National Brain Cancer Lead

Baroness Merron Excerpts

Tuesday 3rd November 2026 Lords Chamber

[Baroness Paul of Shepherd’s Bush]

To ask His Majesty’s Government what progress they have made towards appointing a national lead for brain cancer, and what measures are in place to ensure that the role supports improvements in research funding, clinical care, treatment pathways and patient outcomes across the United Kingdom.

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

My Lords, last month the Government confirmed plans to recruit a national brain tumour lead, with details to follow. As announced by the Prime Minister, the national lead will co-ordinate action and drive forward work to improve outcomes for brain tumour patients, supported by our rare cancer clinical and research leads and working with the National Cancer Board.

[Baroness Paul of Shepherd’s Bush (Lab)]

My Lords, I congratulate 25 year-old Archie Goodburn, the Commonwealth medallist living with a currently incurable brain tumour, on securing this commitment from the Prime Minister for a clinical lead on this devastating disease. Brain tumours are the biggest cancer killer of children and young people under 40, but despite this, there has been no change or progress in treatment in over 40 years. Does the Minister agree with me that the only way to change outcomes is to accelerate at pace the number and range of clinical trials taking place so that there is a chance of a cure for Archie and other patients?

[Baroness Merron (Lab)]

I know how much the Prime Minister appreciated his meeting with Archie. Indeed, the Prime Minister has acknowledged that enough progress has not been made in this area and committed, as my noble friend said, to a number of actions. I certainly would agree with my noble friend’s view on the importance of clinical trials. I can say to my noble friend that, as we set out in the national cancer plan, we are committed to ensuring that the UK supports new clinical trials for brain cancer and boosting participation in research. Both of these really need to be pushed forward, and we are fast-tracking clinical trial set-up times to 150 days to ensure that more patients can access innovative treatments in our country.

[Baroness Pidgeon (LD)]

My Lords, I pay tribute to the swimmer, Archie Goodburn, for his courage in campaigning for people affected by brain cancer. I welcome the Government’s commitment to commission an expert review. Will they ensure that it will set out clear, time-bound recommendations, with named bodies responsible for delivery in this area, and that progress against them is published?

[Baroness Merron (Lab)]

We are keen to be open about this. The immediate expert review, which will take just three months, will be led by Professor Anthony Chalmers. It will examine progress since the 2018 brain tumour research report. I look forward to that review being published within three months. A national action plan, which I am sure will refer to the points that the noble Baroness made, will then help us to move discoveries from the laboratory into treatments and clinical care much more quickly. That is where we need to be.

[Baroness Finlay of Llandaff (CB)]

My Lords, what powers will the appointment have, given that 74% of patients are diagnosed in A&E because of delays in diagnosis in primary care? This results in 45% of patients being told in A&E that they have a brain tumour. Even when they have a biopsy, there are inadequate freezing facilities for biopsies to be taken and kept so that personalised medicine can be developed and entered into studies.

[Baroness Merron (Lab)]

On the point about brain tissue freezing, NHS England has, as the noble Baroness may be aware, just completed a freezer capacity gap analysis and is in the process of working with sites to ensure additional capacity. I share her view that identification in an emergency setting is not the best place, although that will sometimes be the case. All this movement is to reduce that incidence.

[Baroness Mattinson (Lab)]

My Lords, I want to pick up two aspects of this very welcome new appointment. The first is the degree to which the patient’s voice—so often overlooked in this area—will be heard, and that listening to it will be part of the remit. The second is about timing. Can the Minister reassure us on the speediness of the appointment, given that most brain cancer patients have 12 to 18 months to live after diagnosis? They do not have the luxury of time on their side.

[Baroness Merron (Lab)]

I think that has been acknowledged by the Prime Minister in this review being so rapid—delivered within three months—and in the fact that he is taking personal oversight of this work. Again, that is to be welcomed. On the patient’s voice, one of the outcomes from discussions is that the Secretary of State will be convening researchers, clinicians and charities to identify practical ways to increase participation in brain cancer trials. Certainly, the Prime Minister has asked patients, families and charities to work with us to help raise awareness and support participation in clinical trials. For me, the patient’s voice is absolutely critical and I know that it will be at the heart of this.

[Lord Patel (CB)]

My Lords, we recognise that outcomes for people with brain tumours and cancers, particularly children, is a survival time of no more than 13 months to five years. Although it is important to do clinical trials using drugs, the problem we have is the blood-brain barrier, which protects the brain from being affected by these drugs. We need to find novel ways of treatment. Some are being researched; for instance, focused ultrasound, micro-RNA treatments and personalised vaccines developed for particular patients for each of their tumours. We need to support these novel ways of finding treatments for brain tumours that do not apply to other diseases.

[Baroness Merron (Lab)]

The noble Lord is right. That is why we have to work so much more quickly to move discoveries from research into treatments and clinical care. That has been sadly lacking, which is why the points that the Prime Minister announced include an accelerated review by the MHRA of the regulatory arrangements for rare disease medicines, known as orphan drugs—I mention that just as one example—that would see that work completed in two years rather than three. We understand the need for speed and acknowledge that we are in a position, sadly, where not enough progress has been made in this area.

[Lord Kamall (Con)]

My Lords, I too welcome the Government’s commitment to establishing a dedicated national brain cancer lead. My question is about accountability, going back to the question from the noble Baroness, Lady Pidgeon. Will the Government publish a set of measurable objectives for the national lead, particularly for access to treatment and patient outcomes, so that this House and others can assess whether the role is achieving the real progress that patients and families want to see?

[Baroness Merron (Lab)]

I mentioned a national action plan that will be informed by the three-month review, and I confirm that the Government will publish that national action plan. I would expect to see the markers that the noble Baroness and the noble Lord have called for within that.

[Baroness Linforth (Lab)]

My Lords, I am very pleased that my noble friend Lady Paul asked this Question today as our great friend Baroness McDonagh died of a glioblastoma in 2023. I understand that the NHS is currently running 35 clinical trials related to brain cancer, of which nine are related to glioblastoma, the most aggressive form of brain tumour. Will the Minister either tell the House today or write to me setting out how many patients have been recruited to each of those trials?

[Baroness Merron (Lab)]

I am grateful to my noble friend for honouring the memory of Baroness McDonagh, as other noble Lords have done, and Baroness Jowell. I know that many noble Lords are affected directly or indirectly by this and will be feeling the weight of that as we discuss this matter. To answer my noble friend’s question, the number of glioblastoma patients who have been recruited into specific trials is not centrally held. There is a reason for that. It is because many studies enrol patients who have more than one type of brain cancer, and the data is managed by study teams and sponsors. I also note that some data for commercial trials is considered commercially sensitive. Each trial will have its own inclusion and exclusion criteria that are set out by the study team. Having said that, if there are particular things with which I can assist my noble friend, of course I will be pleased to do so.

Health Bill

Baroness Merron Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, I too am grateful to the noble Lord, Lord Rennard, for bringing forward these amendments and for drawing the Committee’s attention to the important issue of diabetes prevention, treatment and care. I particularly welcome the focus in these amendments on innovation, because this is an area in which we see some genuinely promising developments. One example, mentioned by the noble Lord, Lord Rennard, and the noble Baroness, Lady Pidgeon, is the emergence of hybrid closed-loop systems. For people living with type 1 diabetes, this technology has the potential to make an enormous difference.

In April 2024, NHS England began a five-year programme to roll out this technology to eligible children, young people and adults living with type 1 diabetes. That was a very welcome development, and I hope we will continue to see the programme expanded so that more patients who would benefit from the technology are able to access it. It would be helpful to hear from the Minister about that, and about how the rollout of the programme is progressing and how many patients have received the technology so far. As with any issue like this, improvements in accessing the technology are always forefront of commissioners’ minds, so it would be helpful if the Minister can say anything about that. I would also be interested to hear what assessment the Government have made of the availability of specialist staff to support this rollout. Developing an effective new technology is one thing; ensuring that patients can access it, and that clinical teams have the resources and expertise to provide it, is another.

More widely, these amendments raise an important question about the future scale and impact of diabetes in this country. The noble Lord, Lord Rennard, highlighted the statistics and predictions from the International Diabetes Federation. Those predictions present a considerable challenge for not only patients and their families but for the health service. They also reinforce the importance of prevention, particularly in relation to type 2 diabetes, where earlier intervention can make a considerable difference. Can the Minister tell us what steps the Government are taking to strengthen prevention and early diagnosis and to support the wider adoption of new technologies?

Finally, I want briefly to touch on Amendments 225 and 226, which raise a wider point about the abolition of NHS England and the continuity of existing national diabetes programmes. During our consideration of the Bill, we have discussed at some length the importance of ensuring that the abolition of NHS England does not disrupt the delivery of essential services or lead to the loss of programmes and expertise that are already delivering benefits to patients. The noble Lord is absolutely right to raise that concern in the context of diabetes. I am not necessarily persuaded that we need to place each of these requirements in statute, but he raises some entirely legitimate questions. I would welcome assurances from the Minister that these programmes will continue to receive the attention and support they require throughout the transition. I look forward to what the Minister has to say.

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

My Lords, I am most grateful to the noble Lord, Lord Rennard, for tabling this amendment, and to other noble Lords for their contributions. The Government recognise the importance of high-quality diabetes prevention, treatment and care services, and I believe that our actions on this reflect that. Programmes such as the NHS Diabetes Prevention Programme, the NHS Type 2 Diabetes Path to Remission Programme and the National Diabetes Audit all play an important role in improving outcomes for people living with diabetes.

I turn specifically to Amendments 225 and 226. The Bill allows for the transfer of functions and responsibilities from NHS England following its abolition—that means a transfer that will not impact service provision. I say to the noble Earl, Lord Howe, that the Government support effective diabetes services and innovations in various ways, but that includes ensuring the continued commissioning, monitoring and improvement of these programmes without the need for disease-specific provisions in primary legislation. Moreover, specifying programmes at this level of detail would restrict our ability to adapt to new and changing evidence on effective treatments and technologies; I know that is something noble Lords would not want to restrict. Similarly, a diabetes-specific reporting clause would duplicate existing monitoring and oversight arrangements that provide additional assurance without adding administrative burden and additional bureaucracy.

