Health Bill

Baroness Pidgeon Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[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?

[Baroness Pidgeon (LD)]

My Lords, we welcome these Government amendments, which ensure that the devolved Administrations’ boundaries are protected and that there is proper consultation and agreement. But devolution must be integral to any legislation from the start, rather than an afterthought. Granted, there has been consultation with the devolved Governments, but these amendments were tabled very late and this is a worrying sign. It is an indication that aspects of the reorganisation and its governance implications had not been properly thought through at the start—through the lens of the devolved Administrations, rather than simply through that of Whitehall and civil servants centrally. The Minister’s words have provided some assurance, and I look forward to the devolved Administrations being at the start and the heart of legislation such as this in the future, rather than an add-on at a late stage.

[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.

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[Lord Mawson (CB)]

My Lords, I found this an interesting debate, and I am sympathetic to the amendment of the noble Baroness, Lady Bennett, and particularly that of the noble Lord, Lord Patel, because he is right that very little is actually being learned. My colleagues and I have listened, over the years, to lots of conversations about health inequalities. When you spend your life in very challenging housing estates and see very little changing, you know about the distance between all the words and the practice.

That is why, many years ago, we decided to focus on practice and the doing of things, rather than the talking about things. We began to realise what every parent knows: that you only really learn by doing. When I started to work with GPs, originally in east London, they began by telling me that was how you became a GP. You saw one, you did one and then you taught one; it was a very practical matter. Businesses and entrepreneurs nowadays know that you learn by doing things. Yet in the state, which often feels so out of date in the NHS, there is no learning by doing culture. There is a learning by writing very fine reports, often at 60,000 feet, that seem very unengaged with practice.

Over the years, it has been interesting to observe what happened through practice. The Bromley-by-Bow model is well known, so I will not use it, but the noble Earl, Lord Howe, knows that I was also responsible for the transformation of a street following a murder and 10,000 illegal injections being given out in a housing estate. There were some terribly violent circumstances going on at the time. When I brought the first key people on the street together, all of them—the GP, the school and the housing association—were saying, “We cannot deal with this on our own. We need to do it together. These things are so interconnected”, and we built together the St Paul’s Way Transformation Project, which started with nothing and led to a new £40 million school, a £16 million health centre, 600 homes and now a new primary school.

We joined it up, and Professor Brian Cox and I led our 14th science summer school in June this year, with a masterclass at the end of it on quantum physics, for the children from the same housing estates. It is the same children and same families, and now they have one of the best performing schools in Tower Hamlets. The noble Earl, Lord Howe, helped us greatly at one key point with learning by doing, when he met the whole group—housing, health and education—when the NHS was getting in the way of us completing on the deal for the health centre. He was very helpful in enabling that to actually happen.

It was Duncan Selbie, the chief executive of Public Health England in 2015, who gave me £20 million and said, “Andrew, take this culture that you’ve been developing into the north of England”. We built 10 learning by doing innovation platforms in Rotherham, Bradford, Doncaster and Bootle, all of which were about bringing people together to learn about these matters. It was interesting that when I met the public health officials in each of these places, who were lovely people quoting all the same data that I had heard many times before, and said to them, “What are you actually going to do about that data?”, there was absolute silence. It was not their fault. They did not have the skills to know how to turn fine words into practice for some of the most challenging communities in this country.

It is my view that one of the things being missed in this moment is the serious need to get real about innovation and learning by doing. My colleagues and I—I declare my interests—are at the moment creating at place, on the ground, with local people and professionals, what we call these learning by doing innovation platforms, so that we bring together the actual GP, business person and local resident, and you begin to explore these issues together because in the modern world, health is everybody’s business. It is not just a matter for GPs. It is interconnected and we need to explore what that means.

My concern about where we are at the moment in discussing this Bill, which is a fantastic opportunity for this Government, and this country, to move into a form of health that is of this century and not last century, is that we are going to end up building a lot of biomedical boxes around this country that do not explore these interfaces in some of our most challenging communities. The noble Lord, Lord Patel, is right; we need to worry about why he is right and why things are not being learnt.

I finish with the thought that it is our experience over the years that, sadly, we have to say that, in so many respects, the NHS is not a learning organisation. We must have hosted 70 Government Ministers to our work over the years. They all come and say, “Wow, this is fantastic, we need to do more of it”. I can name the four who did anything practical about that, and the other 66 sit on a list in this pocket. This is not to do with bad people. It is about whether, as a nation, we are now going to get upstream into prevention and health creation and create a learning by doing environment in which we all learn together, and in which local people are part of all of that process.

[Baroness Pidgeon (LD)]

My Lords, this is a very important group of amendments, and it has been a really excellent debate. One of the most pressing issues facing us is the widening gap in health outcomes between different communities. Healthy life expectancy has fallen in recent years and the gap between the most and least deprived areas of England, as we have heard, now stands at almost 20 years.

The point made earlier by the noble Lord, Lord Crisp, when he talked about the role of the department being one of leadership for health across government, not just running the NHS, is really important as we approach this group of amendments. We have heard clearly that the current legislative framework places relatively weak duties on government to address these wider determinants of health and tackle inequalities.

The House of Commons Health and Social Care Select Committee, in its scrutiny of the Bill, called for a stronger focus on improving the nation’s health and tackling inequalities, emphasising the need for clearer accountability and a more robust approach to prevention across government. Many of the amendments in this group would help to achieve that aim by ensuring that reducing health inequalities becomes a central objective of health policy, and that progress is measured and reported transparently.

