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.

Health Bill

Baroness Merron Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

I have nothing more to add, noble Lords will be grateful to hear. I just wanted to make that point, based on my experience. We look forward, much more than to my contribution, to the Minister’s response.

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

My Lords, I am most grateful to noble Lords for their contributions to this debate. As before, I will focus on the amendments before us. I start with the future of the NHS federated data platform and the noble Lord, Lord Clement-Jones, who spoke to his Amendments 158, 159 and 172E, and the noble Baroness, Lady Bennett, who spoke to her Amendment 172B.

As I hope noble Lords will agree, decisions about public contracts must be made through fair, open and non-discriminatory processes, which is the point the noble Lord, Lord Kamall, was making. This is governed by UK procurement law and it ensures we get the best outcomes and solutions for the National Health Service. NHS England is reviewing the contract to determine whether it should continue, subject to standard contract management processes and government approvals. This process remains ongoing and decisions will be announced formally.

I can assure your Lordships’ House that the FDP operates under the direction of the NHS and each trust and ICB that has signed up uses it as it sees fit. Furthermore, Article 25 of the UK GDPR, which requires organisations to include data protection by design and default, already applies to the FDP. Were data to be anonymised as Amendment 158 proposes, it would prevent the delivery of national services such as national vaccination and screening, and key activity supporting the management, operation and provision of national health services.

I feel it would be helpful to set out the potential implications of Amendment 172B. When it was tabled, the usual channels received advice from the House authorities that the amendment would, in their view, risk making the Bill hybrid as it seeks to put in the Bill that the contract of one specific company is not extended. If the Bill is hybridised through amendment, those affected will have the opportunity to petition, after which the Bill will be referred to a Select Committee.

[Lord Clement-Jones (LD)]

Can the Minister confirm the date when the decision will be announced on whether or not there will be retendering of that FDP Foundry contract?

[Baroness Merron (Lab)]

I am not able to confirm the exact date, but I can say, as I said earlier, that the decision will be announced formally, so noble Lords will be made aware.

On the questions of security, resilience and sovereign capability, as raised in Amendments 53, 171 and 289 by the noble Lord, Lord Tarassenko, the Government share his determination to protect patient data and to support the strong UK digital health market. However, I am not able to commit to an NHS digital sovereignty strategy, nor additional legislation. Supply risk is not determined by nationality or jurisdiction alone. What matters is the data involved, who can access it, the supplies controls and the contractual protections in place. We already have robust safeguards. The Procurement Act 2023, about which much has been spoken, provides powers to exclude suppliers where appropriate, including on national security grounds. It also provides for setting data protection and cyber security requirements.

I note specifically the noble Lord’s concerns about the procurement of the single patient record, and I am looking forward to a more focused discussion, as I know all noble Lords are, on the SPR at a later Committee stage. I can confirm now that the procurement will have to ensure the resilience of our systems, how we keep within the UK jurisdiction and that the data remains under NHS control. The noble Lord, Lord Tarassenko, raised concerns that foreign laws could require an overseas supplier to give access to NHS data. We take that risk extremely seriously and aim to ensure that the legal, contractual and cyber-security safeguards are in place to avoid this.

I fully endorse encouraging domestic innovation, as I hope noble Lords are aware. As the Chancellor set out in the recent Budget, the Government will use public procurement strategically to back British firms to strengthen domestic capability and to build resilience in key supply chains. We will continue to promote international investment and trade and to open opportunities for British businesses at home and in markets around the world.

The noble Baroness, Lady Kidron, indicated her agreement with the noble Lord, Lord Tarassenko, in this area. The points on sovereign data being an asset will come back in the group beginning with Amendment 142, and again I look forward to debating that. We want a vibrant UK market for tech, and practical action is already under way. NHS England is engaging industry ahead of procurements, structuring opportunities to increase SME participation, and using social value to support good jobs and skills, which we all want to see.

I turn to Amendment 279A, tabled by the noble Lord, Lord Austin. He too raises the important question of accountability within this amendment, and we agree that contracting authorities should be accountable to the objectives of the Procurement Act, which already apply directly to covered procurement. The Act also provides transparency and oversight mechanisms, including powers to investigate compliance. The Procurement Act 2023 already requires publication of contract details for contracts worth over £5 million and, where applicable, key performance indicators and annual assessments of supplier performance against them. This makes a further NHS-specific annual reporting duty unnecessary in our view. For medtech, our value-based procurement approach further supports decisions focused on patient outcomes, total care costs, and longer-term value.

[Lord Scriven (LD)]

The amendment from the noble Lord, Lord Austin, refers to

“medical devices, consumables and services”.

There are two laws in place for procurement for the NHS: one for services and one for goods. What about the services? We have heard about the goods, but what about the accountability and feedback for services?

[Baroness Merron (Lab)]

I made reference to the Procurement Act 2023, and that is the guide by which we go.

[Lord Scriven (LD)]

It is for goods, but NHS services come under the 2022 health Act. There was discussion about whether it should have all fallen under one procurement law, but for NHS goods it is the 2023 Act, and for services it is the 2022 health Act that is applicable. If the Minister could write to me and place a copy in the Library, it would be helpful to see how the health Act also applies.

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[Baroness Merron (Lab)]

So many health Acts. I would, of course, be very happy to do that.

I turn to Amendments 144, 147 and 160, tabled by the noble Lord, Lord Clement-Jones. I recognise the importance of ensuring that NHS IT and data procurements are fair and competitive, and protect the interests of patients and taxpayers. However, there is already extensive procurement law governing the department and NHS organisations. The Government agree with the objective of avoiding supplier lock-in. However, ownership of all connector IP is neither necessary nor the most effective means of achieving that. Appropriate licensing rights, interoperability requirements, open standards and exit provisions can protect portability and future competition without prescribing a single ownership model. Similarly, a blanket prohibition on suppliers that have previously provided free services could have unforeseen consequences, including for voluntary sector providers. Existing procurement rules provide safeguards against unfair incumbent advantage.

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[Lord Clement-Jones (LD)]

The Minister mentioned existing procurement rules, and she gave a partial nod to my Amendments 144, 147 and 160, but said it was not always desirable for all those elements to be observed. Perhaps she could write and say which bits of those amendments—which are quite technical, I admit, dealing with interoperability, data connectors and the prevention of supplier lock-in—she means. It would be helpful if she could write and explain how the procurement rules that she prays in aid achieve some of those objectives.

[Baroness Merron (Lab)]

I will be pleased to do so and thank the noble Lord.

[Baroness Bennett of Manor Castle (GP)]

The Minister referred to national security grounds being considered in the letting of these contracts. When we talk about national security, traditionally we have thought about hostile states proving a threat, but now we are in the context of the broligarchy—tech oligarchs who wield enormous power and influence, frequently opaquely held, with links to far-right politics and Governments who are funding far-right forces in the UK and around Europe. Is the Minister confident that that kind of national security threat is adequately considered when we look at contracts?

[Baroness Merron (Lab)]

That is not a matter I feel able to reply to in detail right now, although I will gladly write. However, to the best of my knowledge, the interpretation of what represents a threat to national security is set out and is understood.

[Lord Tarassenko (CB)]

I thank all noble Lords who have spoken. I think we have mostly sung from the same hymn sheet, with perhaps the odd discordant note—maybe even a few bars, maybe even a whole movement, some people might argue. I am grateful to the Minister for her comprehensive reply.

I found it heartening last week to hear the Secretary of State speak positively about sovereign data and sovereign AI—those were her words. We now have an opportunity to go from concept to implementation within the next two years—namely, the single patient record contracts; that is, not the FDP contracts but the new contracts for the single patient record.

I believe, and I believe that many other noble Lords agree with me, that we have a highly capable—world-leading, I would say—UK medical technology and software sector, with companies that are often university spin-outs now ready to scale up. None of my amendments is in contradiction with the Procurement Act. I believe these companies can win these SPR contracts on merit. We are talking about supporting UK excellence, but we need to remember that the US spends billions to support technology in a radically different, profit-driven healthcare system, which often produces software that has a very poor fit to the NHS. I am sure the noble Lord, Lord Lansley, will be able to tell us that the original EPRs, the electronic patient records, from companies such as Epic and Cerner were a poor fit because they were designed for billing purposes, not for optimising patient outcomes. We made that mistake with the EPRs; let us not make the same mistake with the SPR.

In general, because the UK businesses are much smaller than the Oracles, the Epics, the Palantirs and the IBMs, we need a level playing field. I suggest that we need a signal from the Government to those companies that the Government are keen for them, as was mentioned by the Minister, to use procurement strategically to back UK business. I think that signal is the NHS digital sovereignty strategy, and I believe we will come back to it on Report. I beg leave to withdraw my amendment.

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[Earl Howe (Con)]

My Lords, I start by welcoming Amendment 54, as tabled by my noble friend Lord Lansley. It raises an important concern about eligibility for NHS continuing care. Someone suffering from a serious chronic condition, including severe dementia, should not find themselves disadvantaged in comparison with someone with terminal cancer simply because their condition fluctuates or because they are not considered to be approaching the end of life. Eligibility should be determined by the intensity and complexity of a person’s needs rather than by arbitrary distinctions. Having said that, and while the concept of continuing care is one that we can all embrace, its quality and delivery, as the noble Baroness, Lady Barker, so succinctly reminded us, often fall far short of the ideal. Can the Minister therefore say whether the Government will consider making the existing eligibility framework more responsive to the patients that my noble friend described?

I also welcome my noble friend Lord Harlech’s Amendment 279QE. Recognising the particular medical and dental fitness requirements of reservists is a sensible and clearly proportionate measure. The amendment does not displace the key principle, as he explained, that clinical need must remain paramount in this context. Can the Minister explain how the Government currently expect health bodies to recognise the particular circumstances of reservists and whether further guidance might be necessary?

This debate has been characterised by a consistent measure of concern around commissioning. We have seen this through Amendments 57, 59 and 73, as tabled by the noble Baronesses, Lady Grey-Thompson and Lady Pidgeon, who are seeking greater transparency through impact assessments and reporting requirements, particularly where specialised services are transferred to ICBs.

The noble Lord, Lord Hunt of Kings Heath, in Amendment 58, similarly highlights allergy provision. All this argues for Amendment 80, as tabled by the noble Baroness, Lady Grey-Thompson, which seeks greater scrutiny of the performance of ICBs.

As a significant number of the amendments in this group highlight, including those from the noble Baroness, Lady Scott of Needham Market, and the noble Lord, Lord Sharkey, there is concern that the Secretary of State, with so many priorities, will be unable to provide acceptable standards for certain groups. Accountability and consistency of standards cannot just be taken as a given or as things that will come out magically in the wash. It would be helpful if the Minister could explain to the Committee how the Government intend to reconcile these objectives.

In particular, where specialised commissioning is transferred to ICBs, who will be responsible for ensuring that the necessary commissioning capacity and expertise will be in place? Amendment 74, from the noble Lord, Lord Sharkey, and my noble friends Lady Sater and Lady Chisholm, asks a corresponding and equally important question around clinical leadership. As the noble Lord, Lord Scriven, expressed so well, the amendments in this group demonstrate the complexity of the decisions involved in commissioning healthcare, particularly for specialised services. I do think that further and better particulars are required from the Government before any of us can feel comfortable with the direction in which we are heading.

[Baroness Merron (Lab)]

My Lords, I am most grateful for this debate. I will endeavour to pick up most of the main points, but if I do not manage to do that, given the hour, I will of course be pleased to review the points raised and pick them up—in particular, looking at how I could be more helpful in providing some of the broader information that is being sought.

Perhaps I could start by emphasising that the whole point about the Bill is that Ministers are, of course, responsible to Parliament for how they discharge all their duties, including how they promote the comprehensive health service that we all seek and how we reduce health inequalities in access and outcomes.

The regulations prescribing the services retained for national commissioning will be subject to parliamentary approval. I assure your Lordships’ Committee that, in putting forward the regulations, Ministers have to have regard to patient numbers, provision costs and the number of providers, because they all relate to safety, effectiveness and value for money of commissioning at various different tiers.

Tobacco and Vapes Act 2026 (Display of Tobacco Products) (Consequential Amendments) Regulations 2026

Baroness Merron Excerpts

Wednesday 11th November 2026 Lords Chamber

Moved by

[Baroness Merron]

That the draft Regulations laid before the House on 14 September be approved.

Relevant document:13th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 10 November.

Motions agreed.

Neighbourhood Health Services

Baroness Merron Excerpts

Tuesday 10th November 2026 Lords Chamber

[Lord Lansley]

To ask His Majesty’s Government what assessment they have made of the effectiveness of neighbourhood health services in improving patient outcomes and reducing pressure on hospitals.

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

My Lords, the success of neighbourhood health will be measured against the national goals in the neighbourhood health framework, including improved health outcomes and better urgent and emergency care performance. Early local reported evidence from neighbourhood health approaches is encouraging, including reported reductions in emergency department use and in emergency admissions. The learning from the 43-place national neighbourhood health implementation programme is informing wider implementation, alongside an independent national evaluation commissioned through NIHR.

[Lord Lansley (Con)]

I am grateful for that response from the Minister. Can I ask about the example of heart valve disease, which affects one in 15 people over the age of 75? Of those, half go undiagnosed, which can lead to severe illness, hospitalisation, expensive treatment and, unfortunately, avoidable early mortality. We have digital diagnostics available in the community now which, in the hands of GPs and pharmacists, can enable much of that lack of diagnosis to be met and therefore preventive treatment to be successfully applied. What are the Government doing to enable the spread of diagnostics into the community, which is vital in that transition from hospital to community, from treatment to prevention and from analogue to digital?

[Baroness Merron (Lab)]

The noble Lord comes forward with a good example; digital diagnosis is a huge support in the improvements that we seek to make for patients, so we are investing in digital diagnostic transformation through NHS England’s diagnostics digital capability programme. That will ensure that networks have that core set of digital capabilities so that care can be improved in quality, safety and productivity. Those are all outcomes that we seek in neighbourhood healthcare.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord, Lord Lansley, has underpinned the importance of general practitioners. My noble friend will be aware that there is a big variation in the number of GPs per patient up and down the country. Can she say a little about what the Government are doing to deal with these under-doctored GP areas?

[Baroness Merron (Lab)]

It is true that general practice is a cornerstone of neighbourhood health. I am glad that people will now find it easier to access their doctor and have more choice in how and when they book appointments. With reference to digital access, I believe that will greatly help in accessibility to GPs, but we are improving capacity. We are employing more GPs; there are now 2,800 more fully qualified full-time equivalent GPs employed compared with July 2024. That is the highest number since 2015. We have also made changes to the GP contract so that PCNs and practices can hire more GPs and introduced a practice-level GP scheme. We are focusing our efforts on the more under-doctored areas that my noble friend describes.

[Baroness Pidgeon (LD)]

My Lords, we cannot expect neighbourhood health services to succeed without ensuring that resources shift from hospitals into the community, so can the Minister set out how much additional NHS funding will be directed towards primary and community care, and how this will be monitored?

[Baroness Merron (Lab)]

My Lords, joined-up care requires changes to funding flows in order that we can shift our resources. That is where the focus will be. I am glad that from next year we will be trialling for neighbourhoods and places payment mechanisms which mean that savings from reduced unplanned hospital care can go into increased investment in community services. That will not only provide extra funding in terms of neighbourhood health but drive change, which is what we are seeking. In addition, we announced in the Budget 250 neighbourhood health centres, with 120 delivered by 2030, and the first wave of 27 sites comes with a commitment of £50 million.

[Baroness Finlay of Llandaff (CB)]

My Lords, given that 97% of emergency departments feel that the current pressures on them are unsustainable through the winter, when will the Government establish seven-day services in the community so that bed occupancy rates can fall from their current 93.4% to 85%, which is much safer and will allow emergency departments to deal with really major emergencies and trauma?

[Baroness Merron (Lab)]

By expanding urgent community care, we will reduce avoidable emergency department attendances, hospital admissions and ambulance conveyances. That is why we are engaging not just an urgent community response but virtual ward services. I also point to the fact that we are supporting patients to book the most appropriate urgent care service through NHS 111 or the NHS app before attending emergency departments. There are a number of very good examples around the country of how people are doing that. Winter is going to be hugely challenging, and that is why, for example, we are putting in £190 million to help the NHS manage winter pressures and £140 million for new urgent care schemes.

[Lord Kamall (Con)]

My Lords, we all agree with the shift from hospital to community but, as we discussed on the Health Bill in Committee last night, we are still waiting for details of how it will all fit together. Can the Minister explain whether existing primary care providers, especially local GP practices, will be expected to rebrand as neighbourhood health centres and maybe offer some additional services, particularly secondary services, or will existing GP practices be told to physically move from their current premises into a neighbourhood health centre, and how will they be consulted?

