Health Bill

Baroness Barker Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, I will speak briefly on this group of amendments because they have an impact on amendments that I have in other groups. I read with interest Amendment 45 in the name of the noble Baroness, Lady Coffey, which seeks to ensure equitable palliative care regardless of wealth or geography. I am not entirely sure whether disability would be included in this, but I am keen that disabled people are not forgotten in the Bill.

Last week I spoke to an organisation that works with wheelchair users. It was a very worrying conversation about the impact on general NHS services and specialist services from changes in spinal units and the support they give people who have had a traumatic accident, and about the lack of accessibility to a number of services that we take for granted, particularly breast cancer screening and smears. A number of disabled women have been in contact with me to say that they have been refused those basic treatments because they are disabled or because of the inaccessibility of the machines. I have had to have several mammograms over the years, and the machines are just not designed for somebody who cannot stand. Last time I had one, three nurses had to lift me up into the machine, which was not particularly easy or useful, but they managed to make it work for me. I am worried about the number of people for whom it is not made to work, who might end up in palliative care services far earlier than they need to because of the lack of treatments they are able to access. The postcode lottery is layered on top of that. I am keen that there is a real understanding of the quality of life of disabled people as part of this, to ensure that they get the right support at the right time.

It is really difficult to discuss this Bill without mentioning my recent experience of three stays in hospital since August. The first and second times, I had cellulitis. Interestingly, the papers that I took home with me when I was released the second time had my DNAR status on them. Luckily, it said “no”, but it was interesting that that was not discussed with me; I would not have expected to have that discussion, based on the condition I had, but a number of disabled people worry when their DNAR status is put on their documentation with or without a discussion.

That leads to Amendment 230 in the name of the noble Baroness, Lady Pidgeon, and the conversations it would require. Whether it is one conversation or many, it is about making sure that the right time is made available so that they are properly carried out. In this group, I am keen to focus on the specialist aspect of palliative care: it is about not just generalist education but making sure that we are absolutely able to raise the bar for the specialist palliative care that is available to everyone, to make sure they get the right support at the time they need it.

[Baroness Barker (LD)]

My Lords, like the noble Baroness, Lady Morris, I spend a lot of time sitting on the Woolsack. I did not take part in the debates on the assisted dying Bill; I could not, because I was caring for somebody who, as I said at Second Reading, died in June. I am actually very pleased that I did not take part, because I do not think that I could have done so with the composure required. I listened to a lot of the debates, and that Bill did a substantial amount of damage to this House in many ways.

One of the things it did was to damage the reputation of the House among carers’ groups, because several speeches on that Bill really denigrated carers—“some carers”, I imagine the people who made those speeches would say—leaving the impression that many in this House believe that carers can be unfeeling and mercenary, without any evidence to substantiate that. When we go on to look at what happened with that Bill, as we must, we will need to think carefully about things like that.

I say that because my experience and the experience of my wife was completely different from that. My wife was diagnosed with a condition that she knew would be terminal. At the point that that happened, she made her advance choice direction and she stuck to it; she did not want to be resuscitated. My experience and hers—she was always in charge, as far as I was concerned—was that every healthcare professional she came across asked her about that. They did not argue about it but, time and again, they asked her whether she still wanted it. She was quite clear; her statement was as clear as it could be. Yes, she would be treated for something that was treatable and could be reversed but, no, she did not want to be revived if she was dying.

--- Later in debate ---

[Baroness Gerada (CB)]

My Lords, I also welcome the amendment tabled by the noble Baroness, Lady Shawcross-Wolfson. I will speak to Amendment 253, which is in my name. Before I do, I will say that when I started in general practice in 1991, 80% of the GP workforce were men. We now have a reversal of that, so part of the issue is the feminisation of the GP workforce. Women get pregnant and care for small children and our elders. This was predictable. When I was a GP leader, I said that we needed to replace every retiring male GP with 2.4 GPs—men and women, for various reasons. Nevertheless, I digress.