To turn to Amendment 12, improvement of outcomes for people with diabetes absolutely includes reducing health inequalities, which we debated in an earlier group. That is already captured in the general duty to reduce health inequalities set out in Clause 4. Furthermore, the modern service framework for cardiovascular disease, which was published in July, advocates a holistic cardiovascular/kidney/metabolic approach, including finding those with undiagnosed or unmanaged diabetes, initiating treatment and increasing the number of people whose treatment is optimised, with a strong focus on reducing inequalities.

On Amendment 25, I reassure your Lordships that the Secretary of State and the NHS already have powers to promote innovation across the health service. The risk of singling out diabetes technologies in primary legislation is that it would create inconsistency with the approach taken for other conditions. Rollout of glucose monitoring and automated insulin delivery technologies is already supported through NHS implementation arrangements, based on established NICE guidance. Therefore, listing specific technologies in legislation could reduce the flexibility of the NHS to be as truly innovative as we would all want, as new technology emerges.

[Lord Rennard (LD)]

My Lords, I thank the Minister for her sympathy on these issues, and I thank all the people in her department, who I know are sincerely committed to trying to help people with diabetes, to help prevent its occurrence and to provide the best possible care and treatment. But at the heart of the problem, as the noble Lord, Lord Hunt of Kings Heath, said, is a dilemma: as people try to treat medical conditions such as diabetes differently and say there should be a localist approach, there is a fundamental problem for the whole of the country in that, if we fail to deal with this, the cost is on all of us. The costs to taxpayers, the costs of people not working, the costs of not paying to HMRC and the costs of drawing down on the DWP are growing enormously. This is such a huge problem that, as we have said at many points today, we have to look across all government sections at how we work together on all these issues. On that note, I beg leave to withdraw my amendment.

Health Bill

Baroness Merron Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

Moved by

[Baroness Merron]

1: Clause 2, page 1, line 16, at end insert—
“(1A) The Secretary of State may not make a transfer scheme transferring anything to—(a) a Scottish public body, without the consent of the Scottish Ministers;(b) a Welsh public body, without the consent of the Welsh Ministers;(c) a Northern Ireland public body, without the consent of a Northern Ireland department.”Member's explanatory statement
This amendment would require the Secretary of State to seek the consent of the appropriate devolved nation before making a transfer scheme which transferred property, rights and liabilities from NHS England to a Scottish public body, Welsh public body or Northern Ireland public body.

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

My Lords, as I said at Second Reading, the abolition of NHS England is being taken forward with the interests of patients firmly at its core. It will provide greater clarity for the system. It will restore democratic accountability and free up resources to be reinvested in the front line. It will also bring greater clarity about where responsibility lies, ensuring that Ministers are accountable for national decisions while devolving more power to local NHS organisations. Patients will benefit from faster and clearer decision-making, with less duplication and red tape, with staff being allowed to spend less time navigating bureaucracy and more time focused on care and delivery.

I will address the government amendments to Clauses 2 and 28 together. Amendment 1 and consequential Amendments 2 and 3 make additions to Clause 2, which empowers the Secretary of State to establish transfer schemes. These clauses provide a structured and transparent means of moving property, staff, rights and liabilities from NHS England to the Department of Health and Social Care, integrated care boards and other relevant bodies.

Following engagement with the devolved Governments, these amendments have been tabled to require the consent of the relevant devolved Government should a transfer be made to a Welsh, Scottish or Northern Ireland public body. Amendment 1 does not change the purpose of Clause 2 but provides assurance to devolved Governments that any transfers to their bodies can take place only with their agreement. I emphasise that there are currently no plans for transfers to be made to devolved Governments’ public bodies, but this amendment provides a proportionate safeguard if such circumstances arise in the future.

Likewise, Amendments 103 and 104 are technical amendments to Clause 28, this time in response to engagement with the Welsh Government. They make clear the territorial limit of the clause to ensure it could not be used to establish, or delegate functions to, a Welsh special health authority. I believe these to be sensible and proportionate amendments, and I beg to move Amendment 1.

[Baroness Finlay of Llandaff (CB)]

My Lords, I welcome the Minister’s discussions with the devolved Governments and her saying that nothing is going to be potentially imposed on them, particularly having had those discussions. But can she clarify what will happen to some of the prevention agendas that have been in place—such as the Couch to 5K programme, for which I understand no outcomes have been collected, but which has been part of NHSE and the department’s promotion of exercise—and whether these programmes will be increasingly promoted across England as part of the prevention agenda, and in discussion with the devolved Governments, so that we get consistency in prevention across the United Kingdom?

[Earl Howe (Con)]

My Lords, it is a pleasure to begin our Committee consideration of the Health Bill, and I look forward to the discussions over the coming days. I am grateful to the Minister and to the Government for bringing forward these amendments, which we understand to be principally technical in nature, although there are questions we shall want to ask in later groups about cross-border patient referrals and related issues. We welcome the clarification these amendments provide regarding the consent of the devolved Administrations and the exercise of powers by devolved health bodies, and we are content to support them.

I hope the Committee will allow me to take this opportunity to acknowledge the letter sent by the Minister this morning concerning Healthwatch. Noble Lords across the House will welcome the Government’s decision not to proceed with its abolition, and I am grateful to the Minister for listening to the concerns raised in this House and elsewhere. This is a very positive example of the Government engaging constructively with the scrutiny of this Bill and showing a willingness to reconsider their proposals where legitimate concerns have been raised. That is precisely the spirit in which I hope we can continue our consideration of this legislation, and I welcome the approach the Government have taken on this occasion. I look forward to the Minister’s response.

[Baroness Merron (Lab)]

My Lords, I am grateful for this brief but important debate, and in particular for the support for these amendments. As the noble Earl, Lord Howe, says, they are technical amendments. I say to the noble Baroness, Lady Pidgeon, that this is absolutely nothing to be worried about: we work closely with the devolved Governments, and this is an extra layer of reassurance to them that we felt was helpful, because it is what they sought. These technical amendments are brought forward not as an afterthought but because that is what conversations have led us to think is the right thing to do. I know they very much welcome this, and I am grateful for their assistance.

I hear what the noble Earl, Lord Howe, said about the letter I sent out and the announcement in respect of Healthwatch. I am most grateful to noble Lords for their engagement as we have approached this point in the Bill. As the noble Earl acknowledged, we are always keen to listen. We cannot always do exactly what every noble Lord would want, but I am glad that the noble Earl welcomes the way in which the Secretary of State and the Prime Minister have approached this.

On the point raised by the noble Baroness, Lady Finlay —who also gave her support—about particular programmes, I am very happy to look into that. However, as I have set out, we intend for the programmes to which we are committed to be transferred to the department. What happens in the longer term on the prevention agenda is another consideration. We work very closely with the devolved Administrations on prevention, but, ultimately, healthcare is a devolved matter. I commend the amendment to the Committee.

Amendment 1 agreed.

Moved by

[Baroness Merron]

2: Clause 2, page 2, line 14, leave out subsection (4)
Member’s explanatory statement
This is consequential on my amendment to Clause 2, page 2, line 21.

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[Lord Scriven (LD)]

When we get to Clause 11, the noble Lord, Lord Hunt, will see that some of the powers that the Secretary of State now takes, beyond NHS England, will not come before this Parliament. They will just be at the signature of the Secretary of State’s pen.

In this Bill, form comes first and function will follow in due course. We have the demolition notice but are still to see the drawings of the new structure. Let me say how far behind the Government are. The Nuffield Trust, working with the Institute for Government, compared past public sector reforms and NHS abolitions. It found that the key factors for success are not in place here. The abolition was announced without plans to explain its goals to staff and without redundancy funding, which led to months of delay. Detailed planning for the new department began only in early 2026, almost a year after the announcement. Nuffield’s verdict is that the process has been “poorly handled”.

We are still short of very basic information. At Second Reading and in this Committee, the noble Lord, Lord Stevens, who I admit must know something about running the NHS, pointed out that the costs and benefits in the impact assessment are still marked as “not available”. There are also still a number of questions about the timing of when this reform will come in. We have the Government’s estimates that redundancy exits—across the department and NHS England, ICBs and the commissioning support units—will cost between £1 billion and £1.3 billion, to be met from existing allocations, but we must ask which allocations. Which services pay?

Then there is the timetable. On 15 October the Health Service Journal reported that abolition will have to be formally delayed beyond April 2027 unless decisions on future national structures are made within days. Have those decisions been made? Are staff now aware of where they will be transferred? The new operating model has been waiting for ministerial sign-off for months. Ministers are still weighing whether thousands of staff will go to the department or potentially, as we read, into a new stand-alone agency. This Bill sends nearly every function of NHS England to the Secretary of State, yet the Government have not decided where the people who will perform those functions will sit. The department says that it continues to plan for 1 April 2027, but planning a date is not the same as being able to meet it.

The planned 50% job cuts in the department appear to require moving the large majority of central policy and analytical staff. Or is it about cutting operational staff? As the noble Lord, Lord Crisp, said, we need clarity about which staff and which functions will be in the department. It is not clear that the figure is rested on rigorous assessment of who is needed and why. History tells us how this ends: after previous reforms that moved managers from commissioning bodies, the department consultancy spend peaked at over £600 million a year and the number of managers within five years was higher than going into the reorganisation. I fear that this will be another case of “cut first, rehire later and call it efficiency”.

As the noble Earl, Lord Howe, has said, we need not simply rely on the words of noble Lords in this debate. The Darzi review, commissioned by the Government and updated in May, concluded that a top-down reorganisation of NHS England and ICBs is “neither necessary nor desirable” and added:

“Constant reorganisations are costly and distracting”.


