Health Bill

Baroness Royall of Blaisdon Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank the Minister for the meeting that she has arranged and for the progress we have made, and I hope that we will continue to do that as we debate this issue. However, I too am concerned about the costs and benefits in the timetable that is currently set out.

There are two questions that I want to ask. First, has the strategy—which I firmly believe in; we should move away from NHS England—been looked at against the NHS charter? I ask this because Principle 6 says:

“The NHS is committed to providing best value for taxpayers’ money. It is committed to providing the most effective, fair and sustainable use of finite resources. Public funds for healthcare will be devoted solely to the benefit of the people that the NHS serves”.


How much this is costing and when it will be paid back are fundamental in terms of the charter.

The charter also talks about staff rights, and although I am not working in the health service, I have many friends and colleagues who are. This feeling of uncertainty has been going on for 18 months, and I can say as a mental health nurse that one of the worst things for mental health promotion is uncertainty. This amendment really is important in trying to move us forward on the real timetable. Can the noble Baroness say whether there is, as some rumours are implying, a kind of back-pedalling? Now that we have asked the noble Baroness, Lady Casey, to move forward faster, are we trying to get to a point where we have some of the care service strategy in our mind? What could be worse than making a lot of very capable people redundant, and then needing to re-employ them? The costs to society and the taxpayer would be enormous. I just wanted to make those points, and I welcome what the Minister has to say.

[Baroness Royall of Blaisdon (Lab)]

My Lords, I agree that it is absolutely necessary to have clarity on the transition to the new system, and I add my voice to those noble Lords who have talked about the need for clarity for the staff. Successful reform, which we must have, both for patients and all staff, absolutely depends on retaining the expertise, experience and commitment of the staff. If we expect that commitment, we have to give them some security and knowledge of what will happen to their careers and their families—of whether they are going to be made redundant.

This is of course about the systems and cost, but it is also about the networks—the cancer network mentioned by my noble friend Lady Morgan. It is about the consultants, the doctors and nurses, and the people who keep the hospitals going: the cooks and cleaners, many of whom have been contracted out. Those contracts are bound to change as well. The clarity we are all asking my noble friend the Minister for is critical if we are going to ensure the success of this new enterprise.

[Lord Sentamu (CB)]

My Lords, first, I declare an interest in respect of my work with NHS England. I was appointed chair of the sickle cell and thalassaemia organisation, which was not easy work. We did not know whether the people who were coming to make their representations were from a particular trust or had the authority of the then chief executive of NHS England. It was not an easy job.

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[Baroness Royall of Blaisdon (Lab)]

My Lords, I am very pleased to support many of the amendments in this group, and I absolutely acknowledge that there is a difference between health inequalities and healthcare inequalities, but both need to be addressed. I shout out to my own GP practice, Chatfield Health Care, which is utterly brilliant and serves a very mixed economy. The noble Lord, Lord Patel, rightly said, in my view, that unless we address the issues pertaining to inequalities, then the healthy survival of the NHS is in question. Currently, I do not think that we are in a fit state to address the inequalities; this Bill is a golden opportunity to do that, and we absolutely must.

I go back to the Labour manifesto of 2024, which promised

“a fairer Britain, where everyone lives well for longer”.

It promised a shift to prevention and that Labour would halve the gap in HLE between richest and poorest regions through tackling the social determinants of health. This was followed up by the 10-year plan. Both of these have an excellent vision, but I fear that, too often, short-term pressures hinder long-term plans. I regret, for example, that the Mission Delivery Unit was disbanded and that long-term prevention no longer seems to be prioritised. That is why it is crucial that in this Bill we strengthen the duties on health inequalities.

I welcome the Government’s devolution agenda, about which we hear so much, including the English Devolution and Community Empowerment Act 2026 that we passed earlier this year, and the strong duty in that Act on strategic authorities to improve health and tackle health inequalities. The amendments before us today would place the equivalent duties on the Secretary of State for Health, with a requirement that Ministers across government have regard to them.

I agree that health inequalities should be addressed locally and that power being devolved to strategic authorities and local authorities will help enable those who are well placed to address the wider determinants. However, in a devolution-first world, the responsibilities and budgets of Whitehall departments mean that central government has a pivotal role and responsibility in addressing the many policies which have a profound impact on health that have been mentioned in this debate. Your Lordships supported and achieved parity of esteem for mental health, and the duty before us today would create a parity of esteem for prevention. It would be embedded as a shared goal across national, regional and local government. It is crucial.

The Government have made great progress in some areas, such as the smoke-free generation or ending the two-child limit. These changes will have a long-term benefit for health and reducing inequalities, but they do not represent a strategic across-government approach. In other areas, there have been good ambitions, such as a healthy food standard, but implementation has been slow and there have been loopholes. Such a patchy approach will not achieve health in all policies and will allow inequalities to keep widening. The approach must be across government.

As the noble Lord, Lord Patel, and my noble friend Lord Hunt said earlier, from 2000 to 2010 we made great progress thanks to that cross-government approach. Indeed, the Prime Minister was a part of that Government and in 2010 as Secretary of State he launched the Marmot review and subsequently made Greater Manchester the first Marmot city region. He has pledged to tackle regional inequality with good growth in every postcode, as we know, and to rewire the state in favour of prevention. We have heard many facts and figures today which demonstrate that this pledge must become a reality if our country is to fulfil its potential. I pay tribute in passing to Sir Michael Marmot, whose work is transformatory.