I will speak on district nurses, who are our generalist practitioners in patients’ homes. I will paint a little picture. It is a wet Tuesday evening in November and somewhere in a village, town or city near any of us a district nurse is parking outside a terraced house. Inside is an elderly man with a leg ulcer that will not heal. Down the road there is a woman with diabetes who cannot manage her insulin on her own. A few streets further on a family is sitting with their mother in her final days, frightened and exhausted. The district nurse is the only one who can put up a syringe driver. This district nurse will visit them all. She will dress their wounds, check their blood, ease their pain and hold their hands. Tomorrow, she will do it again. District nurses are there every day of the year, in every corner of this country, at almost every hour of the day and night.

Successive Governments have promised to shift care out of hospitals and into the community. This Government have done the same, and I welcome that. But that shift will be extremely difficult without district nurses. They are not an optional extra; they are the linchpin. Neighbourhood health without district nurses is a building without a foundation. As the Nursing and Midwifery Council has said, district nursing is key to the achievement of the shift in healthcare that this Government seek.

I will remind your Lordships of some of the figures—we have heard a lot of figures today, so I will cut them back. According to analysis by the Nuffield Trust, in 2009 there were some 7,600 full-time equivalent district nurses in the NHS. By 2024, there were 4,322, a fall of 43%. Put simply, for every seven district nurses we had in 2009, we now have four. Over the same period, the number of adult nurses working in hospitals rose by 43%. The contrast is striking. We have said that we want care closer to home, but our workforce has continued to develop in favour of the hospital.

Some will say that this is an artefact of how we count the data because, around 2011, some community services moved to voluntary and independent providers, and some district nurses consequently stopped appearing in NHS figures. That is true, but it does not explain a decline that has continued over 15 years. The picture is even more concerning when we take population growth and ageing into account. On that basis, district nursing has fallen by 55%. The decline is continuing. The Care Quality Commission’s latest State of Care report found that the number of qualified district nurses fell by a further 5% between 2024-25 and 2025-26.

The problem is not just numbers; there is also the question of skills and experience. More than one in four of those recorded as district nurses are employed below band 6, which is the grade at which qualified district nurses would normally start. So we are losing not just numbers but the expertise on which this whole community service depends. What does this mean for patients? When district nurse teams are stretched, the first things to go are the things that matter most and are seen least: psychological support, prevention—such as looking at trip hazards and adequate lighting—and continence care. That care is now too often delivered less well, not delivered at all or pushed on to services that are already at breaking point. Investing in district nursing is not simply an investment in better care; it is an investment in preventing avoidable deterioration, unnecessary hospital attendances and expensive admissions.

The pressure is set to increase further. The Nuffield Trust estimates that the demand for district nurses could rise by 34% by 2040, based on the projected population numbers. So demand has grown but the service has contracted. This is not a failure of district nurses, who have held the line with extraordinary dedication. It is a failure of planning, as we have heard, as well as priorities and political will. That is exactly why this amendment matters. We cannot keep promising to move care into the community without first asking how many people we need to deliver it.

District nurses are indispensable. We cannot deliver neighbourhood health, safely shift care out of hospitals and provide dignified care at home without a properly trained and adequately staffed district nursing workforce. We know what happens when plans fail, and we will see the numbers of patients admitted to hospital. My question to the Minister is: will the Government commit to assessing the number of district nurses needed to meet current and projected demand, identifying the shortfall and setting out a funded plan to address it?

[Baroness Barker (LD)]

My Lords, I will add to what the noble Baroness, Lady Gerada, said. A very high percentage of our district nurses come from other countries. Therefore, what will the Minister do, talking to the Home Office, about the supply of district nurses that we will undoubtedly need in the future?

I will make one or two brief points, following on from what the noble Baroness, Lady Harding, said about planning. If any member of the Committee has spoken to anybody currently employed by an ICB, they will know that seared in their minds is the date on which they were told, about 18 months ago, that their jobs were going to go. For the last 18 months, they have continued to work under that threat. I do not know any other employer that would do that to a workforce and expect to retain it. I talked to members of staff who work for ICBs. I had the misfortune to ask them, “How are you?”, and 25 minutes later I knew how they were—it was not good. I rather suspect that the biggest demand for mental health services at the moment is coming from members of NHS staff, because they have been living with this uncertainty for 18 months.

