also seek to open pharmacies where there are underserved areas.

[Lord Scriven (LD)]

My Lords, community pharmacy has lost thousands of full-time pharmacists in recent years, and many have been recruited directly to other parts of the NHS that can afford to pay more. What more can the Government do to support community pharmacists to minimise this internal displacement and help keep vital local pharmacies open?

[Baroness Merron (Lab)]

This is an important point and why the refreshed 10-year workforce plan, which we will soon see, will deliver the transformation of the health service, which pharmacists are very much part of. We are also looking to support employers in offering a range of national training opportunities for pharmacists and pharmacy technicians. We need to train and upskill the current workforce, and invest in community pharmacy staff. Pharmacists are very important, but there is a whole team with them. Training will include independent prescriber training, clinical examination skills and training the next generation of education supervisors.

Healthcare Services: Acute, Primary and Community

Lord Scriven Excerpts

Thursday 25th June 2026 Lords Chamber

[Lord Scriven (LD)]

My Lords, it is always a pleasure to follow my noble friend Lady Walmsley; I will pick up on her final theme. I thank my noble friend Lady Janke for initiating this important debate. As the vice-chair of the APPG on Pharmacy, I think the case for extra investment has been made by both her and my noble friend Lady Leaman.

When the Government took office nearly two years ago, they came with a narrative of transformation. They promised people a fundamental shift away from the expensive, reactive walls of acute hospitals and toward a proactive, preventative “neighbourhood health service”. But looking at the NHS ledger of the 2026-27 financial year, they are forced to confront a recurring theme: the Government’s policy is built on hope while the NHS is living a different reality.

The Government stated their hope that primary and community care would finally receive the financial engine required to keep people well for as long as possible at home. The reality under their watch is that the gravitational pull of the acute sector is still as strong as ever, accounting for between 75% to 80% of total NHS spend.

The data from integrated care boards for the year ahead show this. Out of a combined £139 billion allocation, the total identified for neighbourhood health transformation activity is a measly 0.25%—and this is to fund the flagship policy of the Government’s health strategy. The reality is that local efforts to invest in community, primary and preventive services have been actively crushed by top-down directives prioritising acute hospital performance.

The Derbyshire, Lincolnshire, and Nottinghamshire ICB cluster tried to deliver the Government’s vision, with a £33 million fund dedicated to community transformation. Yet, within days of launching it, national performance directives forced it to withdraw the whole funding and redirect it to acute services.

The Government’s financial priorities are also written clearly in their capital budgets. They have earmarked £2 billion this year for acute emergency care, yet allocated only £200 million for their flagship neighbourhood health centres. When you contrast £2 billion for the emergency machine against the £200 million for new community infrastructure, their true priority is laid bare.

Nowhere is the gap between the Government’s rhetoric and reality more damning than in community support for learning disabilities. Over the past 24 months, we have witnessed the continuation of the systematic hollowing out of the infrastructure that keeps these people safe and alive. Evidence published only last week by the Royal College of Nursing exposes what is happening right now under this Government’s watch. In its report, Safety, Equity and Expertise, the RCN warned that the specialist learning disability nursing workforce is in absolute crisis. In autumn 2025—the first academic intake under this Government—we see a catastrophic collapse in the pipeline. Fewer than 500 student learning disability nurses enrolled across the entire UK. In the south-east, the intake was exactly zero.

The workforce is evaporating because community budgets are being raided. What is the human cost? For someone with a learning disability, there remains a shocking 20-year life expectancy gap compared with the general public. When the Government force ICBs to pull transformation funds and look the other way as the specialist nursing pipeline dries up, they engage in a false economy of the highest order. When a vulnerable young person loses their community safety net, they land, eventually, in an acute crisis bed. The taxpayer pays a premium for this systematic failure. This is not just a policy failure but a profound human failure which is all too real for my family.

Why have the Government spent the last two years forcing local health systems to continue to feed the acute vacuum? When will they finally align the reality of NHS budgets with the hope of their rhetoric?

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I congratulate the noble Baroness, Lady Janke, on securing a very important debate. I am also grateful to all noble Lords for their contributions. I recognise many of the challenges raised, which is exactly why we are taking the action that we are. I am glad that the noble Lord, Lord Evans, in particular welcomed the direction of movement, as have so many noble Lords, including the noble Baroness, Lady Pidgeon.

It is important that we look at where we started, because I think it reminds us of the scale of the challenge. It was the noble Lord, Lord Darzi, who made the point that we inherited an NHS facing the worst crisis in its history. We all know of people stuck on waiting lists for many years, staff who have felt let down by bureaucracy and little support, and patients who have had to navigate a system that all too often felt complex, disjointed and fragmented—the noble Baroness, Lady Brinton, spoke about literal navigation, which I thought was a key point. Not only was that the situation but we recognise that, while we are making improvements, there is some way to go, and I want to set that out at the outset.

I am grateful to the noble Baroness, Lady Lane-Fox, for talking of her own personal experience, and I can say to her that, yes, the patient is at the centre of all the reforms that we are making.

