Health Bill

Earl Howe Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Baroness Pidgeon (LD)]

My Lords, this has been a really interesting and important debate, trying to tease out many of the issues and concerns with specialist commissioning in the new structures set out in the Bill, and the worries about ICBs—their capability and capacity—and the access to services across the country.

I have two amendments in this group, which I will try to talk to briefly. Amendment 59, to which the noble Baroness, Lady Cass, and the noble Lord, Lord Hunt of Kings Heath, have added their names, seeks to require the Secretary of State to have regard to the specific needs of children and young people when considering devolving responsibility for specialist commissioning services. This has wide support across the sector.

Children and young people make up around 20% of the overall population. Therefore, commissioning arrangements designed at a scale for adults just do not work for the small scale required to be effective for children. Many children are dependent on specialist commissioning, and it is essential for the provision of care for rare diseases and complex conditions, such as childhood cancers. Children are disproportionately affected by rare diseases: 75% manifest in children. The benefits of specialist commissioning being centralised and co-ordinated at a national level are clear, given the small number of patients.

The Health Bill’s direction to split commissioning is of huge concern. There is huge uncertainty out there. We have been in this position before because specialist commissioning, as was mentioned earlier, had been devolved to primary care trusts. They experienced many of the concerns that have been raised today. The previous report by the noble Lord, Lord Carter, recommended that specialist commissioning should be overseen at a national level. We need to learn the lessons from this and not repeat the same mistakes. I hope that before any delegated arrangements are made for children and young people’s specialised services, full consideration is given to the impact on those services.

The other amendment I have in this group is Amendment 279N. I still cannot believe that access to IVF treatment is not equal across the country. Your chance of being able to have a baby is decided by NHS bureaucracy and where you live, rather than clinical guidance and your health. You can have people living in roads next to each other and they can have one round of IVF or three rounds of IVF, despite NICE having recommended three rounds of IVF. We have seen the provision continuing to be reduced. Kent and Medway cut its services earlier this year from two to one and also lowered the age when someone can have treatment from under 40 to under 38. Sussex slashed its services last year from three cycles to one, and now all 10 boroughs in Greater Manchester are reduced to one. Only two of the 38 ICBs offer the NICE-recommended number of three cycles of IVF. Fertility challenges affect one in six people. The physical and psychological impact is huge.

I know the Minister is hearing all our concerns that we keep raising throughout the Bill. I do not feel we are getting much back from the Minister. But surely this is one area where there might be some movement. I urge the Government to look carefully at this and the other amendments in this group. I look forward to the Minister’s response.

[Earl Howe (Con)]

My Lords, I start by welcoming Amendment 54, as tabled by my noble friend Lord Lansley. It raises an important concern about eligibility for NHS continuing care. Someone suffering from a serious chronic condition, including severe dementia, should not find themselves disadvantaged in comparison with someone with terminal cancer simply because their condition fluctuates or because they are not considered to be approaching the end of life. Eligibility should be determined by the intensity and complexity of a person’s needs rather than by arbitrary distinctions. Having said that, and while the concept of continuing care is one that we can all embrace, its quality and delivery, as the noble Baroness, Lady Barker, so succinctly reminded us, often fall far short of the ideal. Can the Minister therefore say whether the Government will consider making the existing eligibility framework more responsive to the patients that my noble friend described?

I also welcome my noble friend Lord Harlech’s Amendment 279QE. Recognising the particular medical and dental fitness requirements of reservists is a sensible and clearly proportionate measure. The amendment does not displace the key principle, as he explained, that clinical need must remain paramount in this context. Can the Minister explain how the Government currently expect health bodies to recognise the particular circumstances of reservists and whether further guidance might be necessary?

This debate has been characterised by a consistent measure of concern around commissioning. We have seen this through Amendments 57, 59 and 73, as tabled by the noble Baronesses, Lady Grey-Thompson and Lady Pidgeon, who are seeking greater transparency through impact assessments and reporting requirements, particularly where specialised services are transferred to ICBs.

The noble Lord, Lord Hunt of Kings Heath, in Amendment 58, similarly highlights allergy provision. All this argues for Amendment 80, as tabled by the noble Baroness, Lady Grey-Thompson, which seeks greater scrutiny of the performance of ICBs.

As a significant number of the amendments in this group highlight, including those from the noble Baroness, Lady Scott of Needham Market, and the noble Lord, Lord Sharkey, there is concern that the Secretary of State, with so many priorities, will be unable to provide acceptable standards for certain groups. Accountability and consistency of standards cannot just be taken as a given or as things that will come out magically in the wash. It would be helpful if the Minister could explain to the Committee how the Government intend to reconcile these objectives.

In particular, where specialised commissioning is transferred to ICBs, who will be responsible for ensuring that the necessary commissioning capacity and expertise will be in place? Amendment 74, from the noble Lord, Lord Sharkey, and my noble friends Lady Sater and Lady Chisholm, asks a corresponding and equally important question around clinical leadership. As the noble Lord, Lord Scriven, expressed so well, the amendments in this group demonstrate the complexity of the decisions involved in commissioning healthcare, particularly for specialised services. I do think that further and better particulars are required from the Government before any of us can feel comfortable with the direction in which we are heading.

[Baroness Merron (Lab)]

My Lords, I am most grateful for this debate. I will endeavour to pick up most of the main points, but if I do not manage to do that, given the hour, I will of course be pleased to review the points raised and pick them up—in particular, looking at how I could be more helpful in providing some of the broader information that is being sought.

Perhaps I could start by emphasising that the whole point about the Bill is that Ministers are, of course, responsible to Parliament for how they discharge all their duties, including how they promote the comprehensive health service that we all seek and how we reduce health inequalities in access and outcomes.

The regulations prescribing the services retained for national commissioning will be subject to parliamentary approval. I assure your Lordships’ Committee that, in putting forward the regulations, Ministers have to have regard to patient numbers, provision costs and the number of providers, because they all relate to safety, effectiveness and value for money of commissioning at various different tiers.