Health Bill

Baroness Harding of Winscombe Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Lord Mawson (CB)]

My Lords, I welcome this debate and I certainly support the amendment. I am encouraged by the letter that we received today that there is an open mind within government and a proper discussion taking place about these very important issues. I am a practitioner, as many of your Lordships know, and we are involved in trying to build some of this new health infrastructure around the country. Indeed, today I have been involved in quite an exciting conversation about a health innovation campus in Huddersfield that we are supporting, which has major implications for this Government’s direction of travel—a lot of which I support—around place, collaboration and other things that the Prime Minister has talked about.

However, we are also in touch at the front end with what is actually happening on the ground, and the word I keep hearing from colleagues across the country is “chaotic”, which is a worrying word to be hearing. Therefore, this debate and the detail that is being discussed today really matter for the NHS, for patients and for those of us who are trying to build this infrastructure. Therefore, I am encouraged that the Minister is starting off in an open, transparent and conversational manner in Committee. It is very helpful.

One of my concerns about the changes taking place at the moment is that there does not seem to be a clear vision about prevention. Those of us who have been involved in this space—in my case, I have been involved in east London, and now nationally, for over 40 years—know that on the ground, in very challenging communities, the real determinants of health often have nothing to do with doctors. If you asked our GPs in Bromley-by-Bow, they would tell you that a person getting a job does more for a person’s health than anything to do with doctors. That is why, in Bromley-by-Bow, we ended up building 97 businesses with local people, because we got real about the social determinants of health. It is about whether you have a decent home that is not damp. It is why we built a housing company, which now has 10,000 properties and owns 34% of the land in Poplar. It is to do with whether your relationships in your family are in a good place and whether you feel part of a community—all these things. The numbers that people far cleverer than me come up with say that the impact of all this is 70% to 80%.

I am not clear, with this real opportunity to reform the NHS in this century and with the things we now know, what this Government are saying about the prevention agenda and how clearly they are or are not joining the dots around the social determinants. Part of this conversation is really important, but part of it needs to be about the prevention agenda. As we work our way through Committee, we need far more clarity about what that will mean in practice and in detail in communities across this country.

[Baroness Harding of Winscombe (Con)]

My Lords, it is a privilege to follow the noble Lord, Lord Mawson, and the noble Baroness, Lady Gerada, who between them have many decades more experience than I do of NHS and health and care reorganisation. I have only one major experience from the inside: the last time we were debating the restructuring of the NHS in 2021-22. At the time, as someone from the private sector, I was somewhat surprised to discover that the NHS got on with the reorganisation before the legislation was passed. It is even odder this time: the NHS has started before the legislation but without a plan itself.

Therefore, I welcome this amendment from my noble friend Lord Howe. It is essential that we understand the plan and the timetable, what it will cost and what benefits it will bring. It really is very straightforward. If that does not exist, the idea that it can be complete by 1 April next year is completely gobsmacking. Maybe I am just an innocent businesswoman who does not understand the ways of the NHS, but it just does not seem right. I think this amendment is basic common sense.

Much as I hear the words of wisdom from Don Berwick, I support merging NHS England with the Department of Health. I saw from the inside, particularly during Covid, how important it is to have clear political accountability. I support the basic premise, but I am very worried that the tendency will be to centralise rather than to push resource out to the regions and local communities. As the noble Lord, Lord Mawson, just said, it is at the local ground level that change really happens.

I am very supportive of seeing fewer people employed in organisations that bear the NHS brand but do not actually treat patients. There are tens of thousands of people who are all trying hard and doing valuable work, but they are a long way away from patients. As we bring NHS England into the department, I would love to see, as part of this amendment, a clear breakdown of the cost savings at the national, regional and local level, so that we have sight of whether we are really pushing accountability, and resource and capability, down to where change will bring the benefits that we all seek.

[Baroness Rafferty (Lab)]

My Lords, I will be brief. I support the point made by my noble friend Lord Hunt that the Minister should reconsider the abolition of governors. I have to declare an interest as a former governor of King’s College Hospital NHS Foundation Trust. I spoke at Second Reading about the value of governors and the extraordinary breadth and depth of feedback and accountability that they provide to trusts. We just ask the Minister to reconsider that decision, for I fear that, if governors are abolished, we will have to find some mechanism to reinvent them.