The noble Lord, Lord Darzi, found that society is getting sicker. People are living longer but in poorer health and with more complex needs. I should emphasise that that burden is not shared equally. The gap in healthy life expectancy has grown between the richest and poorest areas, and the model of care that was in place, which we are still seeking to change, while making progress, is working least well for those with greatest disadvantage, who are most likely to have complex needs. I agree that the system we inherited and are changing has been too hospital-centric, too detached from communities and too organised into silos. To the noble Baroness, Lady Lane-Fox, I say, yes, modern technology has transformed everyday life, and the scale of change certainly had not reached the National Health Service. We had a stark choice, as noble Lords know, and our response is reform

We also heard from staff and patients that they do not want the status quo. To agree with the noble Lord, Lord Scriven, people said that they wanted radical reform, and we have embraced that. I believe that the 10-year health plan responds to that, setting out the three fundamental shifts—hospital to community, analogue to digital, and sickness to prevention—with neighbourhood health at its very core. Our neighbourhood health framework, which was published in March, gives partners the clarity to develop locally led plans.

What is at the core of this debate is how to make that shift real. For the first time, the medium-term planning framework sets a target to reduce long waits in community health services, with at least 80% of activity to take place within 18 weeks by 2028-29. We are restoring GP access; to some of the points made about the important role, which we acknowledge, of the GP, more than 76% of people are now saying that it is easy to contact their GP, which is up from 61% when we came into office.

The noble Baronesses, Lady Brinton and Lady Gerada, and the noble Lord, Lord Scriven, all spoke of the importance of GPs. We are training thousands more GPs, and we are boosting capacity. From July 2024 to April 2026, we had more than 2,000 additional GPs; in total, we now have over 30,000, which is the highest number since 2015. This has meant that we have delivered 12.7 million additional GP appointments this year compared with last year, and I am grateful to GPs.

We are investing directly in the services that will make neighbourhood health possible, which was raised, quite rightly, by the noble Baroness, Lady Cass. I totally agree with her about young people having that voice, and we ensure that that is the case, but I know where to come should we need further assistance.

We have invested an additional £601 million in general practice, taking total GP contract investment to nearly £14 billion in 2026-27. A number of noble Lords, including the noble Baronesses, Lady Janke and Lady Leaman, spoke about the importance of community pharmacy, which I totally align myself with. That is why, to recognise that key role, we have given a 10% uplift, which translates to £340 million. Further on funding, as a number of noble Lords have raised, including the noble Lord, Lord Scriven, over £9 billion is being invested through the better care fund, and there is a commitment to deliver 250 neighbourhood health centres, for which the first 27 sites have already been selected.

This is not just a vision, but vision is important: one of continuous, accessible and integrated care, centred around the patient, which prevents ill health, intervenes earlier and gives people more control, by 2035. I understand the wish for pace, and I share it, but we also have to be realistic. There is a reason it is a 10-year health plan: it is not so we wait but so we have a plan that will transform the model of elective care.

Many interactions will no longer take place in a hospital building, but they will be able to take place. The noble Baroness, Lady Lane-Fox, asked whether we are using technology to the best advantage; the NHS was certainly way behind where it should have been, but we are moving towards that, because interactions will be able to take place virtually or through neighbourhood services closer to home. We will see the first NHS online hospital, the development of the NHS app—which has already greatly improved, as many of us know, as patients access care, information and appointments more responsively through their phones—and, by 2035, two-thirds of out-patient care will take place digitally or in the community. Central to that will be the single patient record, which I look forward to coming to when we receive the Health Bill.

General practice will remain at the heart of neighbourhood health. I heard what the noble Baroness, Lady Gerada, said. We are introducing two new at-scale contracts—the single neighbourhood provider and the multi-neighbourhood provider—to support GPs and partners to work against larger geographies. I recognise the pressure on GPs. We are working with GPs to assist them in their effectiveness and in the way in which they serve patients. Integrated health organisations will take responsibility for local population budgets. They will support integration and move resources to where they have the greatest impact.

Key within this debate, and raised in particular by the noble Baronesses, Lady Pidgeon and Lady Gerada, the noble Lord, Lord Scriven, and other noble Lords, is funding. We know the importance of ensuring that investment supports the shift from hospitals to communities—and I say to the noble Lord, Lord Evans, that that will include mental health as well as primary care and neighbourhood care. The 10-year health plan sets out an operating model that shifts power from the centre to local commissioners and providers. As I mentioned, ICBs and providers are developing medium-term and multiyear plans through the medium-term planning framework to show how they will use funding in line with the priorities.

I assure noble Lords that ICB allocations give greater growth to community rather than acute services to support the community transformation that noble Lords and I seek and to support neighbourhood health. We will continue to set those national expectations, and we will support that by changes to system incentives, such as financial flows. I hear the call for ring-fences, which is often made. It is a legitimate challenge, but they do not by themselves guarantee better outcomes. Our approach is to set national priorities and accountability, as well as enabling ICBs to use funding flexibly, because they are best placed, as we know, to meet local need and secure best value.

[Lord Scriven (LD)]

My point was that flexibility is taken away when national directives come down, forcing ICBs to spend money on acute and emergency care.

