Health Bill

Lord Hunt of Kings Heath Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I welcome the amendment from the noble Earl, Lord Howe, because it enables us to go to the core of what this legislation is all about. Light-touch amendment it is not, but I think it goes to the heart of what we need to talk about.

As I said at Second Reading, I really welcome bringing NHS England essentially into the department. It restores ministerial accountability to Parliament and, for a £200 billion service, that is very important. Essentially, it seems to me that we are going back to a 1948 Bevanite model of the NHS. Of course, we do not recall his dictum, but it is very famous—that when a bucket of slops is kicked over by a maid in hospital in Tredegar, its echo should sound in the corridors of Whitehall. Bevan also said at the time, because of course he backed off Morrison, who wanted local government to control the NHS, that he wanted lots of decisions to be made locally through the hospital management committees and regional hospital boards that were set up. Of course, the moment it started, the Ministry of Health, as it then was, started to issue circular after circular. That is perhaps an inevitability of the way you get there, when you have a national health service funded simply through taxation.

There are some genuine issues around the relationship between the centre and the local National Health Service which we need to tease out. We had a round table at which the chief executive of the NHS Alliance spoke about the concern that the alliance has that integrated care boards will find that their room for manoeuvre is very limited. One response to that is that ICBs’ accountability was solely going to be to the centre. The Government’s decision to keep Healthwatch is very important in terms of having more local accountability—that is why it is so welcome. I know that noble Lords are concerned about Ministers taking over responsibility for the appointment of chairs and non-executives, but I think that we should also keep councils of governors of foundation trusts. They are local people, elected by members of those trusts, who do the current round of appointments. We will come to this later on in our debate on Clause 30. I am really looking for the Government to look at this again.

There are some real issues about the future relationship of the centre to the locality. I commend the brief that we have had from the King’s Fund, which poses some key questions. What should the boundary be between legitimate national oversight and routine operational management? What would prevent this broad power becoming a mechanism for day-to-day management from Whitehall? How will you deal with bottlenecks, and the practical risk that moving a large number of functions and decisions towards the Secretary of State could slow the NHS down rather than speed decisions up, particularly around the appointment of chairs and non-executives? Which of the Secretary of State’s most consequential intervention powers will be subject to intervention, advice or scrutiny? In what circumstances would Ministers expect to intervene in local service reconfiguration? What safeguards will ensure decisions that are often best made locally and on clinical grounds? How is the greater role for local government and mayors to operate alongside stronger central powers and require the Secretary of State to have regard to local decision-making? What statutory safeguards will there be in relation to the powers of the Secretary of State to appoint, suspend or remove the chair and other non-executive directors? For the Secretary of State’s most consequential intervention powers, is there a case for putting relevant decision-making criteria on the face of the Bill?

I do not know the answer to that, but I think that, by Report, it would be helpful if my noble friend could explain in a little detail how the Government think the new arrangements are going to work and how you will prevent unnecessary micromanagement from the centre.

[Lord Kakkar (CB)]

My Lords, I have added my name to the amendment in the name of the noble Lord, Lord Kamall, and the noble Earl, Lord Howe. In so doing, I remind noble Lords of my own declared interests, as chairman of King’s Health Partners and the King’s Fund.

I believe this to be a very important amendment and fundamental to the purpose of the Bill. Your Lordships’ House has taken, quite appropriately, the explanation, reassurances and logic behind the abolition of NHS England provided by the Minister at Second Reading. As the report commissioned by His Majesty’s Government identified very clearly, further reorganisation on a major scale of the NHS should have, at all costs, been avoided, as noted by the noble Earl, Lord Howe. There are clearly in the Government’s mind important reasons why this reorganisation must proceed, and it is important for your Lordships to respect that. It is a fundamental element of His Majesty’s Government’s policy.

However, in proceeding down this route, the other side of the coin is that His Majesty’s Government must be clear, and provide reassurance about the implications, both in the period of transition and thereafter, with regard to the important functions that have sat in NHS England and will now be brought back under central Secretary of State control. We have heard a number of those, and it would be interesting if the Minister could explain to your Lordships how the transitional arrangements that are going to be applied will reflect the ultimate structure of the newly defined function for delivering NHS England within the Department of Health and Social Care. For instance, how will the Secretary of State powers be exercised? What degree of delegation is there going to be? How will that be reflected in the transitional arrangements?

In terms of the broader government agenda with regard to devolution to a local level, is it consistent to have brought all these powers centrally and then expect, within a reasonable time period, proper devolved scrutiny and determination of local health needs to be reflected in the delivery of the NHS? What will be the arrangements for the operational management of the NHS in the intervening period between now and the final adoption of all measures? How is that going to work? What is happening at the moment? Is the Minister content that in the many issues on which there is, or has been, granular oversight within NHS England and its regional structures, that that kind of oversight is being, and will be, delivered in these transitional arrangements?

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[Lord Scriven (LD)]

My Lords, I thank noble Lords who have spoken in this rather revealing debate. I particularly thank the noble Earl, Lord Howe, for introducing this amendment in his normal calm and measured way. Importantly, he has given us all the chance to ask the most basic question of the Bill: where is the plan? It is pleasing that the Minister and the Government have been in listening mode, particularly regarding the Health Services Safety Investigations Body and Healthwatch. I hope that during Committee the Government will continue to listen and make other important changes to the Bill.

At Second Reading, I said the Bill was a power grab. The Nuffield Trust’s October briefing for this Committee puts it more politely. It describes new powers for the Secretary of State as being well beyond those that NHS England holds, which it says enables “more political control” and limits real devolution. The Government are entitled to decide whether they want NHS England’s functions in the department, under political hands. We on these Benches would caution on that, but the Nuffield Trust accepts that some duplication between the department and NHS England is real; the Minister must specify exactly what that duplication is. But if that is the aim, it has to be planned and costed.

I would also caution the noble Lord, Lord Hunt of Kings Heath, and the noble Baroness, Lady Harding, for suggesting that putting NHS England’s functions in the department will bring accountability to the Secretary of State. When we get to Clause 11, we may see that the accountability is missing but the powers are about to be transferred.

Noble Lords will know the architect’s maxim that form follows function, but not here—

[Lord Hunt of Kings Heath (Lab)]

Is the point not that at the moment, parliamentarians can raise issues with Ministers only to be told that something is the responsibility of NHS England? I accept what the noble Lord says about how this is going to work but, ultimately, now the finger is absolutely pointed at Ministers for everything that happens.

[Lord Scriven (LD)]

When we get to Clause 11, the noble Lord, Lord Hunt, will see that some of the powers that the Secretary of State now takes, beyond NHS England, will not come before this Parliament. They will just be at the signature of the Secretary of State’s pen.

In this Bill, form comes first and function will follow in due course. We have the demolition notice but are still to see the drawings of the new structure. Let me say how far behind the Government are. The Nuffield Trust, working with the Institute for Government, compared past public sector reforms and NHS abolitions. It found that the key factors for success are not in place here. The abolition was announced without plans to explain its goals to staff and without redundancy funding, which led to months of delay. Detailed planning for the new department began only in early 2026, almost a year after the announcement. Nuffield’s verdict is that the process has been “poorly handled”.

