Health Bill

Debate between Baroness Neville-Rolfe and Earl Howe

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, in moving Amendment 22, in my name and that of my noble friend Lord Kamall, I will speak also to Amendments 24 and 68. I am also grateful to the noble Baroness, Lady Pidgeon, for tabling Amendments 23 and 67.

These amendments concern a principle which we on these Benches have long supported and which I believe ought to be central to our thinking about the future of the health service: how we can give patients greater choice over their care and make better use of the full range of healthcare services available to them.

Those services are what I would describe as a wider healthcare ecosystem—a complementary system in which the NHS works alongside independent healthcare providers, community organisations, charities and other bodies to deliver services in the way that best meets patients’ needs. The principle behind this is straightforward: many services do not necessarily need to be delivered in a hospital or by an NHS organisation, in an area where other qualified and appropriately regulated providers are capable of delivering them. These might include diagnostic services, physiotherapy, audiology, eye care or other forms of community-based treatment. Where those services can be provided safely and effectively by organisations outside the traditional hospital setting, we should surely be looking at how we can make use of that capacity.

There are several potential benefits that flow from this approach. It can allow patients to receive treatment closer to home and it can reduce unnecessary journeys to hospital. It can also provide access to services more quickly. At the same time, it can relieve some of the pressure on hospitals and specialist services, allowing them to concentrate their resources on the patients who need them most. Where services can be delivered more efficiently, they may also provide better value for the taxpayer.

I appreciate that some noble Lords may have concerns about what they might regard as encouraging the privatisation of the health service, but I want to be very clear that that is not what we are proposing. We are not suggesting that patients should be required to pay for their treatment, nor that core NHS services should be replaced by private provision. We are arguing that the NHS should have the fullest possible range of resources available when it comes to treating patients, and that patients should be able to benefit from those resources regardless of the organisational structure of the provider. The important question is whether a service is safe, clinically appropriate and accessible, and provides good value, rather than whether it happens to be delivered by one particular type of organisation.

This brings me to the question of patient choice. There is a risk in the present system that patients are not always given the opportunity to make decisions that they are well placed to make themselves; for example, a patient may be entirely happy to travel further for a particular service or may prefer to receive treatment closer to home. They may be willing to wait for one provider or prefer to be treated more quickly by another. These are reasonable choices and, wherever clinically appropriate, patients should be supported in making them. However, the watchword of “choice” means very little if patients are not told what alternatives are available or if the way that services are commissioned prevents them from accessing those alternatives in the first place.

Amendment 22 therefore seeks to strengthen the provisions in the Bill relating to patient choice, specifically in relation to out-of-hospital services. Amendments 23 and 24, meanwhile, raise an important question about what happens when a patient is referred onwards by a hospital, an NHS online service or another integrated healthcare provider. As more care is delivered through digital services and integrated pathways, we need to be certain that patients do not lose the choices that would otherwise have been available to them, had they been referred directly by their GP. Amendment 68 explores how we might extend meaningful choice into community services, which can provide an alternative to hospital-based care.

Some of the amendments in the name of the noble Baroness, Lady Pidgeon, mention optometry services. Another good example is audiology. Adult hearing loss affects 11.6 million people in the UK. It is the third leading cause of years lived with disability, and it impacts all aspects of people’s lives. Unlike most other hospital services, audiology is not consultant-led. Currently, choice over elective care applies only to consultant-led NHS secondary care services. As a result, NHS community audiology services are being commissioned in fewer than half of ICB areas. Patients often endure long waits and attend hospital when services could often be offered safely and more swiftly in the community.

The Government’s stated ambition is to move more care out of hospitals and into communities. It is a good ambition, but if we are serious about moving care closer to patients, we must also be serious about making use of the organisations, including independent providers, capable of providing that care. It would be helpful if the Minister could use this debate to tell us a little more about the Government’s plans in this area. What further steps are being taken to empower patients to exercise meaningful choice, particularly in relation to community and out-of-hospital services? I will press her, if I may, on primary care audiology provision in particular, which seems an especially salient example, given the statistics on hearing loss I have just mentioned. What is the position? Are integrated care boards being encouraged to make full use of the healthcare capacity available in their local areas, including through independent charitable and community providers? What barriers might stand in the way of this?

Much of our debate on the Bill thus far has concerned the savings that the Government hope to achieve through structural reform, but I hope we can agree that the structure of the system should not be such as to dictate or otherwise limit the choices available to patients. There is surely an opportunity both to make savings and to improve services, by looking more closely at how care is actually delivered. I look forward to the Minister’s response. I beg to move.

[Baroness Neville-Rolfe (Con)]

I thank the Minister for her helpful letter last week, answering the range of questions I had raised at Second Reading. I think that that is a symptom for a wide variety of policy issues that this important Bill raises.

I have added my name to Amendment 22, on choice, which was so persuasively and sensitively introduced by my noble friend Lord Howe. I believe that private care can complement NHS care, allow treatment nearer to home, and cut waiting times. I particularly support the “have regards” in proposed new subsection (5). I also favour the follow-up review, although there should be more focus on the value and usefulness of the independent sector in a health system that, frankly, is under so much pressure. I have had very positive experiences at Specsavers, which is contracted to do eye and audio tests in a number of NHS trusts.