Health Bill

Baroness Merron Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, perhaps I may start by warmly welcoming the noble Baroness to the Dispatch Box. We wish her well.

This has been a valuable debate on an issue that affects millions of people across the country. While the amendments before us take different approaches, they are united by a common concern that access to NHS dentistry remains increasingly difficult to secure. I particularly wish to speak in support of the amendment in the name of my noble friend Lady Coffey. At its heart lies a simple but important principle: access to dentistry should not depend on where a person lives or what they can afford. Few would disagree that oral health is an integral part of overall health, yet for too many patients access to NHS dental services has become a postcode lottery.

The duty proposed by my noble friend would place equity at the centre of decision-making. That is a principle which this House has supported on many other occasions in many other areas of healthcare. It is surely no less important when it comes to dentistry.

The amendment from the noble Lord, Lord Hunt, and the noble Baroness, Lady Pidgeon, also raises an important issue. One frustration for Parliament and for the public is that discussions about NHS dentistry are too often conducted in the absence of clear, comprehensive and consistent information. Regular reporting on workforce pressures, access, inequalities and unmet need would provide a valuable evidence base against which future progress could be measured and Governments held to account.

The amendment from the noble Baroness, Lady Pidgeon, addresses perhaps the most visible manifestation of the current problem: so-called dental deserts. Finding an NHS dentist has become extraordinarily difficult, if not impossible, in many parts of the country. Today, three in five adults are not accessing NHS dentistry. That is not a marginal problem; it is a challenge affecting communities across the kingdom. We now have areas of the country where fewer than four in 10 adults have seen an NHS dentist in the past two years. That should concern us all. It speaks not merely of pressures within the service but to growing inequalities in access to care.

Patients are travelling significant distances for routine treatment; being forced into the private sector, despite financial pressures; or presenting at GP surgeries, walk-in centres and A&E departments because they have nowhere else to turn. These are symptoms of a system that, despite the dedication and professionalism of the dental workforce, is struggling to meet public demand.

Improving NHS dentistry requires more than warm words. Good oral health is not a luxury; it affects children’s development, educational attainment and well-being. It affects people’s ability to work, to communicate with confidence and to maintain their dignity. Increasingly, we understand its connection to wider physical health and quality of life. At a time when we are rightly focused on prevention, reducing health inequalities and delivering care closer to home, dentistry must be part of that conversation. We cannot continue to accept a situation in which access to NHS dental services depends so heavily on geography, workforce shortages or the ability to pay. These amendments offer thoughtful and constructive ways of advancing that object.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am very pleased to respond to this group, following on from these Benches from my noble friend Lady Hyde, who I am delighted to be working with on this Bill. I am very glad that she made her debut on group 1 today. We look forward to hearing more.

I am in absolutely no doubt of the challenge when it comes to dental services and dentistry. I am also deeply conscious of the situation that we started from. I will refer to some of the points about improvements and the need for further improvements, but let me turn first predominantly to the amendments before us.

On Amendment 49 from the noble Baroness, Lady Coffey, I understand the good intention behind this amendment but do not believe that it is necessary, because under Section 1 of the National Health Service Act 2006, the Secretary of State will continue to have a duty to promote a comprehensive health service in England and that includes NHS dental services.

In addition, Clause 4 strengthens the statutory framework by amending the Secretary of State’s existing duties so that they must have regard to the need to reduce inequalities in access to health services across England. As the noble Lord, Lord Patel of Bradford, rightly said, that includes coastal communities as well as others. The duty that I referred to provides a clear statutory basis for considering geographical and other inequalities in access. A dentistry-specific duty would therefore duplicate the deliberately broader framework that the Bill establishes.

I can reassure the noble Baronesses, Lady Coffey and Lady Pidgeon—because the comments that I am about to make also relate to Amendment 216 in the name of the noble Baroness, Lady Pidgeon—that we are taking practical action to tackle dental deserts. I was grateful for the comments of the noble Lord, Lord Patel of Bradford, who made the point that the definition of a dental desert is rather more complex than just miles, or indeed numbers, and that is indeed the case. The practical actions that we are taking include introducing a package of reforms to address some of the most pressing issues that dentists and dental teams have been experiencing, and therefore the knock-on effect to patients. These reforms prioritise those with the greatest need and shift care away from clinically unnecessary check-ups.

On the matter of addressing dental deserts, we have, supported by some £11 million, brought in some 50 additional dental school places on top of the existing 809. It is interesting to note that the University of Porstmouth and the University of East Anglia are where these will be provided; we are going to train more dentists in the areas that need more dentists. As we know, throughout the medical professions, when you train in an area you are more likely to stay. I add that all NHS regions now have a dental school. We also have the golden hello recruitment incentive scheme, with payments to dentists of £20,000 to work for three years in areas that need them the most. As of July this year, 159 dentists had started working in the areas that needed their services the most.