My noble friend Lady Walmsley’s amendments, spoken to by my noble friend Lady Tyler, and Amendment 7 from the noble Lord, Lord Patel, would strengthen the duty on the Secretary of State to take steps or action, rather than simply “have regard to”. That is really important. Amendment 14, tabled by the noble Lord, Lord Patel of Bradford, and supported by so many Members of the House today, would require the Secretary of State

“to have specific regard to reducing inequalities”

in coastal communities. The point has been made clearly about the added complexities for such communities, whether those are workforce related or in local service provision. Those are really important.

My Amendment 20 looks at health inequalities in urban areas and requests a strategy and an annual report. Impact on Urban Health, which is part of Guy’s & St Thomas’ Foundation, recently reported its State of Urban Health research and found that preventable mortality is 2.7 times higher in the most deprived urban neighbourhoods in England than in the least deprived. Urban areas also face some of England’s starkest health inequalities, with people living just streets apart experiencing significant differences in health. You have only to look over the river to the London Borough of Lambeth, where Impact on Urban Health is based: females who live just over a mile apart face an eight-year gap in life expectancy. As we have heard, these inequalities are driven by unfair and avoidable differences in everyday environments. These include exposure to air pollution, differences in housing quality and access to healthy, affordable food. I pulled this area out for specific attention: rather like the coastal communities amendment, it needs specific action.

My noble friend Baroness Tyler spoke strongly to Amendment 18, which would require a cross-government health inequality strategy and subsequent annual reports to Parliament on progress. That would focus minds and energy across government and would address the key point from the Health and Social Care Select Committee, as well as many of our suggestions in amendments and today’s debate.

If we are serious about narrowing the gap in healthy life expectancy and giving everyone the opportunity to live a healthier life, then action on the wider determinants of health and tackling health inequalities must sit at the heart of the Bill, not at its margins. I look forward to hearing the Minister’s response.

[Baroness Cash (Con)]

My Lords, I begin by thanking all noble Lords who tabled amendments in this important group and for the high quality of debate. At this time in the evening, it falls to me to be as brief as possible. As the quality of debate and the points made have been so thorough, I will try not to repeat anything.

We are all very much agreed: from these Benches, we have heard from the noble Lord, Lord Lansley, from the noble Baroness, Lady Manzoor, and from the noble Baroness, Lady Hodgson. We care a great deal about the inequalities in health outcomes in this country, but I am very grateful to the noble Baronesses, Lady Gerada and Lady Royall, for drawing the distinction between healthcare inequalities and health inequalities. It is important, and it is important for the purpose of the Bill and the duties that ought to be placed on the Secretary of State for Health.

It is incredibly challenging and painful to hear the data regarding ongoing inequalities. We know, of course, that healthcare is not the reason why it is in that state. The factors that play a part sit in different departments, which is why these Benches welcome the amendments which ask for a strategy. I hope that the Minister will consider joining up some of the significant work being done by the Government in the Fonagy review and the Milburn review to look at all these issues together.

It would be helpful to hear from the Minister about the specific actions the Secretary of State would be expected to undertake to ensure the duty as it is currently drafted, and how Parliament would be able to assess those decisions. We have heard from the noble Lord, Lord Lansley, about how we might improve on the current legislation, and it is important that we hear how that might be done. The inequalities in general practice are significant and challenging, and I look forward to hearing from the Minister about the Government’s plans to address them, such as through incentives to serve in different areas, targeted work plans and ensuring that enough training, development and recruitment is going on in those areas. I hope that all these issues will be subject to consideration by the Minister.

We cannot expect to reduce health inequalities without addressing these disparities in primary care. We look forward to hearing what might be done and what might be included in this Bill to do that. In the end, we must judge success by whether patients have access to the healthcare needed at the point of delivery. I look forward to the Minister’s response.

Health Bill

Baroness Pidgeon Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

It is a salutary reminder that one of the reasons why we wish to have central interventions is that the local NHS seems incapable of sorting out things such as this. I am not sure about the noble Lord’s amendments, but I think his aims are very important.

[Baroness Pidgeon (LD)]

My Lords, these amendments tabled by my noble friend Lord Rennard raise some important points and are intended to safeguard national diabetes services following the planned abolition of NHS England, and to ensure that patients do not lose access to proven programmes during that transition.

This is a point that has come to me time and again from different charities representing different disease groups. They are concerned that the specialism and some of the services that are commissioned will be lost. I am sure we will discuss this again on other Committee days.

As we have heard, diabetes is one of the greatest health challenges facing us all. According to Diabetes UK, over 12 million people in the UK are living with diabetes or prediabetes, and it costs the NHS around £10.7 billion every year. That expenditure is linked to complications that can often be prevented through early intervention, effective treatment and consistent monitoring, as well as routine diabetes care.

The amendments would therefore require the Secretary of State to maintain, at a minimum, the current provision of key national programmes. As we have heard, these include the NHS type 2 diabetes prevention programme, the diabetes path to remission programme, continuous glucose monitoring, the rollout of hybrid closed-loop technology and the national diabetes audit programme. I flag that the type 2 diabetes prevention programme is recognised as a world-leading prevention intervention. We do not want to see that lost with this reorganisation.

The amendments would also strengthen transparency and accountability. Before any transfer of functions, the Secretary of State would be required to set out how continuity of these services would be guaranteed. Annual reports to Parliament would then provide clear information on patient access, waiting times and outcomes, while separate assessments over the first four years following the abolition would monitor the impact on funding, workforce capacity or clinical audits, and access to technologies.