[Baroness Merron (Lab)]

We are supporting ICBs, providers and everyone across the NHS to work together differently. That is the main point I want to get across. In March this year, we published Fit for the Future: Towards Population Health Delivery Models, which set out three new population-based contract types. They aim to bring various aspects of services into a single contract, and they will deliver a shift from what is currently fragmented, service-by-service commissioning to end-to-end pathways around the patient. That is where we need to get to. GPs are very much part of that, and we have involved them throughout.

[Baroness Barker (LD)]

My Lords, we cannot have neighbourhood health without having more community nurses, yet the majority of nurses are in the acute sector, so what are the Government doing to increase the number of community nurses?

[Baroness Merron (Lab)]

The noble Baroness will be aware that the Secretary of State has confirmed that the workforce plan will be published in the new year. It will take account of that point and the new way of working—how we build the NHS into the future around patients. The point that she makes is quite right. The workforce plan will set out how we will do that.

[Lord Kakkar (CB)]

My Lords, I draw attention to my declared interest as chairman of King’s Health Partners. Section 131 of the 2006 NHS Act requires NHS England to ensure that it has been properly professionally informed in determining how to provide diagnostic, preventive and treatment health services and public health services. It is proposed that this obligation will no longer apply to the Secretary of State when NHS England is abolished. How do His Majesty’s Government propose to ensure that proper, clinically informed information is available in determining the provision of local health services in the future?

[Baroness Merron (Lab)]

As I recall, we discussed last night in the Health Bill the establishment of a clinical council which could guide and advise the Secretary of State, who is, of course, ultimately responsible.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, community pharmacies are a key pillar of neighbourhood health services, providing treatment for small illnesses and as part of the vaccination programme. Can my noble friend the Minister outline what plans the Government may have to extend and expand the vaccination programme to community pharmacies?

[Baroness Merron (Lab)]

My noble friend is quite right that expanding the availability of NHS vaccinations through community pharmacy is very much the way forward. That is why in the last flu season we enabled the provision of flu vaccinations through pharmacists to two and three year-olds. It is why in this flu season we are extending that still further, to children and young people in clinical risk groups and for catch-up vaccinations. We have also piloted delivery of the RSV vaccination for older adults and pregnant women, which my noble friend has campaigned on very successfully.

Tobacco and Vapes Act 2026 (Age Verification Defence to Underage Sales) (England and Wales) Regulations 2026

Baroness Merron Excerpts

Tuesday 10th November 2026 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Tobacco and Vapes Act 2026 (Age Verification Defence to Underage Sales) (England and Wales) Regulations 2026.

Relevant document: 13th Report from the Secondary Legislation Scrutiny Committee

Motion agreed.

Tobacco and Vapes Act 2026 (Display of Tobacco Products) (Consequential Amendments) Regulations 2026

Baroness Merron Excerpts

Tuesday 10th November 2026 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Tobacco and Vapes Act 2026 (Display of Tobacco Products) (Consequential Amendments) Regulations 2026.

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

My Lords, I shall speak also to the draft Tobacco and Vapes Act 2026 (Age Verification Defence to Underage Sales) (England and Wales) Regulations 2026.

The Tobacco and Vapes Act, which received Royal Assent earlier this year, was landmark legislation that will deliver on the Government’s commitment to create a smoke-free generation and tackle youth vaping. As we know, smoking claims around 75,000 lives a year in the UK. That is why from 1 January 2027 it will be an offence to sell tobacco products, herbal smoking products or cigarette papers to anyone born on or after 1 January 2009, which will help to create the UK’s first smoke-free generation. The Act has also strengthened protections for children by making it an offence to sell vaping products or nicotine products to anyone under the age of 18, closing loopholes in the previous age of sale requirements. This reflects our health advice that, while vapes can be an effective aid for adult smokers to quit smoking, children and non-smokers should never vape or use nicotine products.

The two instruments before the Committee today will support the effective implementation of the new age of sale measures in the Act. I begin with the age-verification regulations. The Act provides powers to set out in regulations steps that retailers may take to verify that a customer has reached the legal age of sale, as a defence to the age of sale offences. This instrument sets out the steps that would satisfy this defence in England and Wales. It aims to give retailers confidence about how they can verify the age of customers attempting to buy these products. It also provides for two alternative methods of age verification which will both satisfy the defence.

First, a person charged with an age of sale offence may rely on the defence where they can prove that they were shown a physical identity document bearing the customer’s photograph, a date of birth and a holographic mark or ultraviolet feature. These criteria capture common forms of ID such as passports, driving licences and PASS cards. Secondly, a retailer may rely on a digital proof of age. This must be verified and delivered through a digital verification service, known as DVS, which has been independently assessed against the UK DVS trust framework and is listed on the statutory DVS register.

The provisions on digital proof of age follow the passage of the Data (Use and Access) Act 2025, which placed the trust framework and the DVS register on a statutory footing. They also follow the coming into force of the Licensing Act 2003 (Mandatory Licensing Conditions) (Amendment) Order 2026, which enables the use of these services as part of alcohol sales. I shall be clear that there is no requirement for individuals to use digital proof of age, nor are businesses required to accept it. It simply provides an additional, voluntary option alongside physical documents.

In developing the criteria for physical and digital proof of age, we have considered three key aims. First, we have sought to mirror the criteria for physical and digital proofs of age that can be used for alcohol sales—something we rightly discussed in Committee. This aims to capture the many retailers who sell alcohol as well as tobacco, vaping and nicotine products, who will need to remember only one set of criteria. Secondly, the criteria ensure that a range of commonly used forms of ID can be accepted. Thirdly, we have sought to future-proof the regulations by ensuring that digital proof of age can be used alongside traditional physical documents. In other words, we are seeking to make this workable.

Neither the Act nor these regulations create a requirement for retailers to ask every customer for proof of age before every sale. The steps set out in this instrument are also not the only means of establishing a defence. The Act provides an alternative defence where a retailer can prove that they took “all reasonable steps” to avoid committing the offence. This is very much a re-enactment of the defence in previous tobacco and vapes legislation of having taken all reasonable precautions and exercised all due diligence. These regulations set out an additional, more prescriptive route to establishing a defence. A retailer who follows the steps in these regulations can have confidence that they would be able to demonstrate a statutory defence if they were ever subsequently challenged over a sale—another matter that arose, correctly, during Committee.

The next statutory instrument I will refer to relates to the display of tobacco products in retail premises. Under the current rules, introduced by the Tobacco Advertising and Promotion Act 2002 and related regulations, retailers in England, Wales and Northern Ireland are prohibited from displaying tobacco products. The 2002 Act includes an exemption that allows retailers to display tobacco products to a customer aged 18 or over, on their request, and a linked defence where a retailer mistakenly displays products to someone whom they reasonably consider to be 18 or over. This statutory instrument updates those provisions so that tobacco products can be displayed, on request, only to people born before 1 January 2009, aligning display restrictions with the new age of sale that comes into force on 1 January.

Without these amendments, under the current display legislation, individuals aged 18 and over could still be shown tobacco products, even if the products could not legally be sold to them. This would undoubtedly create an inconsistent and confusing position for retailers and could increase the risk of accidental underage sales. By aligning the age at which customers can be shown tobacco products with the new age of sale, we are aiming to help businesses comply with the law and to support effective enforcement.

These changes also aim to ensure the continued effectiveness of restrictions on tobacco display. We have decades of evidence to show that reducing the visibility and accessibility of tobacco products helps to reduce their appeal, particularly among young people. Restrictions on display also contribute to a more supportive environment for adults who are trying to quit smoking, by reducing exposure to tobacco products in everyday settings.

These regulations mark what I believe to be an important milestone in the implementation of the Tobacco and Vapes Act. They are a step towards creating a healthier future for today’s children and for generations to come, and I commend them to the Committee.

--- Later in debate ---

[Lord Evans of Rainow (Con)]

My Lords, I thank the Minister for introducing this SI and for turning up this morning. She is clearly under the weather; perhaps she should have a hot toddy and take a rest for the rest of the day, given that she will be in her place at the Dispatch Box tomorrow evening for Committee on the Health Bill.

Protecting young people from the harms of smoking and vaping is the principle underpinning both these measures, but it is essential that the regulations implementing these changes are practical and properly scrutinised. The first instrument I will address today concerns the display of tobacco products, aligning existing exemptions with the new generational ban. At first glance, this appears to be a straightforward change, but it raises wider questions about the cumulative burden being placed on retailers.

The Government’s own impact assessment estimates that the changes to vape displays could cost retailers £26 million. The Association of Convenience Stores has suggested that the costs of a full display ban could actually exceed £160 million for convenience stores alone. These figures demonstrate the substantial financial pressures facing businesses as a result of these reforms. Can the Minister therefore clarify what assessment has been made of the specific costs associated with implementing this instrument, particularly for small independent retailers? What assurances can she provide that businesses will receive sufficient time and guidance to adapt?

The second instrument sets out the steps that retailers must take to check a customer’s age when selling tobacco or vaping products so that they can demonstrate that they have followed the law if an underage sale takes place. These provisions follow on from the fact that the generational ban introduces a fundamentally different approach to age verification. Rather than simply establishing whether someone is over 18, retailers will need to determine whether customers were born before a particular date: namely, before 2009.

This creates additional complexity for shopkeepers and their employees, who will be expected to understand and enforce the law. The Government must ensure that those acting responsibly are not inadvertently exposed to prosecution because of unclear requirements. Can the Minister explain how the Government will ensure that retailers can reliably check whether a customer is legally entitled to buy tobacco, particularly as the age limit will change each year? What expectations are there for people to carry identification as they get older?

During the passage of the Tobacco and Vapes Act, concerns were raised about the extensive powers given to the Secretary of State. Concerns have been repeatedly raised about the breadth of the Government’s regulation-making powers and the importance of parliamentary scrutiny. It is therefore vital that these powers are exercised transparently, with clear evidence supporting the measures introduced. Can the Minister tell us how the Government expect trading standards officers to enforce these additional requirements without providing them the resources to do so?

As my noble friend Dr Caroline Johnson highlighted in the other place, these powers could allow the Government to extend smoke-free restrictions to a wide range of places with limited parliamentary oversight. While these SIs deal particularly with tobacco displays and age verification, the wider concern about scrutiny remains. Can the Minister reassure the Committee that future regulations will be subject to proper consultation and parliamentary scrutiny, and that the Government will clearly explain why further restrictions are necessary?

I hope the Minister will address these concerns and reassure the Committee that these regulations will be implemented fairly and scrutinised properly.

[Baroness Merron (Lab)]

My Lords, I am most grateful to all noble Lords who have contributed to this debate and grateful for the support for the measures that we are taking. I know that many noble Lords who have spoken today have long been active campaigners, and I am extremely grateful. In particular, the noble Lord, Lord Young, welcomed the various steps across government, which speaks to the fact that this is not just a matter for health; there are other actions that we can take. I am also glad that the noble Lord, Lord Rennard, welcomed the clarity that these regulations will provide. He referred to avoiding unnecessary friction. That was very much part of our discussions during the passage of the Bill, and it is one of the concerns of the noble Lord, Lord Evans, which we share.

In just seven weeks’ time, the smoke-free generation will become a reality in this country, and that is something to celebrate. The first young people born in 2009 will turn 18, the law will change and those young people will enjoy a life that is free from the harms of tobacco that have plagued successive generations before them. These two sets of regulations are important steps in making sure that retailers are ready—I take on board the concerns raised—that the law is consistent and that the new age of sale is implemented successfully from 1 January. That is what these regulations seek to do.

I turn to the points raised. The noble Lords, Lord Young and Lord Rennard, raised questions about the tobacco industry’s influence and input into consultations. I remind the Committee that our consultation on proposals to reduce the appeal of tobacco, vaping and nicotine products closed on 2 October. The consultation spoke to aligning the display of vaping products, nicotine products, cigarette papers and heated tobacco devices with display restrictions—in other words, removing them from display and moving them away from the eyes of children and young people. We are currently considering the responses.

Concerns were raised about interference. We have robust controls in place to prevent the manipulation of public consultations. These controls certainly worked effectively in our past consultation, where we set out the case to create a smoke-free generation. I assure noble Lords that we remain alert to the kind of interference raised by the noble Lord, Lord Young, in particular, and we will not be deterred from doing what is necessary to promote healthier living and to protect children and young people.

The noble Lord, Lord Young, asked about a road map. Of course, we very much share the ambition to further drive down smoking rates; we are far from complacent. I know how pleased the Chief Medical Officer was recently at the historic low in smoking rates, but we do not stop there; we will continue. Our immediate priority is delivering the Tobacco and Vapes Act and the comprehensive programme of secondary legislation that sits behind it. With the investment in stop smoking services and enforcement, these measures will form our programme for delivering a smoke-free UK.

It might be helpful if I remind the Committee that the Act includes a requirement for the Secretary of State to review the operation of the Act within four to seven years of Royal Assent and to lay a report before Parliament concluding the findings of this review. I assure noble Lords that we remain open to evaluating the impact of the Act and to being held to account on that. I remember the conversation about what the right length of time was. This is our feeling on the right length of time, so we can give the Act time to make an impact and be realistic with Parliament about what has been achieved.

--- Later in debate ---

[Lord Rennard (LD)]

Before the Minister sits down, can I ask her a little more about this promotional campaign beginning on Monday? What is the budget for this campaign? I am delighted to hear that it will appear on television, radio, social media and elsewhere, but these things cost, and I would like to know how much will be invested in this programme. Perhaps the Minister could let me know another time.

[Baroness Merron (Lab)]

I will be very pleased to write to the noble Lord on that point of detail.

Motion agreed.

Health: Women and Pain

Baroness Merron Excerpts

Monday 9th November 2026 Lords Chamber

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

My Lords, it is unacceptable that women spend more years in poor health than men, while pain is too often dismissed and normalised. Our renewed women’s health strategy treats this as a systemic failure, and this research reinforces that. Patient-reported measures will be introduced in gynaecology services to assess whether women’s pain is heard and effectively treated, alongside testing patient power payments, which will be linked to women’s feedback, including their experience of pain.

[Baroness Nargund (Lab)]

My Lords, I thank my noble friend the Minister for her reply. This large international study has found that more women report pain across 11 body sites compared to men, and over half of them report that their pain has been either ignored or dismissed by healthcare professionals. Given that pain is a leading cause of disability and reduced economic participation, can my noble friend tell us what concrete steps the Government are taking to tackle the gender pain gap and the gender pain management gap, and what actions will be taken if healthcare professionals continue to ignore or dismiss women’s pain?

[Baroness Merron (Lab)]

My noble friend’s observations are quite right. We have already updated NICE guidance and introduced courses in order to strengthen professional education across a range of conditions. We have introduced targeted initiatives, including the Getting It Right First Time chronic pain workstream. Our introduction of Jess’s rule and Martha’s rule will mean that women can challenge when symptoms persist or they feel that they are not being listened to. We are developing a new multiprofessional capability framework for women’s healthcare in community settings, and that will address a pattern of women’s symptoms being dismissed or normalised.

[Baroness Pidgeon (LD)]

My Lords, the Government’s women’s health strategy pledges to eliminate the diagnostic issues for women with endometriosis. In the light of Emma Barnett’s recent BBC documentary and Endometriosis UK’s finding that women wait an average of nine years and four months for a diagnosis, will the Minister support the charity’s call for diagnosis times to be reduced to one year or less by 2030, and commit to publishing national data to track progress?

[Baroness Merron (Lab)]

Women are waiting far too long, which is the reason for the renewal of the women’s health strategy. We have, through the National Institute for Health and Care Research, commissioned a number of studies which are very much focused on the points that the noble Baroness is raising, which are endometriosis diagnosis, treatment and, importantly, experience. We have committed over £4.3 million for new research projects, including a trial to evaluate the effectiveness of pain management programmes, and the noble Baroness will be aware of our commitment for waiting times to be reduced in order that patients, including those with endometriosis, can know exactly what to expect.

[Lord Kamall (Con)]

My Lords, the Minister said that women’s pain and pain management will be addressed by the forthcoming women’s health strategy. What specific goals and objectives have been set and what accountability will there be if those goals and objectives are not met?

[Baroness Merron (Lab)]

Action 4 commits to testing patient power payments, and we are prioritising gynaecology services as a test. That will mean that if a woman’s feedback, which will be actively sought, is not what it should be based on their experience—and that includes pain—then payments can be withheld and invested to improve the situation. I am sure the House appreciates that often it is finance which drives change, and this is just one of our new ways of doing that.