Referring back to Amendment 216 in the name of the noble Baroness, Lady Pidgeon, I make the point to a number of the comments made that since July 2024 we have sought to rebuild NHS dentistry while being in no doubt of the challenge. In 2025-26, just under 3 million additional NHS treatments were delivered compared with the previous year, and around half of those benefited children. I very much share the concerns that noble Lords have described. It is totally unacceptable that the primary reason for emergency care for children is their very poor dental health. Children’s access now exceeds pre-pandemic levels, more adults are being seen and more dentists practise in the NHS, if we compare it with 2019-20.

I absolutely agree with the noble Baronesses, Lady Finlay and Lady Pidgeon, and other noble Lords, about the key role of prevention. That is exactly why, as the noble Baroness, Lady Finlay, said, we have brought in a toothbrushing scheme for young children, as well as fluoridation. We are seeking to tackle—if noble Lords will forgive the pun—the root causes. I cannot think of another word, but perhaps noble Lords will enjoy that anyway. It is important that we prevent as well as treat, for sure.

I turn to Amendment 213, tabled by noble friend Lord Hunt. We agree that transparency and accountability are essential to a properly functioning NHS dental system. However, the amendment risks duplicating existing arrangements. For example, the annual dental statistics help to identify problems and inform policy development, and I know that nobody present would wish to divert resources away from patient services. The whole focus of the Bill is on increasing Ministers’ accountability to Parliament, so I have no doubt of that happening.

I will pick up on some of the other points that were made, in more general terms. The noble Baroness, Lady Coffey, the noble Lord, Lord Lansley, and my noble friend Lord Hunt spoke about the dental contract and expressed concerns about the focus on units of dental activity, which I understand. I agree that reforming the dental contract is a key lever, and that is why we are working with the British Dental Association and other representative bodies to do just that. In addition to that contract, we are looking at how we can better use technology and boost the number of NHS dentists, as well as all the other areas that I have spoken to.

The noble Lord, Lord Patel of Bradford, asked about funding. I can confirm that the dental budget is worth around £4 billion, net of patient charges. The Government want to ensure that the ring-fenced dental budget is spent on the patients who need it most, and we need to maximise treatments for taxpayers’ money. I am pleased to say that we reduced the NHS dentistry underspend, which was standing at £392 million in 2023-24, to £36 million in 2024-25. That will make a major change to the provision of dental services. On the question from the noble Lord, Lord Patel, about the dental framework being developed by the Chief Dental Officer, I will be pleased to write with more detail on that.

I will pick up a few points in response to the noble Lord, Lord Young; where I cannot do so at the moment, I will be pleased to write to him. As I have mentioned, 4 million urgent appointments were delivered in 2025-26; that is 8.4% more than in 2024-25, and more than in any previous year under the current contract. We have now required high street dentists to deliver a minimum amount of urgent treatment as part of their contract. On the point about fluoridation, which the noble Baroness, Lady Finlay, also spoke to in terms of prevention, we are investing £136 million over five years to maintain existing schemes across England and fund the expansion to which the noble Lord referred across the north-east of England. Some 6 million people are already benefiting from fluoridated water, and this latest intervention is expected to reach an additional 1.6 million, to reduce tooth decay and inequalities in dental health.

The noble Lord, Lord Kakkar, talked about bringing together datasets to understand the impact of dentistry on broader health, which is a point I take. I will be pleased to look into that and write to him.

[Lord Patel of Bradford (Non-Afl)]

I thank the Minister very much for that detailed response. When she writes to noble Lords, can she specifically pick up the issue of capital funding? Lots of the places that I am looking at have a population with enough people to have complex problems, but not big enough to have infrastructure. We really struggle without some capital investment. As the noble Lord, Lord Lansley, said, we need some capital funds to set up some of these physical services to actually do the workforce training.

[Baroness Merron (Lab)]

Yes, I will be very pleased to include reference to that. I would probably use the word more broadly—the infrastructure that is necessary to support the dental activity—but I take the point and I will do my best to assist.

[Baroness Coffey (Con)]

My Lords, I thank the Minister for her comprehensive response. There is something in what she said about a dental team. Many noble Lords have talked about children. Dental therapists are unsung heroes and heroines who are perfectly qualified to undertake a lot of the work that has been mentioned today, particularly when dealing with children. The challenge is that too many dentists will not allow dental therapists to practise. I have asked them for reasons why, and there are certain things they cannot and are not allowed to do with NHS paperwork. Dentists also talk about liability, in terms of insurance.

We need to open this up much more widely. I encourage the Minister to speak to the Minister for Health Innovation, who I believe is responsible for dentistry, to see what more could be done. Too many children’s teeth, never mind older people’s, are just being ruined when they do not need to be. It does not need to be a dentist who goes into a nursery to look at these things; there are perfectly well-qualified people who can undertake that.

