Health Bill

Baroness Manzoor Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

Will the Minister undertake to review local arrangements and look at improvements, with a view to better performance, improved efficiency and cutting waiting times? As my noble friend Lord Howe has already said, adult hearing loss alone affects 11.6 million people in the UK, and it is of course rising in line with the ageing of the population—a challenge we recently debated comprehensively in the Chamber. I hope the Minister will give serious consideration to these issues and come back to us before Report.

[Baroness Manzoor (Con)]

My Lords, I support the amendments in the group, particularly Amendments 22 and 24, in the names of my noble friends Lord Kamall and Lord Howe. I say to the Minister that patient choice needs to be significantly strengthened, particularly in three important areas.

Currently, there is choice, but we need to make choice much more meaningful, rather than simply theoretical, by giving patients greater control over access to services and their care pathways and ensuring that choice is available across the whole of the NHS and the health ecosystem, not just elective hospital treatment, as was clearly outlined by my noble friend Lord Howe. Patients are not always aware that they can choose which hospital or provider they attend. In practice, patients may simply accept the hospital suggested by their GP or referral system, without being told about alternatives.

How do we improve this? I passionately believe that GPs should have a duty to routinely explain patients’ rights to choose, and patients should be offered a meaningful range of clinically appropriate providers. They should be provided information about waiting times, quality, outcomes and location, as Amendment 22 suggests. Patients should be supported to make informed decisions, rather than being directed towards a single provider. The NHS England guidance recommends currently that referrers should shortlist an average of five provider choices where it is practical, clinically appropriate and preferred by the patient.

Choice is particularly relevant in relation to NHS 111 and A&E attendance. Patients contacting NHS 111 are often given a recommended pathway, but their ability to access alternative services may be limited. For example, a patient might be advised to contact their GP, attend an urgent treatment centre, access a community pharmacy, receive a telephone or face-to-face clinical assessment, or attend A&E if clinically necessary. The problem is that a recommendation is not necessarily a genuine choice if the alternative service is unavailable.

Improvement is needed. There needs to be better access to same-day GP appointments, wider choice in the NHS and wider health ecosystem, more accessible urgent treatment centres, greater availability of evening and weekend services, better integration between NHS 111 and local urgent care providers, and much greater transparency about where patients can receive treatment. The key principle should be that patients are given practical alternatives, not simply redirected from one service to another—audiology has already been mentioned. Amendments 22, 23 and 24 would enable this. I know that this can happen, because, back when we had regions, we had the ability to refer patients to other providers where waiting times could be reduced, and it worked very well. Of course, we must not allow cherry-picking, which is a danger, and we must clearly define what outcomes are to be expected.

[Baroness Coffey (Con)]

My Lords, I agree with the amendments. The original duty included by the Government feels a bit lightweight and almost declaratory, rather than anything of substance. That it is why it is proving a useful debate, through the variety of amendments, to look at putting more substance to this.

In the real world of the NHS, in my experience as a patient and previously as an advocate, what is convenient for the NHS is more important. We will come to this in a broader sense later in the Bill, but it is vital that we try to help patients, as with the earlier duty in the clause that is not being changed, to have more involvement in their healthcare. As my noble friend Lady Manzoor just said, patients are often not aware of the availability of other services. It would be useful to get an understanding of how the Secretary of State intends, through this clause, to make patients more aware.

At the same time, as my noble friend Lady Neville-Rolfe points out, in effect, probably due to budget constraints, rationing has started by not allowing patients to take advantage of provision in the interests of trying to manage budgets. I am not saying that the NHS is a bottomless pit—it is not—but we have to come back to what the NHS is there for. The constitution is quite clear that patient choice is a key element. That is reasonable in order to try to make sure that we have a healthier society. As my noble friend pointed to, quite a lot of illnesses are stopping people working, or working to their full potential. That is no good. A lot of illnesses mean children are not allowed to reach their full potential and are spending time out of school.

We need to consider such factors when carefully considering the amendments tabled by my Front Bench and that of the Liberal Democrats to beef up what it means to ensure that other provision can be readily accessed to have a healthier society. I hope that my noble friends will bring this back on Report if we do not have any satisfaction today.