At a time when diabetes continues to rise and the impact felt both by individuals and financially throughout the NHS is so significant, it is essential we have confidence that these vital national programmes will not only survive the organisational change but continue to improve outcomes for people living with diabetes. I look forward to hearing the Minister’s response.

[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.

Health Bill

Baroness Pidgeon Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Baroness Nargund (Lab)]

My Lords, I understand the concerns that have prompted the noble Baroness, Lady Tyler, to table her amendment, and I support her fully. Many times in this very Chamber I have raised the issue of the burden of unpaid caring on one’s health, well-being and finances. The majority of unpaid carers are women who sacrifice their own health and well-being needs to care for others. It is very important that we care for them. As many noble Lords said last week, we know that many unpaid carers do not identify themselves, but women are less likely to do so. Identifying carers is important, but they must not simply become another statistic, because behind every carer there is a family. Identification should and must lead to meaningful support for carers and their families.

As the noble Baroness, Lady Tyler, has already pointed out, there is evidence of under-identification of unpaid carers. Analysis by the Nuffield Trust of 13 million GP records found that only 1.4% of patients were recorded as unpaid carers in GP systems, compared with the census estimate of approximately 8.8%. That means that for every unpaid carer identified by GP practices, roughly four were not identified. In other words, around 1 million unpaid carers were missing from GP records.

I welcome Action 102 in the Renewed Women’s Health Strategy for England, which pledges to support unpaid carers to balance their work and care. The single patient record can be an important enabling tool to identify unpaid carers and record all their caring responsibilities. Therefore, can my noble friend the Minister say whether the single patient record will be set up to systematically identify unpaid carers, and whether ICBs will have a clear responsibility to act on that information to protect their health and well-being? Will the Renewed Women’s Health Strategy for England be joined up to this to support women who are unpaid carers? We owe it to them.

[Baroness Pidgeon (LD)]

My Lords, this debate, though it started last week, has highlighted the extraordinary contribution made by unpaid carers across the country. Every day, millions of people provide care, often around the clock, enabling their loved ones to live with dignity and independence. Their contribution is not only invaluable to the individuals they support; it is fundamental to the sustainability of the health and care system as we know it. As my noble friend Lady Tyler rightly pointed out last week, and as the noble Lord, Lord Hunt, pointed out today, the unpaid care provided by an estimated 4.7 million carers in England is worth some £152 billion a year—a figure comparable with the NHS budget. Without those carers, our health and social care services would be unable to cope.

Throughout this debate, noble Lords have highlighted the stark reality that carers too often remain invisible to the very systems that rely most heavily upon them. For too many carers who are not identified by health services, this means that they miss out on support, advice and interventions that would protect their own health and well-being as well. Amendments 88 and 89 would help to address these issues.

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On a practical level when we as a country and the NHS are in such a difficult financial position, I mentioned at Second Reading that the NHS currently spends £90 million a year on unused rooms in health buildings, many of them primary care buildings. Indeed, we have unused rooms sitting there that are costing the NHS all this money. There are deals to be done here with the independent, social and charitable sectors that make financial sense and health sense. I raised this question at Second Reading but got no reply: what are the Government going to do about that opportunity? How do we grasp that nettle of £90 million and turn empty rooms into opportunities for patients in the NHS?

[Baroness Pidgeon (LD)]

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

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

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

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

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

[Baroness Merron (Lab)]

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

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

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

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

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

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

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

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

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

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With respect to audiology, I will be pleased to write to noble Lords with further detail on that point.

[Baroness Pidgeon (LD)]

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

[Baroness Merron (Lab)]

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

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[Baroness Thornton (Lab)]

My Lords, I had not intended to speak in this debate—I was saving myself for social care and those other issues—but I was very moved by the interjection by my friend, the noble Lord, Lord Patel, and I disagreed with the noble Baroness, Lady Coffey. This is an important suite of amendments, because comprehensive integrated care has to include end of life—of course it does. I know that the noble Lord and the Minister will be discussing how best to do that; it may not be to put it on the face of the Bill, but it definitely has to be included in this legislation. The amendment from the noble Baroness, Lady Pidgeon, is a very good one, and I completely agree with it.

[Baroness Pidgeon (LD)]

My Lords, I thank the noble Lord, Lord Patel, and my noble friend Lady Barker for their very personal and raw contributions, as recent carers, on the recent losses of loved ones.

I am grateful for the support from the noble Baroness, Lady Thornton, for my Amendment 230 in this group, which also has the support of Marie Curie and Hospice UK. At its heart is the principle that people approaching the end of life should be able to have their wishes, preferences and priorities for care understood, recorded and respected. Advance care planning enables people with terminal illness to express how and where they wish to be cared for. It supports more proactive and personalised care and, as we have heard, it has been shown to improve patient and family satisfaction while reducing the likelihood of crises, avoidable hospital admissions and the need for emergency care out of hours. I have seen at first hand how, in Devon, the system seems fairly well set up to support people in their own homes, and to have these very difficult conversations with a hospice at home service, with people who have real skill in communicating and talking about these difficult topics at a time when someone may have just learned that they have a terminal illness and when lots of things are going around their mind. It is important for them to be able to get some clarity, going forward, about what they wish for and do not wish for. As we have heard, other parts of the country do not work so well.

Importantly, the evidence suggests that advance care planning does not increase costs to the health and care system, and may in some cases reduce healthcare expenditure by ensuring that care is delivered in accordance with patients’ wishes. We will come on to the single patient record on a later date, but I flag here that advance care planning can be effective only if the information is available to those providing care when it is needed. The single patient record offers a significant opportunity to improve co-ordination and continuity of care, but its success will depend not simply on sharing data but on ensuring that advance care planning is routinely embedded in clinical practice so that people’s wishes can be accessed, understood and acted upon, wherever and whenever care is provided.