I will likely return to the issue of dentistry on Report, but, with that, I beg leave to withdraw my amendment.

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While those figures show that there is a considerable way yet to go, it would not be right to let this debate pass without acknowledging the unstinting efforts and commitment of paramedics, NHS managers and all those who work at the front end of our A&E departments up and down the country in doing their professional best for patients in dire emergency. We owe them a great debt. Against that background, what would be helpful to hear from the Minister is how she believes the changes in the Bill will benefit the ambulance service and the patients whom it serves.

[Baroness Merron (Lab)]

My Lords, I am most grateful to noble Lords for their contributions. Indeed, we all share a determination to ensure that patients receive safe, timely care in the right place. I am grateful to the noble Earl, Lord Howe, for his brevity; I will also seek to focus on amendments, and I hope noble Lords will appreciate that the reason for that is so we can deal with the content of the Bill.

Amendment 50 in the name of the noble Baroness, Lady Coffey, raises the important issue of rural access to ambulance services. I confirm that ICBs already have a statutory duty to meet the needs of their local population and to have regard to the need to reduce health inequalities, with respect to both ability to access health services and outcomes. I can assure your Lordships’ Committee that the funding that ICBs receive for commissioning ambulance services is based on factors such as age and deprivation and is adjusted to reduce health inequalities. To the point on rural areas, this includes adjustments for longer emergency ambulance journeys. We have heard some statistics, but I confirm that the category 2 mean ambulance response time is, as of July of this year, three minutes and 35 seconds faster than in July 2024. That is not the end of the story; I am simply indicating progress that is being made. I recognise, as always, the challenge of the situation that we are dealing with.

On Amendment 229, tabled by the noble Baroness, Lady Pidgeon, I certainly share her determination to reduce long waits in A&E. Trusts are already expected year on year to improve four-hour performance and to reduce waits of 12 hours or more from arrival. There is no complacency about what we have to do to improve performance, which is why the Secretary of State recently announced £140 million of investment in urgent and emergency care schemes across England, including urgent treatment centres, same-day emergency care, emergency department upgrades and additional ambulance capacity.

We are also taking action across the urgent and emergency care pathway to reduce excessive waits and to improve patient safety and flow through hospitals, which the noble Baroness, Lady Finlay, spoke to. I assure your Lordships’ Committee that this will continue following the abolition of NHS England. It is our view that a legal time limit in itself would not address the underlying pressures on capacity and patient flow that contribute to long waits, and establishing a new statutory scheme would risk distracting from the crucial work that is already under way.

On Amendment 219, also tabled by the noble Baroness, Lady Pidgeon, I could not agree more that corridor care must not—not even should not, but must not—be normalised. I am reiterating some of the points that I made in a recent Oral Question, which I believe was from the noble Baroness, on this very important point. Our priority is sustained action to address the causes by improving patient flow and discharge, expanding urgent care capacity and supporting the most challenged hospitals. We have introduced a consistent national definition and reporting arrangements, and we have improved transparency and enabled support to be focused where it is most needed.

The Secretary of State has also asked NHS England to bring forward urgent plans aimed at eliminating corridor care for children. I can say that one in six trusts consistently reported no corridor care across their emergency departments or the wider hospital over the summer. I particularly make the point about the summer because of the extreme pressure due to the weather—not something we usually say, but we are increasingly seeing it. The pressures were immense, and that was their report to us.

The noble Baroness, Lady Finlay, made the strongest case for exactly what we are doing with the neighbourhood health service, which is about moving the focus from hospital to community. I spoke earlier this week in the Chamber about the movement of savings accruing from timely discharge that can be directed to neighbourhood health. We are trialling that, because it is a very clear and practical way to make the move that the noble Baroness rightly identifies.

[Baroness Pidgeon (LD)]

My Lords, may I tease something out that the Minister was saying about corridor care? She quickly moved on to another thing, and I wanted to come back in.

Yes, this is similar to a discussion we had only last week or the week before in answer to a Question I had tabled, but two-thirds of medics working in emergency departments are saying that their trusts are not accurately reporting the data on corridor care. The Minister keeps saying that we have this new definition or whatever; it was decades ago that I worked in the NHS, but we had a way to make sure that people were not counted as being on a trolley: you took the wheels off and it became a bed. Trusts are very creative at finding ways around to meet their definitions. If two-thirds of those surveyed by the Royal College of Emergency Medicine are reporting that their trusts are not accurately calculating this, what are the Government doing to try to get under the data, to make sure that the Minister and the department are getting accurate data to be able to deal with this serious problem?

[Baroness Merron (Lab)]

I feel quite sure that the noble Baroness herself never did such a thing.

[Baroness Pidgeon (LD)]

No, obviously not, but trusts do that.

