Health Bill

Baroness Watkins of Tavistock 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.

Health Bill

Baroness Watkins of Tavistock Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Pitkeathley (Lab)]

Noble Lords will not be surprised to know that I give my enthusiastic support to the amendments on unpaid carers in the name of the noble Baroness, Lady Tyler. As she clearly said, one of the great difficulties about the carers’ movement is that people do not identify themselves as carers. That is partly because you become a carer in different ways: sometimes it creeps up on you, and you start by doing your dad’s shopping and then gradually do more for him until you are in a caring situation; or your mum has a stroke and there you are, suddenly in the carer role. Either way, you do not prepare for it, you do not discuss it with anybody, and you certainly do not identify yourself as a carer. That is why having somebody else identify you is of huge importance, and the only way that you are going to identify yourself as a carer and therefore have access to any kind of services at all.

Ironically, although carers have rights with local authorities under various other Acts in the past, they have no rights as far as health services are concerned, and yet it will probably be with their GP that they make initial contact. We did at one point have a duty on GPs to identify carers, but, sadly, that fell by the wayside during a different Government.

Identifying carers should be a duty, to help them and to support that huge workforce. Similarly, that applies to promoting the health and well-being of carers, because, as we have heard, 72% of carers report a long-term condition compared with 60% of people who are not carers. They do not take care of and neglect their own health because they are too busy caring.

As ever with unpaid carers, there is an economic as well as a moral case for supporting them. Here we have this huge workforce of 5 million people providing care worth, as the noble Baroness reminded us, the equivalent of another health service. It is in everybody’s interest to keep them well and doing what they want to do—they do so lovingly and willingly, usually—and to support them as much as possible.

[Baroness Watkins of Tavistock (CB)]

I support the amendments in the name of the noble Baroness, Lady Tyler. I have little to add to what the noble Baronesses, Lady Tyler and Lady Pitkeathley, have said, except to say that, for young carers, regular respite is essential. That might be going to a club once a week, to get out of the house and maintain other connections outside of school, for example. We know how important that is in preventing mental health problems.

There is huge inequality. For three years, I was a carer for my mother, who had Alzheimer’s disease. When I had had enough, I could afford to pay, along with her, to put her into a really nice nursing home for two weeks—which is in fact where she ended up for the last eight months of her life. It is not difficult if you have the money to plan it, but there are lots of people who do not. I cannot emphasise that enough. It kept me well and, in her moments of lucidity, made my mother feel independent, since she was paying to give me a break. We need to think about how difficult it is for people who cannot do that.

Particularly for people with dementia, admiral nurses should be able to identify those carers who are in need of respite. For many people, two weeks may not be what they need; what they need is 24 hours, once a week. Again, the care home that my mother was in is now offering that, and managing to have three people twice a week. That enables other people to go off. I am pleased to say that some of the beds in that nursing home are now paid for by the local authority, so things may be a bit more equitable than they were then.

There is clear evidence that, if you give respite to foster carers, foster carers can go on. Let us learn from that and see how we can apply that to carers right across the country, but with a particular emphasis on those who cannot fund anything to help themselves.

Health Bill

Baroness Watkins of Tavistock Excerpts

Committee stage
Monday 9th November 2026 Lords Chamber

[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.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I will speak to the amendment in my name, which has been co-signed by the noble Lords, Lord Weir and Lord Blunkett. The new clause it proposes seeks to improve the collection and publication of dementia data through an annual report from the Secretary of State for Health and Social Care, bringing together data from across the dementia pathway and outlining progress towards targets and standards set out in any national plans. This is particularly timely, as the modern service framework for dementia and frailty is due for publication before the House rises for the next recess.

I welcome the development of a national framework for dementia and look forward to seeing the details when it is published. However, a framework alone will not create the much-needed change unless it is delivered on. This amendment would ensure that there is sufficient transparency so that this House and the other place can see where progress is being made and hold government to account in implementing the new modern service framework.

However, the amendment is much wider than simply measuring the progress of a national framework. For too long, dementia has been sidelined. In his investigation into NHS performance, the noble Lord, Lord Darzi, highlighted that there is an important challenge to improve the quality and quantity of care for people with dementia. I do not need to tell the House what a challenge this is. Dementia is the UK’s leading cause of death, according to experts, and the condition which the public fear most. Sadly, too many people still fall through the cracks. The impact extends far beyond individuals and families. Dementia touches every corner of our health and care system and probably the majority of our families.

The condition has significant impacts on our hospitals, GPs, A&E services, the workforce and our economy. Data is the key to unlocking progress in these areas and improving the quality and quantity of dementia care, as called for by the noble Lord, Lord Darzi. Data would provide Parliament, the people living with dementia and the public with a clear picture of how dementia services are performing, allowing us to understand where variations lie and where more attention is needed.

As several Governments have neglected to face this issue head-on, the scale of the challenge is immense. I welcome the action that our Government have taken on dementia to date but believe that data is the foundation to ensuring that these measures make a difference. Efforts to improve dementia research, develop a national care service or bring in new leadership through a dementia tsar are important steps forward in improving dementia care. I look forward to that national care service.

Without joined-up, comprehensive and transparent data, we cannot know where or how these measures have improved the lives of people living with the condition now and in the future. If we want to make a difference in tackling one of the greatest health and care challenges of our time, we must have the data to strengthen our approach. I thank the Alzheimer’s Society, Alzheimer’s Research UK and Dementia UK for their efforts to strengthen the Bill’s focus on dementia. I hope that my noble friend the Minister will recognise the opportunity that this amendment creates to make meaningful progress for the 1 million people living with the condition across the UK. She may regard this as a scoping amendment but, notwithstanding that, I look forward to hearing what she has to say and, on Report, she might table a government amendment to that effect.