My noble friend might well speak of additional burdens, but she herself tabled amendments to the Health and Social Care Bill in 2022 requiring consultation and regular planning and reporting on the health and social care workforce. These amendments take a similar approach. They do not create a lot of processes. In fact, they codify what Ministers have already committed to but which is too often deprioritised. There are several precedents for creating accountability frameworks for cross-government agendas that are much more cumbersome, I would say, such as the Climate Change Act and the Child Poverty Act—not that they are not important; they certainly are.

My noble friend has certainly been in listening mode, and it is a pleasure to have interacted with her in so many meetings. I strongly urge her not just to listen to the arguments made this afternoon but to act and to amend the Bill so that we have a duty to address inequality and that it is done on a cross-departmental basis. It will make such a difference to the life and the health of the citizens of our country and consequently to the economics of our country.

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[Lord Lansley (Con)]

My Lords, I may be the first speaker not to have signed any of these amendments, but that does not mean that I do not agree with them; a great deal has been said with which I agree. The importance of this debate can hardly be overstated.

I just want to contribute one thought, which is that in taking all these issues and understanding how they relate to this Bill, we have to put it in the context of what is already in the National Health Service Act. I want very quickly to outline that.

The Bill before us is an improvement on what is in the NHS Act as far as the Secretary of State’s duties are concerned, because it extends the duty from equal access to healthcare services and facilities to seeking to reduce inequalities and securing equity in outcomes from healthcare services. That is what is in the Bill; I think that is a significant improvement. The Bill focuses at this point on what the National Health Service is doing to secure the prevention of illness and the promotion of successful treatment. It is not about the improvement of public health at that point.

The noble Baroness, Lady Tyler of Enfield, talked about the Bill transferring a duty to the Secretary of State. In fact, the NHS Act has the same duty on both the Secretary of State and NHS England: they are concurrent duties. Therefore, we are not transferring the duty; this is not part of a transfer from NHS England to the Secretary of State.

Under Section 2A of the NHS Act, the Secretary of State has a duty for the protection of public health, which are all those things to do with vaccination, immunisation, et cetera. Section 2B, which was inserted by the 2012 legislation, as my noble friend on the Front Bench will recall, inserted into the Act a duty as to the improvement of public health, and that is on both local authorities and the Secretary of State. It is not, I think, phrased as we would want it to be; more needs to be done to look at that.

I suggest—and this picks up the point made by the noble Baroness, Lady Royall of Blaisdon—that when we talk about wider determinants of health, we are looking at a strategy that relates not only to the Secretary of State—i.e. to the Government—but to local authorities, and she made that point very rightly. But it is in the NHS Act. Local authorities have a duty to improve public health in their area and take such appropriate steps as they can to achieve that, and the Secretary of State has such a duty to improve public health in Section 2B—unaffected, as I understand it, by this Bill. Therefore, when we come to look at it on Report, I hope that those who are thinking about how we might create the right strategy for the improvement of public health do not just think that it is done by attaching it to the responsibilities of the Secretary of State in relation to the NHS but also look at Section 2B.

[Baroness Royall of Blaisdon (Lab)]

My Lords, I am grateful to the noble Lord for giving way. I recently read Section 2B of the NHS Act. I think one would find that it states that local government and strategic authorities “must” improve health and reduce inequalities, but the Secretary of State only “may” improve health. I think that is very interesting to look at. Perhaps that is a wrong that we ought to right.

[Lord Lansley (Con)]

The noble Baroness is absolutely right: local authorities “must” take such steps as they consider appropriate; the Secretary of State “may” take such steps as they consider appropriate. I think I was right in saying—and she has illustrated it—that we can improve what is in Section 2B. I would just make the point that, when we come to Report, it is necessary not only to look at what is in this Bill but to look at how the improvement of public health is promoted through the NHS Act, including Sections 2A and 2B.

Health Bill

Baroness Royall of Blaisdon Excerpts

Committee stage
Monday 9th November 2026 Lords Chamber

[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.

[Baroness Royall of Blaisdon (Lab)]

My Lords, I fully support all the amendments in this group. Anecdotally, on radiotherapy, a friend of mine was a very senior consultant in radiography, and he was so frustrated by the system that he retired earlier than he might. He just gave up the battle; it was so very hard. Obviously, that was to the detriment of his patients, but he could not continue any longer.

I have one question on Amendment 228, about the number of days that people should wait for treatment post diagnosis—62 days seems far too long to me, so I urge noble Lords to make it much sooner than that, because that would save lives.

Amendment 233 is in my name. I am grateful to the noble Lord, Lord Mott, and the right reverend Prelate the Bishop of Manchester for adding their names, and to Prostate Cancer UK for its support. It is a fantastic charity. Prostate cancer, as I have said so many times, is the most common cancer in men in this country. More than 64,000 men are diagnosed every year, and around 12,000 die. It remains the most common cancer without a national screening programme, but, like all cancers, early diagnosis is key.