Health Bill

Baroness Hollins Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Baroness Coffey (Con)]

My Lords, I tabled Amendment 45, which refers to “Promoting palliative care equitably”. In particular, it refers to the need to be

“accessible to all regardless of wealth or geography”.

I am very fond of the Minister. Nobody can get grumpy with the Minister, but I am getting grumpy with the Department of Health and Social Care, and other Ministers, because we still do not have the modern service framework for end-of-life and palliative health care, which has been going on for some time. I think the latest Written Answer, published in September, said that it would be published in the autumn. To be generous to the Government, that normally means right up until Christmas Eve, but I hope we will see this framework; it is a long time coming. The stories that we hear, such as that which we just heard from the noble Baroness, Lady Finlay of Llandaff, illustrate that access to palliative care often seems to be a postcode lottery.

When I first moved to Suffolk, I became aware of the Halesworth Community Nursing Care Fund—it no longer exists, having been absorbed into the Pear Tree Fund, which is still in Halesworth. The local people, frankly, got fed up of waiting for a hospice, and there are still valiant efforts to try to have a building. I appreciate that hospice at home is a key element of the modern hospice service. Nevertheless, it was felt that, unless there were people with deep pockets or those who run marathons around the country, or take part in other ways of raising funding, too often either that nearby hospice would never open or its continuing support would collapse. That is why I welcome the proposals and ongoing targets—I think aimed at 2029—regarding this in the neighbourhood health plans, but we still need the substance. Living in a rural community, I am very conscious that not everything will be on hand, but that does not mean that it should be so far away that it more or less becomes irrelevant. I would like to understand more about how the Government will consider the provision of such care in rural settings.

Amendment 230, tabled by the noble Baroness, Lady Pidgeon, would, as I understand it, require a conversation about end-of-life care once a terminal illness has been diagnosed. The amendment as drafted provides that such a conversation would need to be offered but the person would not necessarily have to take it up. However, another provision in the proposed new clause suggests that, where the person does not or cannot take up the offer, the family must be offered it instead.

I appreciate that having conversations about the end of life can be very tricky. We should bear in mind what happened in the not-too-distant history to people who were nearing the end of their lives. I think of the heinous Liverpool care pathway, where people were, in effect, starved and not allowed water. That was horrific. I was pleased when the recommendations of the review by the noble Baroness, Lady Neuberger—it is good to see her here—were followed by the Government, and that was cast to history.

There is also the wide-ranging element of do not resuscitate, and here I will share a personal anecdote. I recall that, when my mother broke her hip, they constantly tried to get her to do a DNR but then told her that the consultant could do it anyway. It is not very encouraging. When she was finally, sadly, diagnosed in hospital, they did not know exactly what was wrong with her but told her that she had less than a month to live—which was true; that is what happened. It was very clear that, for my mother, her patient choice was that she was desperate to die at home. To be fair, a particular nurse tried everything and was successful, but there was argy-bargy to get it done. For a woman who was dying, I was prepared to shove her in my car and drive home, although eventually we got the agreement for an ambulance to take her home. Even then, all of a sudden, as we were ready to leave, the DNR was there, and I knew my mother did not want it. They went and found her; she was not speaking very much by then, but she shook her head to show that she did not want it. It involves an element of trust, and, frankly, I do not know how many people necessarily have confidence that end-of-life care will be provided.

My mother was a woman of faith, and a priest from the local Catholic church, Father Joseph Welch, happened to be on duty. He came in, and that conversation, more than anything, helped a woman of faith who was scared of dying to effectively be reconciled. It is important, in a different way, to recognise that this is not just about the NHS saying, “Let’s have a chat about the end of your life”, because I am afraid that there is still nervousness about where that will end up.

I am conscious that, when debating another Bill in this House, we spent a lot of time on the fact that people are scared, towards the end of their lives, and that there may be pressure to take a particular pathway. We need to be careful, and how we get that judgment right is important. That is why, although I understand the sentiment behind Amendment 230, I would be pretty nervous about putting it in the Bill and about how delivering it could be done in a way that is absolutely right for everybody. Can we get the quality and a real understanding that this would work to the benefit of the patient, albeit perhaps in their final weeks?

[Baroness Hollins (CB)]

My Lords, I thank my noble friend Lady Finlay for making the strong economic case for specialist palliative care and for these thoughtful amendments. I have added my name to several of them.

On Amendment 78, ICBs already have responsibility for commissioning palliative care. That came about following amendments to the 2022 health Act, which my noble friend Lady Finlay introduced, but there is insufficient accountability for whether and how they are meeting the needs of their local populations. The House of Commons Health and Social Care Committee’s recent inquiry found no clear standards or reporting requirements for ICBs for the provision of palliative and end-of-life care.

Geographic inequality is striking. In 2023, the proportion of people dying in hospital varied from 36% to 52% between ICB areas, and the proportion dying at home varied from 26% to 33%. Why are there so many differences between different areas? We cannot improve what we do not properly measure, and palliative care at the end of life is an essential component of healthcare, not an optional extra. This amendment would require annual performance assessments regarding the standard of palliative and end-of-life care provided.

