Health Bill

Baroness Cass Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Lord Young of Cookham (Con)]

My Lords, I will speak to Amendment 224 on a duty to promote public health. When the Government came into office, they said they had three priorities:

“hospital to community … analogue to digital … sickness to prevention”.

I want to focus on the last. If the Government are going to achieve that ambition, it may require some rewiring of how the NHS works and how funding is distributed. Over the past few years, we have seen acute services taking a growing share of the budget. One understands all the short-term pressures on Ministers, who tend to ignore the long-term benefits.

Tucked away in the Budget Statement was a welcome and important statement. The Chancellor announced ring-fenced prevention spending that will bring down costs in the future. Hurrah for that; it is absolutely the right step to take. I wonder whether the Minister can answer a few questions related to that. First, how will preventive spending be defined? If it is too broad, it becomes meaningless; if it is too narrow, you end up with a number of very small pots. Will it include items that the noble Baroness, Lady Bennett, has just mentioned, such as the warm homes fund? Will it include adult social care? Do the Government plan to use existing definitions of preventive spending, or are they planning to invent a new definition of their own?

Secondly, if there is going to be a ring-fenced preventive spending pot in central government, will that then be distributed down the chain to ICBs, local authorities and GPs? Will it continue to be ring-fenced as it goes down? Thirdly, relevant to that, when will this be introduced? Will it be in the next spending round, or is it going to take longer than that?

Finally, I reinforce what the noble Lord, Lord Rennard, said on Amendment 53A. In earlier debates, I have very much supported this and may have moved some of the amendments myself. Given the pressure on government expenditure, not to explore further the potential of hundreds of millions of pounds, if not billions, from a levy, which does not, as the noble Lord explained, feed through into the consumer prices index—it is not reflected in the price of cigarettes, but comes from the profits made by tobacco companies—I hope the Government do not have a totally closed mind on Amendment 53A.

[Baroness Cass (CB)]

My Lords, I am sorry that the noble Baroness, Lady Walmsley, is not able to be in her place this evening. I had the privilege of serving on the Childhood Vaccinations Committee, which she very ably chaired. I think it will produce a report which Members of the House will find informative and helpful, and I hope the Government will feel similarly. During the course of that report, we spent a long time talking about the relative impact of problems in access and in vaccine hesitancy. Within vaccine hesitancy, multiple different factors affect how parents feel about vaccinating their child. Among those is medical disinformation. We need to understand more about that and what vaccination and the risks mean to different communities and cultures. Much of that work happens on the ground, on the front line, with community leaders, health visitors and GPs working locally. However, that is not a reason for us not to take a national strategic approach.

The second reason I signed this amendment is that it uses the term “medical disinformation strategy” and talks about anti-vaccination and medical disinformation. The Government need to think about how we tackle medical disinformation much more broadly than just within the vaccine arena. I have talked often enough in this House about my review, but I have not on any occasion put on record what it felt like to do that review and, more particularly, what it felt like and has continued to feel like in the two years since.

The disinformation about my review started six hours before the report was released. It was a funded disinformation campaign, and it continues to date. One of the extraordinary things that were said was that I did not speak to any trans people during the review. We spoke to the support and advocacy groups every four weeks and I spoke to the gender clinicians working at the Tavistock every two weeks. It was said that we threw out 98% of the papers on the subject, which was clearly nonsense. It was said that we did not publish the name of the author of the review—and what did “CASS” stand for, by the way? That was probably one of the most extraordinary ones. Then there are those that I take less seriously, which are more recent, on why I have supported the puberty blocker trial. These range from my being the victim of a Russian kompromat, having a trans child of my own, and—this is the best one—that somebody has kidnapped my cat and is holding it to ransom. I am not particularly concerned about the personal attacks, of which there are many, but I am concerned about the disinformation that misleads children, young people, families and clinicians who are looking after them.

During those last two years after the review, I worked first for NHS England. I declare that I am currently an independent adviser for the DHSC. Colleagues have been supportive, but the burden of what to do about the direct disinformation at the end of the day rested with me. DSIT, as it was, seemed to be the locus of how we dealt with disinformation at that time, but it did not own the strategy, and neither did NHS England or the DHSC—although the DHSC has been very supportive in trying to get a communication strategy in more recent times.

My point in going through all this is not as a “poor me” about my experiences, but because it should never come as a surprise to us that there is disinformation, which is going to be an increasing problem going forward. It is no more surprising than bed pressures and flu in winter. Therefore, I suggest to the Minister, who has been exceptionally supportive to me over these matters, that, in thinking about the structures of the NHS, we need to consider strategically how we will be prepared for disinformation strategies, not just in vaccine services or gender services but in many areas as they arise.

[Lord Scriven (LD)]

I will quickly talk about my noble friend’s Amendment 224, on the public health duty of Ministers of the Crown. I think most noble Lords would agree that, if we are going to deal with prevention and the determinants of health, it goes far beyond the department to deal with the issues there.