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These statistics serve to reveal the extent of the challenges facing the psychiatric component of the NHS mental health workforce and why a workforce sufficiency assessment process by ICBs could be so valuable in identifying needs and planning accordingly, including for preventive mental health care. Shortages of personnel restrict innovation and take energy away from prevention. Careful planning is also needed to address bottlenecks in medical education training pathways, as many resident doctors are currently unable to progress in their NHS careers.

[Baroness Manzoor (Con)]

My Lords, I support the thrust of the amendments in this group, particularly Amendment 28 in the name of my noble friend Lady Shawcross-Wolfson. She has put her case forcefully and clearly, so I will not detain the Committee for long.

Poor long-term workforce planning creates significant challenges for NHS staff and patient care. Inadequate forecasting, insufficient investment in training and recruitment and poor staff retention contribute to persistent vacancies and skills shortages. This increases workforce loads, stress, burnout and sickness absence, resulting in low morale and higher staff turnover. The NHS becomes increasingly reliant on expensive agency workers and international recruitment, placing additional pressure on budgets. Consequently, services experience longer waiting times, reduced productivity, compromised continuity of care and potential risks to patient safety.

NHS England estimates an existing workforce shortfall of approximately 150,000 full-time equivalent staff, potentially rising to 260,000 to 360,000 by 2036-37 if there is no intervention. Effective long-term planning is therefore essential to develop a sustainable workforce, improve staff well-being, strengthen retention and ensure safe, high-quality patient care. I strongly urge the Minister to support this amendment. Ministers should be held accountable for the delivery of this workforce plan.

[Lord Patel (CB)]

My Lords, I strongly support the amendment in the name of the noble Baroness, Lady Shawcross-Wolfson, and I have added my name to it. She spoke so eloquently and made her case so strongly that I have put aside what I have written down because it would have been a repetition of what she had already said. I am going to take a slightly different tack but make the same point.

The noble Baroness quite rightly linked education, training and workforce planning. You have to know what workforce you might require for the health service you plan to have. I guess one can say that the Government’s 10-year health plan and the 10-year cancer care plan outline the kind of health service that the Government wish to see develop over the next 10 years. If that is the case, we need to address what kind of training and education and what kind of people we will need to deliver that plan.

I am guessing now that the reason why the 10-year workforce plan is delayed is because the premise on which it was to be formulated was that technology such as AI and digital technology would free a lot of clinical time, and hence the headcount need not be so high. That is a false assumption. It is false because we need to train people to use AI and digital technologies. The assessment is that, if you use these technologies, you might free about 40 minutes a day for front-line clinicians. With the pressure that the NHS now faces and the needs of the workforce it now faces, that time will be used to deliver better care to patients, particularly as the 10-year health plan identifies that technologies such as genomics and personalised medicine will be the way healthcare will go. There is an ambition by 2040 to have 50% of patients with some idea of their genomics, and the treatment is therefore based on that.

If you add all these together, and the Secretary of State now has responsibility for education, training and workforce planning, you ask the question: why is the workforce plan delayed? It is delayed because maybe the penny has dropped that, if you do not count the numbers and do not present a case about how technologies will reduce front-line clinical time, then you cannot plan the workforce.

Furthermore, I wonder whether the Bailie review of productivity in the NHS is based on the premise that greater productivity will be delivered in the NHS because of using technologies such as AI and digital technologies. We do not know that that will happen, but we have to wait until the Bailie review comes out. I wonder whether that is another reason—the Minister might comment on that—why the workforce plan is delayed.

It might be political pressures, it might be fiscal pressures or it might be the pressures from not knowing how to get the workforce numbers that we would require to deliver the 10-year plan and the cancer care plan that are holding up workforce planning. However, as the noble Baroness, Lady Shawcross-Wolfson, pointed out, if we do not have a plan, things will get worse. We will introduce technology, which will not be across the board, and we will then look for workforce that is not trained to deliver it. I hope the Minister will give us some answers about where we are going.