Health Bill

Baroness Scott of Needham Market Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Baroness Scott of Needham Market (LD)]

My Lords, I have tabled Amendment 65 to Clause 15 on the topic of accessible patient involvement. It seeks to ensure that the arrangements for involving patients in commissioning decisions are accessible to those living with long-term, complex or fluctuating health conditions. I welcome the Government’s decision to retain and strengthen Healthwatch England and local Healthwatch organisations. It is an important recognition of the value of independent patient voice, and I am pleased that Ministers have listened to the concerns raised across both Houses and beyond. However, retaining that independent patient representation is only part of the picture. We must also ensure that the mechanisms through which patients are consulted and involved in the decisions which affect their care are genuinely accessible.

I take a close interest in ME. I have a family member with it and I am a member of the all-party group. For people living with severe or very severe ME, conventional forms of consultation can be extremely difficult and quite often impossible. Attending meetings, participating in lengthy phone calls or completing detailed questionnaires can worsen some symptoms considerably. I have spoken about ME, but there are many other conditions for which the same can be said. If patient involvement arrangements are not designed with these limitations in mind, there is a real risk that those people with the greatest need will have the least opportunity to influence the services which should be supporting them.

This concern is particularly relevant given the evidence of poor access to services now. Action for ME’s 2026 big survey gathered responses from more than 5,000 people living with ME and long Covid. They found that 83% of respondents reported barriers to accessing NHS ME services. I was also struck by the large number in the survey who were not able to access any kind of healthcare at all, including routine screening. This is totally unacceptable. We cannot expect services to meet the needs of these patients if they are effectively excluded from the decisions about how those services are designed and commissioned.

My amendment is very modest. It would require the Secretary of State to take reasonable steps to ensure that patient involvement arrangements are accessible and inclusive, with particular regard to disabled people and those with long-term, complex or fluctuating conditions. This could mean greater flexibility in how people contribute and how they are consulted. It needs to recognise the particular circumstances in which patients can participate. It will require a little imagination and quite a lot of empathy, but it ought to be possible. I would therefore welcome the Minister’s assurance that these patients will not be overlooked in the Government’s arrangements for patient involvement and ask whether she would consider putting something in the guidance to make sure that it happens.

[Lord Scriven (LD)]

It is a pleasure to follow my noble friend. I want to come back to the points that the noble Lord, Lord Hunt, made. I believe we are coming to a point in this Bill for us to make reasonable amendments and suggestions. Either we can continue to go down the road without the detail and let the service reorganise itself, or we can start to get some serious detail, particularly regarding specialised commissioning and the capacity of ICBs.

Just to understand, there are about 154 specialised services that are commissioned. Already, around 70 of those are commissioned via ICBs under delegated direction from NHS England, and the rest are commissioned centrally by NHS England. What the Government are asking is for the cuts to be made to staff, for the staff to go, and then for the detailed skills and knowledge that are required for the specialised commissioning to come after that process. The National Audit Office has put out a report which questions, even on existing duties, whether ICBs have the skills, knowledge and breadth to carry out what the Government want.

With these extra services, it could be that ICBs, the delegated strategic commissioners, cannot commission what Government wish them to commission. The noble Lord, Lord Hunt, and I both got quite cross with the then Minister, the noble Lord, Lord Kamall, during the passage of the 2022 Act, that things were happening in the system before Parliament had made the decision. That is what is beginning to happen again; things are happening. The offices for pan-ICB commissioning are not new; they were asked to be determined in April 2026. They were in the impact assessment for the abolition of NHS England, so they are already known about. The key issue is: what services are they going to have to give a joint response for? Will we have the list of specialised commissioning services carried out by ICBs and the Secretary of State by Report? Is that a commitment the Minister can give? If not, we cannot make a reasonable decision on Report about specialised commissioning with the depth and breadth of knowledge that is required. Can the Minister give us that commitment?

As the offices for pan-ICB commissioning—OPICs—were selected in April, can the Minister commit to giving us their duties and the budgets they will have, or will be able to direct, in writing before Report? What powers of direction will the Secretary of State have for consistency of ICB specialised commissioning, and can those be with us by Report? These are important questions that need to be answered because, if not, we will be getting to Report, being asked to support specialised commissioning with two bodies—the Secretary of State and ICBs—and, particularly for ICBs, we will not know whether they have the capacity to do it. I do not think that this House will be able to make a decision about whether it is reasonable, safe or justified for us to continue suggesting that this is a route for ICBs to commission.