Health Bill

Baroness Murphy Excerpts

Committee stage
Monday 9th November 2026 Lords Chamber

[Baroness Murphy (CB)]

My Lords, this is the first time I speak in Committee, and I apologise that I have not intervened very often so far. On this amendment, I feel quite cross with the noble Baroness, Lady Bennett, who wants to take us back to the Soviet model of healthcare, which I thought we were moving away from.

Essentially, there are many services in which you find independent sector providers, and they are not all private. Many of them are not for profit or voluntary run, and many of them are absolutely excellent services, just as good as the NHS, and they keep the NHS on its toes—I speak, remember, as an NHS manager. The fact is that, for example, if you look at simple cataract surgery, people used to wait for years for the NHS to get round to doing their simple cataract extractions and replacement lenses. Now, it is a few weeks in most places, and these services are almost always provided by the independent sector—and very good they are too.

I agree there is an issue about the training of staff, because it is all done by the NHS or recruited from overseas. We need to know where people come from and what we are paying for. However, as an NHS doctor and manager, I can say that I have witnessed the transformation of services by the competition that is provided by some of these independent sector services where commissioners are able to choose the very best for their local patients. I therefore refute and wish to deny the proposals from the noble Baroness, Lady Bennett.

[Lord Patel of Bradford (Non-Afl)]

My Lords, I have added my name to the notice opposing the Question that Clause 10 stands part, alongside those of the noble Lord, Lord Hunt of Kings Heath, the noble Lord, Lord Kamall, and the noble Earl, Lord Howe. I share their concerns about the purpose of this clause and the safeguards governing its use. The Secretary of State should of course be able to improve services and respond to failure. However, patients also need confidence that changes in who provides their care will be justified by the benefits for them and for the communities that those services support.

Clause 10 sets out a duty that applies across health service functions, but it also gives the Secretary of State an exception. They can deliberately change the balance between different types of provider if they believe that this is in the interests of the health service. The scope and safeguards of that exception deserve careful examination. Will the Minister give us some practical examples of when this exception would be used? What specific problem is it intended to solve? Of course, improving services may mean changing who provides care, but the purpose should be to improve care for patients. Why is an exception needed that allows the Secretary of State deliberately to change the balance between public and private providers? Could this exception be used alongside the powers of direction in Clause 11to promote a preferred category of provider, even where a different provider could offer patients a better service?

It is important that we assess the whole effect of a commissioning decision. Quality and safety matter, as do timely access, value for public money and the sustainability of local NHS services. An apparent saving in one contract may create costs elsewhere. Equally, a change that looks attractive nationally may leave patients facing longer journeys, disrupted treatments or fewer services to choose from. That matters, particularly in places with poor transport links and few alternatives, whether they are in rural or coastal communities, towns or cities.

PSR, the provider selection regime introduced in January 2024, already provides a framework for selecting providers of healthcare services in England. Its criteria include quality, value, collaboration, service sustainability, access inequalities, patient choice and social value. Can the Minister explain how the discretion in Clause 10 will interact with the PSR framework and with existing patients’ choice rights?

I support the emphasis on patients in Amendment 34, tabled by the noble Baroness, Lady Coffey. It would require the Secretary of State to consider whether a change is in the interests of patients, rather than the health service more generally. I also support Amendment 35, tabled by the noble Lord, Lord Kamall, and the noble Earl, Lord Howe, which would require a change in the balance of provision to be necessary to improve patient outcomes. Both amendments bring us back to the essential question: how will the proposed change benefit patients?

I turn briefly to Amendments 33, 36 and 51, tabled by the noble Baroness, Lady Bennett of Manor Castle. I respect her commitment to the NHS. We share the objective of excellent care, available according to need and free at the point of use. However, I cannot support these amendments, because of their potential consequences for patients, staff and the services on which they depend. Amendment 33 would establish a presumption in favour of public provision, permitting private provision only where specified conditions were met. The existence of a public alternative does not by itself establish that it offers the best quality, the shortest wait or the most accessible service. We should be asking which arrangement best meets patients’ needs, alongside its effects on the wider NHS. There are also questions about scope. How would charities, hospices, social enterprises and GP partnerships be treated? Providers need to plan ahead to invest in staff, facilities and equipment. Would these restrictions make them less willing to invest because of uncertainty about how much care they would provide, and for how long?

Amendment 36 would require a review of existing private sector arrangements, followed by a plan to return services to public provision where private provision is considered unnecessary. The amendment recognises the need to assess financial, clinical and workforce implications. However, an assessment does not itself provide the staff, premises, equipment or funding that are needed to replace a service, nor does it resolve any contractual costs arising from early termination. Patients who are already receiving care would need continuity, while those waiting for treatment would need confidence that capacity would remain available.