Health Bill

Baroness Harding of Winscombe Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Baroness Rafferty (Lab)]

My Lords, Amendment 279J seeks to increase the transparency of continuous professional development in terms of the funding and protected time allowed, and requests that the Secretary of State report on and review both those variables within six months of the passing of this Act. Continuous professional development, or CPD, is the mycelium—the material—that nourishes and sustains professional development and progression for nurses and midwives. It is also an evidence-based intervention for staff retention. Were the noble Baroness, Lady Watkins, here, she would have added allied health professions to our group, but she will speak to that point on Report.

I am sorry to say that, too often, CPD is paid for by nurses and midwives themselves or treated as an optional extra, although core to training and career development for doctors. Unlike doctors, nurses and midwives lack a predictable career pathway underpinned by training support, despite many elegant models for implementation. Funding has been at the heart of this dilemma, with fluctuations reflecting the buoyancy of the health economy, but a lack of transparency means that such funding is often shrouded in mystery regarding what is available where, when and for whom.

Our amendment seeks to place a responsibility on the Secretary of State to report on funding and, just as important, as I mentioned, on protected time for training, for the first time. This change will open the black box of CPD support from which helpful benchmarking can ensue, putting what has hitherto been hidden on a more secure footing.

[Baroness Harding of Winscombe (Con)]

My Lords, I too support my noble friend Lady Shawcross-Wolfson on Amendment 28, to which I have added my name. My first experience of workforce planning in the NHS was when I applied to be chair of NHS Improvement in 2017. I can remember asking the then Permanent Secretary, who is not in his place at this moment, if there was a plan for the workforce in the NHS. I came from retailing, where we spent a lot of time worrying about long-term people planning. I was absolutely gobsmacked at the time to be told, “Oh no, we don’t really do that here”.

Fast forward two years to 2019, when I was asked by the then Prime Minister to develop a people plan for the NHS. Again, maybe rather naively, I thought, “Good, this is an obviously sensible thing to do”. I remember speaking in this Chamber in 2022 when that people plan had not yet been published. That was not because the numbers had not been run; they had. It was because the Treasury and the Department of Health and Social Care could not agree on whether it would be a good idea to actually publish them.

I do not think it is an accident that there was a workforce plan published in 2023. It was because of the work we all did in this House with the last health Bill. I see the noble Lord, Lord Stevens, nodding his head, and the Minister was herself instrumental in that pressure that together we put on the then Government to publish a workforce plan. So here we all are again, in slightly different positions in this Chamber, but with basically the same problem that my noble friend set out so beautifully. We must not settle for what we did in 2022, which is just a commitment to publish a workforce plan. There are huge structural disincentives for any Government to publish it, as the Minister is undoubtedly feeling at this moment, which is why we have to put it in the Bill.

The first rule of solving a problem is naming it. If you do not acknowledge the problem of the escalating demands for a growing workforce in our health and care system, you cannot even begin to solve it. I am afraid that by not acknowledging it, we also lose the faith and trust of that very workforce. Go and speak to any junior doctor, and they know there is a problem with this. They know that if we do not find better ways of working in health and care, we will all be working in the NHS by the time we die. We have to name it, but I recognise the very real political problems that naming it presents.

Unless we legislate for this, nothing will change, so this is a very important group. I am sad that, once again, the people of our NHS warrant discussion in only one group in the Bill. Frankly, it should be multiple groups so that we really dig deep on how we not just plan for the numbers but change the culture and leadership in the NHS; but it is where we are for the moment. I very much hope that when we come back on Report, we will find a combined amendment. I recognise the challenge from the noble Lord, Lord Scriven, about Amendment 28 being quite speedy, but it would require a regular five-yearly update, which Amendment 253 would not. Maybe we could all align around some combination of those two amendments. I would very much welcome a discussion with the Minister, because I know that she thought deeply about this when she was sitting in another place in this Chamber.