The other amendments in this group from the noble Baronesses, Lady Finlay and Lady Coffey, highlight the many issues with the current landscape of palliative care and specialist palliative care services, and the difficulty in getting access to those services. I look forward to the Minister’s response to that, and her response to the trick or treat challenge.

[Lord Kamall (Con)]

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

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

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

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

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

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

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

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

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

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[Baroness Barker (LD)]

My Lords, I will add to what the noble Baroness, Lady Gerada, said. A very high percentage of our district nurses come from other countries. Therefore, what will the Minister do, talking to the Home Office, about the supply of district nurses that we will undoubtedly need in the future?

I will make one or two brief points, following on from what the noble Baroness, Lady Harding, said about planning. If any member of the Committee has spoken to anybody currently employed by an ICB, they will know that seared in their minds is the date on which they were told, about 18 months ago, that their jobs were going to go. For the last 18 months, they have continued to work under that threat. I do not know any other employer that would do that to a workforce and expect to retain it. I talked to members of staff who work for ICBs. I had the misfortune to ask them, “How are you?”, and 25 minutes later I knew how they were—it was not good. I rather suspect that the biggest demand for mental health services at the moment is coming from members of NHS staff, because they have been living with this uncertainty for 18 months.

I am not being flippant but, if the Minister cannot share great detail with us, can she at least tell us the Government’s working assumptions about the number of staff there will be in the future who are members of ICB staff now? I suspect that the attrition rate will be enormous, especially given the age profile of some members of ICB staff, in particular, who have built up specialist expertise over many years. Secondly, what working assumptions are the Government making about members of staff, particularly nursing staff, who will move out of the acute sector and into the community?

[Baroness Pidgeon (LD)]

My Lords, since taking over as our spokesperson, I have lost count of the number of times the Minister has talked about the workforce strategy that will at some point emerge from the department. I am not sure whether we will be given a season this evening, but hopefully it will be published soon.

My Amendment 253, which the noble Lord, Lord Stevens of Birmingham, and the noble Baroness, Lady Gerada, have added their names to, would require the Secretary of State, within 12 months of Royal Assent, to publish

“a health and care workforce strategy for England”.

I have included “care” on purpose because the two are so importantly linked. It must assess the staff needed to meet current and projected demands, expressly including registered nurses and primary care practitioners, and it must contain a funded plan to close staffing gaps. Annual progress reports would be laid before Parliament, keeping that issue on the agenda for us all. Putting staff in is an important marker too. We need to properly plan and invest in our workforce, both health and care, hand in hand.

The Royal College of Nursing supports this amendment, as do a number of representatives of primary care. Too often, primary care seems to be forgotten in the debate on workforce, but it is critical: GPs and district nurses—we have just heard passionately from the noble Baroness, Lady Gerada, about their role—as well as optometrists, dentists and pharmacists. As the Government look to shift services into neighbourhoods and hospitals—something I think we all support—this is really important. The early years workforce is important as well, as are health visitors.

The other amendments in this group, including that of the noble Baroness, Lady Shawcross-Wolfson, all require similar reports, perhaps on different timescales. Some are focused on really important areas such as the mental health workforce, the education and training that is needed alongside a workforce plan, and continuing professional development. Noble Lords have flagged the current vacancy rates in a number of roles, as well as skills shortages and the need for independent scrutiny of the workforce plan.

My noble friend Lord Scriven rightly stressed, using his personal family experience, the need for nurses for people with learning disabilities and the investment in that workforce, as well as the need to understand the whole workforce, looking at models in, for example, the Netherlands. The noble Lord, Lord Stevens, and the noble Baroness, Lady Gerada, talked about the complexity around primary care and the challenges with part-time workers, with perhaps more women coming into the workforce, as well as the challenges of work-life balance. Some people want to work part-time rather than full-time. These are key questions for the Government on this issue of workforce. I look forward to a comprehensive response from the Minister, and possibly a date, a season or a hint of when we might at last see that workforce strategy.

[Lord Kamall (Con)]

My Lords, this has been a crucial debate, and I am grateful to noble Lords for tabling and speaking to their amendments, which raise fundamental questions about the future of the NHS workforce, the quality of care patients can expect and the Government’s ability to deliver health service reform.

The amendments from my noble friend Lady Shawcross-Wolfson and the noble Baroness, Lady Pidgeon, go to the heart of a simple but vital question: how can this Government, or indeed any Government, credibly plan for the future of the NHS without an independently verified assessment of the workforce that we need? As my noble friend said, the previous Conservative Government, albeit belatedly, recognised the importance of this challenge when we published the first NHS Long Term Workforce Plan in 2023. This was a baseline step in establishing a long-term approach to workforce planning, with clear ambitions to expand domestic training, improve retention and reduce our reliance on international recruitment.

We recognised then, as we must recognise now, that workforce planning cannot be conducted from one spending review to the next. Training doctors, nurses and other healthcare professionals takes years, and decisions made today will determine the quality and availability of care for patients a decade, or decades, from now. Yet we are still waiting, as other noble Lords said, for the Government’s new 10-year workforce plan. The noble Lord, Lord Patel, offered some possible reasons for the delay.