I am not being flippant but, if the Minister cannot share great detail with us, can she at least tell us the Government’s working assumptions about the number of staff there will be in the future who are members of ICB staff now? I suspect that the attrition rate will be enormous, especially given the age profile of some members of ICB staff, in particular, who have built up specialist expertise over many years. Secondly, what working assumptions are the Government making about members of staff, particularly nursing staff, who will move out of the acute sector and into the community?

[Baroness Pidgeon (LD)]

My Lords, since taking over as our spokesperson, I have lost count of the number of times the Minister has talked about the workforce strategy that will at some point emerge from the department. I am not sure whether we will be given a season this evening, but hopefully it will be published soon.

My Amendment 253, which the noble Lord, Lord Stevens of Birmingham, and the noble Baroness, Lady Gerada, have added their names to, would require the Secretary of State, within 12 months of Royal Assent, to publish

“a health and care workforce strategy for England”.

I have included “care” on purpose because the two are so importantly linked. It must assess the staff needed to meet current and projected demands, expressly including registered nurses and primary care practitioners, and it must contain a funded plan to close staffing gaps. Annual progress reports would be laid before Parliament, keeping that issue on the agenda for us all. Putting staff in is an important marker too. We need to properly plan and invest in our workforce, both health and care, hand in hand.

The Royal College of Nursing supports this amendment, as do a number of representatives of primary care. Too often, primary care seems to be forgotten in the debate on workforce, but it is critical: GPs and district nurses—we have just heard passionately from the noble Baroness, Lady Gerada, about their role—as well as optometrists, dentists and pharmacists. As the Government look to shift services into neighbourhoods and hospitals—something I think we all support—this is really important. The early years workforce is important as well, as are health visitors.

The other amendments in this group, including that of the noble Baroness, Lady Shawcross-Wolfson, all require similar reports, perhaps on different timescales. Some are focused on really important areas such as the mental health workforce, the education and training that is needed alongside a workforce plan, and continuing professional development. Noble Lords have flagged the current vacancy rates in a number of roles, as well as skills shortages and the need for independent scrutiny of the workforce plan.

My noble friend Lord Scriven rightly stressed, using his personal family experience, the need for nurses for people with learning disabilities and the investment in that workforce, as well as the need to understand the whole workforce, looking at models in, for example, the Netherlands. The noble Lord, Lord Stevens, and the noble Baroness, Lady Gerada, talked about the complexity around primary care and the challenges with part-time workers, with perhaps more women coming into the workforce, as well as the challenges of work-life balance. Some people want to work part-time rather than full-time. These are key questions for the Government on this issue of workforce. I look forward to a comprehensive response from the Minister, and possibly a date, a season or a hint of when we might at last see that workforce strategy.

Health Bill

Baroness Barker Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[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.

[Baroness Barker (LD)]

I thank the noble Baroness, Lady Merron, for that very detailed and thorough answer. Can I just check that, in the midst of what she said, she made it clear that NHS staff and NHS providers are under a legal obligation to ensure that all the protected characteristics under the Equality Act are treated properly and with respect?

[Baroness Merron (Lab)]

They should absolutely have regard to the law in respect of protected characteristics. That is the fullest answer I can give at this moment.

Health Bill

Baroness Barker Excerpts

Committee stage
Monday 9th November 2026 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I am grateful for the debate that we have just had. With permission, I will address whether Clause 10 should stand part of the Bill, look at the amendments to it and refer to those things together.