[Lord Watts (Lab)]

My Lords, does the Minister agree that the country needs to target the poorest members of our community, male and female, whose health is worse than the average and who need the resources that we require?

[Baroness Merron (Lab)]

I agree with that. That is why, in the 10-year health plan and in our manifesto commitments, we are working towards the commitment to halve the gap in healthy life expectancy between the richest and the poorest regions, and setting a minimum standard of healthy life expectancy of 61 years in all areas. That is consistent with halving the gap, and means that we will give attention to all regions of the country, particularly those that need it most.

[Baroness Hayter of Kentish Town (Lab)]

My noble friend will not be surprised that I ask about osteoporosis. Not only are the fractures themselves painful but so too is the recuperation, and it is particularly women who are affected. As my noble friend knows, I am still awaiting a little more reassurance from the Government. Maybe she could tell us the moves that they will make on this.

[Baroness Merron (Lab)]

As I have previously committed to and confirmed, as my noble friend will be aware of, the 10-year health plan reaffirms the commitment to rolling out fracture liaison services by 2030 as part of more devolved health services. We continue to work with integrated care boards to make that happen, while investing, for example, £2.6 million in 20 new state-of-the-art DEXA scanners, building on the first wave of investment of £1.9 million in 13 of the scanners last year.

[Baroness Hussein-Ece (LD)]

My Lords, recent reports have shown a clear lack of awareness and understanding of women’s reproductive health conditions among primary health care practitioners. Other reports have cited that what is needed is to remove the stigma and for there to be more training and awareness, so that women across the country, wherever they live and whoever their GP might be, can expect the same level of support and pain relief should they need it.

[Baroness Merron (Lab)]

I certainly agree. Looking back at the 2022 women’s health strategy, 84% of women experienced not being listened to by a healthcare professional. As I have already stated, that is totally unacceptable. A third of those women said that this had harmed their mental well-being. This is a very serious matter and that is why we are strengthening professional education across a range of conditions, testing out the patient power payments and introducing patient reported-experience measures. All those should drive improvements of care over the next five years, some more immediately than others.

[Lord Patel (CB)]

My Lords, one of the commendable objectives defined in the 10-year health plan is the development of women’s health centres. Can the Minister confirm that these will be not just advisory centres but diagnostic and, if possible, treatment centres, and that they will be appropriately staffed and funded?

[Baroness Merron (Lab)]

The centres will very much take a multidisciplinary approach, not least because they are about seeing women as a whole rather than as a condition. That is the big change we will see. It will inspire change across neighbourhood health services, not just in respect of women.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, does my noble friend agree that even where chronic pain has been identified in women, or in men, there is often considerable reluctance to accept the available treatment, because long-term pain is very often treated with drugs which have quite significant side effects? Can my noble friend say what work is being done, possibly supported by the health service, to develop pain relief strategies which do not create those side effects?

[Baroness Merron (Lab)]

Women are certainly more likely to experience multiple long-term and limiting conditions, and with that comes pain. In addition, we are absolutely committed to ensuring that there is a standard of care for, for example, gynaecological procedures such as hysteroscopy. We have consulted with the Campaign Against Painful Hysteroscopy for women with lived experiences around painful procedures, and we have gathered their insights. That is an approach we will continue to take as we develop pain management pathways across a whole range of conditions.

Health Bill

Baroness Merron Excerpts

Committee stage
Monday 9th November 2026 Lords Chamber

I therefore welcome the opportunity provided by these amendments to consider whether an approach based more on closely agreed outcomes, transparency and performance assessment, as the noble Lord, Lord Scriven, has proposed, might offer a better balance between national oversight and local autonomy. I would be grateful if the Minister could explain how the Government envisage that balance operating in practice. More generally, I look forward to hearing how she responds to the points made by the noble Lord, Lord Scriven.

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

My Lords, in responding to this group, I will endeavour to set out how we expect the Secretary of State to act and our overall approach to this topic. I am doing that because I hope it will be helpful not just in this group but in the next one, which relates also to the power of direction. I appreciate the understanding of my noble friend Lord Hunt and the noble Baroness, Lady Coffey, in seeing the practical way that the Bill is seeking to work—in the round, I might add. That is what has struck me about this valid debate to unpick what the Bill will do.

With permission, I will address all the amendments in relation to Clauses 8, 11 and 21 together in this group. On Amendment 47, tabled in the name of the noble Lord, Lord Patel, I can confirm that the Secretary of State will continue to routinely obtain appropriate advice to inform all decision-making, and they will have access to a wide range of clinical, scientific and public health expertise. That will ensure that decisions are informed by professional and clinical insight—for example, from the Chief Medical Officer, the Chief Nursing Officer, standing expert committees and ad hoc advice. To further strengthen clinical leadership across the system and advice given to Ministers on the NHS’s major clinical priorities in the health and care system, which is a matter that has come up a number of times, we will establish the first clinical council. This will bring together a small group of senior clinicians to strengthen leadership, and their experience of treating patients and improving services will directly inform our decision-making in those areas.

Before moving on, I want to briefly mention Amendments 30 and 31, tabled by the noble Lord, Lord Scriven, which reference Clause 8 of this Bill. The power in this clause is distinct from the general power of direction in Clause 11, and allows the Secretary of State to direct integrated care boards to exercise functions on their behalf. While the ICB will be legally responsible for discharging a function, the Secretary of State remains accountable for it, may place restrictions on onwards delegation and must publish any directions. This measure empowers appropriate, flexible local service planning by the Secretary of State to assign functions to ICBs, in the way we see them developing.

On Clause 11, I will address as a group Amendment 39, tabled by the noble Baroness, Lady Bennett, and Amendments 40, 55, 56, 69, 76, 77, 114 and 117, tabled by the noble Lord, Lord Scriven. This clause establishes a general power for the Secretary of State to direct integrated care boards in the exercise of their functions, including directing a single ICB, a group of ICBs or all ICBs. If we reflect on the 2012 Act, as I think we should, the fact is that it was overcomplicated. When it comes to practice, it has been harder to respond to challenges, not easier—which is where we want to get to. It is important that Ministers have the humility to recognise what they cannot foresee, and that it is just not possible to legislate for every situation. I believe that it is crucial to have flexibility to meet these challenges when they emerge. The Bill returns us closer to the pre-2012 situation, when—as a number of noble Lords have observed throughout the passage of this Bill—the public expected Ministers to be able to intervene, but expected them to do so sparingly, and Ministers had the necessary powers required.

Over the years, Ministers have had to respond to emerging circumstances, and the noble Lord, Lord Scriven, asked for examples. I reflect back to the fact that Ministers in 2012, for example, did not anticipate having to respond to the situation in the Mid Staffs NHS Foundation Trust, nor could they have predicted challenges to existing contracts in the NHS coming about following the invasion of Ukraine. I am sure that there are many other examples that we could look to. The noble Lord also made reference to subordinate legislation. My reading of that is that it is very much a technical term, including orders, rules, schemes and regulations authorised by this legislation. It is usual for those not to be subject to parliamentary procedure. I confirm to the noble Lord that we can commit to sharing examples of developing drafts of directions as soon as possible.

Looking forward, the power that we are looking at here will be particularly important as ICBs take on a wider set of commissioning responsibilities from NHS England. We intend to use directions more routinely to support the system; for example, in setting standards for specialised services and establishing reporting standards to measure progress—all things that noble Lords, regularly and rightly, press me to ensure are in place. The noble Baroness, Lady Coffey, gave some examples of where powers of direction could be used in addition to the point that I have already made. They are indeed ones that could be addressed by the use of the power of direction.

This clause also includes important limits on the scope of the power. I emphasise that, as a number of noble Lords have expressed concern about it. The reality is that the Secretary of State will not be able to direct ICBs to appoint specific individuals nor to direct the use of a drug, treatment or diagnostic technique that conflicts with NICE guidance or recommendations.

The noble Lord, Lord Stevens, asked about the NICE exception. The Bill reflects that NICE has not made recommendations in relation to a number of treatments and services. It is important to allow the Secretary of State to issue directions in that absence of recommendations in relation to more specialised services commissioned by ICBs.

The noble Earl, Lord Howe, asked where responsibility ultimately lies when things go wrong. As I think all sides of the House know, the ultimate responsibility is with the Secretary of State, and there is no movement on that. Ministers have to act reasonably with directions. Directions will be challengeable in courts and Ministers will ultimately be accountable to Parliament for their use. Directions will be required to be made in writing and to be published as soon as reasonably practicable.

The noble Lord, Lord Scriven, raised a question about scrutiny of some regulations. There may be a need to act quickly. In that situation, as I have said, directions will be published, and Parliament can scrutinise. The Delegated Powers and Regulatory Reform Committee, which the noble Lord referred to, has reported on the Bill and did not challenge this.

Moving to Amendment 39, I can assure the noble Baroness, Lady Bennett, that existing legislative checks and balances on local commissioning decisions will continue, such as having regard to the need to reduce health inequalities and to ensure patient choice. Directions cannot be used to undermine those duties. The intention with this power is not to micromanage the system but to be flexible and reasonable, and for it to be used for the benefit of patients and the public as new commissioning approaches develop. Despite the intention of the amendment, I fear that it works against such flexibility, which I suspect is not the intention of the noble Baroness, Lady Bennett. We do not expect to use this power to constrain ICBs when selecting providers. However, the public expect Ministers to be able to intervene if they need to protect patients and the public.

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[Baroness Merron (Lab)]

I think the bigger question that the noble Baroness is asking is about politicisation; I heard what she and the noble Lord, Lord Stevens, said about the situation elsewhere. I have to remind myself that, if there were, for example, a different Government with whom I did not agree—goodness me—it would be their right to make decisions and bring forward legislation. So, with the best will in the world, whatever we do here, we have to be realistic about what we can achieve. It is also important to note that checks and balances, which I have referred to, are already in the system. We are doing the opposite of tearing them up: we are continuing to apply them.

[Lord Hunt of Kings Heath (Lab)]

In the case that the noble Baroness raised, the issue is that of course we have an Independent Reconfiguration Panel but, ultimately, it should be the Secretary of State’s decision. Otherwise, we would have a situation where a decision to close a service in a locality would be made not by those elected by local people but by an appointed board. Surely, in the interests of democracy and accountability, the Secretary of State must in the end have that intervention power.

[Baroness Merron (Lab)]

My noble friend has put it very clearly and I most grateful. I think the public believe that the Secretary of State has that power already, but in fact she does not, which is a point my noble friend has made on many occasions.

Turning to Amendment 40, I should also draw attention to the distinction we have made between the more routinely used power of direction and the powers specifically reserved for use in cases of significant failure or risk of significant failure. Retaining the distinction between types of direction is important, as is the recognition of when an intervention is undertaken to protect patients, the public or taxpayers. I note the alternative proposal to appoint commissioners from the noble Lord, Lord Scriven, in Amendment 40. My concern is that this approach would likely be more cumbersome and would slow Ministers’ ability to intervene where significant failure was occurring—something that I know noble Lords would not want. Amendment 40 also touches on outcomes frameworks. I assure the noble Lord that I share the sentiment about the importance of outcomes frameworks, and, if necessary, we can complement existing frameworks by using directions.

I will now briefly touch on Amendments 76 and 77, which relate to Clause 21. The clause transfers the requirement to conduct annual assessments of ICBs from NHS England to the Secretary of State and focuses the assessment on the statutory functions of these organisations rather than a narrow list of duties. Currently, the position is that NHS England assesses ICBs annually, using data and local insight to review their performance against their functions, including a list of duties prescribed by the current legislation. The results are published online and they inform the oversight relationship between NHS England and each ICB. However, this list of duties forms a static list of requirements which are already part of the ICBs’ statutory functions. Performance assessments need to adapt to the evolving role of ICBs as strategic commissioners, and evening out the focus across all ICB duties supports that, making assessment more flexible and meaningful as ICBs adapt.

These clauses enable the Secretary of State to support the system, respond to unforeseen challenges and uphold the standards that patients expect and deserve, while ensuring that we have fairness and impartiality at the heart of the National Health Service.

[Lord Scriven (LD)]

My Lords, I thank all noble Lords who have taken part in this revealing debate on the powers of direction of the Secretary of State. What the debate has drawn out is that it is not as clear-cut as the Minister suggests, and accountability is not the same as having the right to make unfettered decisions about the health service based on nearly every clinical decision or every finance decision in a locality.

Throughout the health service, day by day, many decisions are made for which the Secretary of State is accountable. I do not think any noble Lord is asking that the Secretary of State should not be accountable; it is right that they are, and it is within the accountability framework of the NHS. The issue that noble Lords have raised is what powers the Secretary of State should have over the day-to-day running of health services at a local level. It appears from what some noble Lords have said—the noble Lord, Lord Stevens, the noble Baronesses, Lady Manzoor and Lady Bennett, and the noble Earl, Lord Howe—that in the Bill those powers of direction may be too concentrated in the Secretary of State’s hands. I think we will come back to this on Report. The point raised by the noble Lord, Lord Patel, about clinical expertise being drawn on to make the Secretary of State come up with clinically sound decisions, is really important.

I note that, once they are a Secretary of State or a Minister in the Department of Health, nearly everybody who has been in the department—apart from the noble Earl, Lord Howe—wants the powers. I believe that the power to make the strategic direction of the health service, and to be accountable for that, is the Secretary of State’s, and the power to intervene in an emergency or in unusual circumstances should remain with the Secretary of State. To use the Minister’s point, the intention is not to micromanage but to use the powers sparingly. It is very good to hear that that is the role of the present Government. But, as the noble Lord, Lord Stevens, pointed out, a different Government with a different political stance will be making important decisions that could potentially have an effect on clinical access to services, as well as on where certain services are. I do not think the Minister has answered on that balance to many noble Lords’ satisfaction. We will therefore potentially come back to this on Report, but at this moment I beg leave to withdraw my amendment.

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[Lord Scriven (LD)]

My Lords, it is quite a pleasure to follow the noble Lord, Lord Stevens, who asks some important questions about the transparency of the accountability mechanism—particularly since the whole reason for abolishing NHS England was to stop it being a stand-alone body in the department. As he has pointed out, we are abolishing a quango to set up a brand new quango. I look forward to the Minister’s answers on what the accountability mechanism will be if the CQC makes findings into maternity services in Norfolk.

I thank the noble Earl, Lord Howe, for these amendments. We made our position clear in the last group. We do not think that the general power in Clause 11 should exist in its present form, and in the last group we tabled a probing amendment with an alternative based on outcomes. However, if the Government insist on this, Parliament and the public should expect at least what these three amendments offer: a reason, a test and a record of those decisions.

Under the Bill, when the Secretary of State gives a direction under Clauses 8 or 11, they must publish it as soon as “reasonably practicable”. That is all. There is no reason, no duty to consult and nothing on how long it lasts or what it costs. The department’s memorandum to the Delegated Powers and Regulatory Reform Committee confirmed that there is no parliamentary procedure. On Clause 8, the memorandum says that directions avoid taking up “valuable parliamentary time” and that, unlike with voluntary delegation, a directed ICB would be “legally obliged” to carry out that function. It also says that publication means that the power is “used transparently”. Publishing an instruction is not transparency; explaining it would be the transparency that is required.

The Bill already accepts this. Under new Section 14Z62A, the Secretary of State must publish their reasons when they intervene in a board that is failing. A board in significant failure is told why; a board doing perfectly well which is directed under the general power—we should remember that this is a new power to direct an ICB that is not in any way underperforming—is not given a reason why the Secretary of State has decided to intervene. The Government cannot say that giving reasons is impractical when they require it a few lines further on in the Bill.

First, on the reason, the amendments to Clauses 8 and 11 would require a statement within seven working days on the function concerned, the reasons, how long the direction lasts, when it will be reviewed, its financial and operational effects, its effect on the ICB’s local population and who is responsible for what, which is absolutely vital for accountability. The Clause 11 amendment goes further. When subsection (3) is used and a board is made to act without forming its own opinion, the Secretary of State would have to say what opinion they formed and why, and why the board should not be able to form its own. This also matters for money. Clause 8 says that the Secretary of State may make payments, whereas Clause 11 says nothing about funding at all. A direction with no funding moves a cost from Whitehall to local services, and those affected deserve to see that reason.

Secondly, on the test, the memorandum says that directions are needed

“to respond to emerging situations”,

which is absolutely fine, and to secure nationally consistent standards. This amendment would stop neither: proposed new subsection (3D) would let the Secretary of State act first and consult afterwards where there is an urgent risk, with a decision on the direction within 28 days.