Health Bill

Baroness Pidgeon Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

I will be very brief in supporting that suggestion from the noble Lord, Lord Scriven. When I was listening to the debate, I was thinking about people who have told me about feeling discriminated against. They often do not declare their racial, religious or whatever view, because they are terrified of being further labelled and discriminated against. The noble Lord, Lord Shinkwin, spoke about the history of this for the Jewish people; there were lists of who was Jewish, particularly in the Netherlands, which were rapidly exploited to round them up with speed and persecute them further. That is a very deep-seated fear in a lot of these people.

The other fear is that, if they disclose that they have been discriminated against, they will be undermined in other forms that make their lives even harder. I can again think of other specific examples that have been brought to my attention. I commend this solution as a way forward.

[Baroness Pidgeon (LD)]

My Lords, this group of amendments is incredibly important. I thank the noble Baroness, Lady Gerada, for tabling most of them and for her powerful words about Jewish staff and patients, and their experiences in the data that she also presented. In different ways, all these amendments are trying to ensure that all parts of the NHS stamp out antisemitism and racism, and provide the right training on it, as recommended by the review from the noble Lord, Lord Mann.

I completely agree with the neutrality point that the noble Lord, Lord Hunt, raised about the uniform that staff wear. I recall that, several years ago, the Metropolitan Police had a huge issue with badges that officers started to wear as part of their support for charities such as Help for Heroes. That was ruled out of order, and they were not allowed to wear them. I think this is a similar thing, and there has been a sort of creep in uniforms over the years in what is acceptable or not. We need to make sure that all staff are seen to be neutral and behave neutrally.

The amendment on assessing the performance of ICBs is important in ensuring that trusts have a duty to prevent this and respond to it; it would ensure that that is integral to these organisations. The noble Lord raised a point about leadership. We on these Benches fully support the Mann review and the implementation of its recommendations, and my noble friend Lord Scriven’s practical suggestion about the NHS constitution is certainly a good idea worthy of consideration by the Minister. I hope the Government will look at how best to implement these amendments—as worded or in a different way—and I look forward to the Minister’s response.

[Baroness Cash (Con)]

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

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

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

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

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

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

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

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

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

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

Health Bill

Baroness Pidgeon Excerpts

Committee stage
Monday 9th November 2026 Lords Chamber

Moved by

[Baroness Pidgeon]

41: After Clause 11, insert the following new Clause—
“Cancer outcomesIn the National Health Service Act 2006, after section 1GA insert—“1GB Cancer outcomesIn exercising functions relating to the health service, the Secretary of State must treat objectives relating to cancer outcomes as having priority over any other objectives relating specifically to cancer.””Member's explanatory statement
The Secretary of State is currently required to set cancer outcome objectives for NHS England, with those objectives taking priority over other cancer goals. The Health Bill removes this provision. This new clause would place a new duty on the Secretary of State to prioritise cancer outcomes such as survival.

[Baroness Pidgeon (LD)]

My Lords, the number of people diagnosed with cancer in the UK continues to grow. For the first time, the number of new cancer diagnoses each year has passed 400,000. Almost one in two of us in our lifetime will have cancer, and I am sure it has affected all of us in this Chamber.

The commitments made in the national cancer plan to improve cancer outcomes are welcome. Driving up survival rates and increasing earlier diagnosis will transform the experience of people affected by cancer. Amendment 41 in my name, to which the noble Baroness, Lady Morgan of Drefelin, and the noble Lord, Lord Patel, have added their names, focuses on outcomes. Over the past five decades, cancer survival has more than doubled due to life-saving research, earlier detection and cutting-edge treatments. But over time the rate of improvement has slowed, with the 10-year cancer survival index for all cancers rising nearly three times faster in the early 2000s compared with the early 2010s. There is, of course, a substantial variation between different cancers.

The Health and Care Act 2022 included a requirement for the Secretary of State to include cancer outcome objectives in the annual mandate set by the Secretary of State for NHS England, and that those outcome objectives explicitly took priority. The current Health Bill abolishes the mandate, including the prioritisation of cancer outcomes, and a similar duty has not been replicated elsewhere in the Bill. In publishing the national cancer plan, the Government have shown that they are committed to transforming patient outcomes. However, with the removal of the current requirement, there is a very real concern that progress on cancer outcomes risks being deprioritised amid competing priorities. I am sure that this is not the Government’s intention, and I hope the Minister will be able to reassure us today and will consider tabling a government amendment on Report to ensure cancer outcomes are on the face of the Bill.

On the other amendments in my name in this group, Amendment 217 would require the Secretary of State to introduce regulations requiring the Government to co-ordinate research into cancers with the lowest survival rates. This is a long-standing failing in our approach to some of the deadliest forms of cancer. While welcome progress has been made in treatment and outcomes for many cancers, those with the lowest survival rate, which can include cancers such as pancreatic, brain, liver and lung, continue to receive disproportionately less research focus. Greater co-ordination would help identify gaps in knowledge, avoid duplication, encourage collaboration and ensure that our scarce research resources are directed where they can have the greatest impact. If we are serious about improving outcomes and reducing cancer mortality, we must focus on where survival rates remain stubbornly low.

Amendment 228 would give patients a right under the NHS constitution to start cancer treatment within 62 days of referral. There is an inconsistency in the NHS constitution between the rights to treatment and actual waiting times. There is a right to elective care within 18 weeks, but there are other pledges for other waiting times. Cancer does not simply stop while a patient waits for their treatment. Research shows that every four weeks of delay reduces patient survival by an average of 10%. That is why I have tabled this important amendment—so that there is a focus on starting treatment and that it is reported to Parliament.