As a number of noble Lords have rightly emphasised, we are indeed committed to a National Health Service that is free at the point of use. Noble Lords will be very familiar with the changes that we are making to ensure that patients are at its core, and that they find that the system works around them, rather than them having to work around the system. We see that throughout the 10-year plan. For many years, this has included the provision of NHS-commissioned services by charities and the not-for-profit and independent sectors, as referred to by the noble Baroness, Lady Murphy, the noble Lord, Lord Kamall, and my noble friends Lady Nargund and Lord Hunt, to mention a few. The fact is that all these sectors make a valuable contribution to the health of the people whom we serve. We should acknowledge that, but I think we should also celebrate it.

Clause 10 prohibits the Secretary of State using their functions deliberately to shift the balance between types of providers. It strengthens and extends Section 12E of the National Health Service Act 2006 to any health service function of the Secretary of State and applies to all providers, regardless of legal form—to answer the point raised by the noble Lord, Lord Kamall. The clause does not enable privatisation or nationalisation by the front door, the back door, the side door or indeed any door that we can think about. It is a general prohibition, with one exception: where the Secretary of State considers that to act differently is in the interests of the health service.

As to why we need that, currently under Section 12E, a Minister who sees a service failing and concludes that bringing it into the NHS is in the interests of the health service could not act. Equally, Ministers could not deliberately bring in charitable or independent providers to end a risky overreliance on a single NHS trust; nor could they see an entire sector dependent on a few external providers and choose to build more public capacity for the long term—something that noble Lords rightly would encourage—because such purposes are always prohibited, even though the outcomes can be beneficial.

Clause 10 enables Ministers to act when the interests of the health service require it. We expect Parliament to hold Ministers to account in doing so. I say to the noble Lord, Lord Stevens, and my noble friend Lord Hunt that Ministers, in their duty to promote a comprehensive health service, have a duty to act reasonably and rationally and, as I say, to be held to account for doing so.

The noble Lord, Lord Patel of Bradford—

[Baroness Barker (LD)]

I am trying to follow very closely what the Minister is saying. Am I right to take it from what she said that under Clause 10, an acute hospital trust could be moved to the private sector if the Secretary of State decided that that was in the best interests of the health service? Is that possible?

[Baroness Merron (Lab)]

At the risk of repeating myself, as I have said, the judgment is about acting reasonably and rationally and about whether it was fulfilling its duty. It would also be—I know that I am repeating myself, but it bears doing so—accountable to Parliament for its decision.

The noble Lord, Lord Patel of Bradford, raised a question—

--- Later in debate ---

[Lord Patel of Bradford (Non-Afl)]

My Lords, I support Amendments 42 and 44, tabled by the noble Baronesses, Lady Tyler and Lady Watkins, and introduced very clearly by the noble Baroness, Lady Pidgeon, which make the Secretary of State’s responsibility for social care more explicit.

I approach these amendments from my experience in social work and as a former chair of the Mental Health Act Commission. I hope that with that example I might illustrate the point of view of the noble Lord, Lord Scriven, about things not fitting neatly. The noble Earl, Lord Howe, will remember, perhaps fondly, that during the passage of the Health and Social Care Bill in 2011-12, I argued strongly for preserving the protections of Section 117 of the Mental Health Act. We returned to that and those issues during the Care Bill debates in 2013. The principle at stake was straightforward: a person leaving psychiatric hospital after detention may need treatment, somewhere suitable to live, help with everyday life and support to build relationships. Those needs do not fall neatly into separate health and social care boxes. Section 117 recognises that through a joint duty on the NHS and the local authority to provide or arrange aftercare for eligible patients free of charge. Its importance lies in requiring organisations to take responsibility together for the support a person needs.

That clarity remains important because those difficulties are not new. During the 2012 debate, findings from the Local Government Ombudsman showed that some local authorities had unlawfully charged for Section 117 aftercare or ended arrangements without proper consultation. More broadly, responsibility and funding could be disputed between the NHS and local government, leaving patients and their families caught between them. These concerns underlie the need to preserve a clear and enforceable joint duty. The House returned to those issues during the passage of the Mental Health Bill in 2025, which the Minister took through this House. I welcome the provisions clarifying responsibility for aftercare, requiring joint written notice when it ends and strengthening human rights protections for people receiving Section 117 aftercare from registered private providers. I pay tribute to the noble Baroness, Lady Barker, for pressing those human rights issues.

