Healthcare Services: Acute, Primary and Community

Baroness Pidgeon Excerpts

Thursday 25th June 2026 Lords Chamber

[Baroness Pidgeon (LD)]

My Lords, I am delighted to follow the noble Baroness, Lady Gerada, with her first-hand expertise and experience as a GP, and her description of the service that we all would like to see. I am grateful to my noble friend Lady Janke for introducing this vital debate. The relationship between acute services and primary care goes to the heart of how the health service that we value can survive and function. The noble Baroness, Lady Lane-Fox, rightly highlighted the need for the patient to be the focus, not the organisation, and she described the needs of serious trauma patients and the opportunities for technology. My noble friend Lady Brinton highlighted the need for patient-centred services and the whole person being at the heart of this.

The consequences of the deep imbalance between acute, primary and community health services are starkly visible in the data. NHS England discharge data from 2025 shows that patients who were medically fit to leave hospital spent the equivalent of 4.34 million days stuck in beds. They were there not because they needed acute care but because the community and social care that was needed to support them simply did not exist. My noble friend Lord Scriven provided the clear financial reality of acute services being prioritised, community services being reduced and the hollowing out of services for people with learning disabilities.

Let us look at dentistry. NHS England statistics published in 2025 show that four in 10 children—over 5 million in total—had not seen an NHS dentist in over a year. The Darzi review in 2024 found that only around 30% to 40% of NHS dental practices were accepting new child or adult registrations respectively. As my noble friend Lady Walmsley mentioned, official data from NHS England and the Royal College of Surgeons confirms that tooth decay remains one of the most common reasons for hospital admissions among young children in this country. The reality is that preventable dental disease generates acute demand. A child admitted to hospital with rotting teeth is a child whose primary care failed, not their acute care.

The noble Baroness, Lady Cass, brought her expertise in children and young people and questioned how the Government’s plans will really serve families better and bring the change that is needed.

We should look at some other trends in primary care. As we have heard, general practice is under extraordinary and unsustainable strain. Our GPs are the front line of defence, positioned precisely where they need to be to detect health issues early. They are the front door through which the public interact with our health service, and they need investment. If accessing a GP feels impossible, then public faith in the wider health service collapses entirely. My noble friend Lady Walmsley highlighted that the funding of primary care is not keeping up with demand, population and key areas of prevention work. The noble Baroness, Lady Gerada, talked passionately and rightly about how GP services have been left to wither and now have less than 8% of the budget.

As we have heard, according to the Association of Optometrists, access to community eye care services varies significantly across England. As a result, one in four people cannot access these services locally. Patients with common eye conditions are frequently directed to GPs, A&E or hospital eye services, even though they could be safely managed by community optometrists. At the same time, more than 600,000 people are waiting for hospital ophthalmology appointments, adding extra pressure to acute services. This just makes no sense, and it is patients who suffer.

In mental health, the picture is equally distressing. Thousands of children and adults are waiting months, sometimes years, to receive the support that they need. The previous Government left mental health services in a state, but the consequences of mental health being underresourced, and only triaged at the point of crisis, flow directly into acute services. Psychiatric presentations in A&Es, lengthy detentions under the Mental Health Act and ambulance callouts could have been avoided with earlier community intervention. They are the heavy downstream costs of failing to invest upstream.

Emergency departments are already bearing that cost. Department of Health and Social Care figures show that the Government have announced an average of £376 million in emergency winter funding annually, over the past seven years. This is patching up the system, year after year. That is not a sustainable health policy; it has become a bad habit.

The Royal College of Emergency Medicine has long called for staffed hospital beds, social care capacity and community step-down services. The Liberal Democrats have proposed a £1.5 billion plan to deliver 6,000 more beds daily, boost step-down care and enshrine in law the right to be seen in A&E within 12 hours. But let me be clear: beds alone will not solve this. Beds will fill up again, unless what lies beyond the hospital in home care, community services and general practice is also fit for purpose.

Social care sits at the very heart of this problem. Local Government Association figures for 2025 show that total local authority spending on social care reached a record £29.3 billion in 2024-25, up by £12.4 billion since 2015-16. Social care now accounts for up to 80% of many council budgets, putting immense strain on other services, yet the commission tasked with recommending long-term reform is not scheduled to complete its work for a further two years, with implementation potentially delayed until 2036. Those waiting for care, and those stranded in hospital beds for want of it, simply cannot wait that long.

My noble friend Lady Janke described powerfully the role of community pharmacies, which are a key part of primary care, and my noble friend Lady Leaman described the real impact of medicine shortages on children and young people, continuing into acute services. She also referenced the excellent report on medicines security from the Public Services Committee, which I recommend to the House.

This debate has not even touched on ambulance services, the key role that paramedics can play and the potential that they have, with a shift in resources, to help ensure that people are treated in the right place and at the right time, rather than at the critical point we have today. I recommend that noble Lords also read the latest publication from the Public Services Committee on this very topic.

The noble Lord, Lord Darzi, commented in his review of the NHS:

“Since at least 2006, and arguably for much longer, successive governments have promised to shift care away from hospitals and into the community. In practice, the reverse has happened. Both hospital expenditure and hospital staffing numbers have grown faster than the other parts of the NHS, while numbers in some of the key out-of-hospital components have declined”.


The King’s Fund also commented:

“When trying to envision the future of the health and care system in England, the difficult question to answer is not ‘What do we do?’—the vision for care has been outlined by multiple governments in countless policy documents—but ‘How do we actually make it happen?’”


I welcomed the commitment in the Government’s 10-year health plan to shift from hospital to community. It is the pace of change and the resources needed to support the rhetoric that will actually make it happen. Rebalancing an entire national health service requires rewiring funding, stabilising the workforce and completely integrating local services. If we all agree on the diagnosis, we need to work together to implement the long-term, radical changes needed to fix this. I look forward to the Minister’s response to this timely debate.