Finally, Amendment 250 from the noble Baroness, Lady Finlay, addresses the important issue of radiotherapy. This is an area which can often be overlooked in terms of cancer care, facing the longest waiting times and significant problems with access, particularly in rural areas. I understand that England has fewer radiotherapy machines than comparable European countries, and thousands of people are having to travel over 45 minutes for their treatment. With around half of all cancer patients needing radiotherapy, it is important that access to this service is improved. This is a really important group of amendments, and I look forward to the debate. I beg to move Amendment 41.

[Baroness Finlay of Llandaff (CB)]

My Lords, I have two amendments in this group, and I am grateful to the noble Baroness, Lady Pidgeon, for having referred to one of them.

My Amendments 247 and 250 would address genomics and radiotherapy, because there are fundamental weaknesses in how diagnostic genomic services and radiotherapy treatment services are planned and improved across England. In both areas, rapid advances are altering survival and avoiding toxicity from poorly planned treatments. Current international comparisons by the OECD place the UK 31st out of 43 countries for five-year lung cancer survival and 26th for colon cancer survival. Overall cancer mortality data place the UK 26th out of 36 countries. Following on from the questions from the noble Baroness, Lady Pidgeon, I ask the Minister two specific questions. First, why is the UK no longer submitting information to the OECD on cancers? Secondly, will we be renegotiating for our cancer research to become part of the EU4Health programme again?

Diagnostic delays and inadequate radiotherapy services are largely responsible for our poorer outcomes. In cancer genomics, only 3% of pathologists are always meeting the 14-day national target for lung cancer genomic testing. Pathology personnel shortages are particularly severe in genomics and genetics, causing delays, which are compounded by high sample volume workload, administrative inefficiencies, delays in sample processing, and outsourcing, as well as inadequate equipment.

Recently, almost half of healthcare professionals had to start urgent treatment before biomarkers were available. Around 1,000 cancers are diagnosed a day, but delays compromise timely treatment decisions, patient safety, access to targeted therapies and eligibility for time-sensitive clinical trials, while precious time is wasted by fragmented reporting pathways, poor IT interoperability and outdated laboratory information management systems, or LIMS.

Yet genomics is one of the major strategic transformational priorities for the NHS to improve cancer outcomes. Innovation in genomics is advancing very rapidly, and AI advances in analysing and interpreting large-scale sequencing data need digital infrastructure. Although many local pathology laboratories can deliver results within clinically useful timeframes, whole-genome sequencing at genomic laboratory hubs becomes essential for complex cases and inherited cancer syndromes. In addition, it supports research and new biomarker assay development when integrated with tissue pathology and imaging.

The NHS workforce plan, which we have already discussed, must consider training and workforce development in genomics and genetics, cellular pathology, clinical biochemistry, and molecular pathology; otherwise, a bottleneck in cancer and precision medicine pathways will continue to compromise cancer diagnosis and will eventually leave us with even worse outcomes.

Radiotherapy is crucial for cancer treatment. It is the second most widely used cancer treatment. It is needed by half of cancer patients and is key to 40% of cancer cures, and there is also palliative radiotherapy. Yet radiotherapy has the worst waiting times of the main cancer treatments, with significant inequalities in access. The latest NHS figures show that wait times for radiotherapy are far worse than for surgery or cancer drug treatments. Only 42% of patients receive their first radiotherapy treatment within 62 days. In some ICBs, this is as low as 10%, so only one in 10 patients receives their treatment on time—far away from the target of 85%.

Delays to radiotherapy are worse in the east of England, the Midlands and the north-east. Delays jeopardise survival. For some cancers, every four-week delay in treatment, as we have heard, brings a 10% increase in the risk of death. That is very serious. Government data shows that access to radiotherapy among lung cancer patients was as low as 11% in some areas. As the noble Baroness, Lady Pidgeon, said, the UK has only five radiotherapy linear accelerators per million people, compared with more than seven in France, Italy, and the Netherlands. International estimates suggest that 53% of cancer patients could benefit from radiotherapy, yet in England only 35% received it as part of their primary treatment.

Improving this requires a new approach. I, like everyone, welcome the national cancer plan, but a previous error in it highlights the need for this amendment. The cancer plan claimed that 28 replacement radiotherapy machines would enable an additional 27,500 patients to be treated annually, but the now corrected figure is for 27,500 treatments, not patients. Patients can receive dozens of treatments, so this could be a tenfold overestimate in capacity increase. It shows why radiotherapy expertise must be involved in policy, particularly horizon scanning advanced technology.

Radiotherapy services do not map neatly within ICB boundaries and operate within in the wider operational delivery networks. Most ICBs have no named lead, having only one or two radiotherapy centres in their area. So the ICBs lack the necessary specialist knowledge. Secretary of State support to ICBs would improve access to modern techniques, including stereotactic radiotherapy and proton beam therapy. The financial case is compelling.

Radiotherapy is our most cost-effective curative cancer treatment. A curative course costs around £3,000 to £7,000, and palliative treatment is a few hundred pounds. It accounts for just 7% of cancer expenditure in England, despite being second to surgery for cure rates. Radiotherapy investment makes clinical and economic sense for the treatment of cancer patients. We must improve. I suggest that these amendments are practical, complementary to the Government’s cancer plan, and essential.

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[Baroness Merron (Lab)]

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

[Baroness Pidgeon (LD)]

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

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

Amendment 41 withdrawn.

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Moved by

[Baroness Pidgeon]

42: After Clause 11, insert the following new Clause—
“Ministerial responsibility for social careIn section 1(3) of the National Health Service Act 2006 (ministerial responsibility to Parliament), after “service” insert “, and the promotion of social care,”.”Member's explanatory statement
This amendment would extend the Secretary of State’s ministerial responsibility to Parliament under section 1(3) of the National Health Service Act 2006 to the promotion of social care, alongside the provision of the health service.