[Baroness Merron (Lab)]

I take very seriously the point that the noble Baroness made. I am sure it is already being looked into, but I will personally make sure that that is the case.

On corridor care and children, one example of the practical action taken is our recent announcement that the NHS is rolling out a standardised system to spot when a child’s health is deteriorating, so that early warning signs are caught earlier and there is faster action. The paediatric early warning system will be introduced in all emergency departments by the end of 2027-28, with an ambition to also roll this out in ambulance and community settings in the future. This is broader than just corridor care, but I know that that is a particular concern, as I said, when it comes to children. I cannot confirm often enough that we remain committed to fully eliminating corridor care before the end of this Parliament.

Finally, on Amendment 72, in the name of the noble Lord, Lord Patel of Bradford, I can give the reassurance that there is no national policy supporting blanket minimum waits. Indeed, patient safety always comes first. If a commissioner puts capacity measures in place, urgent referrals must be excluded, minimum waits must not be set above 18 weeks and providers must continue to triage patients according to clinical priority.

At the start of the year, it is important and expected that commissioners plan to balance service delivery with their yearly budgets while prioritising patient safety and clinical need. I remind your Lordships’ House that it is due to our approach to financial planning that the NHS stayed in line with its budget in 2025-26 while also cutting waiting lists by over 250,000 between July 2024 and August 2026. Removing the use of tools to support planning could drive unplanned activity and overspending, which would of course undesirably divert resources from other patients.

On the points made by the noble Lord, Lord Patel, about autism and ADHD assessment, expectations have already been set out for ICBs and providers to reduce those long waits and to improve experience, quality and productivity in ADHD services over the next three years. We are moving to a needs-led support model that means earlier access to information and support and appropriate interventions that are individually based, without and before a diagnosis.

On the question about ICBs imposing minimum waits and whether we will publish which ICBs are doing this, there are no plans to publish this information. The data is held locally and that is right, because these are decisions for local areas. To restate what I said before, commissioning decisions are for ICBs to make.

[Lord Scriven (LD)]

The Minister just made a very important point. Can she clarify? Is she saying that there is a requirement for ICBs to statutorily report that they have implemented a minimum wait standard, or not?

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[Baroness Merron (Lab)]

The question from Lord Patel was about whether there were plans to publish this information, and I was explaining that there are no plans and the reasons why.

[Lord Patel of Bradford (Non-Afl)]

Going back to the analogy of taking the wheels off the beds, it feels as if ICBs have certain budgets they want to spend on certain things and they are creating criteria that exclude vulnerable people. This is really important. All I am asking is, are the Government not looking at the more than 50% of ICBs that have put in minimum waiting times without assessments? If they are not assessing that information or looking at the data, how do they know what ICBs are up to? It is not about publishing it—okay, I suggested that we should publish it; it is about examining what these ICBs are doing and what the potential dangers are. I heard the conversation that said, “These are our criteria”. While our clinicians are saying that these people are at risk of suicide, they are saying, “These are our criteria”.

[Baroness Merron (Lab)]

I am glad that the noble Lord understands the reason why the Government are not seeking to publish, which was the question I was being asked about. For me, this is a question about the accountability of ICBs, currently held accountable by NHS England. But the whole purpose of the Bill is to improve the quality of accountability after the abolition of NHS England.

[Lord Patel of Bradford (Non-Afl)]

I just have one last point, and I am conscious that people have said that we do not want to take this too far. Will the Minister reflect on the issue and the principle that somebody who requires treatment or assessment should not have to wait for purely financial or administrative reasons, even though there is a clinical need?

[Baroness Merron (Lab)]

I have already made reference to what the priorities are: need and patient safety. I assure the noble Lord that I reflect on everything noble Lords say, and I certainly believe that I have already given that assurance.

[Baroness Coffey (Con)]

My Lords, this group of amendments has been informative, as have noble Lords’ contributions. I think that the noble Lord, Lord Patel of Bradford, may be referring to situations where a minimum is being deployed for people who have expressed their view that they would like to use an independent provider to tackle the issues, and I think that something is not quite right there. But we also have to be realistic. NHS England and all the trusts have to live within their means and not every area can be bailed out, as continues to happen at the Nottingham University Hospitals Trust and the Liverpool University Hospitals NHS Foundation Trust, which is in the recently published figures.

Obviously, whether it is about an ambulance or going to an urgent treatment centre or SDEC, I am conscious that the philosophy in the NHS up until fairly recently was that it was very proud that it had far fewer beds per person on average compared to other parts of Europe, on the basis that people would often get their operation, be dealt with and go home safely that same day. Thus, the thinking was that not quite so many beds were needed.

I welcome the reference to Sir Chris Whitty’s report, particularly in the context of rural communities. But without further ado, I beg leave to withdraw my amendment.