Health Bill

Baroness Tyler of Enfield Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, it is a great pleasure to follow the noble Baroness. As the noble Lord, Lord Patel, has already made very clear, this is a very important group of amendments: it gets to the nub of what we should be talking about for the NHS. If I am honest, quite a few of these amendments are calling for quite similar or interconnected things and outcomes. I do not mind too much how we get there, as long as we do.

I want to speak specifically to Amendment 18 in my name; I thank the noble Baronesses, Lady Royall, Lady Cass and Lady Lister, for adding their names. I will also briefly touch on Amendments 8 to 10, in the name of my noble friend Lady Walmsley, who, sadly, is unable to be in her place today, and to which my name is added. I will also speak—briefly, I hope—to Amendment 14 in the name of the noble Lord, Lord Patel of Bradford, who is also unable to be in his place; again, my name is attached. There are also other very important amendments in this group to which I am very sympathetic, in particular Amendment 20 in the name of my noble friend Lady Pidgeon.

The case is well known and has been well made already, so I will very briefly say why tackling health inequalities more effectively is so important. All the research shows that the nation’s health is under real strain. Analysis of healthy life expectancy internationally shows, sadly, that we are falling behind. We now have an 18-year gap in life expectancy between different postcodes in the UK. Of course, it is not just about health, important as that is to individuals, but about economics—what I like to call well-being economics. A nation cannot prosper while large parts of its population are having their lives cut short and while its most deprived communities are, on average, living only 52 years in good health. The number of people with a work-limiting health condition is rising, and poor health among young people is one of the drivers of the increasing number of 16 to 24 year-olds who are NEET—not in education, employment or training.

Before we get too despondent, if you flip it on its head, the good news is there is real potential for what I would call health-enabled growth. Modelling by the Health Foundation suggests that returning just to 2014 levels of health would see 600,000 people back in work, grow GDP by 2% and save the Treasury £70 billion nationally.

I think we all understand that health inequalities are driven not simply by how the NHS functions and operates but by wider social, economic and environmental factors, including poverty, poor-quality housing, lack of green space, poor working conditions and barriers to accessing affordable and nutritious food. I know that, if she were here, my noble friend Lady Walmsley would really want to emphasise that.

As others have already pointed out—the noble Lord, Lord Patel, made this point very strongly—there is a real opportunity to place in the Bill a stronger duty on the Secretary of State to improve health and reduce health inequalities, but that needs to be supported by a statutory framework for co-ordinated cross-government action and accountability. It is an overall package we need, if you like. Coupled with consistent joint working at national and local level, this could really support the shift that I think we all want to see from sickness to prevention. It is in the 10-year plan and the devolution agenda.

Health Bill

Baroness Tyler of Enfield Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I underline first of all what the noble Lord, Lord Hunt, said about how very less than ideal it is to be dealing with an important group of amendments of such sensitivity this late in the day, but we are where we are. I very much support the amendments put forward by the noble Lord. I remember clearly my personal anguish at not being able to visit my mother for a long time in her care home. It really was agony for me. What happened during Covid must never be allowed to happen again. I think of those care home residents who died without the love and support of any of their relatives by them. It is an absolute scandal. It is shocking. We must make sure it does not happen again.

My amendments are about unpaid carers and their relationship with the NHS. As we know, unpaid carers have very frequent contact with the NHS, but recognition and support for them can be very variable indeed. This Health Bill presents an important opportunity to place essential rights and support for unpaid carers in legislation for the first time, to bring them on a par with existing rights that carers already have in relation to local authorities. My amendments are designed to improve the identification, health and well-being of carers, as well as improving the provision of breaks, to which they should be entitled.

There are some 4.7 million unpaid carers in England, and the value of carer support is worth £152 billion in England alone. That happens to be about the same as the budget of the whole NHS. We have so many unpaid carers that they are holding the NHS together.