We have had six statutory major reorganisations in 30 years, none with clear evidence that the restructure has brought about improvement. The Government commissioned that review; they should read it and learn from it.

I have six questions for the Minister. When will the target operating model be published, and will that be before Report? Is the latest thinking to put transferred NHS England functions and staff into the department, or will the Government set up a stand-alone body? Will the Government publish a full, costed impact assessment, including benefits, and explain where the £1 billion to £1.3 billion comes from? What are the expected costs of disruption, and how will any further delay be limited? Are the Government confident that the 50% cut will not drive up consultancy spending by the end of this Parliament? If the Government do not accept the amendment from the noble Earl, Lord Howe, will they commit to laying a transition plan before Parliament and before Report? In substance, that is what this amendment is asking for.

We on these Benches are not defenders of the status quo. I started in the NHS in the early 1990s and lived through more reorganisations than I care to count. Every one promised less bureaucracy and a freeing up of the front line; none delivered it. If the Government want to put NHS operational matters into political hands, that is their choice, but they owe this House a plan and then a price and then a Bill, in that order. At present we have a Bill and we are still waiting for the other two. I look forward to the Minister’s reply.

[Baroness Merron (Lab)]

My Lords, I am most grateful to the noble Earl, Lord Howe, for moving this amendment, and to the noble Lord, Lord Kamall, for tabling it. As other noble Lords have observed, it is comprehensive and thorough. It makes the point, which a number of noble Lords have made, about the importance of ensuring that the right processes and assessments are undertaken as we move towards the abolition of NHS England—one of the key things in the Bill. As we are at the beginning of our deliberations, I say to noble Lords that I listen, and have listened, very carefully to the points that are made. I will endeavour to answer a number of points, but I will take some away and write to noble Lords. As ever—and as noble Lords will recall from previous Bills—those letters will be available to all Peers, because I want to do justice to those points.

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[Lord Scriven (LD)]

I asked one specific question, which the Minister may not be able to answer at this moment, but perhaps she could put it in writing. As the Minister has just pointed out to the noble Lord, Lord Stevens, is it the Government’s intention to transfer all the staff into the department or is a stand-alone body being looked at as a potential route for those staff?

[Baroness Merron (Lab)]

The intention is the former, but I will gladly write further to the noble Lord on this point.

[Earl Howe (Con)]

My Lords, I am grateful to the Minister for her wide-ranging response, and to all noble Lords who have contributed to this important debate, which has been very useful.

The Committee has spoken with one voice in underlining the scale and complexity of the task which lies ahead and the importance of ensuring that the abolition of NHS England, or its transformation, as the noble and right reverend Lord, Lord Sentamu, put it, is managed carefully, transparently and with proper accountability.

As I said at the outset, we are not opposed to efforts to reduce bureaucracy or to improve efficiency in the health service. However, we have to be confident that the Government have a clear understanding of the costs involved, the savings which can realistically be achieved and the risks associated with a reorganisation on this scale. Above all, we must not lose sight of the people whom these reforms are intended to serve. The ultimate measure of success must be whether patients receive better, safer and more timely care, rather than simply whether we have succeeded in changing the administrative structure of the NHS.

Despite what she said, I hope the Minister recognises that my amendment was put together as a giant probe of the Government’s transition plans, rather than as a model form of words to be written into the Bill. I therefore welcome her assurance that she will reflect carefully on the concerns that have been raised today, particularly around the need for a clear and independently assessed transition plan. We will consider the Minister’s response ahead of Report. However, for now, I beg leave to withdraw my amendment.

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[Lord Scriven (LD)]

My Lords, I speak for these Benches on this short but important group. I thank the noble Earl, Lord Howe, for the amendment on Supply Chain Coordination Ltd and the noble Lord, Lord Hunt of Kings Heath, for his important amendment on value-based procurement.

These amendments may look technical, but they go to something that matters in every clinic and every operating theatre: how the NHS buys what it needs and who is accountable when things go wrong. NHS Supply Chain manages an estimated £8 billion a year of NHS spending on products, and, since 2022, it has carried out the department’s PPE programme. Yet under Clause 2, its shares can be moved by a transfer scheme at the Secretary of State’s discretion. There is no requirement to tell Parliament where they are going, who will exercise the shareholder role, or how continuity of supply will be protected.

Asking for a plan first seems modest. If the pandemic taught us anything, as the noble Lord, Lord Hunt, suggested, it is that supply chain resilience is first and foremost a patient safety issue.

However, a report is not a safeguard in itself. The real risk is that the transfer happens in the middle of a reorganisation, cutting the central headcount by half. The very people who understand how the company works may be gone before the scheme is made. The National Audit Office found that Supply Chain Coordination Ltd was meeting only seven of its 18 key performance indicators and that trusts spend more than £3 billion outside it. A company with that record needs careful handling, not a transfer done in a rush.

On value-based procurement, we welcome the direction of travel. As the noble Lord, Lord Lansley, just pointed out, this is not novel. We do not even have to take his experience of Unipart as an example. We can look at value-based procurement elsewhere: in Denmark, Canada, Italy and even Indonesia. There are models which the Government could use to look at how it is done.

The national guidance published in June is a genuine step forward, asking what delivers the best outcome across the whole patient pathway, rather than simply what the cheapest price is. But with NHS financial pressures, the temptation will always be to grab the lowest price today, without the skills, the capacity, and a finance regime that rewards long-term value. So I ask the Minister: what thinking is being done, not just for the pilots but as part of the new powers that the Secretary of State will have from the transfer of NHS England, on rewarding long-term value in the financial regime? What changes, if any, will the Government make to the financial regime?

There is a wider point that both amendments expose. NHS procurement still sits apart from the rest of the public sector. When the Procurement Bill passed through this House, my noble friend Lady Brinton, with support from all sides, including from the noble Lord, Lord Hunt, asked why the NHS should be treated differently. She warned that the NHS arrangements were not visible and that they were

“SIs at the discretion of any Secretary of State for Health”.—[Official Report, 28/11/22; col. 1578.]

Today, we have one regime for healthcare services and another for goods. NHS buyers are told to take legal advice on how the new value guidance fits both. With NHS England abolished, all that discretion will sit with the Secretary of State, and my noble friend’s warning has become even more relevant.

Therefore, I ask the Minister four simple questions. First, where will the shares in Supply Chain Coordination Ltd go, and when, and will Parliament see the plan before the transfer is made? Secondly, what independent assurance has been commissioned on the continuity of supply during the transition? Thirdly, after NHS England’s abolition, who will own value-based procurement and make sure that it is built into national service frameworks? Fourthly and finally, will the Government now review whether two separate procurement regimes for NHS services and goods still make sense, or will they at least publish how the boundaries between them will be policed, once the Secretary of State holds the pen on both? These are modest amendments, asking for sensible things, and I hope the Minister can give the Committee reassurance.

[Baroness Merron (Lab)]

My Lords, I most grateful to noble Lords for their observations and the way they have dealt with this. At the outset, I pick up the point that my noble friend Lord Hunt started with and others, including the noble Baroness, Lady Finlay, developed further. We are particularly concerned with personal products and products that need to be personalised. The illustrations that noble Lords have given have been most helpful. The reason for the changes is to see more of that.

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[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Baroness, Lady Jones, for opening the debate on this group, starting with the amendment laid in the name of her noble friend, the noble Baroness, Lady Bennett. I am grateful to all noble Lords for their consideration on a topic that is key to this Bill and to all our work. I will return to this, but it includes the 10-year health plan, which provides the framework for all that we do.

I start with Amendments 6 to 11 and 13 to 20. I assure your Lordships of our commitment to tackling inequalities. We have debated this several times in this Chamber and rightly so. I certainly agree with the comments made, including those from the noble Baroness, Lady Cash. This is about people’s ability not just to access services but to achieve the right outcomes for them regardless of who they are, their background or where they live.

I turn to Amendments 8 to 10, tabled by the noble Baroness, Lady Walmsley, and spoken to by the noble Baroness, Lady Tyler, and Amendment 7 in the name of the noble Lord, Lord Patel. These test whether the duty on the Secretary of State is strong enough. It is right to discuss that point. I appreciate the intention—which was emphasised by my noble friends Lady Royall and Lady Lister, and the noble Lord, Lord Lansley—to ensure that we are taking action, because that is ultimately what we are here to do. However, I would caution against amending the Bill in the way that the amendments seek to do. As a number of noble Lords will be aware, the “have regard” formulation in legislation has a number of precedents across the statute book, and it is familiar to government departments and to decision-making in the public sector.

There was an exchange between the noble Lord, Lord Lansley, and my noble friend Lady Royall over Sections 2A and 2B of the NHS Act. I tread with some trepidation at this stage, but we do not believe that it is necessary to change “may” to “must”, certainly for the duty in Section 2B. This is for the reason I have just outlined about risking confusion because it is moving away from the usual way of doing things. It would also potentially reduce the ability of Ministers to make decisions about priorities. There is no practical intention to reduce the importance of tackling inequalities. The noble Baroness, Lady Gerada, has moved from her place.

[Baroness Gerada (CB)]

It was cold down there.

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[Baroness Merron (Lab)]

I am sorry to hear that it is cold, but I am glad the noble Baroness is here. I appreciated the useful distinction that she drew regarding what we are talking about when we talk about inequalities.

Amendments 18 and 19, tabled respectively by the noble Baroness, Lady Tyler, and the noble Lord, Lord Patel, have regard to new strategies for tackling health inequalities. I know that your Lordships’ Committee is aware, but it is worth saying again that we remain absolutely committed to our comprehensive 10-year health plan. It was drawn up with a very wide range of input and, importantly—as has been referred to on this group and elsewhere—it was underpinned by the independent investigation of the NHS by the noble Lord, Lord Darzi. Tackling inequalities is at the very core of the 10-year health plan, which dictates everything that we do. It is therefore important that we focus on practical action rather than diverting towards developing new strategies. To assure noble Lords, I repeat that tackling inequalities is what I call core business; it is not an add-on or a sidecar—it is absolutely key.