Proposed new subsection (3A)(c) expressly counts the benefits of consistency. It simply asks whether guidance, agreement or existing oversight would do the job and whether the direction is necessary and proportionate. It would also require the ICB to be consulted. If the Minister says, as I expect she may, that Ministers intend to act in this way, there is nothing to lose by saying so in the Bill. The Health Foundation has asked Ministers to set out safeguards for how the powers will be used, but we are still waiting for those safeguards and a full explanation.

Thirdly, in relation to the record, the proposed new clause after Clause 22 would put each direction in the board’s annual report: what has changed, what it cost, what risk the ICB warned about, and where responsibility lay. Under Clause 11, an ICB can be directed and, under Clause 21, is assessed on how well it has discharged its functions. Under new Section 14Z62A, failure includes failing to act

“consistently with what the Secretary of State considers to be the interests of the health service”,

and the chief executive can be removed. A board could follow an instruction, see its performance suffer and then be held to account for the subsequent result. Clear responsibility protects the ICB and protects patients.

I will be honest about the limits. None of these amendments gives Parliament a vote. Statements would be published, not laid. The test rests on the Secretary of State being satisfied, and Clause 8 has no such test. There is also a burden: consulting every ICB on a national direction takes time. Some of the drafting needs tidying before Report, but the general principle is one to be welcomed. The Minister may well call this bureaucracy, but if the Secretary of State cannot say within seven working days why they have given a direction, how long it lasts, what it costs and who is responsible, the Secretary of State really needs to think about why that direction has been given in the first place.

I have two very quick questions for the Minister. If reasons are required for a failing board, why not for every board, including boards that are performing well? Most importantly, what happens when an ICB follows an intervention and a direction from a Secretary of State and clinical outcomes or finance get worse? What happens in those circumstances and who, ultimately, will be held responsible? A reason, a test and a record—that is not much to ask of the Secretary of State who is taking so much power. I look forward to the Minister’s replies.

[Baroness Merron (Lab)]

My Lords, I am most grateful for this debate, particularly following on from the last group. I hope that noble Lords found that the previous group laid some helpful groundwork ahead of addressing Amendments 32, 37, 38 and 86 in relation to Clauses 8, 11 and 25. I am grateful to the noble Lord, Lord Kamall, for tabling Amendment 32, which was spoken to by the noble Earl, Lord Howe.

As I noted in the previous group, I share noble Lords’ commitment to transparency and to the appropriate use of directions. However—this applies to a number of the points that were raised—this needs to be balanced with some caution about overspecifying requirements in the Bill, given that that could well come at the cost of flexibility and speed, which I know noble Lords understand the need for. In some cases, the information required may not be relevant in terms of the amendment. I assure the noble Earl, Lord Howe, that it is currently standard practice for much of the information that is being asked for in the amendment to be included in directions issued by NHS England and the Secretary of State, where it is operationally relevant. I have no expectation that this will change in the future.

The duties of ICBs were raised by the noble Earl, Lord Howe. ICBs will continue to have a duty to commission a comprehensive health service except for those services that are commissioned by the Secretary of State as specialist, and the Secretary of State retains the duty to promote that service.

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[Baroness Manzoor (Con)]

I would like just a bit more clarification, and for anyone listening to this debate, on this real issue of patient services and how we are going to improve them. So, are there the positive directions? I understand there will be special directions by the Secretary of State, which is totally understandable—it has always been the case, certainly in the last 30-odd years that I have been involved with the NHS in one form or another. If we are going to improve our NHS, we need duties regarding the outcomes. Is there any thinking on that? Sorry to push a bit further, but that is critical if we are looking to improve the NHS for patients.

[Baroness Merron (Lab)]

There is no need for the noble Baroness to apologise; that is what we are seeking to do. The point here is that we are, by definition, confining our discussions to when things are going wrong or there are concerns. It is important to state that all the changes we are making and all the frameworks that are in place—the whole suite of measures—are there to ensure patient safety, the right outcomes and the right service to patients. In this discussion there is inevitably a greater focus on when things go wrong, but we are trying to ensure that things do not go wrong.

[Lord Scriven (LD)]

My Lords, many of us are struggling and asking quite basic questions because we still have not seen the operational model or the framework for how the new system will work. Can the Minister give a commitment that, before Report, the operational model will be made available to noble Lords? If not, this is becoming a bit like trying to find your way through a maze while blindfolded. It really is difficult, and that operational model is vital for us to make legislation and help the Government improve it, which is in the interests of patients and the system as a whole.

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[Baroness Merron (Lab)]

I will always make available as much information as possible. Some of the core of our discussion is around what is appropriate to be in the Bill and what is not. It would be unusual to have the detail of an operational model in the Bill—which the noble Lord is not quite suggesting. However, I can certainly undertake to give as much information as possible.

[Earl Howe (Con)]

My Lords, I am grateful to all noble Lords who have taken part in the debate on this group of amendments and for their insightful contributions. I am particularly grateful to the noble Lord, Lord Scriven, for his very helpful comments. As I mentioned in my opening speech, these amendments are intended to press the Government to address the key distinction between ministerial direction and local direction that the Bill has yet clearly to define, and to tease out more on the operational model, as we have just heard.

I thank the Minister for her reply, but I shall need to reflect carefully on her assertion that no explicit threshold on the use of the powers is appropriate or necessary. The noble Lord, Lord Stevens, set out a good hypothetical example of what could happen if amendments along the lines of those I have proposed are not adopted, especially Amendments 32 and 38 on transparency. The key questions are the ones so well expressed by the noble Lord, Lord Scriven, and, like him, I think that these are issues we shall wish to return to on Report. I am grateful for the briefing later this week to which the Minister has just referred, but I hope she will be open to working with us on these issues as we go forward. For now, I beg leave to withdraw the amendment.

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I know many noble Lords have asked very similar questions, and I know that we all look forward to hearing from the Minister as she addresses the questions and the amendments in this group.

[Baroness Merron (Lab)]

My Lords, I am grateful for the debate that we have just had. With permission, I will address whether Clause 10 should stand part of the Bill, look at the amendments to it and refer to those things together.

As a number of noble Lords have rightly emphasised, we are indeed committed to a National Health Service that is free at the point of use. Noble Lords will be very familiar with the changes that we are making to ensure that patients are at its core, and that they find that the system works around them, rather than them having to work around the system. We see that throughout the 10-year plan. For many years, this has included the provision of NHS-commissioned services by charities and the not-for-profit and independent sectors, as referred to by the noble Baroness, Lady Murphy, the noble Lord, Lord Kamall, and my noble friends Lady Nargund and Lord Hunt, to mention a few. The fact is that all these sectors make a valuable contribution to the health of the people whom we serve. We should acknowledge that, but I think we should also celebrate it.

Clause 10 prohibits the Secretary of State using their functions deliberately to shift the balance between types of providers. It strengthens and extends Section 12E of the National Health Service Act 2006 to any health service function of the Secretary of State and applies to all providers, regardless of legal form—to answer the point raised by the noble Lord, Lord Kamall. The clause does not enable privatisation or nationalisation by the front door, the back door, the side door or indeed any door that we can think about. It is a general prohibition, with one exception: where the Secretary of State considers that to act differently is in the interests of the health service.

As to why we need that, currently under Section 12E, a Minister who sees a service failing and concludes that bringing it into the NHS is in the interests of the health service could not act. Equally, Ministers could not deliberately bring in charitable or independent providers to end a risky overreliance on a single NHS trust; nor could they see an entire sector dependent on a few external providers and choose to build more public capacity for the long term—something that noble Lords rightly would encourage—because such purposes are always prohibited, even though the outcomes can be beneficial.

Clause 10 enables Ministers to act when the interests of the health service require it. We expect Parliament to hold Ministers to account in doing so. I say to the noble Lord, Lord Stevens, and my noble friend Lord Hunt that Ministers, in their duty to promote a comprehensive health service, have a duty to act reasonably and rationally and, as I say, to be held to account for doing so.

The noble Lord, Lord Patel of Bradford—

[Baroness Barker (LD)]

I am trying to follow very closely what the Minister is saying. Am I right to take it from what she said that under Clause 10, an acute hospital trust could be moved to the private sector if the Secretary of State decided that that was in the best interests of the health service? Is that possible?

[Baroness Merron (Lab)]

At the risk of repeating myself, as I have said, the judgment is about acting reasonably and rationally and about whether it was fulfilling its duty. It would also be—I know that I am repeating myself, but it bears doing so—accountable to Parliament for its decision.

The noble Lord, Lord Patel of Bradford, raised a question—

[Lord Scriven (LD)]

If the Secretary of State was acting under Clause 11 powers, Parliament would not have knowledge of that or any say on it. Does the Minister agree that that would be a correct interpretation of Clause 11 being used to bring about a change in public/private provision in Clause 10?

[Baroness Merron (Lab)]

I am not sure that I can answer that right now, but I will certainly review the various clauses and come back on that point.

The noble Lord, Lord Patel of Bradford, raised a point about publishing reasons where an exception is made. I will look at that because, as he knows, we are very much committed to transparency.

I turn to the amendments from the noble Baroness, Lady Coffey, the noble Lord, Lord Kamall, and the noble Earl, Lord Howe, which I will discuss together. The phrase

“the interests of the health service”

reflects the Section 1 duty to the health of all people in England—both those currently using the NHS and those who might want to use it in the future. That said, I understand the points noble Lords are making and, as with all things, I will certainly look at them. But we believe that substituting the phrase so that the test may be used in the interests only of patients, as spoken to by the noble Lord, Lord Kamall, is a narrower approach that risks excluding the potential benefits to the service over time, and it excludes the interests of people who are not currently patients—which I know is not the noble Lord’s intention.

I would also caution against using an additional requirement that exceptional action must be

“necessary to improve patient outcomes”.

This might prevent the rescue of a failing service, given that it relates to improving, and not stabilising, services. For example, if a dialysis provider serving a large area failed, stepping in would clearly be necessary to keep treatment going, before any action to improve it. It therefore risks failing the proposed test at a time when decisive action is needed.

[Lord Kamall (Con)]

Surely stepping in to continue that dialysis service is in the interests of patients.

[Baroness Merron (Lab)]

It is, and that is why I said I understand the point that noble Lords are making. We are not talking about the interests of the health service for the interests of the health service; it is there to promote the right outcomes for patients and their interests, too. That is why I acknowledged the points that the noble Lord and others made.

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[Baroness Nargund (Lab)]

I would like some reassurance about making sure that the private sector does not offer any additional treatment at additional cost to NHS patients—it tends to happen in the IVF sector. When there is a block contract for NHS patients in the private sector, they may advise patients to have add-ons to get them to pay extra. Can the Government make sure that add-ons are not offered to patients with additional costs when they are NHS referrals?

[Baroness Merron (Lab)]

My Lords—

[Baroness Nargund (Lab)]

Sorry, I must declare an interest: I am an authority member of the Human Fertilisation and Embryology Authority.

[Baroness Merron (Lab)]

I would not wish to stop any noble Lord from declaring their interest, so I am sorry that I stood up too quickly.

My noble friend speaks to the point of the importance of proper commissioning by ICBs, drawing lines around what is provided and how they performance-manage all their providers. I will certainly be aware of the point that she makes.

The amendment of which we were speaking would mean that a service that served patients well but could in principle be provided publicly would have to go, while one that served them poorly but could not be replaced by public provision would remain, and I do not think any of us would want to see that.

I recognise that there are a range of opinions and disagreements about provision in the health service and how it should be organised, but, as I mentioned earlier, we are focused on being pragmatic, providing fairness and improving access and quality for patients. We are not in favour of favouring one form of provider over another for ideological reasons, and I am glad that a number of noble Lords share that feeling.

[Lord Scriven (LD)]

Just to be helpful, will the Minister write to the Committee before Report explaining the reason for Clause 10? I am not sure whether other noble Lords were in the same position as I was, but I did not understand and was not convinced as to why it was required, even after the Minister explained. Could she give real, practical examples of why the clause is required, based on the 2006 Act not allowing the Secretary of State the powers to make the provision between private and public that is required to improve patient care in a particular area? That would be helpful, I feel.

[Baroness Merron (Lab)]

I will be pleased to write further on the comments that I made.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank all noble Lords who have taken part in this fascinating and important debate, and I thank the Minister for her response.

The noble Baroness, Lady Coffey, said she thought I would be alone in my views, but we have heard from different quarters around your Lordships’ House expressions of concern about the destructive impact of markets and tendering on the NHS; the noble Lord, Lord Hunt, said so in his speech, and indeed he is nodding now. There is good evidence that the views of your Lordships’ House do not reflect the views of the public. I point noble Lords particularly to a study in Social Theory & Health in 2022, which I believe is the only time there has been an open-ended, representative survey of UK citizens about their view of privatisation. Lots of basic questions have been asked, such as “Do you think privatisation is a bad thing?”, but I think that is the only time the question has been asked: why do people think that? The largest single reason was the extraction of profits from NHS services. There is strong public resistance to that, and noble Lords should bear that in mind. The public see clearly that money that should be going to services is going to profits instead, and that is what my group of amendments seeks to address.

We have Committee stage for a reason, to probe amendments, and many noble Lords have probed at mine. To reassure the noble Baroness, Lady Thornton, and others, I certainly need to look at the wording of this. When I was talking about public and private, by “private” I was referring to for-profit providers. I reassure the noble Lord, Lord Scriven, and others that there is no intention here to do away with hospice provision, charity provision and not-for-profit provision. These amendments are all aimed at the for-profit sector.

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We on these Benches will support any progress that seeks to push towards better outcomes for every patient. I hope that the Minister can provide not merely assurances of ambition but clear commitments on the NHS’s capacity for this treatment and towards accountability and measurable progress on this truly terrible disease. For those living with cancer, progress cannot come soon enough.

[Baroness Merron (Lab)]

My Lords, I am most grateful for the constructive amendments that have been tabled on cancer services. Noble Lords will know that we take this issue very seriously, as evidenced by our national cancer plan, which sets out very clear priorities to transform cancer care and outcomes over the next 10 years. In addition to that, I say to the noble Lord, Lord Evans, that what is being spoken about now strikes at the very core of the Health Bill and the reasons we are taking the actions that we are to be able to improve the situation still further. I recognise the impact of cancer on many noble Lords, either directly or indirectly, and I thank them for bringing their personal experience to the debate. It is important not just within this Chamber but to so many people outside, where one in two will be affected by cancer.

I will address some of the amendments before us. On Amendment 41, I can assure the noble Baroness, Lady Pidgeon, of our commitment to improving cancer outcomes. The noble Lord, Lord Stevens, welcomed our national cancer plan, which sets out an ambition to increase five-year survival to 75% by 2035, which will save an estimated 320,000 more lives over the next decade. The current law requires the NHS mandate to include cancer outcome objectives, which NHS England must prioritise over other cancer-specific objectives. With the abolition of NHS England that mechanism will no longer be needed, but that is because our focus on prioritising cancer outcomes remains. I hope that that is the start of a reassurance to my noble friend Lady Morgan, who raised this point, and rightly so, at Second Reading.

The plan provides a clear programme for delivery, supported by annual reporting on progress against key measures and targets. Last month, we confirmed a new independent National Cancer Board that will help scrutinise our progress—progress that the noble Lord, Lord Patel, rightly seeks—and, importantly, will ensure that the voice of cancer patients is heard. I know my noble friend Lady Ritchie will particularly welcome that. We therefore consider an additional statutory duty to prioritise cancer outcome objectives unnecessary, in terms of legislation. Our priority, as the noble Lord, Lord Patel, spoke to, is to deliver the commitments of the plan.

Amendment 217 addresses research into cancers with the lowest survival rate. We invest around £1.8 billion each year on research through the National Institute for Health and Care Research. Cancer is a major area of expenditure, standing at £141.6 million in 2024-25, which reflects its high priority.

We recognise that research into all cancers—a point that a number of noble Lords have raised—including those with the lowest survival rate, is a key priority. Research is funded through open competition and peer review to ensure that the highest-quality proposals—the ones that are most likely to deliver real impact for patients—are funded without imposing financial targets or limits. Our cancer plan includes a commitment to make progress on rare cancers one of the six key research priorities, to tackle stubbornly low survival rates. Our aim is to be in the top quartile across 28 countries for survival of 14 rare and less common cancers.

To the point made by my noble friend Lady Nargund, we are strengthening international research collaboration. For example, a joint call with the Japan Agency for Medical Research and Development opened just last month, to which the NIHR is committing a total of £2 million to support UK-based components. In respect of my noble friend’s question about pathways from MHRA and NICE trials to making treatments available, this is absolutely key. A new cancer trials accelerator will make the NHS the first-choice partner for cancer clinical trials.