We are still short of very basic information. At Second Reading and in this Committee, the noble Lord, Lord Stevens, who I admit must know something about running the NHS, pointed out that the costs and benefits in the impact assessment are still marked as “not available”. There are also still a number of questions about the timing of when this reform will come in. We have the Government’s estimates that redundancy exits—across the department and NHS England, ICBs and the commissioning support units—will cost between £1 billion and £1.3 billion, to be met from existing allocations, but we must ask which allocations. Which services pay?

Then there is the timetable. On 15 October the Health Service Journal reported that abolition will have to be formally delayed beyond April 2027 unless decisions on future national structures are made within days. Have those decisions been made? Are staff now aware of where they will be transferred? The new operating model has been waiting for ministerial sign-off for months. Ministers are still weighing whether thousands of staff will go to the department or potentially, as we read, into a new stand-alone agency. This Bill sends nearly every function of NHS England to the Secretary of State, yet the Government have not decided where the people who will perform those functions will sit. The department says that it continues to plan for 1 April 2027, but planning a date is not the same as being able to meet it.

The planned 50% job cuts in the department appear to require moving the large majority of central policy and analytical staff. Or is it about cutting operational staff? As the noble Lord, Lord Crisp, said, we need clarity about which staff and which functions will be in the department. It is not clear that the figure is rested on rigorous assessment of who is needed and why. History tells us how this ends: after previous reforms that moved managers from commissioning bodies, the department consultancy spend peaked at over £600 million a year and the number of managers within five years was higher than going into the reorganisation. I fear that this will be another case of “cut first, rehire later and call it efficiency”.

As the noble Earl, Lord Howe, has said, we need not simply rely on the words of noble Lords in this debate. The Darzi review, commissioned by the Government and updated in May, concluded that a top-down reorganisation of NHS England and ICBs is “neither necessary nor desirable” and added:

“Constant reorganisations are costly and distracting”.


We have had six statutory major reorganisations in 30 years, none with clear evidence that the restructure has brought about improvement. The Government commissioned that review; they should read it and learn from it.

I have six questions for the Minister. When will the target operating model be published, and will that be before Report? Is the latest thinking to put transferred NHS England functions and staff into the department, or will the Government set up a stand-alone body? Will the Government publish a full, costed impact assessment, including benefits, and explain where the £1 billion to £1.3 billion comes from? What are the expected costs of disruption, and how will any further delay be limited? Are the Government confident that the 50% cut will not drive up consultancy spending by the end of this Parliament? If the Government do not accept the amendment from the noble Earl, Lord Howe, will they commit to laying a transition plan before Parliament and before Report? In substance, that is what this amendment is asking for.

We on these Benches are not defenders of the status quo. I started in the NHS in the early 1990s and lived through more reorganisations than I care to count. Every one promised less bureaucracy and a freeing up of the front line; none delivered it. If the Government want to put NHS operational matters into political hands, that is their choice, but they owe this House a plan and then a price and then a Bill, in that order. At present we have a Bill and we are still waiting for the other two. I look forward to the Minister’s reply.

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[Earl Howe (Con)]

My Lords, Amendment 5 stands in my name and that of my noble friend Lord Kamall. I am grateful to the noble Lord, Lord Hunt of Kings Heath, for his Amendment 211 in this group.

Amendment 5 concerns the future ownership and governance of Supply Chain Co-ordination Limited following the abolition of NHS England. It is a rather more specific amendment than the one we have just debated, but it raises an important question about the wider process of transition, in particular how the Government intend to ensure that essential services and functions continue to operate effectively as NHS England is abolished.

As I emphasised earlier, NHS England sits at the centre of an extraordinarily complex and interconnected healthcare system, with responsibilities, contracts, assets and operational relationships extending throughout the NHS. When we interfere with one part of that system, we need to be certain that we understand what depends upon it. This is particularly important in relation to procurement and supply chains.

NHS England currently holds the shares in Supply Chain Coordination Limited, which plays a central role in the NHS Supply Chain arrangements through which hospitals and other healthcare providers obtain essential equipment, medical devices and supplies. These are functions which may not attract a great deal of public attention, but they are absolutely fundamental to the day-to-day operation of the health service. Hospitals depend on reliable access to medical equipment, consumables and other essential supplies in order to deliver treatment. When those supplies are disrupted, the consequences can obviously be very serious indeed. Procedures can be delayed, costs can increase and clinical staff can find themselves unable to provide the care that their patients need. It is therefore essential that, as the Government undertake this reorganisation, we do not inadvertently destabilise or create disruption in areas of the health service which are currently operating effectively.

That is the concern which this amendment seeks to address. As NHS England is abolished, its shareholding in Supply Chain Coordination Limited will need to be transferred. Our amendment does not seek to prevent that transfer, nor does it prescribe what the future ownership arrangements should look like. Instead, it asks the Government to set out clearly how that transfer will be managed, who will be responsible for the company afterwards and what measures will be taken to ensure that its operations continue without interruption.

There are some fairly straightforward questions here. First, who will assume ownership of the company and who will exercise the shareholder responsibilities, both during and after the transition? It surely cannot be intended that day-to-day control of the organisation will fall to the Secretary of State. But if not, then to whom and under what organisational structure? Secondly, pursuant to that, what governance and accountability arrangements will be put in place? Will there be any changes to the company’s operating model, and, if so, what assessment has been made of their potential consequences? Thirdly, and perhaps most importantly, what assurances can the Government give that the transfer will not disrupt the procurement, storage or distribution of essential supplies across the health service? I would be particularly interested to hear what assessment has been made of the risks involved in transferring these responsibilities and what contingency arrangements will be available if the process proves more complicated than anticipated.

Procurement and supply chain management depend on experienced people, established relationships and systems which have been developed over many years. We know that NHS reorganisation will involve staff cuts. To what extent will this organisation be subject to cuts in staff, and at what levels? What steps are being taken to ensure that the relevant expertise is retained and has any independent assurance been obtained about the resilience of these arrangements during the transition?

More broadly, I regard this amendment as representing a microcosm of the larger questions that surround the abolition of NHS England. The success of this reorganisation will depend not only on whether the Government can transfer functions and responsibilities on paper but on whether the systems that patients and clinicians rely upon continue to work in practice. I hope the Minister will be able to provide some reassurance on these points. I beg to move.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I very much agree with the noble Earl, Lord Howe, that procurement is important in itself, but that it is an illustration, in a sense, of how the new arrangements might play out. Where I disagree with him is that he was really implying NHS Supply Chain is doing a good job, and we do not want to disrupt it. Actually, there are a lot of concerns about the current performance of the supply chain, which I would like to come to, because this is an opportunity to improve what it does, and, in particular, to try and get the relationship between NHS Supply Chain and local NHS bodies on a much better footing.

My Amendment 211 is grouped with Amendment 5 and has the support of the noble Lord, Lord Markham, the former Health Minister, who has been a great advocate of value-based purchasing. I declare an interest as patron of the Health Care Supply Association, the organisation for professionals in health service procurement, who contribute so much to a very important function.