Those were important advances. The question now is how those protections will translate into dependable support in people’s lives. Section 117 illustrates why the amendments before us matter. Parliament has recognised that some people’s needs require health and social care to act together. Making the Secretary of State explicitly responsible for social care would help Parliament hold Ministers to account for how those services work together in practice. As the recent mental health reforms are implemented, how will Ministers know whether joint aftercare arrangements are working? Will oversight examine whether people receive the full package of support they need, whether disputes about responsibility or funding delay care and whether gaps in community provision prevent a safe discharge? Where those arrangements fail, how will the Government ensure that the responsible organisation puts matters right? A patient may have a carefully prepared plan, but that plan must lead to services being available and delivered. Families should not have to negotiate repeatedly between the NHS and local government social care to make that happen.

Section 117 concerns a particular group of patients, but the lesson is wider. Social care is essential to people’s independence, dignity and recovery. It deserves clear responsibility at national level and effective joint working locally. I support these amendments because they would make that national responsibility explicit.

[Baroness Barker (LD)]

My Lords, as I said at Second Reading, I have spent a lot of time over the last five years with people who are caring for people with severe neurological conditions. I want to tell one story, because I think it is the apposite, right moment to do it.

I know a carer who cares for her elderly mother, who has a very rare neurological condition. Her mother also has dementia—I do not know whether that is part of her condition or whether it is unrelated. With the assistance of their very supportive GP, she managed to get her mother an appointment at an acute hospital for a physical procedure. The carer got her mother to the hospital, which is no mean feat when somebody cannot move or stand, has to be taken in a wheelchair to get there and would have had to be hoisted on to a bed had things gone as they should have. When they got there and started to talk to the doctor, the doctor queried the fact that the mother could not consent to the procedure. She could not consent to the procedure because she had dementia. Because the carer could not at that moment produce evidence of an LPA, which she did in fact have, the procedure did not happen.

I was thinking about that this morning when I was sitting in an NHS waiting room and I looked at a sign that said, “If you don’t turn up for an appointment, that costs money”. Well, having systems that are so disconnected and acute hospitals that believe they are the be-all and end-all and do not understand that the majority of caring happens before somebody gets to their door and when they leave, is one of the most expensive ways of treating individuals. We will go on to talk about corridor care and all of that.

I listened with great care to what the noble Baroness, Lady Ritchie of Downpatrick, said. She talked all the way through about dementia services. The majority of health treatment for people with dementia will not be dementia services at all. It will be all the rest of the services they need: everything from dentistry onwards. So we cannot focus just on data in dementia services. We need all sorts of things. We need changes to the forms that people have to fill in before they go for assessment, so they can put down the fact that they have access needs and so on. That was the result that came out of that, because the carer just about lost it and was articulate enough to go and see somebody and say, “This is wrong”. They have actually changed the admission forms for that.

We need a wholesale cultural change throughout acute care if we are to cope with dementia, or else we are all going to break.

[Lord Kamall (Con)]

My Lords, I am grateful to noble Lords for bringing forward this group of amendments. They raise a number of important questions about the future of social care, ministerial accountability and the support available to those who depend on care services. Of course, although the previous Government proposed an integrated health and social care service, the British people decided not to give us a chance to deliver it. Therefore, when a new Government came in, they decided they were going to have a separate national care service. That deserves a number of questions to be asked. I fully respect the fact that there is a commission at the moment, but we do not seem to be getting much detail. We also know that you cannot fix healthcare until you fix social care, which is one of the many reasons why I tabled Amendment 180, and I will focus some of my comments on that.

We on these Benches recognise the importance of reforming the social care system. We understand all the reasons behind the proposal for a national care service: to raise the profile of social care, and to do many of the things that the other amendments in this group suggested to do so. To answer one of the questions from the noble Baroness, Lady Thornton—I feel like a Minister again, just as the noble Baroness, Lady Bennett of Manor Castle, did, but on the other side; I am happy to rehearse that if we are ever back in government—we will support the Government where they demonstrate that their proposals are affordable, sustainable and deliverable. We are not going to oppose for the sake of opposition. I hope the Minister will recognise that, as an Opposition, we have always tried to be constructive, particularly when it comes to health and social care.