Turning to Amendment 88, on the duty to identify and record unpaid carers, the Care Act 2014 already places duties on local authorities relating to the identification of unpaid carers, but no equivalent duty exists for integrated care boards, which commission in the vast majority to health services. Unpaid carers are more likely to come into contact with health services earlier than they are with local authorities, and there is evidence of significant underidentification of unpaid carers within the NHS. Analysis by the Nuffield Trust of 13 million GP records found that for every one carer identified by GP practices, four were not, meaning around 1 million carers were effectively missing from GP records. So, there are real problems with identification rates, which are compounded by the fact that more carers are identified in affluent areas than in deprived areas.

There are many cogent reasons why identification is important. For example, public health measures can be targeted at unpaid carers, such as free flu vaccinations and assessments for common health problems. Winter pressures on the NHS can be alleviated with targeted support and advice for unpaid carers, and of course, inclusion of unpaid carers in hospital discharge planning could help to reduce avoidable readmissions. That is just to name but three.

The last key point I will make here is that, ironically, unpaid carers can take a long time to identify themselves and understand that they are carers. In fact, some research I saw said that for some 36%, it took up to three years to understand they were a carer. Without a statutory duty, I fear that identification of carers will continue to depend on local priorities and resources. While some areas have excellent systems, others identify very few carers. A statutory duty here would introduce much greater consistency.

Amendment 89 would place a duty on ICBs to promote the health and well-being of carers. I think we all know that unpaid carers consistently experience poorer physical and mental health outcomes than non-carers: they just forget and neglect their own health needs. I have just one statistic here: the GP Patient Survey 2025 found that 72% of carers reported a long-term condition or disability, compared with 60% of non-carers. Many carers are just not able to prioritise their own health. Most tellingly, Carers Week research from last year found that 40% of current carers said they had postponed or cancelled a medical appointment, test, scan, treatment or therapy because of caring. That is an estimated 4.8 million people. My final point here is that ICBs rely heavily on unpaid carers to keep people well at home and reduce hospital admissions. Therefore, supporting carers’ health, I maintain, is vital to NHS sustainability.

Finally, my Amendments 175 and 176 are about a right to a break for unpaid carers and a national respite scheme, and I very much thank other noble Lords who have added their names to these amendments, and to all my amendments in this group. These two amendments essentially do the same thing: they ensure that carers who are assessed as being entitled to a break actually receive one, because although many carers in England are entitled to this assessment under the Care Act, many assessments just do not result in meaningful breaks or replacement care. There are many statistics here, but I will mention just one: official data from 2023-24 shows that only 8% of all unpaid carers were assessed or supported by their local authority, which is a shockingly low figure. Unsurprisingly, carers describe severe exhaustion, burnout, isolation and worsening mental health resulting from being unable to step away from these caring responsibilities.

Local flexibility in the delivery of breaks has too often resulted in inconsistency and postcode variation. Whether an unpaid carer can access a meaningful break should not depend on where they live or the financial pressures facing their local authority. That is why Amendment 176 also establishes a requirement for the Secretary of State to provide financial assistance to deliver this. There was much more I wanted to say, but the time is very late.

Health Bill

Baroness Tyler of Enfield Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Lord Patel (CB)]

My Lords, I strongly support the amendment in the name of the noble Baroness, Lady Shawcross-Wolfson, and I have added my name to it. She spoke so eloquently and made her case so strongly that I have put aside what I have written down because it would have been a repetition of what she had already said. I am going to take a slightly different tack but make the same point.

The noble Baroness quite rightly linked education, training and workforce planning. You have to know what workforce you might require for the health service you plan to have. I guess one can say that the Government’s 10-year health plan and the 10-year cancer care plan outline the kind of health service that the Government wish to see develop over the next 10 years. If that is the case, we need to address what kind of training and education and what kind of people we will need to deliver that plan.

I am guessing now that the reason why the 10-year workforce plan is delayed is because the premise on which it was to be formulated was that technology such as AI and digital technology would free a lot of clinical time, and hence the headcount need not be so high. That is a false assumption. It is false because we need to train people to use AI and digital technologies. The assessment is that, if you use these technologies, you might free about 40 minutes a day for front-line clinicians. With the pressure that the NHS now faces and the needs of the workforce it now faces, that time will be used to deliver better care to patients, particularly as the 10-year health plan identifies that technologies such as genomics and personalised medicine will be the way healthcare will go. There is an ambition by 2040 to have 50% of patients with some idea of their genomics, and the treatment is therefore based on that.