Procurement is there to ensure value for money for the health service, but it can do much more. We know since Covid of the essential need for supply chain resilience. Effective procurement can provide this, ensure investment in innovation and support UK industry. I believe it can link closely with the Government’s ambitions on matters of sovereignty, regional development and growth. NHS Supply Chain has a clear role in this, and it is absolutely right to scrutinise what the arrangements are going to be when the shares transfer from NHS England to the Department of Health.

In particular, I want to raise the shortcomings of NHS Supply Chain. The 2024 Public Accounts Committee report found that NHS England had been weak in its oversight and support of NHS Supply Chain. The PAC reported that neither NHS England nor the department had validated the savings the company reported, and that trusts’ satisfaction with the service was already “in steady decline”. Nor was the committee’s criticism confined to NHS England. It found that the department, which owned the company before 2021, had been “far too lenient” in its oversight.

Returning the shareholding to the department really does not change this one way or the other, but, as I said earlier, it is a chance to put the relationship between NHS Supply Chain, its shareholder, Ministers and the NHS organisation it serves on a much clearer footing. I want to make the point that it is there to serve the NHS. It does not, however, behave in a way that actually recognises that its customers are local NHS bodies. I should say here that there is a view that it is very arrogant in its dealings with NHS bodies. This is what we want to see changed, and I hope ministerial control will actually do something about it.

The ABHI has also reported to me that currently, NHS Supply Chain does not publish the agendas, papers and minutes of its board meetings. I find that very surprising. The noble Lord, Lord Scriven, will raise this in relation to Clause 11, but at the very least I hope to get some assurance that this will be put right.

I also ask the Minister whether, under the department, NHS Supply Chain will continue with its commitment to value-based purchasing. This is very important. I have long argued for it, and the noble Lord, Lord Lansley, is very much with me on this. The point is getting away from always going for the lowest price, and going for quality to improve patient outcomes. I acknowledge we are making progress, and the department itself is very supportive.

I want to quote one example. Value-based purchasing was launched this year to ensure a higher quality of healthcare by raising the standard of procurement. During a pilot in the South Tyneside and Sunderland NHS Foundation Trust, working with Essity, patients were provided with the most appropriate absorbent continence product for their clinical needs and preferences, even if that product was more expensive than other options under consideration. The results showed an 8% reduction in the number of continence products used and a 48% reduction in leaks, and 71% of patients said they would now find it easy to change the product themselves. This is a wonderful example of hugely improved patient outcomes because they did not go for the cheapest products—so this is what this is all based on.

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Mental health needs to be front and centre of any response. Many coastal communities face particular challenges in accessing timely mental health support, particularly for children and young people. In places where transport is difficult and specialist services can be many miles away, access to early intervention can become a serious problem. It is acute when it comes to suicide prevention. The relationship between mental health, isolation, economic insecurity and access to services is so important in these communities when support is difficult to reach. I am sure that if the noble Lord, Lord Patel of Bradford, had been here, he would have put it far better than I can, but his amendment would ensure that, in exercising health service functions, the Secretary of State has specific regard to reducing inequalities between coastal and inland communities, particularly in prevention, planning and commissioning and the health workforce.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Baroness, Lady Tyler, and the noble Lord, Lord Patel, made some important points about cross-government working. I was thinking back to what the noble Lord, Lord Patel, said, basically that what started under Tony Blair was continued under Gordon Brown. It was backed up by, first, a specific Cabinet committee, which underpinned the inequalities work, and, secondly, by what were called PSA targets, which tied different departments in. I think that was a good mechanism. In defence of the Government, though, the important work that is being undertaken in relation to health inequality by Alan Milburn, working with different government departments, is going to be pivotal because it embraces the terrible outcomes for so many people who come under the NEET category. It is also looking at the dreadful mental health support for children and adolescents, which goes to the heart of many of these issues. If we can pull this off, we can start to achieve some of the equality issues that we have been talking about.

Like the noble Baroness, Lady Tyler, I am here to say a few words about coastal health because the noble Lord, Lord Patel of Bradford, told us we must. Five years ago, the Chief Medical Officer devoted his 2021 annual report to health in coastal communities. He identified high levels of poor physical and mental health, an ageing population with increasingly complex needs and serious challenges in recruiting and retaining the healthcare workforce. The noble Lord, Lord Patel, basically has three asks, on which I want to reinforce what the noble Baroness, Lady Tyler, said. Five years after the CMO’s report, we have no strategy. First, will the Government publish a substantive account of progress against his recommendations? Secondly, how will the Government ensure that coastal populations are separately identified? Unless we do that, we do not have the data on which to plan and strategise and see whether improvements can be made. Thirdly, will the department work across government to develop and test commissioning prevention workforce models suited to the distinctive geography and needs of coastal communities? I would be very grateful if my noble friend would agree to meet the noble Lord, Lord Patel of Bradford, to discuss this further, because it is an important consideration.

My Amendment 11 relates to the terrible distribution of GPs in England currently and asks for a much more equitable distribution. I am grateful to the noble Baronesses, Lady Gerada, Lady Hodgson and Lady Manzoor, for their support. Last week I was very fortunate to have a meeting with Minister Dame Diana Johnson and her officials, which I found extremely helpful, and I was grateful to her officials for the way they have been prepared to communicate on this.

This morning, the RCGP published the State of General Practice 2026 report. Chapter 4, about fair and sustainable general practice care—equitable care—makes clear that action is needed. One area where I believe we need action is what the noble Lord, Lord Darzi, described as

“huge and unwarranted variations in the number of patients per GP”.

Data from the NHS general practice workforce team shows that the national average list size of fully qualified full-time equivalent GPs hovers at around 2,200 patients. John Gooderham, a retired civil servant who once worked for me, undertook a number-crunching exercise showing that the differences in average list sizes are almost unbelievable. His evidence, which was published by the Institute of Health and Social Care Management, showed at least 20 areas with an average list size ranging from 8,300 to 4,400 patients, almost four times as many as the national average. All of them are clearly severely underdoctored. At the other end of the scale, there are 20 areas with an average list size ranging from 1,000 to 1,444 patients.

The trouble is that there seems to be no approach or system to rectify this. We used to have the Medical Practices Committee, which was set up by Nye Bevan in the 1946 Act and lasted until 2001. I have to confess that I took through the legislation abolishing the MPC. Mea culpa—it was a mistake. At the time, the line that I took—I looked it up—was that area health authorities would sort it all out. Where are area health authorities? They did not, and none of their successors has. I think we need to go back to a system that identifies areas that are overdoctored or underdoctored to consider how we can justify this situation. It cannot be allowed to continue. I know that officials feel that the kind of MPC system we had is not fit for today’s more modern circumstances, but one way or another, either through financial incentives or through some restrictions, we have to do something about this. I hope the Government will be sympathetic.

[Baroness Manzoor (Con)]

Noble Lords will know that I am passionate about improving the health of all. The National Health Service is the National Health Service, not the ill service. So many disadvantaged, marginalised groups are not receiving the care or the health that they need. I will not go back into the disparities and the health inequalities. I have put my name to the amendment from the noble Lord, Lord Patel, who spoke very clearly. It is a simple amendment but would be a pivotal, key amendment to the Bill.