While we welcome the Government’s ambition to improve social care, as I said, we remain concerned by the lack of detail. We have been told that the groundwork for this service will be laid during this Parliament and its establishment will take place in the next one, yet we know remarkably little about how it will operate in practice, what it will cost, whether the end of the triple lock will provide enough money to fund it and what it will mean for those delivering care.

All that Amendment 180 would do is require the Government, within six months of the Bill passing, to set out some intended functions and the scope of the national care service. We are not asking for a detailed funding plan for the next 15 years or anything like that—we just want a little more detail. This is a probing amendment to tease out a bit more detail from the Government and, hopefully, help them to clarify some of their thinking around social care and what the national care service means. What will the functions and scope of the national care service be? We are not yet clear about that. What about its relationship with the NHS? We are going to have not an integrated national health and care service but a separate national care service, so what does that mean for the interface between the National Health Service and the national care service? What about its proposed commissioning arrangements, its estimated costs and its sources of funding? As the noble Lord, Lord Scriven, said, what we are really asking is how it will all fit together. It is as simple as that.

My concern is affordability. The Government have indicated that the money will come from changes to the state pension triple lock, but that is not the same as providing an implementation plan. Has any assessment been made of what this new service would actually cost, what proportion of that cost will be met by central government and what responsibilities will remain with local authorities? We do not need a commission to answer some of those questions.

There is an important question about whether the savings anticipated from the triple lock will materialise in time to meet the ramp-up costs of establishing a national care service. As the Minister will appreciate, major reforms of this kind usually require an awful lot of up-front investment and then, in time, the annual costs hopefully will stabilise once the infrastructure and systems are in place. Is the Minister yet in a position to tell us whether the Government are confident that we will have sufficient funding available when it is needed? While I admire optimism, it seems to me rather optimistic to assume that the cost of establishing an entirely new service will neatly coincide with and be offset by the savings arising from the changes to the triple lock.

We must also be clear about what services the national care service will actually provide. We know that free personal care is not the same as free social care. Residential accommodation, nursing provision and other essential forms of support can represent substantial costs for individuals and their families. While the Government have provided some welcome clarification on accommodation costs, important questions remain on eligibility, the precise scope of support and the position of working-age adults who currently have care needs.

My second concern is the future of existing care provision. Our social care system is supported by a remarkable range of providers, charities, social enterprises, mutuals, co-operatives, family-run businesses and independent care providers, and they all provide essential services, often with deep roots in the community they serve. We welcome the Minister’s recent recognition that there will continue to be a role for different types of provider and that this will be commissioned at the local level, but we need to understand how that commitment will work in practice. Once again, is the Minister in a position to tell the House what the establishment of a national care service will mean for these existing organisations? What about the relationship with local authorities? Will that change?

As the noble Baroness, Lady Pitkeathley, said, there are important questions about the workforce. We all recognise the important dedication of those working in social care, as well as the millions of unpaid carers who provide indispensable support to their loved ones. We welcome the efforts to improve pay, training and career progression, but these commitments will have to be met with a credible assessment of their costs. In establishing the NHS workforce plan, will there be a corresponding national care service workforce plan? How will these two things fit together?

Health Bill

Baroness Barker Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

I have three questions for the Minister. Will the regulations under new Section 250E provide for reserve service to be recorded within the single patient record? Will the Government publish the findings of the reserves medical readiness summit? Given that new Section 3B expressly includes the Reserve Forces, does the department accept that service status is already a lawful consideration in the commissioning of services? I would welcome a meeting with the Minister and officials before Report. I look forward to the Minister’s reply.