The noble Lord, Lord Patel, put a number of observations to me and asked whether I agreed with them. My answer is that I appreciate them all and agree with most. I particularly welcome the acknowledgement by the noble Lord, Lord Patel, the noble Baroness, Lady Manzoor, and a number of my noble friends, of the achievement of the last Labour Government—which was somewhat exceptional in the period we have been talking about. The only point I would make to the noble Lord, Lord Patel, is that when he was running off a list of Ministers at the time, I hoped he might mention me—but I am doing so.

[Lord Patel (CB)]

I was going to do so after I heard the Minister’s response.

[Baroness Merron (Lab)]

I was very proud to have been part of that as Public Health Minister, working with Andy Burnham. But it is not enough to just rest or delight on one’s memories; we must take what worked and bring it into the current time.

I agree with the noble Lord, Lord Patel, that tackling health inequalities is key to not just the NHS but the broader economy—and, of course, the well-being of people. I agree with all noble Lords who said that a cross-government approach is crucial. That is why we are taking that approach, underpinned by the 10-year health plan. Tackling inequalities, for example, informs the key initiatives of the 10-year health plan, such as neighbourhood health centres. On that, we are starting in the most deprived communities. We are not going to the communities that are easier to work with; we are starting where there is the most challenge. I welcome that radical approach.

I believe accountability is extremely important. I assure noble Lords that the department will continue to report on action taken to address health inequalities as part of its annual report, alongside a whole range of published metrics, including the health inequalities dashboard. The dashboard’s measures cover 20 indicators, including—I will give noble Lords a couple of examples —the prevalence of adult and childhood obesity, and healthy life expectancy at birth.

My noble friend Lady Nargund supported the call for a cross-government strategy, which we are already working on. Recent cross-government action in this area includes the warm homes plan, the Keep Britain Working review and the homelessness strategy—all of which speak to the points that noble Lords are calling for. That is one of the reasons why I caution against putting in the Bill a duty to develop some independent strategy, when in fact it is core to what we are already doing.

Amendments 13 and 14 were tabled respectively by the noble Lords, Lord Patel and Lord Patel of Bradford. My noble friend Lord Hunt asked whether I would meet the noble Lord, Lord Patel of Bradford; I would be very pleased to do so, and I open that meeting up to other noble Lords who are interested in coastal and rural areas. Amendment 20 was tabled by the noble Baroness, Lady Pidgeon. These amendments are concerned with tackling health determinants and inequalities in coastal and other areas.

Health is determined not just by our health and care system but by our wider environment. We know that geographical variation has grown over a number of years, and this Government seek to tackle it. That variation runs from housing and employment to education and our local high streets, to name just some. It has informed the content of our 10-year health plan and the overall guiding aim that we pursue: to halve the gap in healthy life expectancy between the richest and the poorest—to which noble Lords referred. That is why we are introducing the neighbourhood health centres, to which I referred, where they are needed most. We are now going further by devolving power to local communities so that those who know their areas best can make sure that the services are there for them. I remind noble Lords that ICB funding allocations, for example, are already adjusted for health inequalities and take account of factors such as an ageing population and deprivation. The Core20PLUS5 approach gives ICBs a range of tools to tackle inequalities, and we will—and do—hold ICBs to account for their progress.

I am grateful to my noble friend Lord Hunt for tabling Amendment 11 on accessing GP services—an area raised by other noble Lords, including the noble Baroness, Lady Gerada. I agree that equitable distribution of GPs is crucial to ensuring that people in all areas get timely access to care. When I say that, I mean not that every area should have exactly the same number but that the distribution should be sensitive to the needs of an area. Progress is being made: there are 2,600 more GPs than in July 2024—the highest figure since 2015; the average number of patients per GP practice is improving; and we continue to boost recruitment through the practice-level GP reimbursement scheme in 2026-27. Because GPs—like other professions —are more likely to practise where they trained, we are delivering 1,000 more GP training practices by 2028, targeted towards the areas of greatest need. We are also reviewing the Carr-Hill funding formula because, to reduce health need, we have to ensure that resources are allocated much more accurately—as noble Lords expect.

The noble Baroness, Lady Hodgson, also commented on this area. We are uplifting the GP contract by £601 million for 2026-27, which builds on last year’s £1.1 billion of additional investment. In the year to August 2026, 15.8 million additional appointments—including Covid vaccinations—were delivered, compared with the previous 12 months. This is the way we are going. When I make these points, I am not saying that the job is done, but I am showing movement and improvement.

--- Later in debate ---

[Lord Patel (CB)]

The Minister did what I thought she would do: point to areas in the legislation that might help reduce inequalities in health and in outcome, and therefore inequalities in healthcare provision. She mentioned the 10-year health plan, but she was not able to point to where it says the gap is, which is around cross-government action. Neither did she mention examples in the Bill that demonstrate that there is cross-government action. She said she did not agree with me in one area—maybe it was that one.

[Baroness Merron (Lab)]

Oh, no—I agree with the noble Lord about the need for cross-government action. I simply part company with the idea that it needs to go into primary legislation. That would not be usual, because that is a process. I also referred to examples of where we already have cross-government action to deal with health inequalities, as distinct from healthcare inequalities—the noble Baroness, Lady Gerada, referred to that.

[Lord Patel (CB)]

Why not, when, as she mentioned, the Minister was previously so successful as part of the Government who demonstrated how they could implement cross-government action and reduce inequality?

[Baroness Merron (Lab)]

I am not sure we are that far apart on this. I am just picking up the point about primary legislation, rather than the intent of the noble Lord, which I agree with.

[Baroness Jones of Moulsecoomb (GP)]

I will stand up before anybody else does.

I thank the Minister for her replies; I really admire the positivity in there. I have been using the NHS since 1949, and it is absolutely amazing. My working-class parents were incredibly delighted by its introduction, but I rather suspect that my age cohort has had the best of it—I hope that that is not true. I would love to respond to a lot of the points, including on coastal communities, which often suffer from huge environmental pollution in rivers, along seashores and so on. This has been a fascinating debate, and I can see an exciting Report stage in the offing. In the meantime, I beg leave to withdraw my amendment.

LED Lighting: Health Effects

Baroness Merron Excerpts

Wednesday 28th October 2026 Lords Chamber

[Lord Davidson of Glen Clova]

To ask His Majesty’s Government what assessment they have made of the developing science on the adverse health effects of LED lighting.

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

My Lords, the risk to the general population is considered low. Potential health risks from lighting are not unique to LED lighting. The Government continue to monitor evidence on the health impacts of LED lighting, publishing guidance on flicker reduction and healthy lighting environments. The UK Health Security Agency contributes to international research and standards and works with experts to better understand how light exposure affects health and to promote good lighting design.

[Lord Davidson of Glen Clova (Lab)]

I thank my noble friend the Minister for her response. I congratulate the NHS on the new Moorfields hospital, which will open next year. However, given the cutting-edge research that has been carried out at UCL on the link between daylight and health effects, can my noble friend assure the House that the new hospital will avoid the problems of 100% LED lighting?

[Baroness Merron (Lab)]

I too very much welcome the new Moorfields hospital which, as my noble and learned friend says, is to open next year. The architecture integrates national daylight with 100% LED lighting. I can assure the House that it has been developed in accordance with applicable net-zero design standards, approvement requirements, technical standards and assurance processes, as I am sure noble Lords would expect. We are seeking confirmation from the trust about any daylighting studies or assessments that have been undertaken as part of the design process. When I get that information, I will be very pleased to write to my noble and learned friend.

[Lord Robathan (Con)]

My Lords, what research is being done on the effects of high-visibility headlights on cars? I am not sure whether they are LED, but they are causing people to have accidents.

[Baroness Merron (Lab)]

The DfT is undertaking independent research and is approaching this with regulatory changes and through international safety standards. The noble Lord raised the question of why glare is a problem. The Which? report on this, published only yesterday, talked not just about brighter LED but the height of vehicles and beam alignment. The DfT has just this week updated driver advice in the Highway Code on this very point, encouraging people to get it checked.

[Baroness Pidgeon (LD)]

My Lords, the Advertising Standards Authority upheld a complaint in June about an LED face mask that claimed it was clinically proven it could reduce wrinkles in four weeks.

[Baroness Pidgeon (LD)]

Exactly. Given there are numerous adverts for at-home LED beauty devices in the run-up to Christmas, will the Government urgently assess whether existing regulation adequately protects consumers in terms of product safety and the evidence supporting claims about health benefits?

[Baroness Merron (Lab)]

This is ongoing work. If it was a true claim, I am sure that many noble Lords would have been very keen to benefit—me included.

[Noble Lords]

No!

[Baroness Merron (Lab)]

How kind. But quite seriously, it is good that the Advertising Standards Authority is looking into this. We have regulations to ensure that people are not misled and are protected. Tangentially but linked, I am sure that the House would welcome our recent work on cosmetic surgery regulations, which really strengthens this point.

[Baroness Rafferty (Lab)]

My Lords, does the Minister agree that the practice recently put in place by King’s College Hospital of exposing intensive care patients to daylight has promoted their earlier recovery and should be adopted by other NHS trusts?

[Baroness Merron (Lab)]

My noble friend is absolutely right to highlight the fantastic King’s critical care roof garden. I was very pleased to see the media coverage of it earlier this year. Not only are the team providing full life support to the patients, staff and families, allowing them to feel the therapeutic effects of being outside and in nature, but they are using the spaces they have developed for research on whether it gives the right support and enhances people’s health. I am very much looking forward to what they come up with. It is very impressive on top of their medical excellence.

[Lord Evans of Rainow (Con)]

My Lords, given the growing evidence that exposure to artificial light at night can disrupt sleep and the circadian rhythms, does the Minister agree that the Government should do more to ensure that the public are aware of these potential health risks? Will the Minister commit to updating existing public health guidance to reflect the latest scientific evidence?