I can confirm to the noble Baroness, Lady Finlay, that the DHSC still participates in and influences the EU cancer mission. I hope that noble Lords will appreciate that we very much see the importance of international work, both with our EU partners and beyond the EU.

My noble friend Lady Morgan seeks reassurance that there will be an appropriate and dynamic focus on improving participation in clinical trials. The answer to that is yes. We are also looking into options to contact patients with rare cancers to offer them the opportunity to be part of clinical trials, through a tailored version of the Be Part of Research service. My noble friend will also know the demanding targets we have set ourselves in terms of setting up clinical trials.

Turning to Amendment 228, improving performance against cancer waiting standards is absolutely key. There has been year on year progress with waiting times, but I would be the first to admit that there is some way to go. To my noble friend Lady Royall, as well as the noble Lord, Lord Evans, I can say that cancer waiting time targets, including the 62-day referral to treatment target, are not set at 100% for several reasons. They include patient choice, clinical guidelines and the reality and complexity of diagnosis and treatment planning, which mean that not every patient can or should be treated within the waiting time standard.

Change, including improvements to parts of the cancer pathway and tackling variation in performance across trusts, which is something I know is of concern to noble Lords, will not be delivered overnight, but the national cancer plan sets out the concrete and measurable actions in how we are going to get there. I assure the Committee that the plan makes a clear commitment to meet all the cancer waiting time standards. We will go further, reviewing them once they have been met, to consider whether they should be strengthened. In other words, it will not be case of job done and move on; we will review what more we can do.

I am grateful to my noble friend, Lady Royall, for bringing Amendment 233 before the Committee today. The Government are determined to improve outcomes for men with prostate cancer, and we have partnered with Prostate Cancer UK on the £60 million TRANSFORM trial to find the best way to screen men for prostate cancer. That was something the noble Lord, Lord Evans, raised.

However, as noble Lords will be aware, the case for an early detection programme has recently been considered through the UK National Screening Committee’s established evidence review process. For men without symptoms, early detection would, in practice, amount to screening. The committee therefore recommended screening only where the evidence shows that the benefits outweigh the harms. With prostate cancer, earlier detection is not always better. Many prostate cancers are slow growing and may never cause harm, while PSA testing cannot reliably distinguish these from aggressive cancers. Screening can therefore sometimes lead to overdiagnosis and unnecessary treatment, with potentially life-changing consequences, so we continue to be guided by the evidence.

My noble friend Lady Royall also asked about further inclusion. Prostate Cancer UK is using local government engagement grants to ensure that local organisations that work in Black communities can support recruitment to the trial, which was the point she was concerned about, and can also spread awareness of the trial.

Turning to Amendments 247 and 250, tabled by the noble Baroness, Lady Finlay, the Government agree that genomic testing should be timely, equitable and fully integrated into cancer care. The cancer plan commits to providing genomic testing to every cancer patient who would benefit from one within a clinically relevant timeframe, so that the results can inform treatment decisions.

Our focus is on ensuring that the NHS Genomic Medicine Service works consistently for patients and ensures that results inform treatment. To the point about workforce, we will create 5,000 learning and training opportunities each year, including opportunities to develop knowledge of emerging technologies, such as genomics.

At the same time, NHS England is improving the links between pathology and genomics, expanding molecular profiling and developing national digital arrangements for requesting and tracking tests. These improvements are best taken forward through NHS commissioning and service arrangements, in our view, rather than through a broad statutory duty, so there can be adaption as clinical evidence and technology develops. I was glad to hear the noble Lord, Lord Patel, welcome the establishment of the genomic hubs and the work they do.

Finally, I turn to Amendment 250. We share the ambition in terms of radiotherapy, and patients should have timely access to modern, effective treatment wherever they live. The noble Lord, Lord Tarassenko, spoke to the points on radiotherapy. However, it is our view that a specific duty for the Secretary of State for one treatment in particular would set a precedent and cut across the devolved models in which local systems and cancer alliances are expected to deliver.

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[Baroness Finlay of Llandaff (CB)]

My Lords, I am most grateful to the Minister for her comprehensive response to the amendments, including mine. Can she assure us that the data that she spoke about will now be supplied directly to OECD as well, so that we will be able to resume international comparisons, and that it will include quality of life data as well as simply survival data, because survival data itself may be misleading? In among the quality of life, of course, there is the impact of the family reported outcome measures as well, which can go along with that and be very informative. Unless all the data, including genomics data, is linked to demographic data, we will not get much further in untangling some of the underlying causes, which may be environmental, of the increase in malignancies that we see in the younger population. There has been an upward creep, but it is definitely there.

[Baroness Merron (Lab)]

I will need to check on the first point that the noble Baroness asked me about—the supply of information—but I will gladly write to her once I have looked at it. I absolutely agree with the point that she makes about data being one thing, but it is only as good as the use you can put it to. We seek to collect the right data for the right purpose; in other words, to improve outcomes.

[Baroness Pidgeon (LD)]

I thank noble Lords for the quality of the debate on this group. I particularly thank the noble Baroness, Lady Ritchie, for sharing such a personal story earlier.

I am glad to hear that the Government are committed to improving cancer outcomes, but I still have questions. Given that it was in the 2022 Act, and part of that Bill, where is the annual mandate that was set out for NHS England going to sit now? Perhaps the Minister can write to noble Lords setting out how that will not be lost, just to assure us. It is not just noble Lords here who are concerned; the sector and charities are very concerned that it will be lost. It was in a Bill before, so let us try to understand why the Government do not think it is needed now. But given the response we have had and the debate, I beg leave to withdraw my amendment.

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I hope the Government will recognise the value of Amendment 180 in ensuring that important questions are answered well before the next Parliament. Let me be clear: I am not asking for a detailed plan sufficient for the noble Lord, Lord Stevens of Birmingham, to go through and question it. I am seeking greater clarity than we currently have. I look forward to the Minister’s response.

[Baroness Merron (Lab)]

My Lords, I am most grateful to noble Lords for bringing the important matter of social care before the Committee. I am sure that the noble Lord, Lord Kamall, knows that, as much as I would love to give him every dot and comma, there is a reason why that is not possible.

Amendments 42 and 44, tabled by the noble Baroness, Lady Tyler of Enfield, and spoken to by the noble Baroness, Lady Pidgeon, my noble friend Lady Pitkeathley and the noble Lord, Lord Scriven, relate to the Secretary of State’s role in respect of social care. I think we could not have been clearer—we have discussed the role of the Prime Minister today—about the strength of national leadership that is required. The noble Baroness, Lady Pidgeon, acknowledged that the Prime Minister committed to establishing a national care service in the next Parliament to sit alongside our National Health Service and to be linked with it.

On the matter of the amendments, the reality is—at the risk of sounding simply pragmatic in legislative terms, but I will take that risk—that adult social care already has its own statutory framework under the Care Act 2014, which is separate to this legislation. That Act provides legal duties on local authorities for the provision of care and support in England and gives the Secretary of State overarching supervisory and intervention responsibilities.

As we develop our plans for national care services, that is where we will consider the responsibilities, the accountabilities and where they will operate—to refer to some of the questions that the noble Lord, Lord Scriven, raised. As I have indicated, although they are linked, health and adult social care have distinct roles—complementary, yes, but distinct—and each is crucial in its own right to providing care for our citizens, as the noble Baroness, Lady Barker, described.

As plans for reform develop—I will come back to the point about the noble Baroness, Lady Casey—we will work with partners and stakeholders to consider how we can do exactly what noble Lords are rightly asking for: consider how accountability, funding flows and responsibilities can be clear and more consistent. But my noble friend Lady Thornton described this as a Bill of moving parts, which was a good description. On the basis that we are talking about moving parts, nailing down one before all the relevant parts have been dealt with will get us into more difficulty. Frustrating it may be, but that is the honest reality.

[Lord Scriven (LD)]

Following that logic, why are we nailing this part down before the others are ready?

[Baroness Merron (Lab)]

The reason is that we consider that these parts can sit on their own, and the Bill allows us to look forward too. It would not be acceptable—the noble Lord is not suggesting this—if we stopped all our work while we waited until everything was in place. Although my noble friend is right, I cannot really remember a time when we did not have a lot moving parts—or perhaps we had some parts that should have been moving more but were not, to be more precise.

I go back to the commission on adult social care of the noble Baroness, Lady Casey, about which the noble Lord, Lord Kamall, asked further questions. First, its work has already been brought forward by a year by Prime Minister Andy Burnham. We have already actioned the initial recommendations. As a reminder, we worked at pace on that and I emphasise that the review is independent, which by definition means that we are allowing the noble Baroness, Lady Casey, to do her work.

The other point, which has been absent in previous iterations of attempts at this work, is that we are committed to making this an all-party answer that can survive Governments. All Governments previously have failed to do that, and this is too big and too important an issue to fail to secure that backing. The early recommendations that we put straight into place were—oh, I see the noble Lord standing up; I thank him for being very specific.

[Lord Kamall (Con)]

I want to ask specifically what that cross-party approach means. For example, many noble Lords on all Benches have spoken about social care in this debate and at other times. There is great expertise in this House. When will they—including me, if I am considered worthy enough of “expertise”—be engaged in this cross-party approach?

[Baroness Merron (Lab)]

How might I put it? That will be down to the appropriate levels of the parties to decide who is included. However, I can say to noble Lords that, after the contributions that have been made not just in this Chamber but in the reports that have been made, I have been a number one advocate to my ministerial colleagues, including Secretaries of State, of looking to the expertise in this House—because the work that has gone on and continues to go on is extremely significant. The noble Lord can be assured of that.

I do not think that I referred to what the earlier recommendations were from the noble Baroness, Lady Casey, but, if I did, forgive the repetition. On dementia, adult safeguarding and motor neurone disease, we are also driving significant progress through £4.6 billion of additional funding available for adult social care in 2028-29, compared to 2025-26, which includes £500 million for the first ever fair pay agreement for care workers. We have said we will establish a national care service in the next Parliament, providing free personal care for older people.

On funding, I can only repeat what the Prime Minister and Chancellor have said, which is that it will be fully funded and made possible through adjusting the triple lock from 2030. I give the confirmation that we will not borrow to pay for reform, and we will continue to meet our fiscal rules. I think there is a proper conversation to be had, as the noble Lord, Lord Kamall, said, on the choices and trade-offs necessary to deliver a system that can work for everyone into the long term, as well as the immediate. That is exactly why the Prime Minister is continuing cross-party talks to achieve this. The other thing I would emphasise is that we are determined to deliver rapid progress on social care, and we want to work, and are working, in partnership with those who draw on care and support.

On Amendment 180, tabled by the noble Lord, Lord Kamall, as I have already indicated, I do not believe that we should pre-empt the commission’s recommendations on fundamental reform questions ahead of building a public consensus as well as a political one. We should not legislate for an implementation plan within a fixed timeframe.

With regard to a national care service work plan, the review from the noble Baroness, Lady Casey, will have important implications for the shape and skills of the future adult social care workforce. Noble Lords will recall that this Government have committed to a long-term workforce plan for adult social care, which will therefore need to be linked with the outcome of that review. I certainly welcome that workforce plan.

On the amendment on dementia tabled by the noble my noble friend Lady Ritchie, and spoken to by a number of noble Lords, including the noble Lord, Lord Weir, dementia, as with social care, touches the lives of many in and outside this Chamber. That is why I am glad that my noble friend welcomes the development of the modern service framework for frailty and dementia. We plan to publish the full MSF by the end of this calendar year, which was recommended by the noble Baroness, Lady Casey. The framework will set new national standards. However, until we finalise those standards, I think it would be premature to propose introducing a new annual report. The reason for that is that it would lack the necessary measurable metrics to support the meaningful analysis that I know noble Lords are looking for, as indeed I am. It is not about denying the role of data; it is about the process. We are looking at options for how we can reduce waiting times and improve diagnostics and care, including reviewing targets and metrics and, importantly, to the points raised by noble Lords, data. We will seek to develop a list of best evidenced interventions following analysis of this area.

Some of the data requested and referred to in the amendment is already available through the NHS or provided by charity partners. A new report would, unfortunately, be something of a duplication of this work. We must also have some regard to the demands of additional data collection. The assessment is that the additional data collection that would be required for this work would be somewhat onerous and would distract from the core task of improving dementia care. That said, I understand why noble Lords are raising this, and I can assure them that the points they have made will be considered as we look at our development of the modern service framework.

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I hope the Minister agrees and that she will have words of comfort to impart to my noble friend Lady Neville-Rolfe, either now or in writing prior to Report.

[Baroness Merron (Lab)]

My Lords, I am grateful for the contributions to the debate today and for the amendments that gave rise to the debate. Primary care is a key part of our health service, as we have heard. In view of the time, I am going to address directly the amendments and some of the comments made.

Amendment 218 was tabled by the noble Baroness, Lady Pidgeon. We recognise the importance of timely access to general practice, particularly when patients need urgent care. However, it is the case that not every patient will need an appointment within seven days, although I understand the intent, because there are a number of patients who seek to book routine appointments in advance. Where a doctor considers care clinically urgent, patients should be seen that day, and we have made changes to the GP contract to require that urgent requests be handled the same day. In August this year, nearly 78% of such requests were handled the same day.

I want to correct some of the representations made by the noble Earl, Lord Howe, as I have done previously when we have been debating this Bill. As of August 2026, there were more than 2,600 more GPs compared to July 2024. We have introduced a practice-level GP reimbursement scheme, worth £292 million, that allows practices to hire additional GPs or fund extra GP sessions with existing GPs. Our absolute intent, as I know is the noble Earl’s, is to improve access. We want to support GPs, improve patient satisfaction and boost capacity—something we are all signed up to.

On Amendment 43, tabled by the noble Baroness, Lady Neville-Rolfe, and spoken to by the noble Baronesses, Lady Finlay and Lady Gerada, the Government support the principle—if that could be regarded as a word of comfort—as sought by the noble Earl, Lord Howe. However, we regard the amendment as unnecessary because existing contractual and operational arrangements already strengthen continuity, which is the key point in this. That includes named GPs and team-based continuity in hospitals. The noble Baroness, Lady Gerada, asked whether there was a possibility of the splintering of community services through hubs. I would say that neighbourhood health provides the core framework that brings it all together into a single model very much focused on improving access and experience, which is at the core of all that the noble Baroness rightly seeks.

I turn to Amendments 63, 108, 109 and 110 from the noble Baroness, Lady Janke, about pharmacy care. I agree with all the comments about the vital contribution that pharmacies and their staff provide to patient care. I also acknowledge that, where a provider, particularly a larger chain, fails to meet NHS terms of service, the consequences can be significant for patients, communities and staff. The Bill will give ICBs responsibility for pharmaceutical services, including monitoring compliance and enforcing NHS terms of service. We are also streamlining appeals to ensure that we can resolve disputes more quickly. Where there is provider failure, our priority is to maintain the continuity of services for patients. ICBs can issue remedial and breach notices, remove contractors following repeated breaches and, with professional regulators, suspend providers where there are serious concerns putting patients or the public at risk.

I say to the noble Baroness, Lady Pidgeon, that the Bill strengthens arrangements to ensure continued access to pharmaceutical services and allows the Secretary of State and ICBs to support new providers taking over pharmacy premises, including financially. We of course sympathise with staff affected by provider failure, but the reality is that, as we have discussed on a number of occasions, community pharmacies are independent businesses responsible for employing and paying staff. Existing employment and insolvency law already protects employees, as in other sectors. Therefore, a separate regime, as suggested, would not be appropriate.

I feel that Amendment 64 would limit flexibility to balance rural access with wider patient and pharmacy needs. The distribution of pharmacy funding is determined through an established national process. All pharmacies receive the same NHS service fees, while eligible isolated pharmacies receive additional pharmacy access scheme funding.

I turn to Amendments 60 and 62 from the noble Lord, Lord Scriven. We recognise that people with learning disabilities are more likely to experience sight problems and may face additional barriers to eye care, exactly as the noble Lord described. He has already referenced this, but I emphasise that free NHS sight tests are already available to eligible groups, including people at increased risk of specified eye disease. Adults with learning disabilities may qualify through these routes, including via the NHS low income scheme, but there are no plans to review eligibility, as he sought.