I also support the amendment in the name of the noble Lord, Lord Hunt, because without having the first line of defence of GPs, marginalised groups do not have the access to doctors that they desperately need. Everybody knows the effects of inequalities on the economy, the NHS and individuals. The Government have a great opportunity to enhance the Secretary of State’s power and strengthen it, rather than transfer the current power.

As I indicated earlier, in my region we had a duty to bring down inequalities in a deprived area. I worked closely with Alan Milburn and other Ministers, including the then Prime Minister, Tony Blair. It worked when that key emphasis, monitoring, duty and strategy were put in place. We need a health strategy, as the noble Lord, Lord Patel, indicated. I leave the question on the table for the Government. This is a fantastic opportunity. It is not about all the structural change that we have been talking about; this is about making a real difference to people’s lives and to the health of our nation.

Health Bill

Lord Hunt of Kings Heath Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, it seems that this goes to the heart of some of the issues we were discussing in relation to the noble Earl’s Amendment 4. It is about the balance between what the noble Lord, Lord Rennard, is attempting to seek, which is much more central direction in relation to diabetes services, and the wish for the NHS to be able to make its own decisions locally. Going back to the round table that we had on Monday, the CEO of the NHS Alliance was concerned about central interference, as I think he would call it, into decisions made locally.

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Moved by

[Lord Hunt of Kings Heath]

21: Clause 5, page 3, line 34, after “carers” insert “, health and care partners,”
Member’s explanatory statement
This amendment seeks to ensure that health and care partners can be involved in decisions about a patient.

[Lord Hunt of Kings Heath (Lab)]

My Lords, clearly, it is not ideal to start a really important debate at this time of night, but I hope noble Lords will feel they are able to take part in it as they would have done if we were doing this at a reasonable time. I have four amendments in this group: Amendments 21, 173, 174 and 214. I am grateful for the support of the right reverend Prelate the Bishop of Newcastle, the noble Baronesses, Lady Finlay and Lady Barker, and the noble Lord, Lord Blackwater.

At Second Reading, many Peers expressed the wish to promote actions that would directly improve the health outcomes and experiences of NHS patients. I believe there is a good opportunity here. There were fewer mentions of social care, yet the lived experience of people reliant on care services, particularly those in residential care, is just as important as that of those treated in hospitals. Many of these considerations also apply to mental health service in-patients. We know that, clearly, many people are fearful of entering hospital. Some say they would rather die than move into a care home. Treatment in mental health units must routinely be enforced by the process of being sectioned, a term that evokes fear.

My amendments are designed to offer all service users the assurance that, if there is someone who matters to them and is prepared to support them when they are receiving care or treatment, not only in their own home, they can nominate that person as their health and care partner. In most cases, this would be an entirely voluntary role, accepted by a spouse or partner, a close relative or a special friend. Some people who live with a paid companion, or individuals with complex needs who employ a personal assistant, may choose to nominate that person as their health and care partner. The essential element is that it must be the individual who makes the choice.

Health Bill

Lord Hunt of Kings Heath Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Baroness in Waiting/Government Whip (Baroness Hyde of Bemerton) (Lab)]

My Lords, before we continue to debate Amendment 21, I remind the Committee that this is an adjourned debate. Therefore, unless you were present at the start of consideration of the group, you are not able to contribute. The Clerk at the Table has a full list of those who were present.

[Lord Hunt of Kings Heath (Lab)]

My Lords, as I moved the first amendment in this group, it might be helpful if I recap the nature of the debate last week. The noble Baroness, Lady Tyler, spoke to a number of amendments on carers. She said that there are

“4.7 million unpaid carers in England”.—[Official Report, 28/10/26; col. 1234.]

They lack support. One of the reasons for that is that we do not have a system of identifying who they are. This was backed up by the noble Lord, Lord Young, who spoke about young carers. He spoke of

“15,000 schoolchildren spending more than 50 hours a week looking after their parents or siblings, and 3,000 of those were aged between five and nine”.—[Official Report, 28/10/26; col. 1237.]

They face many disadvantages in the field of education, as the noble Lord, Lord Young, identified. They are rarely identified by the relevant authorities until, on average, three years have passed since they first began caring.

My amendments run in parallel to those tabled by the noble Baroness, Lady Tyler. They are about introducing a new legal right to ensure that no one is cut off from relatives and friends in care homes, hospitals and other care settings. This would mean that anyone relying on health and care services, either in the short or longer term, would have the right to nominate a trusted relative, friend or paid carer to provide essential in-person support. Their access will be protected and their advocacy respected. During Covid in particular, but subsequently too, there was a lot of evidence that, when a carer, relative or friend raised concerns about their loved one in a residential care home, in some cases they were told that they were not allowed to visit again. There have been some cases, too, where the resident was required to be removed from the home. The noble and learned Baroness, Lady Hallett, recognised the importance of this in her recent Covid-19 inquiry report:

“In a future pandemic, visits from essential carers should be available to all residents where possible and should be distinct from considerations regarding general visiting”.


Her report recommended this protection be framed as a right.

[Baroness Morris of Bolton (Con)]

My Lords, it is sometimes frustrating when sitting on the Woolsack or at the Table during Committee when a debate is taking place and you wish you could jump up and say something—a situation I found myself in on Wednesday night. I was very glad when the Committee adjourned the debate on Amendment 21; in fact, I think I was the person who adjourned the debate, which allows me to say just a few words today on this group of important amendments.

I must admit to noble Lords that I have not spoken on a health Bill since I was the Opposition health Whip to my noble friend Lord Howe many years ago. I was also the shadow Minister for what was then the department for children, schools and families. In that capacity, I met many young carers. I was humbled by their dedication and the sacrifices they willingly accepted; my admiration for them—then and now—knows no bounds.

I wish to add my voice to the powerful speeches already made on this group, particularly in support of respite care. In doing so, I have just one question for the Minister. I recognise from the Government’s unpaid carers action plan that much work is going in to the collection of data and identification of unpaid carers by bringing together multiple services, but, from my own experience, many young carers are wary of official services, fearing that they may think them unable to cope. However, many will turn to the wonderful charities who are active in this space, such as Action for Children. Therefore, can the Minister say whether the voluntary sector will also be included in this bringing together of services to improve the outcome for young carers—indeed, all carers—and their families? Will carers also have a voice?

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[Baroness Merron (Lab)]

The noble Baroness makes extremely fair points. The discharge process takes account of whether somebody can be safely and properly discharged. The care that is provided, whether by a professional or an unpaid carer, has to be absolutely right. She is right to make the points and I am sympathetic to them.

[Lord Hunt of Kings Heath (Lab)]

My Lords, in seeking leave to withdraw my amendment, I thank noble Lords who have taken part in this debate both today and last week. I particularly thank the noble Baroness, Lady Tyler, for her amendments.

The noble Baroness, Lady Morris, made an important point for us to consider on respite care for young carers, as did the noble Baroness, Lady Nargund, on the identification of women carers. The noble Baroness, Lady Pidgeon, made the point that intervention before crisis occurs is so important. The noble Earl, Lord Howe, spoke about the pressures facing carers more generally.

My noble friend the Minister is resistant to legislation because of the existing needs assessment framework. On the recording of people, she felt that the 10-year plan, alongside the action plan she mentioned, would meet those needs. One must take that as a positive response.