[Baroness Barker (LD)]

My Lords, I have shared with the House the experience of caring for somebody with a very rare neurological condition. It was because of that that, a few days ago, I went to the meeting that the Minister was good enough to organise with people from NHS England, where we discussed this very topic with them. I think they were meant to assure noble Lords that the transition from NHS England to ICBs would be a step forward, but they did not—they really did not. I echo the point made by my noble friend Lord Scriven that we are still awaiting the detail on those 150 conditions that are currently commissioned by NHS England, 70 of which will supposedly be transferred down to ICBs, and how that will work. I know people who work in ICBs and have a great concern that, because they have been left in limbo about their employment status for so long, there is a haemorrhaging of staff out of those bodies. I do not know whether there will be the clinical experience and corporate knowledge within those bodies to take on the enhanced commissioning role.

I just want to pick up on what the noble Lord, Lord Lansley, said about continuing healthcare. If noble Lords think that SEND is a scandal, they have not paid any attention to what is happening in continuing healthcare. People who have complex conditions, from which they are never going to get better, get shoved around, batted back and forth between social services and particularly the health service, like hot potatoes. The summer before last, an edict went out that lots of people had to be assessed for continuing healthcare. They never got it. There was never a hope that they were going to get it. They just had to go through a cynical process that somebody thought up centrally and shoved down the line. I went through it—we went through it—and I know other people who went through it.

I wish the Minister could have been there to listen to those people as they said, “I can cope, but the NHS—that’s going to break me”. The continuing healthcare system is an utter scandal. I am really glad that the noble Lord, Lord Lansley, has begun to shine some light on it.

[Baroness Pidgeon (LD)]

My Lords, this has been a really interesting and important debate, trying to tease out many of the issues and concerns with specialist commissioning in the new structures set out in the Bill, and the worries about ICBs—their capability and capacity—and the access to services across the country.

I have two amendments in this group, which I will try to talk to briefly. Amendment 59, to which the noble Baroness, Lady Cass, and the noble Lord, Lord Hunt of Kings Heath, have added their names, seeks to require the Secretary of State to have regard to the specific needs of children and young people when considering devolving responsibility for specialist commissioning services. This has wide support across the sector.

Children and young people make up around 20% of the overall population. Therefore, commissioning arrangements designed at a scale for adults just do not work for the small scale required to be effective for children. Many children are dependent on specialist commissioning, and it is essential for the provision of care for rare diseases and complex conditions, such as childhood cancers. Children are disproportionately affected by rare diseases: 75% manifest in children. The benefits of specialist commissioning being centralised and co-ordinated at a national level are clear, given the small number of patients.

The Health Bill’s direction to split commissioning is of huge concern. There is huge uncertainty out there. We have been in this position before because specialist commissioning, as was mentioned earlier, had been devolved to primary care trusts. They experienced many of the concerns that have been raised today. The previous report by the noble Lord, Lord Carter, recommended that specialist commissioning should be overseen at a national level. We need to learn the lessons from this and not repeat the same mistakes. I hope that before any delegated arrangements are made for children and young people’s specialised services, full consideration is given to the impact on those services.

The other amendment I have in this group is Amendment 279N. I still cannot believe that access to IVF treatment is not equal across the country. Your chance of being able to have a baby is decided by NHS bureaucracy and where you live, rather than clinical guidance and your health. You can have people living in roads next to each other and they can have one round of IVF or three rounds of IVF, despite NICE having recommended three rounds of IVF. We have seen the provision continuing to be reduced. Kent and Medway cut its services earlier this year from two to one and also lowered the age when someone can have treatment from under 40 to under 38. Sussex slashed its services last year from three cycles to one, and now all 10 boroughs in Greater Manchester are reduced to one. Only two of the 38 ICBs offer the NICE-recommended number of three cycles of IVF. Fertility challenges affect one in six people. The physical and psychological impact is huge.

I know the Minister is hearing all our concerns that we keep raising throughout the Bill. I do not feel we are getting much back from the Minister. But surely this is one area where there might be some movement. I urge the Government to look carefully at this and the other amendments in this group. I look forward to the Minister’s response.