Community optical practices also already provide services with reasonable adjustments where needed. Those who are unable to attend unaccompanied, and who are eligible because of illness or disability, may receive NHS domiciliary sight tests. As the noble Lord rightly said, children and young people with learning disabilities or autism can receive free eye tests in special educational settings, where locally commissioned. I heard the noble Lord talk about difference in provision, and I also thought I heard him acknowledge the potential for the Bill perhaps to assist in that regard.

On Amendment 61 from the noble Baroness, Lady Pidgeon, I understand the concerns that the Bill could lead to variation in eligibility for NHS sight tests, the scope of the service or the fees payable. However, ICBs already commission primary ophthalmic services under nationally set contractual terms, so eligibility and service scope are set nationally, and fees are set through national direction. The Bill does not alter the national framework or how eligible patients access sight tests.

On Amendment 61A by the noble Baroness, Lady Gerada, local planning begins with joint strategic needs assessments, through which health and well-being boards assess local population health and care needs. These assessments will then inform locally led neighbourhood health plans, which set out the approach to meeting the identified needs. ICBs, in their role as strategic commissioners of local health services, including eye care services, will focus on ensuring the best value in securing services and improving population health, reducing inequalities and improving access to high-quality services. Given these existing arrangements, we do not believe it necessary to prescribe service-specific reporting requirements in primary legislation.

[Baroness Neville-Rolfe (Con)]

My Lords, this has been a constructive debate. I am grateful for the convincing support of the noble Baroness, Lady Gerada, and my noble friend Lord Howe for an amendment of the kind that I have proposed.

I thank the noble Baroness, Baroness Finlay of Llandaff, for her perspective and her comment about the non-verbal advantages of continuity of care, which very much echoes with me. I remember my husband being saved by a perceptive GP when he had come out of an operation. I heard what the Minister said, and I thank her for it, but we need to do more on continuity of care as well as on continuity of services, so I reserve the right to return to this issue on Report.

As it is late, I will not delay the Committee on the other amendments, which have been well articulated by the noble Lord, Lord Scriven, and the noble Baronesses, Lady Janke and Lady Pidgeon. I agree with the noble Baroness, Lady Janke, that pharmacists can play a larger part in our National Health Service. I also agree with the noble Baroness, Lady Gerada, about the postcode lottery of eyecare. That is a concern, and the Minister may recall from our earlier debates that I thought it could perhaps be improved by the better use of the independent sector and community eyecare. For now, though, the time is late and I beg leave to withdraw my amendment.

Health Bill

Baroness Merron Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Baroness Cash (Con)]

My Lords, this looked like a very serious group of amendments on paper but, until we had this debate, quite how grave the current gaps are in the NHS did not really emerge. I thank the noble Baroness, Lady Gerada, for tabling her amendments and the noble Lords who spoke to them. I also pay tribute to the noble Lord, Lord Mann, for his review and to the Government for accepting the recommendations that Members from all Benches in the House appear to accept unreservedly.

I sympathise with and support the intent of every amendment in the group. I particularly support Amendments 79, 258 and 259, given the gaps they highlight and the urgent need to close them. Even in light of what the Government have accepted, it is quite apparent that shocking levels of antisemitism are continuing, and there need to be some urgent interventions to stop that.

I spoke quite recently in this House on Sir David Bell’s review of the levels of antisemitism in schools. It is really quite sad, and a shame for this country, that the review by the noble Lord, Lord Mann, shows the same pattern in the NHS. There is clearly a major problem and it is racism, plain and simple, directed at Jews. Too many institutions are tolerating it in a way they would never tolerate against any other group.

The facts are devastating. Community Security Trust recorded 3,700 antisemitic incidents in 2025—the second-highest total ever recorded. In the 2025 NHS staff survey, as we have heard, 13% of Jewish staff recorded discrimination from their own managers or colleagues. That is intolerable in your workplace. How can anyone possibly feel safe going about their day-to-day interactions? We have heard from a number of noble Lords this evening that Jewish people are the only religious group, the only ethnic group, for whom discrimination from colleagues is more common than discrimination from patients. The hostility is coming from inside the institution, and it is therefore beholden on us, debating this Bill, not to miss the opportunities to address this and close the gaps.

The Commission on Antisemitism found Jewish patients considering whether they should remove their religious symbols before treatment. Imagine feeling so unsafe in a healthcare setting, when you are at your most vulnerable, that you may have to consider concealing that about your identity. Patients who feel they have to hide who they are to be treated have lost trust in the NHS; they have lost faith that their doctors will do no harm—the first and basic premise of healthcare—and they have lost confidence that they will be safe.

The regulator has not done its job, which is why I support these amendments, even though the Government have actions in progress and even though they have accepted the recommendations of the review by the noble Lord, Lord Mann. Around 70% of completed appeals by the GMC against tribunals have succeeded, and we know that if the regulators are succeeding seven times out of 10, there is something fundamentally wrong in the disciplinary decisions.

I will not repeat what has been said by noble Lords in support of their amendments, but we should give serious consideration to the proposal from the noble Lord, Lord Scriven, so that we can address the fundamental issue here: a loss of neutrality and an overt willingness to attack colleagues and patients on the basis of their Jewish identity. My noble friend Lord Blencathra goes even further in his Amendment 279C, and I look forward to hearing the Minister’s response to that. He outlined the very serious reasons why he has asked for that, and those reasons and facts need to be addressed.

On Amendment 29 and training, I support the recommendation of the noble Lord, Lord Mann, that it is needed, but he was very specific in what he asked for. He called for the mandatory module, used by 1.5 million staff already, to be updated with quality assured content on antisemitism and anti-Muslim hostility. He added that subject experts should be consulted and that the training be monitored and reported on publicly to ensure it has the desired impact, but I have real reservations about the training that would be possible under Amendment 29, because as drafted it does not contain any of the noble Lord’s safeguards. That does not mean we should not consider or expedite the training that is needed.

The record of equality training in the public sector gives a good reason for us to take care. In 2020, the Government phased out unconscious bias training in the Civil Service after a review found no evidence that it changed behaviour, and some NHS anti-racism training has left out antisemitism entirely. Moorfields Eye Hospital’s compulsory anti-racism seminar was reported last year to have made no mention of Jews at all. Training built on theories of privilege has too often placed Jews among the privileged and therefore outside the protection it claims to offer. So, there are lots of types of training that will make the problem a lot worse. I would like to hear from the Minister what types of training and suppliers will be used, and what accountability and monitoring there will be for anything currently being developed.

It is very important to note that the noble Lord, Lord Mann, recommended mandatory training for the chairs and chief executives of NHS trusts within six months of his review, but the Government’s same statement in response to his review said that senior leaders would be invited to complete it by March 2027. I hope that the Minister will explain to noble Lords why a recommendation for mandatory training became an invitation to train, and when that training will be completed by all chairs and CEOs of NHS trusts, as recommended.

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

My Lords, I am most grateful to noble Lords across the House for their sensitive consideration of something that is very insensitive: antisemitism and other forms of racism. I know that the words spoken today—the sentiments and the commitments—will resonate across communities in a way that will make a difference, and I personally am most grateful for that. I also am grateful to my noble friend Lord Mann for his review and, indeed, to the former Secretary of State, Wes Streeting, for listening to the voices of those for whom the situation they have to live with day in, day out, is quite intolerable, and for commissioning that review. That set the tone.

As the noble Baroness, Lady Gerada, observed from the outset, we have accepted in full the recommendation of my noble friend’s review, and we are taking action to deliver. As was referred to, we provided our latest update last month. This work is continuing, and I understand that noble Lords are asking for more to be done. Indeed, there is no let-up, but we want to get this right, of course.

I will address Amendments 29, 79, 258, 259 and 279C together. We have all said this, but it always bears saying: there is no place for discrimination, antisemitism or racism in our NHS. As noble Lords have said, patients and staff and those associated with them must be free from all forms of racism and religious hatred—and, indeed, from the fear of that, as well as the actuality. That is at the core of these amendments and this debate.

I say to the noble Lord, Lord Shinkwin, that Ministers have asked all NHS bodies to adopt the IHRA definition of antisemitism. We are receiving a good response and will continue on that.

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[Lord Scriven (LD)]

My point about the important value of neutrality is this, and let me give an example. You might not be discriminatory: you have somebody who is Jewish, somebody who is Muslim, somebody who is Christian and somebody of no faith, and you treat them all equally, but you might have something on your body which is not neutral to two of them. You are therefore possibly treating that person differently, from their perspective. If neutrality and fairness is such an important value for the NHS, can the Minister go away and look seriously at making it a key component in the NHS constitution, because it is not there at the moment?

[Baroness Merron (Lab)]

I take that point and I certainly accept the spirit in which the noble Lord suggests it. I will take all the points that have been discussed away to see whether there is any way that we can work with it, rather than extending a debate on what neutrality means, because I know what the noble Lord is getting at. It is helpful that he has given thought to that.

On Amendment 258, NHS bodies are already subject to clear legal duties to prevent and address discrimination and racial harassment, alongside established responsibilities to tackle extremism and safeguard patients and staff. In a technical fashion, I certainly caution against adding further legal duties here because it would risk confusion about what we expect ICBs and trusts to do. I know that is not something that any of us would wish to do.

On Amendment 259, we have accepted the recommendation from the noble Lord, Lord Mann, to consider amending the performers lists regulations, which would enable conditions to be imposed on suitability grounds. We intend to amend the regulations, subject to consultation. The amendment is unnecessary as the Government are already taking forward the substance of it. It would also impose a six-month statutory deadline before the necessary consultation and consideration have taken place, whereas we have to allow sufficient time to make sure that any changes are legally robust, proportionate and workable. Nor would we wish to pre-empt consultation by committing in this moment to how particular forms of conduct should be addressed in the regulations.

On Amendment 279C, under NHS staff standards—which, as I referred to on the comments from the noble Baroness, Lady Manzoor, were launched on 6 July—employers must take sustained and meaningful action to prevent and root out racism. NHS organisations will be measured on this through the national oversight framework. In addition, I say to the noble Lord, Lord Blencathra, that regulatory processes are already in place to which all registered healthcare professionals are subject. Regulatory fitness to practise processes allow concerns about misconduct to be investigated. They allow evidence to be considered and the appropriate regulatory action, which could indeed include removal from the register, to be determined in each case. The Professional Standards Authority for Health and Social Care acts as an independent body in this regard to make sure that regulators apply the right sanctions. Where it considers that a decision does not provide sufficient public protection, it has the powers to refer the decision to the courts for consideration.

In drawing this together, I assure the noble Baroness, Lady Gerada, the noble Lord, Lord Patel of Bradford, and your Lordships’ Committee that we are ensuring that ICBs and providers are fulfilling their duties. The key means to do that is through performance assessments. I gently caution against adding additional criteria to the current approach, because it is important that assessments have sufficient flexibility to adapt to the evolving role of ICBs as strategic commissioners, which, after all, is at the heart of the Bill.

[Baroness Barker (LD)]

I thank the noble Baroness, Lady Merron, for that very detailed and thorough answer. Can I just check that, in the midst of what she said, she made it clear that NHS staff and NHS providers are under a legal obligation to ensure that all the protected characteristics under the Equality Act are treated properly and with respect?

[Baroness Merron (Lab)]

They should absolutely have regard to the law in respect of protected characteristics. That is the fullest answer I can give at this moment.

[Baroness Gerada (CB)]

My Lords, I am grateful to noble Lords who have spoken and to the Minister for her assurances. I just want to make a few very brief comments, because I am aware of the time.

I was struck by the noble Lord, Lord Shinkwin. If I heard him correctly, his orthopaedic surgeon was on the last Kindertransport out of Prague. Our own noble Lord, Lord Dubs, was also on the last Kindertransport from Prague, as was my father-in-law. Such are the coincidences that happen in this life.

I am not Jewish, but I have been subject to antisemitism. I suspect that is because people assume I am Jewish. I have been left fearful, hurt and angry, with all those emotions and not knowing where to take them. If I experience that, I can see that my Jewish colleagues experience it in spades. I work in the NHS, and I can tell noble Lords that antisemitism has become normalised. Although the figures we have seen—13% and 11%—are pretty awful, I suspect it is considerably higher than that. It has become almost de facto that one can abuse Jewish colleagues, although not necessarily Jewish patients because you are subject to greater regulatory forces. Certainly, in the last 12 to 18 months Jewish staff have been subjected to quite appalling behaviour from colleagues with whom they work. Antisemitism has been normalised and almost accepted.

Nevertheless, I thank the Minister. I hope that the training does not become a tick-box exercise and includes the issues that we heard about from the noble Lord, Lord Shinkwin. I may wish to return to this issue on Report, but at this stage I beg leave to withdraw the amendment.

Health Bill

Baroness Merron Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, the Committee will undoubtedly be grateful to the noble Lord, Lord Hunt, and the noble Baroness, Lady Tyler, for bringing forward these important amendments and for highlighting the vital contribution that unpaid carers make to our health and care system.

It is an obvious truth, but a truth worth stating, that carers are the people who know the person they care for best. They provide not only practical support but continuity, reassurance and an understanding of individual needs that can make a real difference to the quality of care. I very much welcome the recognition of the key role that carers play and the need to ensure that they are, first, identified—as many noble Lords have emphasised—and then listened to and appropriately involved in decisions about the people they support, while at the same time respecting the wishes and rights of patients themselves.

Carers are often family, friends and neighbours, and they usually do not foresee the duty happening upon them. They demonstrate the most admirable qualities in fulfilling that duty. The pressures that caring responsibilities can place on individuals and families are frequently very considerable, which is why we must never lose sight of the need to support carers’ own health and well-being, including opportunities to take a break from caring, as the noble Baroness, Lady Pidgeon, mentioned.

Amendment 21 would enshrine the right of carers to be involved in patients’ decisions, which seems eminently sensible and right. Carers, with patient consent, already have the right to be involved in discussions with clinicians. At the same time, clinicians will always need to make a judgment according to the situation, because it is just as important to go back and check the wishes of the patient and to make sure, for example, that they have privacy when they want it. Without wishing to downplay in the slightest the value of these amendments, it would be helpful to have confirmation from the Minister that a patient has the right to withhold from a carer sensitive information in their medical records that they might not want shared.

We will be debating the Government’s proposals for a national care service in a later group, but I wonder whether the Minister can give us a sense of how the Government view the position of unpaid carers in the context of those proposals. In what way do they think a national care service could or should affect the status of family carers? I ask because, with the concerns that noble Lords have raised during the debate, it seems doubly important that we do not inadvertently sideline or devalue the extraordinary contribution to society, and indeed to the economy, that unpaid carers make, or overlook the practical support and respite that carers need.

Unpaid carers are the backbone of so much of our health and social care system. Carers can be of any age. My noble friend Lord Young of Cookham rightly emphasised the role of young carers. Their contribution is immense, as are the burdens they carry, yet so often those things go unseen. Caring is a profoundly challenging role that, over time, will undoubtedly affect a person’s mental and physical health. The support for carers that noble Lords have so often called for can come in different forms: the noble Baroness, Lady Watkins, referred to the vital importance of respite and the part that care homes play in providing it. My noble friend Lady Morris has just reminded us that there are many great charities operating in this field. I wonder whether the Minister could give us a sense of what the Government’s vision is for how such support and respite should be delivered: whether they see it as primarily a role for the state or whether there is a broader palette of provision that is right and sensible to avail of.

Whatever the future structure of our care system, we must not lose sight of the people who give so much to care for others. Their voices and needs must be recognised.

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

My Lords, I am most grateful to my noble friend Lord Hunt and the noble Baroness, Lady Tyler, for initiating this important debate about carers, and indeed health and care partners. The points that have been made in the debate on this group were well made and well heard, and I know they are very much rooted in personal as well as professional experience. I too pay tribute to the vital work that carers, friends, families and neighbours all do to support their loved ones, often in the most challenging circumstances. I particularly note the reference to young carers by the noble Lord, Lord Young, the noble Earl, Lord Howe, and my noble friend Lord Hunt.

I turn first to Amendments 21, 214, 173 and 174, in the name of my noble friend Lord Hunt. Integrated care boards have an existing duty to promote the involvement of patients, and their carers and representatives, in decisions relating to their care or treatment. To the point the noble Earl, Lord Howe, has just raised, carers are the patient; they are the key person and they have control, as long as they are able, to make decisions about what is appropriate and what is not, as is usual. In addition on these particular amendments in this group, local authorities are required by the Care Act to have regard to the importance of people participating in decisions and being provided with information. I point out that the Health Bill also introduces a duty on integrated care boards to promote opportunities for visiting and a duty for local authorities to have due regard to the importance of individuals being able to involve other people in decisions about their care and about being able to receive visitors.