We have been here before, though, and a huge number of carers, faced with the bureaucracy of the local system, find it very difficult to get support. Respite care, in a sense, is a visible indication of the issues that we face. I am sure noble Lords will wish to come back to that.

On my amendments, I am grateful to the noble Baroness, Lady Finlay, for her support last week, and also to Care Rights UK and to John’s Campaign, which have been campaigning for a long time to see some statutory protection for loved ones and partners who see and have concerns about the way their loved ones are treated in a care home. They have faced vindictive action by the people operating those care homes for raising legitimate concerns.

I take the Minister’s point about definitions; obviously, that is something to reflect upon. I also take the point about the current statutory duties. However, I think that people need some protection against the behaviour of so many care homes, when faced with legitimate questions about their loved ones. I hope, because the noble and learned Baroness, Lady Hallett, produced her recommendation on this only recently, that the Government will consider legislation in the light of it. Having said that, I beg leave to withdraw my amendment.

Amendment 21 withdrawn.

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[Lord Patel (CB)]

My Lords, I have put my name to Amendments 26, 78 and 242, tabled by the noble Baroness, Lady Finlay, and support everything that has been said by the noble Baronesses, Lady Finlay and Lady Hollins, and others. They have highlighted the serious problem of the underfunding of palliative care, whether that is specialist, community or hospice palliative care.

To make my points, I need to personalise them, which I hope I can do successfully. What impressed me most when I had to experience the provision of palliative care was the personalised care plan that was written by the team who were going to look after my wife when she died last year. That was so fundamental for the family and for the patient. The other important bit was the compassion that was shown. I do not know of any other branch of medicine in which I personally feel that compassion is so paramount. It is a person who is dying. There can be nothing more final than death. If we cannot show compassion at that time, then we fail.

The next bit was communication: with the patient, with the team who were going to look after her, and with the family—and the inclusion of family in that communication was extremely important. The team was identified: it was the GP, the district nurses, and the specialist palliative consultant, who, in the end, did not need to provide her services but who none the less was available.

The other important bit was the co-ordination. There was total co-ordination of Macmillan nurses, district nurses and the GP, importantly to assess the medication that was required on a daily basis, 24 hours a day, seven days a week. What I learned, although I am a doctor of long standing, was that for patients who are dying, medication tends to change hour by hour, because their symptoms change. There are not just the symptoms of pain; there are other symptoms that make them uncomfortable, and they need to be relieved of those. In the middle of the night, that service was available. At 2 am, by phone call, somebody appeared five minutes later to provide that medication and care by the team.

The next factor was continuity of care. It was the same GP who visited every day, and the same district nurses, including at the weekends, day and night. That continuity of care was provided all the time.

The next bit was comfort. It is difficult to understand how much comfort is important to these patients when they are dying. They are uncomfortable because of pain, because of the disease that is killing them, and because they have developed symptoms that are difficult, such as retching, vomiting and other symptoms. That requires treatment at the time. If that is not available, the patient who is dying suffers.

Choice—patient autonomy—was another factor: that patients have a say, even though they are dying, as to what would help them. That was important. Furthermore, it was about control, that the patient was helped to achieve their goals. They do have goals, even though they are dying. They know what they want, in terms of comfort and other issues.

Any palliative care proposals and frameworks developed must address this issue, paramount in which should be compassion. If we fail to do this, then we fail. We should not rely on funding from charities organising fêtes and coffee mornings; we should fund the service appropriately and demonstrate that we are a compassionate society.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I take a rather different view from that of the noble Lord, Lord Patel. We need to look back at the foundation of the hospice movement—it was founded within the charitable sector. It has always been valuable that a lot of the funds to run them have been raised by hospices themselves. That has given them a certain degree of independence, which they clearly would not have if they were funded entirely by the state. It also meant that they brought innovation into palliative care in a way that directly funded services would have found difficult.

There is, however, a need now for more support from government. I acknowledge and welcome the resources the Government have put in in the last two years. I hope my noble friend can say when the framework is coming. As I understand it: one of the issues about hospice funding is that it is so hand to mouth. For some reason ICBs, and their predecessors, have seemed to be incapable of giving longer-term contracts and certainty—they always give short-term contracts and operate hand to mouth.

In a sense, this takes us to the heart of the Bill. So many of these amendments are really because we do not trust ICBs to do the job properly. Their main focus is on waiting times and financial performance. With the huge variation in the funding of palliative care, can we have any confidence that, even with the modern framework, we are actually going to get a more comprehensive package of long-term services for hospices?

Of course, there is a wider challenge of palliative care in the NHS itself, which the noble Baroness, Lady Finlay, referred to. Some reassurance on the hospice issue—that the framework, when published, will mean that ICBs have to sort this out, that they have to give long-term certainty and deal with some of the variation in funding that we see at the moment—would be welcome.

[Lord Stevens of Birmingham (CB)]

My Lords, the noble Lord, Lord Patel, spoke movingly and others spoke powerfully to make the case for palliative and end-of-life care, and I will not seek to repeat what they said. The whole of Parliament has expressed that view extensively over the last 18 months.

I will comment briefly on whether the provisions should be in the Bill or should rely on action by the Government. I anticipate that the Minister will make the case that this does not need to be specified in primary legislation; it can be done by an administrative or political act from the Department of Health and Social Care. I believe that to be the case. In principle, there is no need for new Secretary of State powers or administrative reorganisation to allocate funding to meet unmet need in palliative and end-of-life care. However, the question before the Committee is: are the Government actually going to do it? What we can do is give the Minister a bit of leverage inside the department between now and Report by perhaps sending a signal that if the modern service framework for palliative and end-of-life care has not emerged by then, it is possible that your Lordships’ House will take a more stringent view on the need for primary legislation.

The Minister told us in writing on 4 June that we will see this modern service framework for palliative and end-of-life care in the autumn—as the noble Baroness, Lady Coffey, pointed out. We are now in November: the nights are drawing in; the clocks have gone back; Guy Fawkes night is this week; and Halloween has been and gone. Is the promise of an autumn modern service framework trick or treat?

Health Bill

Lord Hunt of Kings Heath Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

This amendment would protect not only Jewish patients but the reputation of doctors themselves. It seeks to establish a clear and consistent principle: if a healthcare professional is found to have engaged in antisemitic behaviour or speech, as defined in my amendment and by reference to the Government’s own definition, removal from the register should follow. The NHS cannot function without trust. Antisemitism destroys that trust. I commend my amendment to the Committee.

[Lord Hunt of Kings Heath (Lab)]

My Lords, following the review by the noble Lord, Lord Mann, I certainly hope that the regulators toughen up their act, and in accepting its recommendations the Government certainly expect them to. I agree with the thrust of where the noble Lord, Lord Blencathra, is coming from. Whether all discretion should be taken away from the regulators, I very much doubt, but it will be interesting to hear what my noble friend has to say on that.

In supporting the amendment tabled by the noble Baroness, Lady Gerada, I want to reflect on two points. First, I repeat what the noble Baroness said, which was striking, arising from the report of the noble Lord, Lord Mann. Drawing on the NHS staff survey, Jewish staff are the only religious group where discrimination from managers and colleagues exceeds discrimination from patients. This is a very serious indication of the stress and pressure on Jewish staff within the NHS.