[Baroness Merron (Lab)]

If there are particular things the noble Lord thinks the Government are not doing, I would be very pleased to receive details. I am glad that he did not refer specifically to LED lighting. As I have said, there is no evidence that it is directly harmful in normal use in the general population. However, through the Committee on Medical Aspects of Radiation in the Environment, we are developing an evidence-based review programme on artificial light and health, just as he asks, and gathering evidence and identifying gaps. We are also supporting research and working internationally. I would be very pleased to give further details if the noble Lord would like.

[Baroness Hayter of Kentish Town (Lab)]

I will revert to the question of headlights that people know I have been campaigning on. With LED lights, there are questions both about the luminance—that is, the strength —and about it being a blue light rather than the softer yellow of halogen lights. Would my noble friend agree to put the expertise at the Department of Health together with that at the Department for Transport, which is doing good research on this, so we can make sure these two lots of expertise tie up together?

[Baroness Merron (Lab)]

The policy for lighting is shared across a number of departments—not just the Department for Health and Social Care but the Department for Transport, as my noble friend says, as well as the Department for Energy Security and Net Zero, the Department for Business, Innovation, Science and Trade, and a number of arm’s-length bodies. We do all indeed co-ordinate and, as I mentioned earlier, work internationally, particularly with the UN Economic Commission for Europe, because we need to ensure that we update international vehicle lighting to meet the point that my noble friend is concerned about.

[Lord Patel (CB)]

My Lords, the Minister referred to blue light and its effect on children, which is correct, but a similar biological effect occurs in the retina of children based on the amount of time they spend on screen usage, particularly at night, because, as mentioned already, it disrupts melatonin production, which disrupts sleep. The same effect happens based on the length of time children use screens as for LED lighting, particularly higher-wavelength LED lighting. I thank the Minister for commenting on that.

[Baroness Merron (Lab)]

The noble Lord is quite right and highlights exactly the point I was making earlier on the first question about cars and lighting. There are a number of factors. Screen use can indeed be harmful, particularly where it replaces sleep, physical activity or leisure time. As the noble Lord will know, we advise families with under-fives to limit screens around bedtime and to ensure that content is age appropriate. I know that our department and the Department for Education will be publishing wider guidance for five to 18 year-olds in January.

Fracture Liaison Services: National Coverage

Baroness Merron Excerpts

Tuesday 27th October 2026 Lords Chamber

[Baroness Murphy]

To ask His Majesty’s Government what progress they have made in developing a delivery plan to achieve national coverage of fracture liaison services in England by 2030.

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

My Lords, the 10-year health plan committed to rolling out fracture liaison services by 2030, and it outlines our vision for a more devolved health service. The 10-year health plan and, more recently, the renewed women’s health strategy highlight community-based models of fracture prevention services. Integrated care boards are responsible for commissioning these services and are best placed to determine how they should be delivered to meet local need, while supporting overall development of fracture prevention outcomes.

[Baroness Murphy (CB)]

My Lords, I am very aware that the Minister has had this Question in almost identical wording, and I think there is another one soon to come from somebody else. So I will move away, if I may, and ask: does the Minister agree that the importance of these fracture liaison services is not simply to pick up fractures of the long bones, which are associated with osteoporosis, and to treat them—the fundamental purpose of the liaison service—but to establish connections between orthopaedic surgeons and geriatric medicine, so that, with other problems such as, for example, older people not getting their operations quick enough after a fracture, which Dr Mark Porter mentioned in the Times today, it will speed up the total relationship between the two departments and get better access to care for frail older people? Does the Minister agree that that is the most vital thing about these liaison services?

[Baroness Merron (Lab)]

I agree with the noble Baroness that that is one of the most important functions, because of course prevention and recovery are also key. As I have mentioned, ICBs are focused on providing services closer to home. Also, we are working with NHS England so that we can improve frailty services in acute settings as a priority, including through same-day emergency care and through comprehensive geriatric assessments.

[Baroness Pidgeon (LD)]

My Lords, what assessment have the Government made of the workforce and funding required to deliver national coverage? Will those requirements be reflected in the delivery plan?

[Baroness Merron (Lab)]

I refer the noble Baroness to the forthcoming 10-year workforce plan, which will make sure that the NHS has the staff that it needs, including in frailty services. Fracture liaison services deploy multidisciplinary teams to ensure prompt diagnosis and appropriate treatment. We have made available, through the Department for Education, loans for living costs to support students from the lowest income families to make sure that they can train and be part of the workforce. That is one area where we are developing recruitment and training.

[Lord Black of Brentwood (Con)]

Can the Minister confirm my understanding that, despite the Government’s commitment to a national rollout of FLS by 2030, the patient assessment rate, which is the key treatment measure, has shockingly increased by only 3% since 2024? At this rate of expansion, it will take 38 years—until 2064, my 100th birthday, incidentally—to fulfil their pledge, with tens of thousands of people dying unnecessarily.

[Baroness Merron (Lab)]

I hope we will all get to celebrate the noble Lord’s 100th birthday with him. As he will recall from just last week, we are taking a whole-pathway approach to fracture prevention, including improving access to diagnosis, adopting effective treatments and encouraging local systems to develop services that focus on those at greatest risk. I am always open to the points the noble Lord makes—he is right to make them—but it is important to acknowledge the actions and improvements taking place and the way we are supporting the development of services, particularly for those who need them most.

[Lord Weir of Ballyholme (DUP)]

My Lords, fracture liaison services is one area in which the three devolved institutions are, in effect, ahead of England; it is provided universally in Scotland, Wales and Northern Ireland and has been of great benefit in those jurisdictions. Can the Minister say what liaison is taking place with the three devolved institutions to learn lessons so that, when rollout happens in England, those lessons can be adapted to make sure we get the best service in England?

[Baroness Merron (Lab)]

I suggest some caution about the situation under the devolved Governments. Without any wish to disregard any improvements that have been made, the situation is not quite as the noble Lord describes, and I would be very pleased to write to him to confirm why. We certainly liaise closely and regularly with the devolved Governments to ensure that we can see progress across the whole of the United Kingdom.

[Lord Kamall (Con)]

My Lords, the Minister has just told the House that decisions on fracture liaison services will be made by local ICBs, yet at the national level the Government have made a welcome commitment to universal coverage in England by 2030. Does she accept that leaving delivery to the discretion of individual ICBs risks creating inconsistencies? Would such disparities be an example of where the Secretary of State could use their power of direction, as proposed in the Health Bill?

[Baroness Merron (Lab)]

I am sure we will discuss that at great length in Committee. While I absolutely accept there is a difference in the service level across the country—that is not acceptable, as I am sure we would all agree—it is not the hands-off approach that is often suggested. We have made, through the medium-term planning framework, the neighbourhood health framework and the 10-year health plan an identification that those at risk of frailty are a priority cohort. Our best practice guide was recently updated to give the NHS and local government joint ownership of delivery. In all these ways and a number of others, we support local decision-making and provision.

[Baroness Nargund (Lab)]

My Lords, osteoporosis disproportionately affects more women at menopause. Tens of thousands of women under the age of 40 who undergo menopause tend to receive a delayed diagnosis, and some end up with fractures before their menopause diagnosis is made. Does my noble friend the Minister agree that the fracture liaison services need to be integrated into women’s health hubs, so that younger women with menopause receive not only an early diagnosis and treatment but advice on fracture prevention?

[Baroness Merron (Lab)]

My noble friend is right to identify that there is a higher incidence of osteoporosis in women than men; it is more common. Some 80% of osteoporotic vertebral fractures are not identified and not managed appropriately, which again is unacceptable. That is why NIHR research has investigated the use of a new questionnaire to improve the diagnosis of these fractures in women. If it is successful—I hope it will be—it will reduce fracture risk and change clinical practice, particularly for older women with back pain.

[Lord Patel (CB)]

My Lords, in response to the question asked about the devolved Administrations, the Minister suggested we should interpret the data with caution. The caution is this: Scotland established one of the world’s first fracture liaison services, which is recognised globally as the most effective. Claims of a 50% reduction in repeat fractures might be exaggerated, but not by much. So what is the caution?

[Baroness Merron (Lab)]

The caution—I am very happy to write to noble Lords with more details on this —is that it has been suggested that it has 100% coverage, but I am advised that that is not exactly the case.

Corridor Care

Baroness Merron Excerpts

Tuesday 20th October 2026 Lords Chamber

[Baroness Pidgeon]

To ask His Majesty’s Government what progress they have made on their commitment to end corridor care.

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

My Lords, corridor care is unacceptable, and we are tackling its causes by preventing avoidable admissions, improving patient flow and accelerating safe discharge. Just this weekend, we announced almost £140 million for 14 urgent care schemes, alongside 25 new or expanded sites, which are due to open for winter. Despite unprecedented summer demand, around 50 trusts reduced corridor care. We are working to end corridor care by the end of this Parliament.

[Baroness Pidgeon (LD)]

My Lords, the Royal College of Emergency Medicine has reported today that two-thirds of clinical leads say their trust does not count as corridor care patients on chairs in corridors, patients who have been put on chairs in waiting rooms or even patients in corridors on the way in. What action will the Government take, and by when, to make sure that every trust counts every patient, so that we have a true picture of corridor care in this country?

[Baroness Merron (Lab)]

We are a lot closer to having a true picture, because in March this year we introduced a consistent national definition of corridor care, which I know the noble Baroness has been very keen on. In addition, for the first time monthly national data has been published since June, which is giving us greater visibility of where corridor care is occurring and, in particular, allowing support to be targeted at the most challenged hospitals.

[Lord Harris of Haringey (Lab)]

My Lords, in the 1990s, when I was a little boy, I was director of the Association of Community Health Councils. Each year, we ran something called National Casualty Watch, which involved local community health council members going into every local casualty department and not only counting the number of people there but asking them how long they had been waiting. Successive Secretaries of State, some of whom are in your Lordships’ Chamber, were not very happy about this, but it had a profound effect on making people realise that this is not a way to run A&E departments. Can my noble friend the Minister assure us that, given that the Government are rethinking their plans to abolish Healthwatch and national Healthwatch, facilities will be available for that sort of thing to continue in whatever new arrangements come forward?