[Baroness Pidgeon (LD)]

My Lords, I am moving Amendment 42 and speaking also to Amendment 44, in the name of my noble friend Lady Tyler, who is not in her place today. These amendments are both designed to make explicit in the legislation that the Secretary of State’s duty, in line with the ministerial title, embraces social care as well as health—the two being inextricably linked, as we have said so many times during the passage of this Bill.

Amendment 44 would extend the Secretary of State’s core duty in Section 1 of the National Health Service Act 2006 to cover social care, so that the duty matches the ministerial title. It also reflects Section 2 of the Health and Social Care (Reform) (Northern Ireland) Act 2009. Amendment 42 would extend the Secretary of State’s ministerial responsibility to Parliament under Section 1(3) of the National Health Service Act 2006 to the promotion of social care alongside the provision of the health service.

Let me just explain why we think that this is necessary and would send a really important signal. The amendments recognise the importance of ministerial responsibility at a time when power is being transferred back to the Secretary of State, with the abolition of NHS England.

These relatively small changes would signal acknowledgement of and respect for the growing number of people in England who need and will continue to need a well-supported social care system alongside a properly functioning NHS. The amendments would give legislative effect to the so-called

“new way of doing politics where we come together, face the challenge head on and build an integrated system that gives people security and dignity”,

announced by the Prime Minister when outlining his commitment to social care in July 2026. He also said explicitly that

“broken social care will in the end break the NHS”.

Correcting the mismatch and seeming imbalance between the ministerial title and duty would also help to ensure that the current momentum is sustained into future Parliaments and would not fall down the agenda again.

The background here, as I am sure many noble Lords will remember, is that the ministerial title was changed back in January 2018 as part of Theresa May’s Cabinet reshuffle. Jeremy Hunt went into Downing Street, amid all sorts of expectations that he might be moved on, and emerged an hour later with the enhanced title of Secretary of State for Health and Social Care—such is politics. However, let us make sure that the title and responsibilities fully match up and social care is given the important standing it needs alongside health. I beg to move the amendment.

[Baroness Watkins of Tavistock (CB)]

I have added my name to Amendments 42 and 44. I agree with the need for them, as outlined by the noble Baroness, Lady Pidgeon, on behalf of the noble Baroness, Lady Tyler, and will add only a few points. The health service is designed to prevent ill health, as well as providing services. Provision of high-quality social care reduces hospital care and provides respite to carers, as previously described on the first day in Committee on this Bill.

The Secretary of State for Health and Social Care has proposed a new special health authority to replace NHS England which, it is argued, will be a temporary measure. Earlier in Committee, I asked the Minister whether the Bill should be delayed to make adequate provision for the proposed revision of social care, which is to be initially detailed in the report of the noble Baroness, Lady Casey. If these amendments are supported in principle, this would prepare a path for further integration, where appropriate, of health and social care provision, and enable consideration of the metamorphosis of the special health authority to a new body—or possibly two bodies, depending on how we move forward on social care—to oversee areas in both health and social care services, particularly where they need to overlap.

Throughout our debate today, I have listened to various discussions about patients, but essentially the health service and social care are for the public. If we are to take health promotion and social care seriously, it should be feasible for service users to have real choice, not only in acute care but in mental health and physical health promotion, screening, prevention, deterioration prevention and, of course, where necessary, evidence-based health treatment, which is a vital end-process but should not in most cases be the beginning of the support that people have.

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[Baroness Pidgeon (LD)]

I thank the Minister for her response to this interesting debate. Of course, we know that the plans for social care are under development. We have the review by the noble Baroness, Lady Casey, and we have the interest from the Prime Minister, so we are in a state of flux. However, on the so-called cross-party talks, the leaders met in July, during the Summer Recess, and there is talk of further meetings, but I do not believe that any of them have happened yet. If we want cross-party work, it needs to be active rather than just words.

I heard what the Minister said about where the legal duties are around care, but I still did not really hear an answer as to why the Secretary of State’s core duty and ministerial responsibility could not be extended to cover social care if, as the noble Baroness, Lady Pitkeathley, said, we going to increase the status of social care and make sure that we are explicit about that responsibility, as the noble Lord, Lord Patel, said. I do not feel that the Minister has addressed that. We will consider whether we wish to bring this back on Report, but at this point I withdraw the amendment.

Amendment 42 withdrawn.

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[Baroness Janke (LD)]

My Lords, I thank the noble Baroness, Lady Coffey, for noticing my apparent absence and am happy to reassure her that I am here and in the flesh.

Amendments 63, 64 and 108 to 110 in my name underpin the importance of community pharmacies to local healthcare provision and the importance of maintaining continuity of the services that they provide —as well as reassurance for the pharmacy workers and residents. Pharmacies are the pillars of local healthcare and have become even more essential as waiting times for GP appointments have grown. However, the picture of local pharmacies is changing, as the noble Baroness, Lady Coffey, has said, for different reasons. More than 1,300 pharmacies have closed over the last decade and more are operating at a loss, leaving many communities risking a lack of access to a crucial front-line service.

Pharmacies, of course, are independent contractors, not public agencies, so the means of ensuring their continuation and continuity of care are perhaps going to be different. But, on this side, we feel that to maintain continuity of service in the light of the failure of local pharmacies, whether through financial or other difficulties, is essential. Amendments 63 and 108 would give stronger powers of intervention to ICBs when pharmacies are failing to provide their contractual services, whether through business failure or other reasons. They need to maintain their services, which are vital to their communities, and to address issues of availability of treatments and medicines.