Amendment 26 would require urgent investment in palliative care through a transformational fund. The Health and Social Care Committee considered the specialist palliative care workforce to be in a critical situation. It described 78 consultant vacancies and around 40% of hospitals not providing a seven-day face-to-face specialist palliative care service. More funding would support the Government’s intended move towards more care in the community and help to avoid needless prolonged hospital admissions.

Amendment 242 would ensure that NHS and hospice services can work together effectively, with timely information sharing and the access to beds, medicines, equipment and appropriately trained staff that patients need and deserve. At the moment, it is so fragmented; it is very hard for people trying to co-ordinate and manage their own end-of-life care at home, as I know only too well after my husband died last year.

The scale of the voluntary sector’s contribution is considerable. In 2024-25, hospices across the UK provided palliative and end-of-life care to 310,000 people, alongside direct support to 89,000 family members, friends and carers. But the financial pressures they face are significant, and of course they rely heavily on charitable donations and fundraising. However, voluntary sector providers are not peripheral to our health and care system; they are essential partners.

The Public Accounts Committee in the House of Commons has estimated that 300 hospice in-patient beds have been lost due to lack of funding. It would be very timely to agree all these amendments and I give my wholehearted support to them.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I commend all the amendments in this group. As the noble Baroness, Lady Finlay, said when introducing it so powerfully, I attach my name to the noble Baroness’s Amendment 26, which would provide for a transformational fund for improvements in access to support service redesign by scaling proven models of care, supporting also the planned shift from hospital care to community care.

As the noble Baroness, Lady Coffey, alluded to, we have to consider this group of amendments in the context of the Terminally Ill Adults (End of Life) Bill, generally known as the assisted dying Bill. I spoke at its Second Reading in your Lordships’ House and my noble friend Lady Jones covered Committee. It is worth noting that, the second time the Bill was presented in the other place, Andy Burnham said, in a very influential intervention, that before assisted dying is considered in England and Wales, the funding of palliative care should be fixed. That is what the amendments in this group, in their various ways, seek to achieve. The Government often say they will do this when legislative time allows. We have the opportunity before us at this moment.

We have covered many of the points already, but it is worth noting that, by 20 October, more than 100,000 people had signed a petition, which was delivered to No. 10, calling for sustainable hospice funding to be made a national priority. At that event, the Shakespeare Hospice chief executive said:

“Our ask is simple: a fair and sustainable long-term funding model that ensures everyone can access high-quality hospice care, regardless of where they live”.


The fact is, of course, that, in many ways, hospice care and provision is not only a postcode lottery but is going backwards in many parts of the country. On average, about 270,000 people each year receive hospice care, but only 40% of the funding comes from government sources: 60% of the funding comes from people—very often pensioners—standing at train stations rattling buckets. We have a reliance on charity shops, but that funding model is in significant difficulty, in part because of fast fashion and other changes. We have a cost of living crisis that means many people who may have made contributions before are simply not in a position to make contributions now.

I have spoken in your Lordships’ House previously about the very sad closure of the Richard House hospice in east London in 2025. I note as one further example the Queenscourt Hospice in Southport, which has been going for 35 years. In the middle of this year, it cut its in-patient provision by 50%, decreasing bed capacity from 10 to five. It also reduced out-patient services, therapies and hospice-at-home clinical provision. Associated with that was the loss of 20 full-time equivalent medical posts.

I note also that the Royal College of Nursing, at its congress in May, supported overwhelmingly a resolution that the RCN advocates for decent coverage of hospice care. That should not be necessary. We have before us a Bill that gives the possibility for the Government to put this into a legislative statutory framework to support proper palliative care, which the Prime Minister has said that he wants to do.

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[Baroness Shawcross-Wolfson (Con)]

My Lords, I am grateful to the noble Lord, Lord Patel, and the noble Baronesses, Lady Harding of Winscombe and Lady Cass, for their support for this amendment. In moving Amendment 28, I want to make a very simple argument. The Bill gives Ministers direct responsibility for training and educating the NHS workforce. I believe that it should also make Ministers responsible for setting out what workforce they believe the NHS requires and for developing a training and education plan to deliver that workforce.

This is not a controversial proposal—Amendments 92, 252 and 253 in this group make a very similar case—nor is it a new proposal. In 2022, your Lordships’ House passed a very similar amendment to the Health and Care Bill, not once but twice, with support from the Labour Benches, the Liberal Democrat Benches and the Cross Benches. In 2023, the Conservative Government published a long-term workforce plan and asked the National Audit Office to scrutinise the modelling behind it. In 2024, the Labour Party manifesto promised “regular, independent workforce planning”, and Ministers subsequently committed to producing a new workforce plan with independent scrutiny.

Therefore, in theory, we all agree. But in practice, we are now more than two years after the election and Ministers have set aside the Conservative Government’s 2023 plan, understandably, but have still not published their own. In June, Ministers said it was coming imminently. We are now told that it will arrive in due course.