[Baroness Merron (Lab)]

The principle of assessing patient experience, as my noble friend described, is absolutely key to the Health Bill, and I know we will discuss this more. Since my noble friend was a young pup—as he described himself, in a different way—we now have the facilities to be much more transparent and to use data. It is important to say that the collection of data is new—it started only this year and did not exist before—and we are continuing to work with providers to improve the consistency and quality of reporting. That is absolutely key.

[Baroness Finlay of Llandaff (CB)]

My Lords, given that three-quarters of physicians report difficulties in accessing essential equipment, sometimes including resuscitation equipment, for patients in corridors, and even more report compromised care, what work are the Government now undertaking with the Royal College of Emergency Medicine to increase the provision of medical assessment units, particularly working with the clinical governance leads for those emergency departments?

[Baroness Merron (Lab)]

All of this is important, as the noble Baroness said. We are already undertaking a number of actions and one is about additional urgent care capacity; for example, in total some £2 billion is going into urgent care, particularly capital projects, which the noble Baroness did not specifically mention. The improvement of facilities, which is part of this, is absolutely key, as is getting care closer to home. With the kinds of improvements we are already seeing—for example, the emergency departments at Basildon and North Tees have had refurbishments—and by working with clinical leads, we will improve a long-standing situation that should never have been normalised and should only be exceptional.

[Baroness Browning (Con)]

I am sure that the Minister has seen some of the hospitals that have solved this problem. Is there a problem with hospitals that have overcome what is a very difficult problem sharing that information with other hospitals that are struggling? It always amazes me: when you see best practice, you just do not understand why it is not shared. If they do not voluntarily share it, is there anything the Minister can do to make them share it?

[Baroness Merron (Lab)]

The noble Baroness is right. While we are very mindful of the need to make more progress, sharing best practice is key to how we are improving things across the whole pathway. The majority of corridor care occurs in a small number of trusts, and that is why we are putting in targeted teams to work with those trusts to do exactly what the noble Baroness suggests.

[The Lord Bishop of Southwell and Nottingham]

My Lords, I pay tribute to the NHS staff who provide vital care under immense pressure. Recent reporting from the Queen’s Medical Centre in my diocese of Southwell and Nottingham has highlighted their compassion and professionalism. Does the Minister agree that the challenge of corridor care is one not only of clinical safety and privacy but of human dignity? Hospital chaplains provide invaluable pastoral and spiritual support to patients and families at moments of vulnerability and distress. What consideration have the Government given to ensuring that access to such support is not diminished when patients are cared for in temporary settings?

[Baroness Merron (Lab)]

I pay tribute to the service provided by hospital chaplains, because they extend support to those of all faiths and none, and that is crucial. Corridor care is not an acceptable normalisation. We want to end it by the end of the Parliament. I agree that dignity is very much part of it. The guidance given to hospitals is that, in exceptions where there has to be corridor care, they must take account of supporting the patient in the best way possible. For example, that can, of course, include support from hospital chaplains.

[Lord Kamall (Con)]

My Lords, the Minister said that the department, or maybe NHS England, has been able to identify the hospitals where corridor care is at its worst levels. What specific targeted support does the Minister’s department or NHS England intend to offer to those particular hospitals in order to reduce the high levels of corridor care?

[Baroness Merron (Lab)]

We are putting in specialist teams to work with those particular hospitals. The Secretary of State has made it quite clear that ending corridor care for children is an absolute priority. As I said to the noble Baroness earlier, we are ensuring that best practice is applied. Because of the additional funding, we have been able to and will be able to extend capacity. The noble Lord will have looked at the areas that are receiving targeted financial support. Where we have greater levels of corridor care, our teams are working with those hospitals to say, “Why is this the case? This is how to sort it out”, and make sure that they can. The small number of trusts means that there is greater reliance in some areas than others, and that is not all right.

[Baroness Watkins of Tavistock (CB)]

My Lords, what additional support are the Government going to give to the healthcare staff in accident and emergency departments, who are feeling very demoralised following a difficult summer and now face a difficult winter? Most importantly, in preventive terms, is it not time that we linked care in the community by subcontracting some beds in care homes, so that patients who could be discharged immediately if that was available can be, to enable things to be a bit better for staff and patients this winter?

[Baroness Merron (Lab)]

I share the views of the noble Baroness, as I do the comments of the right reverend Prelate about the role that our healthcare staff play. The noble Baroness is right about the connection with social care. Better patient flow and discharge actually rely on that, and that is why we have published the Model Emergency Department, the Model Acute Pathway and the Model Discharge Pathway, so that we can see earlier assessment, timely senior clinical review, improved discharge and better patient flow, because it is down to beds and also to pressure. If there is one thing we are promoting in terms of prevention, it is for everybody to get a flu jab who is eligible, because we want to prevent people unnecessarily presenting at hospital. That will assist us greatly.

Neighbourhood Health and Social Care

Baroness Merron Excerpts

Tuesday 15th September 2026 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I draw the House’s attention to my register of interests.

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

My Lords, this Government support the integration of neighbourhood health and social care. Our approach to neighbourhood health brings services together so that people experience more joined-up and person-centred care, including from integrated neighbourhood teams. In March, we published the Neighbourhood Health Framework, promoting joined-up partnership arrangements between ICBs and local authorities and asking health and well-being boards to develop neighbourhood health plans for implementation from 2027-28 at the latest.

[Baroness Thornton (Lab)]

I thank my noble friend for that Answer. I felt moved to put this Question because there seems to be more hope today than for many years that local integration of social care, health and primary care might happen. With so many moving parts in the reform agenda—the Casey review, the 10-year plan and so on—there may be a danger of reform steaming ahead without the voices and views of patients, carers and those with lived experience being properly baked into the design process. I seek reassurance from my noble friend that those voices will indeed be heard and heeded.

[Baroness Merron (Lab)]

I certainly can give that reassurance to my noble friend. I am glad she recognises that our move towards neighbourhood health is not just a shift on paper but a real turnaround in how we see people and services. Coproduction is required for neighbourhood health plans, which would be all the poorer if we did not include the voices to which she refers.

[Baroness Manzoor (Con)]

My Lords, integration is harder than colocation. For instance, housing and social isolation are key detriments to health, yet they sit outside the NHS. Therefore, a social worker sitting next to a GP may be helpful, but the reality is that this social worker will not get extra money, extra access to health beds in the community or extra staff. What will the Government do to erase these difficulties, particularly when the health needs of the population are growing and the workforce has not kept pace with the complex needs of the ageing population?

--- Later in debate ---

[Baroness Merron (Lab)]

The noble Baroness is quite right to talk about people having more complex needs, and, indeed, we are also living longer. However, the current health system is organised around institutions and services that are complex, disjointed and difficult to navigate, as she said. On housing, for example, I know that the health and well-being boards, which are the key to this, can design themselves to bring in services. I can think of a number which have already done that and included people from housing in the way that she describes. It is absolutely encouraged and health and well-being boards across the country are already doing that.

[Baroness Pidgeon (LD)]

My Lords, a recent workforce assessment by Skills for Care found that adult social care in England still had around 96,000 vacancies and projected that a further 410,000 posts will be needed by 2040 to meet demand. What are the Government doing to address these shortages and deliver genuine integrated patient services?

[Baroness Merron (Lab)]

We recognise the continuing challenge that we inherited in terms of workforce, but that is why we are investing in the adult social care workforce. In 2028, the first ever fair pay agreement will come in, which will be backed by £500 million of funding. It will improve pay and conditions for the workforce, which is crucial. We are also implementing the first ever universal career structure for the adult social care workforce, as well as investing up to £10 million this year in the learning and development support scheme. This, along with all the other changes, will make a massive difference to the workforce in terms of retention, recruitment and development.

[Lord John of Southwark (Lab)]

My Lords, my noble friend has already mentioned health and well-being boards, in which local government is a key participant and player. Having said that, and with the Government’s commitment to devolution in mind, can she tell us more about the role that local government will play in improvements to health and social care going forward? I am delighted to declare my interest as a vice-president of the Local Government Association.

[Baroness Merron (Lab)]

My noble friend is right to identify that, if we are going to deliver neighbourhood healthcare and make improvements in social care, we have to join up the NHS and local government. That is key to our whole approach to neighbourhood health. That is why health and well-being boards, which are responsible for drawing up the local plans for what the locality needs, will bring together and have on them local authority representation and voice, along with the NHS and others. We will manage this only by doing so, because, in order to reduce health inequalities and deliver locally, it cannot just sit with one. I am grateful to local government for what it is doing.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Minister explain how health and social care will be planned to ensure intergenerational input, in particular from young carers and young people, who often have very good innovative ideas about how to provide such services?

--- Later in debate ---

[Baroness Merron (Lab)]

That is a very good point. Young carers are sometimes left out, to the detriment, as I said earlier, of services and policy. I bring us back to the requirement in the Neighbourhood Health Framework, which we published just in March of this year, and add to that our introduction of neighbourhood health centre schemes across the country. The voices of local people, particularly those in the higher-priority cohorts, which can include young carers, will be heard and be part of the coproduction of how we provide neighbourhood health and social care.

[Lord Kamall (Con)]

My Lords, the noble Baroness said that the health and well-being boards will be responsible for making sure that there are sufficient social care services at the neighbourhood level. Following the question of the noble Lord, Lord John, to whom will they be accountable if they do not deliver sufficient social care at the neighbourhood level?

[Baroness Merron (Lab)]

The Neighbourhood Health Framework published in March, which I mentioned, requires local systems to develop neighbourhood health plans. That will give a very clear basis for measuring impact, which we do not have at the moment. I certainly agree with the noble Lord that it is not about the quality of the plan but about the quality of delivery. That is why the framework empowers local leaders in five minimum national goals that include, for example, as we have discussed many times, improving access to general practice, as well as the join-up with social care.