Amendment 110 would require that staff be paid and protected during any intervention or remedial action that may take place in the operation of a pharmacy’s services. Staff do not need to lose confidence and leave what they see as an insecure situation, resulting in closure of the pharmacy through lack of staff. Amendment 109 would place an obligation on the Government and ICBs to support, in the event of failing, closed or disrupted pharmacies, new and independent pharmacies taking over to establish new relationships with pharmaceutical manufacturers and suppliers so that the continuity of the local service can be effectively maintained. Amendment 64 would require pharmacy funding to reflect the

“costs of providing services in rural and sparsely populated areas”.

These are often areas of low income, where the health of the local population is poor and pharmacy services are much needed, but where private pharmacy businesses have difficulty in being able to thrive.

These amendments are particularly relevant, as so many pharmacies are increasingly unable to sustain themselves as private businesses and changes to the operation of pharmaceutical services overtake them. These amendments, if accepted by the Government, would show a commitment to local pharmacies as essential providers of local healthcare and ensure that front-line services, which are very much in demand, are retained where and when they are particularly needed.

[Baroness Pidgeon (LD)]

My Lords, getting primary care right is absolutely crucial for our health service to work for patients and to ensure that neighbourhood health really delivers. Amendment 61 in my name would ensure that access to NHS sight tests remains nationally protected and is not subject to local variation once integrated care boards take on the commissioning of primary ophthalmic services. The national sight testing service remains the foundation of eyecare across the country and is one of the most effective public health services in the NHS. Primary eyecare in England provides more than 23.6 million appointments every year, covering sight tests, enhanced eyecare services and contact lens care.

Protecting vision means supporting people’s independence and safety, including from falls and accidents, and enables people to live well and work well. It is important, as raised by my noble friend Lord Scriven, for the needs of people with a learning disability. The national contract model is the most cost-efficient way of commissioning the service for the NHS. This is because the funding offered by the NHS, as we have already heard, does not come close to covering the cost of an eye test, and it is feared that any fragmentation of the commissioning route will only add more bureaucratic costs. This is a probing amendment, and I would be grateful if the Minister could confirm whether the national NHS sight testing service provided through this cost-effective national contract model will remain in place under the Bill. I also fully support Amendment 61A from the noble Baroness, Lady Gerada, on access to community-based, urgent and minor eyecare.

Amendment 218 in this group would give patients a new right in the NHS constitution to receive a GP appointment. Patients should be able to access primary care when they need it, and too many people across the country are forced to wait weeks for a GP appointment, only to see their condition deteriorate, which does ultimately place greater pressure on emergency departments and hospital services.

That is why these Benches are proposing a new right in the NHS constitution for patients to receive a GP appointment within seven days or within 24 hours if their need is urgent. This is not merely a target but a commitment to restore confidence in GP services and to ensure that timely access to primary care is recognised as a fundamental patient right.

General practice remains the front door to the NHS. Ensuring prompt access to a GP can lead to earlier diagnosis, more effective treatment and better management of long-term conditions, as we heard from the noble Baroness, Lady Gerada. Ultimately, it can reduce demand on overstretched hospitals. The amendment on continuity of care from the noble Baroness, Lady Neville-Rolfe, and supported by the noble Baroness, Lady Gerada, is really important to consider as part of the Bill.

My noble friend Lady Janke’s amendments on ensuring that community pharmacies are supported is important. Her challenge on the cost of medicines and how pharmacists are reimbursed is an important issue that was raised when the Public Services Committee looked at medicines security. I was quite astonished that pharmacies often provide medication at a loss; it is no wonder so many are going under. This group is really important, so I hope the Minister can assure the Committee.

[Earl Howe (Con)]

My Lords, this has been an illuminating discussion that has elicited some valuable contributions from across the Committee. I do not intend to add much to what other noble Lords have already argued so well, but I will underline how much I agree with my noble friend Lady Neville-Rolfe on all that she said about continuity of care. Continuity of care is something on which patients place enormous value, whether in primary care, in community settings or in hospital. My noble friend’s amendment rightly prompted a wider discussion about how we can strengthen those relationships across the health service.

At a time when many patients feel that their care is fragmented and impersonal, it is worth our looking closely at how the NHS can better support relationships between patients and the professionals who care for them. Continuity of care is not simply about patient satisfaction; as has been said, it undoubtedly contributes to better outcomes, often through earlier intervention and a more personalised experience of healthcare.

I have no doubt that the single patient record, when it is eventually rolled out, will be of huge benefit to the efforts of primary and secondary care clinicians to deliver seamless care to patients. However, the noble Baroness, Lady Gerada, was quite right: seamlessness of care is not the same as continuity of care. I agree with her and with my noble friend that, in this context, the more immediate focus for the NHS is that of primary care. More than 90% of patients’ direct experience of the health service is through primary care and, at the moment, many patients experience an NHS under increasing pressure.

The number of trained GPs has gone up over the last decade but, as we noted in an earlier debate, the number of full-time equivalent GPs has fallen. At the same time, despite GP practices employing more nurses, pharmacists and other healthcare professionals, the rise in patient demand has been unrelenting, especially in areas of the country that could fairly be described as underdoctored. These pressures make continuity of care particularly difficult to achieve within general practice. That is not to say that some GP practices do not still achieve it, but the demand curve does not look likely to flatten in the short or even medium term.