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.