It is always interesting and actually vital to read final impact assessments, because you will find little gems in them. In the final impact assessment on abolishing NHS England, it says:

“The Secretary of State will retain existing public health”


duties. But the NHS England functions to be repealed are not given to the Secretary of State. It says:

“NHS England’s duty to consult with public health professionals to obtain advice on the discharge of its functions will be repealed and not transferred to the Secretary of State”.


I have a very simple question for the Minister. I declare an interest in that my husband is a former director of public health. Anybody in the medical world who comes into contact with a doctor from public health will say that they are a very strange creature; living with one, I can confirm that is the case—but professionally, they look at things very differently. They are not about one part of the body or one disease; they take a much more holistic approach to the determinants of health and population health. Why is the Secretary of State retaining public health functions but not taking NHS England’s function to sit down with, listen to and consult public health professionals when carrying out those directions? It seems a very strange system to take the functions but not have the duty to sit down with and listen to public health officials. If that duty is not transferred to the Secretary of State, what body in law does the Secretary of State have to sit down with and listen to that is composed primarily of public health professionals?

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I thank all noble Lords for their considered contributions on a wide range of public health issues. I hope I have provided reassurances on government action across those concerns.

[Baroness Cass (CB)]

Can I ask the Minister one more thing? The Government are being active on vaccines, as she said, but disinformation—the noble Baroness, Lady Pidgeon, made this point as well—goes further than just a vaccine strategy. It is really about the Government having a disinformation preparedness approach in the same way as they have preparedness for a pandemic, because there will be disinformation campaigns that we have not yet anticipated in other areas. Are there further thoughts on how that might be approached?

[Baroness Hyde of Bemerton (Lab)]

I thank the noble Baroness for that question. The Government are aware of the whack-a-mole nature of this and the constantly evolving picture. There are things that we cannot even imagine today that tomorrow will seem inevitable. I will write to her with a more comprehensive reply. We absolutely accept that this is not just about vaccines and that there is work to do.

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[Lord Scriven (LD)]

It is a pleasure to follow my noble friend. I want to come back to the points that the noble Lord, Lord Hunt, made. I believe we are coming to a point in this Bill for us to make reasonable amendments and suggestions. Either we can continue to go down the road without the detail and let the service reorganise itself, or we can start to get some serious detail, particularly regarding specialised commissioning and the capacity of ICBs.

Just to understand, there are about 154 specialised services that are commissioned. Already, around 70 of those are commissioned via ICBs under delegated direction from NHS England, and the rest are commissioned centrally by NHS England. What the Government are asking is for the cuts to be made to staff, for the staff to go, and then for the detailed skills and knowledge that are required for the specialised commissioning to come after that process. The National Audit Office has put out a report which questions, even on existing duties, whether ICBs have the skills, knowledge and breadth to carry out what the Government want.

With these extra services, it could be that ICBs, the delegated strategic commissioners, cannot commission what Government wish them to commission. The noble Lord, Lord Hunt, and I both got quite cross with the then Minister, the noble Lord, Lord Kamall, during the passage of the 2022 Act, that things were happening in the system before Parliament had made the decision. That is what is beginning to happen again; things are happening. The offices for pan-ICB commissioning are not new; they were asked to be determined in April 2026. They were in the impact assessment for the abolition of NHS England, so they are already known about. The key issue is: what services are they going to have to give a joint response for? Will we have the list of specialised commissioning services carried out by ICBs and the Secretary of State by Report? Is that a commitment the Minister can give? If not, we cannot make a reasonable decision on Report about specialised commissioning with the depth and breadth of knowledge that is required. Can the Minister give us that commitment?

As the offices for pan-ICB commissioning—OPICs—were selected in April, can the Minister commit to giving us their duties and the budgets they will have, or will be able to direct, in writing before Report? What powers of direction will the Secretary of State have for consistency of ICB specialised commissioning, and can those be with us by Report? These are important questions that need to be answered because, if not, we will be getting to Report, being asked to support specialised commissioning with two bodies—the Secretary of State and ICBs—and, particularly for ICBs, we will not know whether they have the capacity to do it. I do not think that this House will be able to make a decision about whether it is reasonable, safe or justified for us to continue suggesting that this is a route for ICBs to commission.

[Baroness Cass (CB)]

Briefly, I support the comments of my noble friend Lady Grey-Thompson and the noble Lord, Lord Hunt, and thank the noble Baroness, Lady Pidgeon, for Amendment 59, which I fully support. It is all right for me to support all of these people, because according to the best disinformation sources, I am in the pay of the Tories, but not the other parties. I did hesitate over whether I should allow a friend on the Opposition Benches to buy me a cup of tea the other day.

On a serious note, I worry, as others do, about ICB capabilities, and my noble friend Lady Finlay and I have spent years struggling with a postcode lottery on the commissioning of specialist palliative care services for children. They are commissioned at the wrong level, and therefore vary hugely from ICB to ICB, and should be commissioned at a higher level. The notion of greater devolution fills me with anxiety, so I fully support that amendment.