I am afraid that, so far, the response from management has been pretty poor. We have seen that in relation to what we might call uniform policy. As the noble Lord, Lord Mann, described it:

“Examples such as the brandishing of badges, the display of uniforms on political marches or the co-branding of the NHS by staff or others with third parties has made it unclear what patients can expect from the NHS”.


Patients are entitled to be treated without seeing staff display any political leanings whatever or support for campaigns. Teachers are simply not allowed to do this. One has to ask, what is with NHS employers that they have failed to put across to their staff the behaviour that is expected of them?

The noble Lord, Lord Mann, clearly called for NHS England to review what we might call its uniform policy. It is not the standardised uniform, but what people wear and how they display it. My understanding is that that work is being undertaken, subject to consultation. I hope that, when it comes out, it is not going to be wiffly-waffly, leaving too much discretion to local employers. Now that the Government are taking this over—because I doubt it will be finished before 1 April next year—they should make it abundantly clear to NHS employers what should and should not be expected.

I know that Manchester has been cited as a very good example. As the noble Lord, Lord Mann, said, some trusts do not permit the wearing of political badges, of any item of clothing with a political message or of a uniform to political rallies. We need to see something firm about this so that employers are implementing what is required of them from the centre. For employers, this would be much easier than going through the agony of developing local policies that are subject to consultation and lead to variation. Patients and staff are entitled to be in an environment where somebody else’s political views are not displayed in a way which causes huge upset and concern.

[Baroness Manzoor (Con)]

My Lords, I understand and support the aims and sentiment behind this group of amendments—particularly Amendment 29 and 258. Any form of discrimination or racism is abhorrent. How one identifies oneself should not be a problem. Antisemitism is not acceptable.

It may be helpful to remind ourselves of some figures as, sadly, racism and discrimination remain embedded challenges within the NHS, affecting both staff and patients, as acknowledged by the noble Baroness, Lady Gerada. It is worth noting that 28.6% of NHS staff in 2024 were from ethnic-minority backgrounds. That was around 450,000 people, yet only 12.7% of senior managers came from those backgrounds. The 2025 NHS staff survey found that ethnic-minority staff were more likely to experience discrimination from managers and colleagues: that is 13.9% of ethnic-minority staff compared with 6.51% of white staff. Some 29.16% of ethnic-minority staff experienced harassment, bullying or abuse by patients and by the public, compared with 23.54% of white staff. It is important to further strengthen legislation as there are gaps.

The Equality Act 2010 prohibits racial discrimination, harassment and victimisation. However, significant weaknesses remain. The public sector equality duty requires organisations to “have due regard to” equality but does not guarantee measurable improvements. The NHS equality standards lack sufficient enforcement and meaningful consequences for persistent institutional discrimination. Will the Minister consider how the Government can strengthen this further, particularly as reporting, investigating and addressing racism remains inconsistent, with inadequate protections and support for whistleblowers? How will the Government address this? There is no sufficiently robust uniform accountability framework ensuring that perpetrators and senior leaders face consequences, as the noble Baroness, Lady Gerada, stated. Will the Government consider developing such a framework on all forms of discrimination? This would also support the 2026 review by the noble Lord, Lord Mann, which reinforces the need for stronger investigations, transparency and organisational accountability.

Health Bill

Lord Hunt of Kings Heath Excerpts

Committee stage
Monday 9th November 2026 Lords Chamber

[Lord Patel (CB)]

My Lords, I have Amendment 47 in this group. I have others that were related—Amendments 241 and 83—but I am not speaking to them today as the Bill team did not like them being grouped together, so I have been kind and let them go. However, they all concern one thing: a total absence in the Bill of any public health and prevention safeguards, despite that being the key theme of the Government’s 10-year health plan.

I will speak briefly to Amendment 47, which is neither a probing amendment nor a way forward, but concerns a no doubt unintentional omission on the part of the Government regarding the Secretary of State’s statutory duty to consult public health professionals. Of significant concern is the repeal of the existing statutory duty on NHS England to consult public health professionals in the discharge of these functions. The duty removed by the Bill is not explicitly transferred to the Secretary of State. The BMA says that although the Bill’s Explanatory Notes state that

“the Secretary of State should continue to seek public health advice, relying on ministerial discretion”

—we should note the phrase “ministerial discretion”—

“rather than a statutory requirement weakens an important safeguard and risks further politicising”

public health decision-making. I hope that the Minister will agree that that duty needs to be reinstated.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I find myself in sympathy with the noble Baroness, Lady Coffey, in her approach to Ministers’ ability to determine what happens in the National Health Service. Many of the amendments tabled, particularly when it comes to specific services, call for the intervention of the Secretary of State. That is very simple, because integrated care boards do not have any mechanisms for being locally elected, so their accountability is to the Secretary of State, and we cannot run away from that.

We have had power of direction in the health service since 1948. The Lansley Act modified it, and, although the wording has changed, we are essentially moving back to the original position. The fact is that the power of direction has been used very sparingly over the decades the health service has been in existence. It has rarely been required because in general, when Ministers or their officials are on the phone to the chair or CEO of those bodies, they understand that they need to do something—although I accept, as the noble Baroness, Lady Coffey, says, that there are some occasions when the additional powers in the Bill are probably required.

We really cannot have it both ways. If we want the NHS to be a national service, we know that the public do not accept that there should be variation. The very idea of a postcode lottery in this country is simply not accepted. It must follow that Ministers are accountable to Parliament, and therefore they must have the tools by which to determine the general way the health service is being run. There is a counterbalance. The reason why I am so pleased about the Healthwatch decision is that we need mechanisms at local level to secure some form of local input. But, ultimately, if we want a national health service, we have to accept that, in the unique way the NHS is funded and organised, Ministers need the tools to ensure that their accountability to the public is discharged effectively.

[Lord Stevens of Birmingham (CB)]

My Lords, I find myself in sympathy with the thrust of Amendments 39 and 40, but I want to draw your Lordships’ attention to some specific changes to the exceptions to the legal powers that the Secretary of State will have that are contained in the Bill. In 2022, Parliament decided that the Secretary of State should have a general power of direction over NHS England, which in turn would cascade through the system. In coming to that decision, the Government of the day rightly inserted three exceptions to the use of that power: a politician could not direct the individual treatment that a patient would get, who individually would be employed or not by the National Health Service or individual treatment availability.

For those who perhaps have not studied the text of the Bill in as much detail as I am going to now bore you with, I have to tell you that a very significant change is lurking in Clause 11, at proposed new Section 14Z62, specifying the exceptions. That is that, whereas the 2022 exception said that the Secretary of State could issue a direction about a specific medicine, treatment or diagnosis if NICE had said it should be available on the NHS, this Bill flips that and says that the Secretary of State can now direct what should or should not be available—particular treatments, particular medicines—in any situation where NICE has not opined on the topic. Given that the vast majority of treatments available on the NHS are not subject to a NICE appraisal or recommendation, that means we are giving a politician the ability to say, ex cathedra, “This treatment will not be available on the NHS; this type of diagnosis will not be available on the NHS.” This is a massive infringement on the medical autonomy and clinical judgment that we expect clinicians to be exercising across the NHS.

