Health Bill

Lord Crisp Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Lord Crisp (CB)]

My Lords, I have been resisting the temptation to get involved in this debate, partly because I was not able to join the Second Reading debate, and I apologise for speaking now, having not done that. I start by making just one point, which is that at the beginning of this century, I was running both the NHS and the Department of Health. I had the two jobs, so I have seen some of what we are talking about from inside. I think some of it was extremely successful. On the point about regional offices, there are some models that I am quite sure can be followed.

The reason I stood up is that the noble Lord, Lord Mawson, spoke about prevention. What I realised when I was running the Department of Health is that, with a hospital management background, I had turned it into the department of the NHS, and we had lost some of our health focus. The future is about health, not just about healthcare. We have to focus not just on prevention but on creating health and the conditions to be healthy. I am not going to get into a Second Reading speech, but I want to ask how the Government are going to preserve the proper role of the Department of Health when it gets all this responsibility for the NHS.

The NHS, on which I speak as a former chief executive, runs 24 hours. You get contacted all the time. How will the important responsibility of leadership for health across government be managed? As the noble Lord, Lord Mawson, said, 80% is about housing, employment and the environment. The health system provides the other 20%, and I have to say it is a vital 20%—if you have a nasty cancer or your leg has just fallen off or something, you need that. My question to the Minister is, how are the Government going to preserve the proper responsibility of the Department of Health for all the health functions, as opposed to the NHS functions?

[Baroness Campbell of Surbiton (CB)]

My Lords, I had not intended to speak in this debate, but I have been listening very closely, and I think what is missing is what happens to people at the grass roots—patients who rely on their ICBs to behave and do the right thing in terms of their care and support. When I heard that NHS England was going to shut down, I have to say that my heart went in my boots. That is because I have been working with certain departments to look at ways that we can deliver NHS personal health budgets, from when they were first conceived to now. There was an awful lot of organisational expertise, memory, support and guidance from what was then NHS England to local ICBs across the country. In doing so, personal health budgets became a good way of delivering personalised care at home for people with complex impairments. I should probably declare an interest because I have been negotiating with my ICB for about 15 years. It is not easy. What I worry about in the transition is that we do not have a plan for what is going to happen to the people in NHS England who have all that expertise, history and know-how in supporting ICBs to deliver their support to complex patients in the community in the future.

I am afraid I am not that positive, because in the last two years, since we heard that ICBs were going to make 50% savings, ICBs have been behaving quite oddly towards people with complex and sometimes expensive care in the community. They are institutionalising them even though they were supported in their own homes quite happily; for example, doing their degrees. They are restricting where you can go with your personal health budget and PA and even whether you can be outside the home, because they have told me that it is unsafe. Something odd has been in the air since we knew that NHS England was going. I believe that there were only four people left in the department supporting those ICBs with their delivery and, quite frankly, they are going backwards. I would be keen to have a plan about what is going to happen when NHS England goes. Who is going to do this work? ICBs need ongoing guidance in this area. They do not have the expertise locally, but someone has to do it.