An insufficient NHS workforce is a problem that has been many years in the making. At the end of June, the NHS in England had more than 100,000 vacancies. But vacancies are not the whole story. Since 2015, the number of patients registered with GP practices has risen by more than 10%, but the number of fully qualified full-time GPs has gone down. Others in this House can describe far better than I can what workforce shortages mean on the front line, so I will not talk about how hard it is to plan services when you have insufficient staff to deliver them or the toll on healthcare professionals when we constantly ask them to cover gaps or the impact on patient care. But I hope that others in this debate will do.

Instead, I want to talk about how we ended up here. I believe that all Governments understand the importance of NHS workforce planning. But experience shows that very few are able to develop and deliver a comprehensive plan. That comes down to the very simple fact that training must be paid for today and the benefits of training are realised only in the future. It takes three years to train a nurse, around 10 years to train a GP and up to 15 years to train a consultant. So Ministers constantly face a choice between the pressures of today and the prospect of a better NHS in three, 10 or 15 years’ time. Every £1 spent on a GP for 2035 is £1 not spent this winter or on this year’s political priorities. At any one moment, choosing to prioritise today makes sense. But, repeated year after year, that choice leaves us with a workforce that cannot possibly meet the demands it faces.

Of course, politicians can and sometimes do take long-term decisions. As chair of the Health and Social Care Committee, Sir Jeremy Hunt championed independent workforce forecasts. As Chancellor, he was in a position to fund an NHS workforce plan and did so. That 2023 plan was backed by over £2.4 billion. It set out ambitions to double medical school places, increase GP training places by half and almost double adult nursing training places. It was not a perfect forecast, and the NAO kindly pointed that out when it was asked to scrutinise it, but it was a baseline and it showed that, when the political will exists, it is possible to plan for and invest in the future. However, hoping for sufficient political will is not a strategy. We will not often have a Chancellor who was previously Health Secretary.

This amendment would make long-term workforce planning a duty and not a matter of personal commitment. It would require independently verified assessments of what staff the NHS needs and a 10-year plan to train and educate the staff needed. The first assessment and plan would have to be published within one month of Royal Assent to the Bill. Both the plan and assessment would be kept under review and would have to be revised at least every five years.

In 2022, the noble Baroness, Lady Merron, told the House that

“without mandated forecasts of staff numbers, meaningful workforce planning—something that every other efficient organisation undertakes—cannot take place”.—[Official Report, 26/4/22; col. 223.]

I really agree with her and hope that she will support this principle from the Government Benches as she did from the Opposition Benches, and back this amendment or one along similar lines.

I would be grateful if the Minister could also answer two questions. First, when will the Government publish their own workforce plan? Secondly, who will undertake the independent scrutiny of that plan?

Every Government must have the right to set their own spending priorities. But every Government should be transparent about the workforce they believe the NHS needs and what the decisions they are making today about education and training will mean for tomorrow’s workforce. I hope the Committee will agree. I beg to move.

[Baroness Hollins (CB)]

My Lords, I am grateful to the noble Baroness, Lady Tyler, and the noble Lord, Lord Singh of Solihull, for co-signing my amendments in this group.

I will start with Amendment 252 because it relates to the points made by the previous speaker. It would place a duty on the Government to publish a follow-up mental health workforce plan within 12 months of the highly anticipated publication of the next 10-year NHS workforce plan. It would require detail on how the mental health workforce will be effectively retained and recruited to meet the scale of the mental health demand. Retention and recruitment measures, combined with a clear commitment to the resources required, would help to assure many patients and people across the mental health sector about how the Government’s ambitions in this area will be matched by a strategic approach to delivery. The sector is looking for tangible outcomes for patients, particularly those who live with a serious mental illness.

Mental health and well-being support for NHS mental health staff is integral to the plan, including developing occupational mental health capacity and investing in staff mental health and well-being hubs nationwide. Staff sickness figures reveal that anxiety, stress, depression and other psychiatric illnesses continue to be the most reported reasons for sickness absence among the NHS workforce. In the 12 months up to and including May 2026, those conditions accounted for more than 8.3 million days of sickness absence, equivalent to 29% of total sickness absence over that period. So, while I welcome the commitment in the 10-year health plan to introduce staff treatment hubs for NHS staff, I am keen to understand how the hubs will interact with existing NHS staff mental health and well-being hubs. A dedicated NHS mental health workforce plan would help to ensure that the hubs are as effective as possible.

Amendment 92 would require ICBs to assess and report on mental health workforce efficiency for their local area every two years and propose measures to address the challenges faced by their workforces in delivering services for the communities that they serve. This takes me back to the discussions during the passage of the Mental Health Bill about the need for sufficient community services for people with learning disabilities, and autistic people, to avoid unnecessary and lengthy admissions to hospitals.

Localised focus is vital. Organisations across the mental health sector are concerned that the NHS 10-year plan is too vague about how ICBs are expected to both successfully manage system pressures and, at the same time, meet the ever-growing need for an expanded mental health workforce. Does the Minister agree that requiring ICB-led assessments would be an effective way to ensure that the Government’s programmes of national reform can be matched with local plans so that the ambitions of the 10-year health plan can be delivered?