When one looks in the Explanatory Notes to see why the provision to amend the 2022 version has been proposed, answer comes there none. So this requires very considerable scrutiny, potentially on Report. I am not in any way detracting from the wisdom of the Secretaries of State that the health service has had in its history to date, but, as we have previously discussed, one has only to look across the Atlantic to the current US Health Secretary, RFK Jr, who has some pretty interesting personal views on vaccines. I will not list them: you can google them yourself. Were we to find ourselves with a future Secretary of State with a similar opinion set, does Parliament really want to grant that person the ability to strike out whole treatments or tests from the National Health Service? I would suggest not.

So that exception needs looking at. The other exception through which a coach and horses has been driven by this Bill is the exception that limited the Secretary of State’s power to the appointment or employment of a particular individual. Clause 37 allows the Secretary of State to fire named individual nursing directors and medical directors of foundation trusts. Again, we must ask ourselves, looking forward, whether that is something that we want or whether it is political overreach: in my opinion, it is.

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[Baroness Merron (Lab)]

I think the bigger question that the noble Baroness is asking is about politicisation; I heard what she and the noble Lord, Lord Stevens, said about the situation elsewhere. I have to remind myself that, if there were, for example, a different Government with whom I did not agree—goodness me—it would be their right to make decisions and bring forward legislation. So, with the best will in the world, whatever we do here, we have to be realistic about what we can achieve. It is also important to note that checks and balances, which I have referred to, are already in the system. We are doing the opposite of tearing them up: we are continuing to apply them.

[Lord Hunt of Kings Heath (Lab)]

In the case that the noble Baroness raised, the issue is that of course we have an Independent Reconfiguration Panel but, ultimately, it should be the Secretary of State’s decision. Otherwise, we would have a situation where a decision to close a service in a locality would be made not by those elected by local people but by an appointed board. Surely, in the interests of democracy and accountability, the Secretary of State must in the end have that intervention power.

[Baroness Merron (Lab)]

My noble friend has put it very clearly and I most grateful. I think the public believe that the Secretary of State has that power already, but in fact she does not, which is a point my noble friend has made on many occasions.

Turning to Amendment 40, I should also draw attention to the distinction we have made between the more routinely used power of direction and the powers specifically reserved for use in cases of significant failure or risk of significant failure. Retaining the distinction between types of direction is important, as is the recognition of when an intervention is undertaken to protect patients, the public or taxpayers. I note the alternative proposal to appoint commissioners from the noble Lord, Lord Scriven, in Amendment 40. My concern is that this approach would likely be more cumbersome and would slow Ministers’ ability to intervene where significant failure was occurring—something that I know noble Lords would not want. Amendment 40 also touches on outcomes frameworks. I assure the noble Lord that I share the sentiment about the importance of outcomes frameworks, and, if necessary, we can complement existing frameworks by using directions.

I will now briefly touch on Amendments 76 and 77, which relate to Clause 21. The clause transfers the requirement to conduct annual assessments of ICBs from NHS England to the Secretary of State and focuses the assessment on the statutory functions of these organisations rather than a narrow list of duties. Currently, the position is that NHS England assesses ICBs annually, using data and local insight to review their performance against their functions, including a list of duties prescribed by the current legislation. The results are published online and they inform the oversight relationship between NHS England and each ICB. However, this list of duties forms a static list of requirements which are already part of the ICBs’ statutory functions. Performance assessments need to adapt to the evolving role of ICBs as strategic commissioners, and evening out the focus across all ICB duties supports that, making assessment more flexible and meaningful as ICBs adapt.

These clauses enable the Secretary of State to support the system, respond to unforeseen challenges and uphold the standards that patients expect and deserve, while ensuring that we have fairness and impartiality at the heart of the National Health Service.

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My support for the stand part challenge reflects the need for convincing answers to those questions. I remain concerned about retaining this exception without clearer limits. I hope that the Minister will explain why it is necessary and accept the case for stronger safeguards, including the patient outcomes test in Amendment 35. Patients need confidence that any change in who provides their care will deliver better outcomes, with clear reasons, continuity of care and proper accountability.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have given notice of my opposition to Clause 10 standing part of the Bill to probe exactly how the Government intend to use the clause. Reflecting on the three amendments tabled in group 1 by the noble Baroness, Lady Bennett, she was arguing for greater discretion at local level for NHS bodies; here, though, she wants to constrain them quite extensively. We are all guilty to an extent of ambiguity in this central-local relationship, which shows how hard it is to get the balance right.

I do not take an ideological approach to the use of the private sector in the health service, because we have seen some of the benefits. I think of how waiting times were virtually eradicated in the 2000s—we used the private sector quite extensively. The noble Baroness, Lady Murphy, illustrated the impact on cataract surgery as one example. However, I bitterly oppose the proposals of the noble Lord, Lord Lansley, which were enacted, for compulsory contracting out and competitive tendering. I believe that it is horses for courses. Where we think the private sector can add value to what the NHS can provide, we should use it, but there should not be an edict that you have to contract out everything or go through the mechanisms of competitive tendering and all the rest of it, which have proven to be so expensive and, in many cases, destructive.

Clause 10 is a bit of a puzzle—you can read it any way that you want. It could be used to increase the amount of private sector provision or, equally, to reduce it. In what circumstances will it be used? Will there be any guardrails around its use in the future, by which I mean in the years ahead, when we may have Governments with a different approach? The Explanatory Notes do not make clear how it would be used.

[Lord Stevens of Birmingham (CB)]

My Lords, the noble Lord, Lord Hunt of Kings Heath, has nailed it. Essentially, Clause 10 says that the Secretary of State must not do something unless the Secretary of State thinks that it is a good idea—it does not matter whether a good idea is construed as being in the interests of the health service or patients. Any Secretary of State thinks that all their ideas are good, so that is an unrestricted new power.

If the Government do not like Section 12E of the NHS Act 2006 then they would be better zapping that section rather than introducing this clause amending it, which, for the reasons that the noble Lord, Lord Hunt, has given, would be an ideologue’s charter. Under these powers, a Secretary of State could determine that all elective surgery should be done only by private hospitals, and that would be consistent. Another Secretary of State could decide the exact opposite, or they could decide that no NHS-funded terminations of pregnancy will be done by the independent sector. Since that is 81% of terminations in this country, the NHS would not be able to cope, and that would then constitute a massive restriction on terminations of pregnancy.

You can have your own ideological view on whether these are good or bad things, but that is what this clause permits. Therefore, contrary to what the noble Baroness, Lady Bennett, says, it does not lock in the status quo but produces the possibility of quite extreme swings on the part of future Governments. This Government should remember that what is sauce for the goose will be sauce for the gander.

Health Bill

Lord Hunt of Kings Heath Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Baroness Coffey (Con)]

My Lords, I am grateful to my noble friend Lord Singh of Solihull for his amendment and for the other contributions made. I respect the noble Baroness, Lady Bennett of Manor Castle, but—it will probably be the same the other way around—I do not agree with what she has asserted today. I think work is a good thing.

I am grateful to the Minister for her reply. As I expected, sadly, the Health Minister did not contribute in this debate, which somewhat sums up the situation we have within government. It is my understanding that the noble Baroness, Lady Hyde of Bemerton, is a Government Whip—I did not know that she had a policy role in the Department of Health and Social Care.