[Baroness Merron (Lab)]

I always appreciate the expertise of the noble Lord, but I have set out our approach. We are focusing on outcomes and the best way to achieve them. We keep them constantly under review and discussion, so it is not top-down but how we are going to get to the place that all noble Lords want us to get to.

I know that I will be able to refer to only a limited number of questions, and I hope noble Lords will forgive me. The noble Baroness, Lady Walmsley, raised dental deserts. We are offering incentives to attract dentists under the golden hello scheme, which is what it says on the tin. Importantly, we are also increasing the supply of dentists. We have just announced the first sustained expansion of dental school places since 2007. The noble Baroness, Lady Walmsley, also asked about progress being made on publishing health food standards and the consultation. I acknowledge her particular interest and expertise. We will soon be consulting on the proposals for healthier foods targets and reporting. Importantly, we remain on track for delivering on this 10-year health plan commitment in this Parliament. If the noble Baroness would like further information, I would be very happy to obtain it for her.

The noble Lord, Lord Evans, asked about milestones that will be used to ensure that the shift from hospital to community is taking place, which is important. That is why we have published the Neighbourhood Health Framework, which will ensure that accountability. I am very alive to the points he made about mental health services, and I am sure that he welcomes the mental health strategy that will bring together all the points. I am very enthusiastic about the fact that we are piloting community-based mental health centres. I was glad to visit the one in Birmingham, which totally persuaded me of their value, but we must of course wait for the evidence.

I know that noble Lords know that the NHS that we inherited was under intolerable pressure. We have chosen reform, we have invested, we are rebuilding access, we are enhancing digital tools and we will deliver an NHS closer to home that is more preventive, joined-up and equal. That is the way we will take the NHS into the future.

Puberty Blockers Trial: Consent

Lord Scriven Excerpts

Thursday 25th June 2026 Lords Chamber

[Baroness Cass (CB)]

My Lords—

[Lord Scriven (LD)]

My Lords—

[Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)]

My Lords, we will hear from the Liberal Democrats.

[Lord Scriven (LD)]

My Lords, the review from the noble Baroness, Lady Cass, warned that having no formal medical routes risks driving families towards unregulated online pharmacies and private clinics abroad. Given that an indefinite pause of the trial left some highly vulnerable young people in a state of clinical limbo, does the Minister agree that getting an evidence-gathering trial under way would be an effective way to protect them from the dangers of these unregulated and unmonitored markets?

[Baroness Merron (Lab)]

I certainly do agree. As I have said, having put a ban in place, we will take action against those who seek to transgress and benefit from it by seeking to sell drugs that are not permitted. That is a totally unacceptable route for them to follow. They risk the safety and well-being of children.

PATHWAYS Study: Puberty Suppression

Lord Scriven Excerpts

Wednesday 24th June 2026 Lords Chamber

[Baroness Merron (Lab)]

I will approach this in the most straightforward way I know. Obviously, if there are other matters, I would be very happy to talk to the noble Baroness, as I have before. From my point of view, the number one safeguard is not an either/or. Participation can occur only with the consent of a parent or guardian and—not or—the child themselves. In some of the circumstances the noble Baroness raised, that will not be an issue. Clearly, if there is any doubt about consent, assent or suitability, the child or young person will not be included in the trial; it is only where it can be shown that all the safeguards apply.

[Lord Scriven (LD)]

My Lords, I listened very carefully to both sides of the argument, which is very emotional and charged because people hold strict views on the trans community or the risks to children. Without the clinical trial, where will we be? Is not the clinical trial needed to answer some of the very questions that have been asked?

[Baroness Merron (Lab)]

The noble Lord takes me back to where I started. This Government, any Government, have a choice, but there is no neutral option here. We know that the status quo—which the last Government accepted and the noble Baroness, Lady Cass, clearly identified—is totally unacceptable and young people are not being protected. It would not be responsible to do nothing about that. We can discuss and disagree or agree about what the right thing is to do, but in his Statement, the Secretary of State made it clear that he has a responsibility to look at evidence and take clinical advice. That is the right thing to do.

Resistant Hypertension

Lord Scriven Excerpts

Wednesday 24th June 2026 Lords Chamber

[Baroness Merron (Lab)]

As my noble friend says, we have had great success, and it has really helped us to have pilot projects in other areas such as mental health services. I ask my noble friend warmly to anticipate the modern service framework, because that will set out how we are to go forward in this regard.

[Lord Scriven (LD)]

My Lords, following on from my noble friend’s question and the Minister’s answer, there is no definition in the department of preventable spending. Will the new modern service framework determine a definition of what preventable spending is so that it can be tracked over time to see whether prevention is becoming the norm?

[Baroness Merron (Lab)]

The modern service framework will focus on the cardiovascular disease pathway. I take the point that the noble Lord is making and assure him that, as he and the House will be aware, one of the three main pillars in the 10-year health plan is the move from sickness to prevention. Therefore, we will be looking at how we ensure that it delivers the results that we need. The modern service framework will be focused on consistent high quality and equitable care—in other words, on outcomes.