If you add all these together, and the Secretary of State now has responsibility for education, training and workforce planning, you ask the question: why is the workforce plan delayed? It is delayed because maybe the penny has dropped that, if you do not count the numbers and do not present a case about how technologies will reduce front-line clinical time, then you cannot plan the workforce.

Furthermore, I wonder whether the Bailie review of productivity in the NHS is based on the premise that greater productivity will be delivered in the NHS because of using technologies such as AI and digital technologies. We do not know that that will happen, but we have to wait until the Bailie review comes out. I wonder whether that is another reason—the Minister might comment on that—why the workforce plan is delayed.

It might be political pressures, it might be fiscal pressures or it might be the pressures from not knowing how to get the workforce numbers that we would require to deliver the 10-year plan and the cancer care plan that are holding up workforce planning. However, as the noble Baroness, Lady Shawcross-Wolfson, pointed out, if we do not have a plan, things will get worse. We will introduce technology, which will not be across the board, and we will then look for workforce that is not trained to deliver it. I hope the Minister will give us some answers about where we are going.

[Baroness Tyler of Enfield (LD)]

My Lords, I was very pleased to add my name to the two amendments tabled by the noble Baroness, Lady Hollins, Amendments 92 and 252, regarding the mental health workforce. More generally, I was very taken by the way this important group of amendments was introduced by the noble Baroness, Lady Shawcross-Wolfson, because she is right that all the things that we have been talking about in this Bill so far—all the things we all want to see to improve the health of this country, and all the things we want the NHS to be able to do with, yes, efficiency and increased productivity but also with great care and compassion—will none of them be achieved unless we have the right workforce with the right skills and the education and training in place. That is why I think this is such an important group of amendments.

As I said, I was very pleased to add my name to the two amendments tabled by the noble Baroness, Lady Hollins, on the mental health workforce. She set out the case clearly, so I do not need to do it again. I simply reiterate that, once we have the long-awaited NHS workforce plan, this will be vital. I would be grateful if the Minister could make some commitment here about how quickly we will see a follow-up mental health workforce plan. We need to see some detail about how the mental health workforce will be recruited and retained and will be able to meet the scale of the mental health demand, which we have debated so many times on so many occasions. That is critical. Both those amendments are important in that respect.

My final point is that, during the passage of the Mental Health Bill, in which many noble Lords here were involved, we all quite rightly thought how important it was that as many mental health services as possible should be located in the community. We all agreed with that; it was the premise, as it were, on which the rest of that legislation was built. As important as the consultants and psychiatrists and so on are—of course they are; it is a wide-ranging workforce and includes mental health nurses and others as well—unless we have that workforce in the right place, in the community, appropriately skilled, educated and trained, we will never be able to deliver those community mental health services, which are so vital. So I was very pleased to support these amendments.

[Lord Kakkar (CB)]

My Lords, I support the amendment in the name of the noble Baroness, Lady Shawcross-Wolfson. It is an important amendment raising two fundamental questions, which I hope the Minister will be able to answer. The first is this: ultimately, in preparing a workforce plan that will enjoy broad confidence, there must be external scrutiny of that plan. It would be most helpful if the Minister could confirm how His Majesty’s Government’s healthcare workforce plan will be independently scrutinised. Also, how will His Majesty’s Government be able to reconcile potential differences generated as part of that independent scrutiny with what they consider to be deliverable at this particular moment in time?

The second issue is how a mechanism will be secured—now that the functions independently exercised in NHS England will become the responsibility of the Secretary of State for Health—in respect of long-term workforce needs and short-term financial pressures. As we have heard, investment in the workforce is a long-term investment, and Ministers will always be faced with short-term financial problems and crises. Historically in the NHS, the education and training budget has been periodically sacrificed when there have been other service, access and delivery demands on NHS institutions.

In providing an opportunity now with this Bill, how will the Government address that fundamental tension and secure a mechanism both for independent scrutiny and to ensure—with all the powers now lying in the hands of the Secretary of State for Health—that the education and training budget that secures the long-term development of the workforce cannot be sacrificed for short-term exigencies?