[Baroness Nargund (Lab)]

My Lords, I declare an interest as a former vice-chair and trustee of the British Red Cross. I have seen at first hand how the British Red Cross delivers health and social care across communities in our country by helping people to transition from hospital to home, giving them independence at home and avoiding readmissions. Does my noble friend the Minister agree that bringing together the voluntary sector with local authorities and the NHS will help to deliver more connected, effective and compassionate social care in every postcode?

[Baroness Merron (Lab)]

I certainly agree with my noble friend on that point. That is why achieving neighbourhood health will rely critically on that strong partnership, which will include civil society, as she says.

[Lord Evans of Rainow (Con)]

My Lords, the noble Baroness did not answer the question from my noble friend the Front Bench spokesman on who will be accountable if this does not work out properly.

[Baroness Merron (Lab)]

All the local systems have their line of accountability, with which I know noble Lords are familiar. Currently, for example, ICBs report to NHS England. Subject to the passing of the Health Bill, that will now come within the department and there will be an accountability mechanism. Transparency will be a key part of that. If noble Lords have any particular concerns, I am always happy to hear them.

Patient Data: Research

Baroness Merron Excerpts

Thursday 10th September 2026 Lords Chamber

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

My Lords, I congratulate the noble Lord, Lord Patel, on securing this debate and on his acknowledgement of the importance of patient data to research and of what the Government have done to date. I also thank noble Lords for their very thoughtful and informed contributions. I very much understand the point about trust, which has been made several times. We will come back to that, but I want to assure all noble Lords of the understanding that it is not always whether people have distrust because of something factual; if they feel distrustful, that in itself is a challenge for us.

We have some of the richest health data in the world, thanks to our diverse population and because we have an NHS that has supported and cared for us for some 78 years; we are fortunate indeed. It is the case that patient data drives life-saving discoveries. The noble Baroness, Lady Brinton, spoke very personally to that point, and I know many noble Lords could also draw on their personal experience to do so. It helps us to understand disease and to develop new treatments, many of which we could never have dreamed of.

This is also essential to improving the nation’s health and prosperity; it is key to our life sciences sector, and to creating jobs, driving investment and powering innovation. Ensuring that benefits flow back to patients and the public, as the noble Lord, Lord Patel, asked for, is also, I agree, essential. That is why we have published a value-sharing framework for NHS data, and also why we will charge organisations for access.

I can assure my noble friend Lord Davies, who asked about an oversight body, that the confidentiality advisory group is the independent oversight body; I feel that is probably what he seeks. It decides whether confidential patient data can be used for research without individual consent. As many noble Lords have acknowledged, we all know that people do want their patient data to be used for research, but I completely agree that this trust is conditional on our keeping the data secure and making that known.

We are committed to moving from a system of data sharing, in which copies of people’s data are sent to researchers, to a system of data access by default, using secure data environments. The noble Lord, Lord Patel, spoke to this very point. Perhaps I can give some further outline and further reassurances and pick up a number of the questions. On any key questions that I cannot answer because of time, I will be glad to write to noble Lords.

The noble Lord, Lord Patel, said that NHS England now uses secure data environments—SDEs—as the default route for accessing data for research. Its network brings together around 300 local and regional datasets that were not available previously. The Health Data Research Service—HDRS—will build on that foundation by developing a much clearer route into the system and more consistent processes. That is important more broadly because, although investment in secure data environments had begun previously, and services were being established, we are now taking the system from where it was—as has been said, it was somewhat fragmented—to a coherent approach. I can say to your Lordships’ House that a simpler, safer and more accountable set-up is where we will get to by the end of this Parliament.

In answer to the point raised by the noble Lords, Lord Patel and Lord Weir, last year we commenced powers to allow us to mandate information standards and to create binding rules across both GPs and trusts. Yes, there is more work to do, but I think that sets us absolutely in the right place. There are some examples of very good practice. We can look to Greater Manchester, where they have linked GP and hospital data. This is not commonplace, because it is GPs who currently decide, on a practice-by-practice basis, how their patient data are used. We are currently running a programme of national engagement with GPs on the use of patient data, and we will use that to work with GPs and other primary care professionals to improve the use of GP data in the future. Our new guidance on enabling safe access to UK human genomic data demonstrates that we expect human genomic data to be accessed through secure data environments—and, I would emphasise, only by approved researchers.

I agree with my noble friend Lady Gill that we have to act swiftly and robustly where things go wrong. Of course, we minimise that possibility, but we have to be realistic.

I am grateful to the noble Lord, Lord Tarassenko, for setting out the facts on Biobank, to which my noble friend Lord Davies also referred. I will not repeat the points he made, because I share his analysis.

On the federated data platform, I say to the noble Baroness, Lady Bennett, that it is not used for research; it supports NHS operations and direct care. This means that opting out of sharing your health data for research and planning will not stop your data being used by the FDP to support your care. That is an important reassurance to those who wish to opt out of sharing their health data. As I mentioned, the FDP contract will be reviewed ahead of the February 2027 break clause.

I say to the noble Baroness, Lady Freeman, that the issue of gaining and maintaining trust is key. That means giving people meaningful choices over their data. So, following public engagement, we are reforming how people can opt out of having their data used for planning and research, and making it clearer and simpler, so that they do not feel bound should they not wish to participate.

As noble Lords have said, it is true that people generally support the use of patient data when they understand who is using it, why it is being used and for what purpose. I accept that awareness remains low, so we have to be transparent about its purpose, as well as maintain strong safeguards and involve the public in decision-making.

On the safeguards about which I have spoken, we want to make it easier for legitimate researchers to access data. The Sudlow review described just how long it can take for approved researchers to access health data. That is an issue. So, through the NIHR, we are investing around £1.7 million a year in research and research infrastructure. Alongside that, the NHS data and analytics academy is developing the workforce of data engineers, analysts and other specialists we need, as per the point of the noble Lord, Lord Patel, in order to turn this into better treatments and care.

Our NIHR reforms mean that clinical trials are being set up some 47 days faster than last year. But we want to go further and faster, which is why we have established the HDRS. I say to the noble Baroness, Lady Murphy, that the question of dementia research will indeed be one for the HDRS.

The noble Lord, Lord Mair, asked about HDRS. Processes will indeed be streamlined. On the matter of funding, I say to him that the future funding model is to be developed and we certainly will take into account the patients and the public. I am sure that is something we will want to develop further.

This has been a helpful debate. We are moving towards a coherent strategy. A number of other questions were raised, including from the noble Lord, Lord Kamall, and others, and I will be glad to follow up on those. For now, I hope this will take us forward and that we can all move to using patient data to better manage how we provide our health services.

Funeral Directors: Regulatory Regime

Baroness Merron Excerpts

Wednesday 9th September 2026 Lords Chamber

[The Archbishop of York]

To ask His Majesty’s Government what plans they have to establish a regulatory regime for funeral directors.

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

My Lords, the Government laid a Written Ministerial Statement on 1 September confirming that detailed proposals for formal regulation of the funeral sector are being developed. The Department of Health and Social Care is leading this work with the Ministry of Justice and other departments, working closely with bereaved families, funeral providers, faith groups, local authorities and others.

[The Archbishop of York]

In thanking the Minister for her response, I pay tribute to those affected by the terrible failures in Hull, where I serve, and to the clergy and local community services that have supported the bereaved. I welcome proposals for regulation; what happened in Hull must never happen again. I therefore ask the Minister: when will the department set out further details on the timeline for these proposals and their implementation? Mindful that many of those who suffered in Hull were those least able to afford a funeral for their loved ones, I ask also whether questions of cost and its links to bereavement also be considered.

[Baroness Merron (Lab)]

I also want to express my sorrow and support for those who are so deeply affected. Those who have died cannot speak, so it is left to the rest of us to speak for them. In this case, terrible tragedies were put in the path of proper grieving and understanding about loss. I very much want to associate myself with that and to say that all the matters that the most reverend Primate refers to will be considered. We have already accepted the majority of the 75 recommendations from the Fuller inquiry, but obviously the Written Ministerial Statement says how much further we are going to go. When I am able to update on timelines, I will be glad to do so.

[Baroness Barker (LD)]

My Lords, I too want to register our condolences to the people in Hull who were affected so badly. Scotland, as of 2025, has a fully searchable database of registered funeral directors. One can work out who the owners are, read reports and have details of any complaints which have been made. How long is it going to take us to get to where Scotland already is?

[Baroness Merron (Lab)]

We look forward to working with other jurisdictions to see how their best practice works, and that will, of course, include Scotland. I am very keen that we continue to work closely, for example, with the funeral provider cohort, most of whom, let us acknowledge this, do a first-rate job with immense dignity and professionalism and have been let down also. Safeguards have to be effective without imposing disproportionate burdens and, while it is a bit premature for me to prescribe how the regulatory framework will work, I can assure the noble Baroness that we are looking very closely at what she raises.

[Baroness Browning (Con)]

My Lords, I support the Government in regulation, because what has happened in Hull has been tragic for the people concerned. We have noticed increasing television advertising for funerals without any form of ceremony or service. Of course, that is personal preference, but it looks as though the public are increasingly putting their faith in funeral directors to have sole charge of the deceased from the time they die to the time they are cremated, without necessarily having any input from people around them—of course, some people have no surviving relatives or friends—and I think that trust needs to be regulated.

[Baroness Merron (Lab)]

That, my Lords, is exactly why we are taking the action that we are.

[Lord Sahota (Lab)]

My Lords, some communities prefer to have open-air funeral pyres. What is the Government’s policy on that?

[Baroness Merron (Lab)]

I cannot give a detailed reply to my noble friend, much as I would love to, but I will be glad to look into that and write to him. The main thing to say is that, in all this work, our focus is on the security and dignity of people after death across a wide range of settings. That is what will guide us.

[Lord Brennan of Canton (Lab)]

My Lords, it is quite shocking that, in this third decade of the 21st century, there are currently no minimum standards of care for the deceased, and there is no system of statutory professional regulation or duty of care to a person after they have died. Is it the Government’s intention that those matters should be covered in the regulations they intend to bring forward?