Regulation 9A already provides legal protections by placing a duty on care home, hospital and hospice providers to facilitate visits and accompaniment in a way that meets the person’s needs. As I just said, at the centre of all this are the needs of the individual. To clarify, a visit includes somebody providing physical support or companionship in person, and encompasses the support envisaged from a health and care partner.

My noble friend Lord Hunt and the noble Baroness, Lady Finlay, raised this matter in the earlier part of the discussion. The existing legislation intentionally avoids establishing a distinct term of “health and care partner”, simply because a single definition may not appropriately reflect the range of relationships that there may be and those that apply across different health and care settings. Also, the reference in Clause 57 to “other people” encompasses family, friends and carers and would already include a health and care partner.

The proposed amendments may inadvertently constrain how contact and support are provided and would inadvertently fail to provide for exceptional circumstances where offering support becomes a significant risk to the health, safety or welfare of a person using the service or on the premises. Instead, we are building on existing protections through non-legislative measures, including through the development of the NHS health and care partner policy. I hope that will meet the intentions behind these amendments.

Amendments 89, 175 and 176 tabled by the noble Baroness, Lady Tyler, relate to unpaid carers. The existing legal framework already requires the system to support carers. The Care Act 2014 places requirements on local authorities to assess and meet eligible needs. Carers are also explicitly referenced in the NHS constitution, and local authorities and NHS bodies have a duty of co-operation.

As for Amendments 175 and 176, existing legal duties establish a framework where needs assessments and subsequent care planning focus on the individual and their circumstances, rather than prescribing a particular service or solution such as respite care—something to which the noble Earl, Lord Howe, referred.

Amendment 88 tabled by the noble Baroness, Lady Tyler, raises a point that a number of other noble Lords have spoken to, including the noble Baroness, Lady Pitkeathley. It is of course important that carers are properly recorded and identified in the system. However, we do not believe that setting explicit requirements is appropriate for legislation, important though that is. We are making clear commitments in the 10-year health plan and are taking practical steps to improve identification, recording and support.

My noble friend Lady Nargund asked specifically about the single patient record. The Bill contains powers that will enable regulations to make patient information available to people other than patients on the patient’s behalf, if that is required. That can include all carers. The main point here is that we want to ensure that carers who act on behalf of those they care for can also get full benefit from the single patient record.

There is also guidance to support general practice to better identify and record which patients are unpaid carers. There is ongoing work to improve identification by promoting more consistent coding of unpaid carers by GPs.

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[Baroness Finlay of Llandaff (CB)]

My Lords, can the Minister confirm that the partner policy that she referred to—which is being developed as guidance and would avoid anything going into statute—will include a requirement that the carer providing principal care for someone when they are discharged from a unit will be assessed for how much they can and are willing to do in providing care and will be taught procedures that may make the care of the person easier? This includes simple things such as how to help someone get up from a chair, how to manage if someone falls on the floor and even how to give injections for breakthrough medication, such as for pain relief if that is indicated—so that carers are not left feeling that they do not know what to do when the person they are caring for comes home.

[Baroness Merron (Lab)]

The noble Baroness makes extremely fair points. The discharge process takes account of whether somebody can be safely and properly discharged. The care that is provided, whether by a professional or an unpaid carer, has to be absolutely right. She is right to make the points and I am sympathetic to them.

[Lord Hunt of Kings Heath (Lab)]

My Lords, in seeking leave to withdraw my amendment, I thank noble Lords who have taken part in this debate both today and last week. I particularly thank the noble Baroness, Lady Tyler, for her amendments.

The noble Baroness, Lady Morris, made an important point for us to consider on respite care for young carers, as did the noble Baroness, Lady Nargund, on the identification of women carers. The noble Baroness, Lady Pidgeon, made the point that intervention before crisis occurs is so important. The noble Earl, Lord Howe, spoke about the pressures facing carers more generally.

My noble friend the Minister is resistant to legislation because of the existing needs assessment framework. On the recording of people, she felt that the 10-year plan, alongside the action plan she mentioned, would meet those needs. One must take that as a positive response.

We have been here before, though, and a huge number of carers, faced with the bureaucracy of the local system, find it very difficult to get support. Respite care, in a sense, is a visible indication of the issues that we face. I am sure noble Lords will wish to come back to that.

On my amendments, I am grateful to the noble Baroness, Lady Finlay, for her support last week, and also to Care Rights UK and to John’s Campaign, which have been campaigning for a long time to see some statutory protection for loved ones and partners who see and have concerns about the way their loved ones are treated in a care home. They have faced vindictive action by the people operating those care homes for raising legitimate concerns.

I take the Minister’s point about definitions; obviously, that is something to reflect upon. I also take the point about the current statutory duties. However, I think that people need some protection against the behaviour of so many care homes, when faced with legitimate questions about their loved ones. I hope, because the noble and learned Baroness, Lady Hallett, produced her recommendation on this only recently, that the Government will consider legislation in the light of it. Having said that, I beg leave to withdraw my amendment.

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[Baroness Pidgeon (LD)]

My Lords, I am grateful for the support for this group of amendments from noble Lords across the Committee. If the health service is to be truly patient-centred, patient choice needs to be a key part of this. Different patients will have different needs. Therefore, choice is a key part in having ownership of their care and treatment.

My Amendment 23 in this group picks up a key issue as we move to greater use of digital health. The NHS app will start to play a greater role. My amendment picks up the potential loophole that if a patient is seen in person, they may be referred for treatment or diagnostics by their GP or other primary care practitioner and given a choice of where to go for their referral. However, if this is done virtually, via an app or online, patients may not have the same choice that they would have received in person. This amendment seeks to ensure that there are no closed lists and that patients are referred to one provider only. Amendment 24 is similar in its aims.

Amendment 67 in my name, Amendment 22 in the names of the noble Lord, Lord Kamall, the noble Earl, Lord Howe, and the noble Baroness, Lady Neville-Rolfe, and Amendment 68 in the names of the noble Lord, Lord Kamall, and the noble Earl, Lord Howe, are similar. My amendment specifically pushes for patient choice for non-consultant-led community services, including optometry-led glaucoma care and community urgent eye care services. The amendment seeks meaningful choice from providers available in an ICB area for out-of-hospital services. We know that waiting lists have increased for community services, yet these are often preventive services. I have raised in this Chamber before that 600,000 people are on hospital waiting lists for eye care services, yet we have optometrists on every high street who could be used to help address this and bring routine treatment nearer to people’s homes, thus leaving specialists able to deal with patients who need their services in a more timely manner.

Audiology, as we have heard, is another really important area. As the noble Earl, Lord Howe, highlighted, NHS community audiology services are commissioned across the whole of an ICB area in just 42% of ICBs. This means that the majority of patients are being denied choice. Often, patients are required to attend hospital-based services and experience long waits for services which could be offered safely and in a more timely manner in the community. This could be nearer to home or to a family member’s home—somebody who helps them get to an appointment and helps them with transport—giving them genuine choice. If we are serious, as we debate the Bill, about shifting care out of hospitals and into the community then patients must be given the same right to choose their provider for community services as they currently have for consultant-led hospital care.

Community waiting lists have now reached record levels, with around 1.25 million people waiting for treatment. Patients should be empowered with clear information on waiting times and location, allowing them to choose the provider that best meets their needs. By placing choice in the hands of patients rather than commissioners, which it too often is, we can improve access to timely treatments and actually deliver on the Government’s ambition of more personalised care closer to home. I look forward to the Minister’s response.

[Baroness Merron (Lab)]

My Lords, I will address the wider principles underpinning Clause 5 and Amendments 22, 23, 24, 67 and 68. I am grateful to noble Lords for their contributions and consideration of matters that are key to patient choice—a concept that is, as I know noble Lords are aware, neither new nor innovative but is absolutely at the core of the Bill.

Clause 5 introduces new duties to require the Secretary of State to promote the involvement of patients, their carers and their representatives in decisions relating to the prevention or diagnosis of illness, care or treatment. This applies where the Secretary of State exercises her health functions. As I said, this is absolutely core to the Bill and I am sure that noble Lords will welcome that.

The clause also requires the Secretary of State to act with a view to enabling patients to make choices about the health services provided to them. I hope that noble Lords are aware that the Government are committed to involving patients and carers in decisions about their care, as we discussed in the last group. One of the reasons is that we know it supports better experiences of care and in many cases leads to a better outcome. It is not just a “nice to have”, but a “necessary to have”.

I refer the noble Baronesses, Lady Manzoor and Lady Coffey, and the noble Earl, Lord Howe, to the new Choice Charter, which will strengthen this approach by setting out—this is key—what patients can expect so that they can make informed decisions about their health and care. There is no point in just expressing a wish to have patient choice if we are not equipping patients to make that choice. That is why we are protecting the patient’s right to choice and the duty to involve them in decisions. As I said, that will remain a central principle of the health system. I was glad to hear noble Lords across the Chamber welcoming the move from hospital to community provision. As the noble Baroness, Lady Pidgeon, set out, many services can be provided better in the community than they can in hospital. I welcome that support.

Amendments 22, 23, 24, 67 and 68 have been tabled by the noble Lord, Lord Kamall, and the noble Baroness, Lady Pidgeon. These amendments would go further than Clause 5 currently does by expanding patients’ right to choice to a wider range of out-of-hospital services and onward referrals by virtual and integrated health services, and by prescribing how this must operate in practice. I reconfirm our commitment to strengthening patient choice as part of our wider agenda to improve access to care and reduce waiting times. It might be helpful to remind your Lordships’ House—the noble Earl, Lord Howe, might be particularly interested in this—that existing choice rights already apply to some consultant-led out-of-hospital services where the regulatory conditions are met. These include dermatology, pain management services, gastroenterology and diabetes services.

The noble Lord, Lord Patel of Bradford, made a number of key points. Community services are by their very nature designed differently from hospital services. I assure him that those who need help to exercise their choice will get it around what their needs are. They will not simply be expected to manage with one size fits all. The points that have been made are fair and I take them on board but, as a point of principle, we do not think that this level of operational detail, important though it is, is appropriate for primary legislation. Our preference is to use secondary legislation to set out the services covered by choice rights and the detailed requirements for offering choice. The key thing is that that will allow that framework to be updated as services, evidence and system capability develop, because we are not going to be stuck in one place and healthcare will develop as we go along. I say to the noble Lord, Lord Patel of Bradford, that we will continue to look at the scope of the choice rights and ensure that we are provide the most effective offer to patients.

I say to the noble Baroness, Lady Coffey, and the noble Earl, Lord Howe, that we are taking the practical actions they seek, as set out in the elective reform plan. We are empowering people to take control of their health by making the NHS App and the “Manage Your Referral” website the default route for patients to choose their provider. To enable patients to make an informed choice, we are improving the information available to them, following the point I made earlier, including on waiting times. The noble Lord, Lord Patel, was right to say that not everybody can use online access. We completely understand that, and I emphasise that online tools are in addition to traditional channels. We will ensure that people who need help to make a choice receive that support and information in the way that suits them, as raised by the noble Baroness, Lady Pidgeon.

On the point made by the noble Baroness, Lady Neville-Rolfe—this might also be helpful to other noble Lords—patients will continue to be able to choose any provider that holds a contract to deliver NHS services. As I said in my letter to the noble Baroness, that includes independent sector providers, within set circumstances. It is the responsibility of ICBs to ensure that their processes comply with the right to choose. That includes any qualifying contract requirements, clinical appropriateness and eligibility criteria. There is guidance for the use and implementation of indicative activity plans and activity management plans. That is detailed in the NHS standard contract technical guidance. If the noble Baroness would like more information, I will be happy to ensure that it is there.

The noble Baroness, Lady Manzoor, talked about the need for real choice to be strengthened. The government guidance on choice makes it clear that GPs, dentists and optometrists have clear duties to ensure that patients are offered a choice of where they go to their first out-patient appointment. I totally agree with her that a right is only as good as the information and confidence that you have. That is why we are taking these steps.

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[Baroness Pidgeon (LD)]

Before the Minister sits down, she mentioned that the Government are minded to use secondary legislation rather than amendments to the Bill. Are the Government minded to include the non-consultant community services we have been discussing in the Chamber today in such secondary legislation, for genuine patient choice?

[Baroness Merron (Lab)]

Secondary legislation will ensure patient choice across all NHS services, so that will be included.

[Baroness Neville-Rolfe (Con)]

I think the Minister’s answer showed that this local variation is a problem, partly because of the standards, contracts and framework that she described. Some of this may be in future secondary legislation, as the Minister has just said. I would like to pursue this a bit further to see if one can tap the capacity that could reduce waiting times in these important community areas of medicine. I am worried that the existing system is not providing the incentive for that. I would like to understand a little more detail, perhaps in a meeting before we get to Report.

[Baroness Merron (Lab)]

I would be very happy to do that.

[Lord Scriven (LD)]

I have been listening very carefully and, in answer to my noble friend, the Minister has just said that secondary legislation will be for all NHS services by choice. What stops that being put on the face of the Bill?

[Baroness Merron (Lab)]

This is the point I have just raised: we feel that secondary legislation is the better place to put it for flexibility and future-proofing; it is not appropriate, in a static way, for primary legislation.

[Lord Scriven (LD)]

As I am sure the Minister agrees, that would make sense if you were putting the operational services down. If you were making a commitment in Clause 5 that all NHS services in secondary, primary and community services will be accessible for choice, it would then give discretion within that boundary. I do not understand what stops the Government putting those principles on the face of the Bill, rather than making the operational amendments, which the Minister said were too restrictive.

[Baroness Merron (Lab)]

I think we just have a difference of approach to and opinion about the roles of primary and secondary legislation. I respect what the noble Lord is saying and I will of course review the points that have been made, as I always do; however, the position is exactly as I have described.

[Earl Howe (Con)]

My Lords, I am most grateful to the Minister for her response and, indeed, to all noble Lords who have contributed to this debate. This has been a valuable opportunity to explore how we can give patients greater choice while making better use of the resources and expertise available across our wider healthcare system. In particular, services such as optometry and audiology have been highlighted.

I was encouraged by much of the Minister’s response, particularly her reference to the need to empower patients, not least to optimise patient outcomes. She is right that there are already several consultant-led NHS services delivered in the community. It would be helpful, though, if she could reflect on the issues I raised about audiology, which is not consultant-led. Perhaps she could consider what could be done to increase audiology provision in the community. As I said at the outset, our intention is not to undermine the NHS but to support it. Where independent charitable and community providers can deliver high-quality care closer to home and more efficiently, we should be making full use of that capacity.

My noble friend Lady Coffey rightly said that politicians of every colour all too easily make declaratory statements about choice, but that we do not do enough to bring meaningful choice to the attention of patients. I confess that I worry sometimes that the absence of choice in certain situations may, in part, not be wholly unintentional. As we heard from my noble friend Lady Neville-Rolfe, it sometimes seems to suit NHS commissioners not to bring down waiting times. The primary reason for that, I suspect, is the way commissioners channel and direct their commissioning budgets. It is important, though, to keep in mind, and perhaps remind commissioners, that out-of-hospital services can often be less expensive to provide than services delivered in hospital.

Having said that, I hope the Government will take these points away and give further consideration to how patient choice can be strengthened as this Bill progresses. For now, I beg leave to withdraw Amendment 22.

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[Lord Kamall (Con)]

My Lords, this has been an important and timely debate, coming not long after the Terminally Ill Adults (End of Life) Bill and the Prime Minister’s remarks. While these amendments address a range of issues, they all point to the same conclusion: palliative and end-of-life care must have a central place in this conversation.

If the Government are serious about shifting care from hospitals into communities, supporting people to remain closer to home—notwithstanding the comments from the noble Baroness, Lady Barker—and delivering truly patient-centred care, palliative care must be part of that vision from the outset. The need for action is clear. Marie Curie estimates that each year around 170,000 people in England die with unmet palliative care needs, equivalent to almost one person every three minutes. We must ensure that those approaching the end of their lives can access the support they need, when and where they need it. This is closely linked to my noble friend Lady Coffey’s amendment. She spoke movingly of her mother’s experience and the need to ensure that patients have access to high-quality palliative care, wherever they happen to live and choose to die.

If the Government’s proposed national care service is to succeed, it cannot simply be a discussion about structures, responsibilities and reorganisations. It must be about the experience of those who rely on care. No group demonstrates that more clearly than people approaching the end of their lives. Palliative care is perhaps one of the clearest examples of where health and social care are inseparable. While clinical support may be provided by the NHS, the ability of a person to remain at home or close to home, to maintain their dignity and spend time with loved ones, often depends just as much on the availability of social care. For many families, social care provides the day-to-day support on which good end-of-life care depends. Evidence shows that when effective support is available in the community, people are more likely to be cared for and pass away in a place they choose, rather than in hospital. As the noble Baronesses, Lady Finlay and Lady Hollins, said, this will also reduce hospital deaths, save the NHS money and make more beds available.