[Baroness Merron (Lab)]

I can assure my noble friend that that is indeed what will guide us.

[Viscount Stansgate (Lab)]

My Lords, I warmly welcome the most reverend Primate’s Question and the Government’s response to it. The terrible events in Hull remind us that there are occasions when terrible events lead to worthwhile reform. In the 1820s, the discovery that Burke and Hare were murdering people in Edinburgh led this House to pass the Anatomy Act 1832, which was a step forward in this area. Can my noble friend outline what range of consultations will be held? There are many reputable funeral director chains, but there are also individuals; it is a wide field. Can my noble friend outline the extent of the consultation that will precede what I hope will be government action?

[Baroness Merron (Lab)]

My noble friend endorses the point that I made earlier, which I know the House recognises: that the majority of funeral providers, even within the current set-up, are providing a first-rate service that encourages trust as well as respect and service. However, because of these terrible circumstances, we have to act to protect people. I say to my noble friend that we are working very closely with funeral providers to get it right, so that they can do the work they need to do without undue burden, but with protection for those whom they are working for.

[Lord Kamall (Con)]

My Lords, I associate these Benches with the comments that were made about the poor people and their families who had to suffer in Hull. The most reverend Primate spoke about the impact on local communities and how legislation should consider costs. Given this, do the Government intend to ensure that smaller independent funeral directors—most of which, as the Minister said, do an amazing job in helping families through a very difficult time of bereavement, and which serve many of our communities with great care—are properly involved in shaping these reforms, and that it is not just the bigger companies and organisations that are involved? What steps will be taken to guarantee that any new requirements are proportionate and do not place unsustainable extra burdens on providers, while of course avoiding a repeat of the scandal that we saw in this case?

[Baroness Merron (Lab)]

This is the way that we are conducting ourselves. It would be a bit premature to draw conclusions on any funding requirements—we are, of course, talking about private businesses. However, we are looking—as we always do, but particularly in this area—at the costs, benefits and the impacts of different approaches before decisions are taken. Within that, we are working with the full range of funeral providers and not just the large funeral providers.

[Baroness Finlay of Llandaff (CB)]

My Lords, this is much to be welcomed, because a funeral is a very important part of marking the passing of, and respect for, a person. So, in the consultation, will the Government ask hospice bereavement counsellors—specifically those who see people on the ground face to face—for their comments? Often, managerial people higher up in the bereavement service may not know some of the details that have been extremely important to families and that may have caused great offence or may have been particularly helpful, and they can get lost in the retelling as things are passed up the chain.

[Baroness Merron (Lab)]

The noble Baroness is quite right that funerals are very personal matters—personal to the deceased, who may or may not have left their wishes, and personal and affecting for those left behind. So hospices and other groups will be worked with closely in the way the noble Baroness describes, as they are important stakeholders for us.

[The Lord Bishop of Manchester]

My Lords, I want to pick up a point made from the Opposition Front Bench a few moments ago about family funeral directors. Over the last 20 years or so, we have seen many of those, in effect, bought up by large conglomerates. It is important that any regulation is created in a way that makes it commensurate for those small providers and does not create a further incentive for the large, sometimes multinational, bodies that do not have that degree of personal understanding of a particular local community.

[Baroness Merron (Lab)]

On that point, I was interested to look at the figures, which show that the largest three businesses collectively account for approximately a third. The right reverend Prelate emphasises a point made by other noble Lords about the importance of ensuring that regulation enables all sizes and scales of businesses in this area to do the job we need them to do and has regard to all the points that we have referred to here, while letting them conduct their business.

NHS: Agency Medical Staff

Baroness Merron Excerpts

Wednesday 9th September 2026 Lords Chamber

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

My Lords, in the 10-year health plan we committed to eliminate agency spending by the end of this Parliament. We are making significant progress. Medical agency spending fell by one-third, from £963.5 million in 2024-25 to £642.6 million in 2025-26. Overall NHS agency spending fell from £2.1 billion to £1.2 billion over the same period, a reduction of 43% and the lowest level on record.

[Baroness Davies of Devonport (Con)]

I thank the Minister. It is important to ask what efforts the Government are making to increase the number of permanent staff against bank or agency work. A friend of mine is a senior mental health nurse, and she tells me that agency staff cannot intervene in a severe mental health situation or give immediate medication in A&E. Can I ask specifically what permanent staffing for mental health nursing is going to be happening, and how can the Government try to increase this, bearing in mind we have an epidemic of mental health issues among young people?

[Baroness Merron (Lab)]

In the not-too-distant future, the mental health strategy will pull together all of the strands that the noble Baroness and her colleague are concerned with, and she is right to be concerned about them. In all these areas, patient safety comes first. That is the driver as to why we are reducing the use of agency. I agree that the end game in all of this is to increase the numbers of permanent staff, and the forthcoming workforce plan will support us in that.

[Lord Patel (CB)]

My Lords, can the Minister say in the spring of which year the workforce plan will be published?

[Baroness Merron (Lab)]

On the basis we have moved beyond spring of this year, I can say that, to ensure the workforce plan reflects the new Government we have, the Secretary of State and my colleague, Minister Karin Smyth MP, the responsible Minister, are working to ensure the workforce plan properly reflects the priorities —so I hope we will not be keeping your Lordships’ House or the noble Lord waiting for too long.

[Lord McColl of Dulwich (Con)]

My Lords—

--- Later in debate ---

[Baroness Merron (Lab)]

I am not sure about something that specific. Our whole emphasis is to end spending on agency staff, but patient safety has to come first. That is why we still have some use of agency staff, and where we need temporary staff, using the NHS staff bank, we can call on a pool of healthcare workers who are more established to directly fill temporary shifts. I would not say there is an allocation to what is described as corridor care, because we are also driving it down.

[Lord Watts (Lab)]

My Lords—

--- Later in debate ---

[Lord Watts (Lab)]

My Lords, does the Minister agree with me that health trusts could do a lot more than they do at the moment to offer flexible hours for nurses and other medical staff? I have known of many cases where nurses, for example, have tried to get flexible hours and, having been refused, then end up coming back as agency staff.

[Baroness Merron (Lab)]

The key theme my noble friend is raising here is very much about staff retention within the NHS. That is not only the ideal but the practical, best way forward. We are taking action, including, as my noble friend talks about, on flexible working. We are also taking action to make staff feel safer in the workplace, enhancing support for staff health and well-being by, for example, improving access to support for mental health and musculoskeletal conditions. They are the two biggest causes of sickness absence, which also drive demand for temporary cover.

[Lord McColl of Dulwich (Con)]

My Lords, when the permanent staff are asked to do overtime or to fill in, rather than have agency medical staff, they are paid at a lower rate. Why do we not pay them the same rate as the agency medical staff? This would boost morale, lead to more continuity of care and also reduce the hassle of finding agency medical staff.

[Baroness Merron (Lab)]

Agency staff can cost the NHS more, which the noble Lord referred to. That is why we now have the agency price cap, which did not exist when agency spending rose completely out of control—for example, it stood at around £3.7 billion in 2015-16, because there were limited national controls. The agency price cap is the maximum amount that an NHS trust would normally pay for an agency worker. I do not quite recognise the situation that the noble Lord referred to on NHS staff, but I will take it away and check the situation.

[Lord Scriven (LD)]

My Lords, while the Minister talks about reduced agency spending, which is welcome, total temporary workforce costs remain largely unchanged, seemingly displacing into bank premiums, overtime and other insourcing. Will the Minister commit to publishing the total combined costs of flexible staffing, so that Parliament can judge whether taxpayers’ money is actually being saved or merely reshuffled within budget lines?

[Baroness Merron (Lab)]

I will certainly take away the points that the noble Lord raised, but I do not recognise his description of reshuffling, not least because the requirements on local health providers to reduce agency expenditure are quite clear. They have to report against them and drive further reductions. Those moneys are directed into front-line care. After all, that is what we all want to see.

[Lord Kamall (Con)]

My Lords, I thank my noble friend Lady Davies for raising this important point. I will touch on a number of issues that have been drawn together. Within the NHS, there are three very different categories of non-permanent staff—agency, bank and temporary staff—each with different implications for the continuity of care, as my noble friend referred to. Given that agency staff are supplied externally, bank staff are supplied from the trust’s own books and temporary staff are moved between services, can the Minister tell the House whether her department monitors the impact of each of these differences on the continuity of care for patients, including whether patients can see the same doctor, if possible? If so, where is that data available?

[Baroness Merron (Lab)]

The noble Lord has welcomed our emphasis on the continuity of care. It is the best form of healthcare that we can offer. The only way to do that properly is through an established NHS workforce. The reality is, as noble Lords will be very aware, that there are times that we need to use some type of temporary cover in order to secure patient safety. The main thing is that we are committed—and it will be delivered through the workforce plan—to a more settled workforce and a workforce that can properly provide the care that we need. We are not yet in that place, but the steps that we are taking will get us there.

[Baroness Watkins of Tavistock (CB)]

My Lords, the Minister quite rightly said that retention is one of the most important things, both for our own staff and the advantage to patients. Yesterday, the Health APPG heard evidence from senior staff in Georgia, USA, who explained that by starting to pay off student loans between three and five years of continuing service, they had managed to retain and get a much more stable workforce. When will the department look at the cost-benefit analysis of such an approach?

[Baroness Merron (Lab)]

The noble Baroness has not asked me to make a commitment, and I am glad that she did not, because I could not give that commitment at this stage. However, in addition to the action that we are taking, which I referred to earlier in this Question, we are looking broadly at how we can retain people. The cost to individuals is a key matter. The noble Baroness will be aware of the constraints upon us. It is a matter of seeing what else we can do. We are undertaking targeted retention work, not least to understand why staff have left. There are a variety of reasons: some obvious and some less obvious. They all need to be tackled, and we are taking a multifaceted approach.