Palliative care does not begin and end with the NHS; it depends upon social care providers, community services, carers, local authorities, hospices and voluntary organisations working together around the individual and their family. When those services are joined up, people are more likely to receive care in the setting they choose and with the support they need. When they are not joined up, it can profoundly affect those approaching the end of their lives.

In that context, I welcome the amendment from the noble Baroness, Lady Finlay, which recognises that good palliative care depends not on any single organisation but on effective collaboration across the NHS, adult social care and the voluntary sector. Too often, services that support people approaching the end of their lives are commissioned, funded and delivered separately, despite the fact that patients and families experience them as part of a single journey. The amendment would help to ensure that integrated care boards take active steps to bring those services together, whether through access to specialist hospice care, shared equipment, medicines, workforce development or closer collaboration between providers.

Crucially, the amendment recognises the vital contribution of hospices and charitable organisations to the delivery of palliative and end-of-life care. These organisations are not peripheral to the system; they are an essential part of it. If the Government are serious about creating a national care service and a neighbourhood health service that are genuinely joined up for patients, the expertise and capacity of the voluntary sector must be properly integrated into the way care is planned and delivered.

Indeed, some of the most important services available to people at the end of their lives are delivered by hospices and charitable organisations. For decades, as the noble Lord, Lord Hunt, said, the voluntary sector has not merely supplemented statutory services but has been fundamental to the provision of specialist palliative care. But too often it is forced to operate at the margins of the system, dependent on local arrangements, local funding decisions and local fundraisers, and subject to tax rises, such as employers’ national insurance, from which state providers are understandably exempt. The noble Baroness, Lady Bennett, shared examples of recent hospice closures.

If the Government wish to build a neighbourhood health service and develop a national care service, integration must mean integration not only within the NHS but between the NHS, adult social care and the voluntary sector. Ultimately, the measure of success will not be the structures we create but whether individual patients receive seamless support at one of the most difficult moments of their lives and for their families.

The issue of patients having a conversation about their end-of-life care, addressed in the amendment in the name of the noble Baroness, Lady Pidgeon, was illustrated by the very moving stories from the noble Lord, Lord Patel, the personal experience of the noble Baroness, Lady Barker, and the concerns raised by the noble Baroness, Lady Grey-Thompson. These amendments seek to move us towards that goal. I hope that the Minister will give careful consideration to the issues that have been raised during the debate.

[Baroness Merron (Lab)]

My Lords, I can certainly confirm to the noble Lord, Lord Kamall, that I will give complete consideration to the points raised.

As other noble Lords have acknowledged, I thank the noble Baroness, Lady Barker, and the noble Lord, Lord Patel, for bringing their loved ones’ stories into the Chamber for the benefit of others, and for their willingness to share with us such a painful but realistic time. I believe that many people will identify with what the noble Baroness and the noble Lord said, and it will mean so much to so many.

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[Lord Stevens of Birmingham (CB)]

Conditionally.

[Baroness Merron (Lab)]

The noble Lord says “conditionally”. I would I expect it always to be conditional, but I thank him for clarifying.

To address the concerns of the noble Baroness, Lady Coffey, as we have already discussed in Committee, Section 1C of the NHS Act 2006 states:

“In exercising functions in relation to the health service, the Secretary of State must have regard to the need to reduce inequalities between the people of England with respect to the benefits that they can obtain from the health service”.


This is a deliberately overarching duty that applies across the whole of the health service, so we do not consider it appropriate to create separate versions of that duty for individual services. That would risk duplication and make the legislative framework overly prescriptive.

The much talked about modern service framework for palliative care and end-of-life care was referred to as a “trick or treat” test by the noble Lord, Lord Stevens —I will leave him to conclude, when I finish. I also assure the noble Baroness, Lady Coffey, that no one in this Chamber wants her to feel grumpy, and I am sure that nobody in the department wishes her to feel grumpy.

The modern service framework will focus on reducing inequalities. It will identify, measure and reduce inequalities, and reduce unwanted variation in access, experience and outcomes—I say to the noble Baroness, Lady Grey-Thompson, that that absolutely includes in respect of disability. The modern service framework is indeed anticipated in the autumn, which we remain in. I know that we are all keen to ensure that everyone can receive high-quality and personalised care in the right place at the end of life. I look forward to the modern service framework giving us the best way forward on that.

I turn to Amendment 78, also in the name of the noble Baroness, Lady Finlay. As per Clause 21, the Secretary of State is already required to undertake an annual performance assessment of each ICB in discharging its statutory functions. Again, that was spoken to by my noble friend Lord Hunt. I say to the noble Baroness, and to the noble Baroness, Lady Hollins, that the latest report for 2024-25 was published on 17 December last year. Future assessments will continue to consider how ICBs are discharging their statutory palliative care duties. I very much understand the calls from noble Lords across the Chamber and their emphasis on how important this is.

The modern service framework will indeed build on the ambitions set out in the neighbourhood health framework, which includes increasing the identification of those approaching end of life by 10% and reducing non-elective admissions and hospital bed days by 10% for those at end of life. I take the point that the noble Baroness, Lady Hollins, made about measurement and ambition in particular. On the NICE guidance in this area, in keeping with all NICE guidance, although it is not statutory or legally binding, as local healthcare professionals need autonomy to make clinically appropriate decisions in relation to their patients, there is an expectation that commissioners and service providers take it into account when they make those decisions on how to meet the reasonable needs of their populations.

On Amendment 230, tabled and spoken to by the noble Baroness, Lady Pidgeon, alongside the existing statutory framework that I have already outlined, the already published universal principles for advance care planning promote opportunities for individuals, including those with a terminal diagnosis, to discuss their wishes, their preferences and the clinical recommendations. Health and care professionals are expected to provide appropriate opportunities for individuals to engage in advance care planning. This area was spoken to by the noble Lords, Lord Kamall and Lord Patel, as well as the noble Baroness, Lady Barker.

These principles explicitly recognise the importance of involving a person’s family, carers and those who are important to them. I emphasise the point that those who are important to us do not always come neatly packaged. They are to be involved in discussions, including through the nomination of a named spokesperson. The outputs of these discussions may include one or more of the following: an advance statement —I have heard how helpful that is, along with the importance of an advance decision, where it is to refuse treatment—context-specific treatment recommendations and lasting power of attorney, where it is appropriate, in line with the Mental Capacity Act 2005.

Additionally, for those nearing the end of their life, the Government’s priority is to provide people with financial support quickly and compassionately. The noble Lord, Lord Patel, and the noble Baroness, Lady Barker, both spoke to the absolute importance of compassion being at the core of everything that is done. In a practical sense, the main way that this is done is through the special rules for end of life, which apply to five key benefits, including the personal independence payment.

I move on to the points on medicines access raised under Amendment 242, tabled by the noble Baroness, Lady Finlay. The pharmacy quality scheme forms part of the community pharmacy contractual framework. The scheme’s palliative and end-of-life care domain aims to ensure sufficient arrangements are in place so that patients, relatives, carers and healthcare professionals can obtain medicines in a timely manner—again, something spoken to very clearly by the noble Lord, Lord Patel. ICBs commission out-of-hours dispensing arrangements where there is a need for patients to access medicines outside core pharmacy hours.

Finally, I will address Amendment 26, tabled by the noble Baroness, Lady Finlay, on which we heard a number of contributions. Funding for palliative and end-of-life care is available through existing NHS funding arrangements and, as I have outlined, ICBs have statutory responsibility for commissioning. Indeed, as we have discussed on a number of occasions, local commissioners are best placed to determine how funding should be allocated according to the population need, local service provision and the best use of available resources. The ring-fenced fund proposal, which would mean establishing it in primary legislation, would, we believe, risk being overly prescriptive and would limit the flexibility of local commissioners to determine how resources are best used.

On the point about hospices and funding, I very much recognise, as have noble Lords, the absolutely vital part that voluntary sector organisations, including hospices, play when providing support to people at the end of life, but also to their loved ones. It is also worth noting that the majority of palliative and end-of-life care is provided by NHS staff and services, to whom and for which we are also most grateful. It is true that the amount of funding for each charitable hospice will vary but, by definition, that depends on the demand in local areas and on the type of palliative care provision. My noble friend Lord Hunt made the point that hospices value their operational independence—that is something that I have found in my discussions with them—and they are great innovators. I understand the point about funding, as I do in this whole area. However, when I have looked at this and spoken with hospices, that ability to operate independently is one that they really value.

The modern service framework will ensure that palliative care and end-of-life care is well within a strategic commissioning model. Importantly, there will be clear and transparent contractual arrangements, which I hope noble Lords will welcome.

[Baroness Finlay of Llandaff (CB)]

My Lords, I am extremely grateful to all noble Lords who have spoken in this debate, particularly my noble friend Lord Patel and the noble Baroness, Lady Barker, for sharing recent experiences, and my noble friend Lady Hollins and the noble Baroness, Lady Coffey, who have also drawn on their experiences. Everybody in this Chamber has experienced being bereaved: it is a universal experience, and we all carry with us the mark of whatever happened.

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[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Lord, Lord Kamall, for bringing this debate before the Committee. I commend his honesty that this is born out of frustration and a wish to improve things, rather than seeking a legislative response—something the noble Lord, Lord Scriven, also observed in looking at the amendment. I agree with the noble Lord, Lord Scriven, that the amendment raises important points to be considered more broadly, so I assure the noble Lord, Lord Kamall, of that consideration.

I will make a few points that may be helpful. The NHS Innovation Service already provides a wide national point of access. The way it works is that an innovator makes one request, creates one product record and is referred according to product type, maturity and location. More than 2,200 products have been registered with and have received support through the service, including 710 innovations in the 2025-26 financial year. All health innovation networks participate alongside 11 other organisations. That means that innovators have access to a broad range of expertise through a single service. Almost all products reach at least one health innovation network and are referred to four organisations on average. Innovators may also approach a network directly. Support can span several networks and regions, with onwards referral requiring no new application. Uptake is already reported at a high level while, of course, protecting commercial confidentiality.

I hope that the noble Lord, Lord Kamall, will understand that funding a second route—or, as I believe the noble Lord, Lord Scriven, said, a second front door, which would confuse us—where an effective national service is already in place may not exactly represent what we might call the most effective use of public resource. The amendment’s core aims are therefore already met. Prescribing an operating model in legislation could limit its ability to evolve—something I know the noble Lord understands.

The noble Lord, Lord Kamall, asked about health innovation networks. I can confirm they are subject to performance and impact monitoring. They also produce impact reports to show what their local impact is. The noble Lord, Lord Scriven, asked what would happen following the abolition of NHS England. Nationally funded health innovation networks’ work will continue and will be overseen by the Secretary of State. I will look at the other points that have been raised, because they are all certainly relevant and will be drawn to the attention of my colleague, the relevant Minister, Chris McDonald.

[Lord Kamall (Con)]

My Lords, I am grateful to the very many noble Lords who queued up to speak in this debate—I obviously raised a very important point. I am also grateful to the noble Lord, Lord Scriven, for reminding me how innovative I was when I was the Technology and Innovation Minister. In fact, I set up the very service that I am now asking for many years later. It does beg a question, because even I, as the person who set it up, still did not know that this service existed. When I speak to people in NHS England and elsewhere and say, “You know what you need? You need a front door for innovators”, they say, “You’re absolutely right; we haven’t got one”. So even people in NHS England do not know that this exists.

I was up front that I knew this was not meant to be in the Bill. I just wanted to get discussion. It probably helped to prompt my memory as well—my thanks to the noble Lord, Lord Scriven—but it is really important that more people know about the NHS Innovation Service. Perhaps the Minister could write to me and the many other noble Lords who are interested in this topic to let us know what the Government intend to do to promote the NHS Innovation Service, so that more people are aware and so I do not ask for the same thing next time we have a health Bill.

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[Baroness Merron (Lab)]

My Lords, I am grateful for the debate we have just had. Unsurprisingly, but not exclusively, a lot of it focused on the promised workforce plan, so I will address that straight off. There has been lots of thought about why it is “in due course”, and that is the situation. I am glad that the noble Baroness, Lady Coffey, appreciated the impact, without blame, of a new Secretary of State: she is well placed to speak to that point.

Let me say that, first, our absolute commitment to the workforce plan for the NHS remains. There is no shift in that. I also say that, as I mentioned, the reason we await it and it is “in due course” is that, as is absolutely reasonable and right, a new Secretary of State has to be allowed to provide views; that is the situation. I hope that clarifies the position.

With permission, I will address Amendments 28, 92, 240, 252, 253 and 279J together. Amendments 28 and 253 have been tabled by the noble Baronesses, Lady Shawcross-Wolfson and Lady Pidgeon. I absolutely agree that the health and care workforce is fundamental. It is fundamental to everything we are doing and to this entire debate, and it is fundamental to the interests of patients, which is why we will publish the 10-year workforce plan. As most noble Lords spoke to the plan, I will emphasise that the Secretary of State already has duties to ensure effective planning and the delivery of healthcare, education and training—as has been called for, rightly—and also has a duty to report on the system for assessing and meeting NHS workforce needs.

To the noble Lords, Lord Kakkar, Lord Stevens and Lord Kamall, I can say that an expert panel of external stakeholders has scrutinised the 10-year workforce plan approach to workforce planning. To the noble Baroness, Lady Hollins, I can confirm that sickness absence is indeed factored in to the workforce planning process. I heard the noble Lord, Lord Stevens, talking about the way in which the workforce has changed; that is absolutely right and, again, the plan will reflect that.

The noble Lord, Lord Kakkar, and the noble Lord, Lord Stevens, raised points about short-termism versus long-termism in workforce planning, and so on. I am sure noble Lords will understand that decisions about the education and training of healthcare professionals will continue to be driven by data, based on evidence and intelligence led. That will be through the new restructured system. The point here is to make sure that we have the right people in the right places, with the right skills, to care for patients when they need it.

The noble Baroness, Lady Hollins, asked about a bottleneck in medical training pathways. I can say on that point that noble Lords will recall the passage of what became the Medical Training (Prioritisation) Act, and we are easing competition for medical training by prioritising UK-trained graduates for foundation specialty training places, alongside some other groups. The recently agreed 2026 resident doctors deal also significantly expands specialty training places by up to 4,500 over three years, including 1,000 next year.

The noble Baroness, Lady Gerada, made a very strong, and correct, point about the role of district nurses, borne out by the noble Baroness, Lady Barker. Through NHS England, we are actively monitoring future nursing and midwifery student numbers and will continue to assess the 2025-26 graduate guarantee as a mechanism. There is a wide range of measures to support students, educators and universities with the transition into employment, including Student Hub, which offers guidance and resources for students and newly qualified practitioners.

To the point made by the noble Baroness, Lady Barker, I will be pleased to speak to colleagues in the Home Office about the supply of district nurses, if not directly then through the appropriate Minister.

The noble Baroness, Lady Shawcross-Wolfson, in her opening comments made reference to numbers of GPs. We have committed £292 million for GP recruitment this year, which translates to 1,600 GPs, and there are 4,100 more GPs than a year ago. It is important to note that, while we wait for a workforce plan, we have not waited in taking action. For example, we have resolved the long-running doctors’ dispute and we have published a set of core NHS staff standards.

On adult social care, and the point made by the noble Baroness, Lady Harding, that was another point I pushed when we last debated this matter and when we were in Opposition. There was also a comment about legislating on planning duties. That would pre-empt the vital work to develop a national care service which will follow from the recommendations of the noble Baroness, Lady Casey, which we will receive in the summer. That work will have important implications for the shape and skills of the future adult social care workforce. I agree with noble Lords: it is inextricably linked with the NHS workforce, which is a point I have made over a number of years. In the meantime, we will commit to publishing a workforce plan and we will set out immediate action to further support and develop the adult social care workforce.

My noble friend Lady Rafferty tabled Amendment 279J on continued professional development for nurses and midwives. I agree that that is critical for patient safety and outcomes. That is why we are investing in their professional development, with £181 million of continued professional development funding allocated for nurses, midwives, nursing associates and allied healthcare professionals in 2026-27 as part of a three-year cycle and to support equitable access to professional development. To respond to her questions, I can tell my noble friend that organisations are responsible for the planning and governance of their CPD, to ensure that staff have a fair opportunity to benefit from the funding. We expect employers to provide support, supervision and guidance, and to foster a culture of continuous learning, which, again, we would expect throughout the NHS.