[Lord Hunt of Kings Heath (Lab)]

Nonsense!

[Baroness Coffey (Con)]

Why is the noble Lord saying that?

[Lord Hunt of Kings Heath (Lab)]

The noble Baroness is being extremely discourteous. It is the tradition in this House that, when a Bill is going through, duties of the Government Benches are shared by Ministers and Whips, and my noble friend is doing it very well.

[Baroness Coffey (Con)]

I am not disputing that the noble Baroness spoke very well. I am just saying what I feel it shows about this key issue. Sir Charlie Mayfield’s review is nothing new; it is great that he agreed to do it and has the clout, but it is no different from reports that came out in the last year. It is great that Alan Milburn is engaged—I hope he will bash heads together to get something really powerful done, and he has the clout to do that. I am flagging that, sadly, the Department of Health and Social Care and the NHS more broadly tend to not really get engaged. I thank the noble Baroness, Lady Hollins, for her contribution in that regard.

The NHS has a challenging time ahead with its own employees, and so does business. That is why working together will be absolutely vital.

Finally, noble Lords have talked about friendships. There is a workforce survey used by the best companies in the world: Gallup’s Q¹². The most important question is question 10: “Do you have a best friend at work?” Initially, that can be quite a difficult thing to get through. Here we are on Armistice Day; people who serve their country often do so because they have their friends and comrades and the camaraderie. That matters at work too. That is why, building on what my noble friend Lord Singh of Solihull said, we need to look at this carefully. I hope the Department of Health gets far more engaged than simply the DWP programmes we have heard about today, which I still hope will continue to do well. With that, I beg leave to withdraw my amendment.

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[Lord Hunt of Kings Heath (Lab)]

My Lords, I have Amendment 213 in this group. What is interesting in relation to dentistry is that on the one hand we know that many people are finding it difficult to get access to NHS dentistry, but on the other hand we rarely debate dental matters in Parliament. This is a welcome opportunity to allow the Government to say some more about what they have been doing and to discuss ways in which we might see future improvements.

There is no question that since Covid there has been a sharp drop-off in the number of adults who have seen an NHS dentist in the previous two years. It was never good—it has always hovered around 50%—but, as I understand it, it has dropped to 40%. Behind that is the fact that there are areas where it is very difficult to get a dentist. We know that some people have had to go abroad, particularly where expensive treatment is concerned, because they cannot get it on the NHS. In some situations we have seen reports of people doing DIY dentistry, which, frankly, takes us back many decades.

The Government have done a lot. One must acknowledge the phased introduction of the new contract, the commitment to providing an additional 700,000 urgent and emergency NHS dental appointments each year, rolling out supervised toothbrushing programmes for children and supporting the expansion of water fluoridation schemes. These are all making a big difference and I commend the Government for them, but clearly there are some fundamental underlying issues which still need to be tackled, including workforce issues, such as whether we have the right contract to provide preventive dentistry. I agree with the BDA that the units of dental activity do not meet the modern needs of oral health in this country and we have to start to move away from that.

My amendment is about ensuring that we get, on a regular basis, an assessment of the state of dentistry services in this country, alongside a more general analysis of oral health challenges to enable us as a country and as a Parliament to have a regular update of where we are going, what the problems are and how we can solve them. This is a very long amendment, which I plead guilty to drafting, but I hope the Government will understand the principle behind it and the need for us to try to prioritise dentistry in a way that has perhaps not been done over the last few years.

[Lord Patel of Bradford (Non-Afl)]

My Lords, I support the aims of all three amendments in this group. At Second Reading I raised the stark health inequalities facing people living in our coastal communities, and I thank the noble Lord, Lord Hunt, and the noble Baroness, Lady Tyler, for introducing my amendments while I was not here. I particularly thank the Minister for agreeing to meet us to discuss coastal and rural health inequalities. For clarity, when I am talking about coastal communities, I normally think of small towns of 10,000, 20,000 or 50,000 people. Collectively, we are talking about 10.4 million people, which is nearly a fifth of the population.

I declare my interest as chair of the Coastal Navigators Network, a community interest company originally founded by NHS England. It brings together more than 20 coastal towns and locations to put into practice the recommendations of Sir Chris Whitty’s 2021 report, Health in Coastal Communities. Several of those areas are working to improve oral health and access to NHS dentistry through prevention, local workforce training, and community-based services. Their experience can help us understand where people are struggling to get care, and what needs to change locally.

Sir Chris Whitty’s latest report, Health in Rural Areas and Small Towns, was published just last week. It highlights a national framework for improving oral health in rural and coastal areas. This has been developed by the office of the Chief Dental Officer, working together with the Coastal Navigators Network. The work is led by Jason Wong, the Chief Dental Officer for England, and his team. Our contribution has been to bring practical experience and case studies from our coastal communities.

I was going to give two examples, but I will only give one, because one was about Lowestoft, which the noble Baroness, Lady Coffey, has already mentioned. The other example is Dorset, where the report says that only 35% of adults currently access NHS dental care, and no practices are accepting new adult NHS patients. In response, Health Sciences University, based in Bournemouth, and NHS Dorset are developing a proposed oral health institute, bringing together care, prevention and local workforce training. It is intended to support more than 30,000 clinical patient contacts a year. That is an amazing, potentially promising, answer, but they need the premises and facilities to deliver the care, and train the workforce.

The latest business case still shows a funding gap of around £10.25 million, mostly in capital funding. Without that capital investment, there is a real risk that this work will be delayed, or that the institute will not go ahead at all. The Dorset example shows why identifying unmet need must lead to practical action. Commissioning more NHS dental care will take us only so far if the facilities to provide it are not there. We need capital investment alongside commissioning, so communities can develop services and train the people who will deliver them.

The geographical problem is substantial, and perhaps the noble Baroness, Lady Pidgeon, will talk about this. A study published in the British Dental Journal in August estimated that around 2.3 million people in England live in neighbourhoods with a centre that is more than 5 kilometres from the nearest NHS dental practice. But distance is only part of the problem. Is the practice accepting NHS patients, and can someone without a car get there? For coastal communities, transport difficulties, travel costs and a shortage of NHS appointments can put all the care out of reach. That is why I welcome Amendment 213, tabled by the noble Lord, Lord Hunt, and the noble Baroness, Lady Pidgeon, with its emphasis on unmet need, workforce distribution and geographical inequalities. National and ICB averages must not hide communities where access is particularly poor.

I also welcome the focus of Amendment 216 on practical action, including emergency access, contract reform and workforce planning. There is, however, an important question about how we identify a dental desert. Amendment 216 counts practices: excellent. The British Dental Journal measures distances from one place, a home, to a dental practice. Both are useful, but we also need to know whether those practices have any NHS appointments available, and whether people can reach them.

I would welcome the Minister’s response on a couple of practical points. Will the Minister ensure that reporting shows whether people in coastal communities can actually get NHS dental appointments, and include the barriers caused by workforce shortages and difficulties with travel? Where that reporting identifies unmet need and dental deserts, how will the Government ensure that commissioning and investment follow? Will that include capital funding, where the premises and facilities are simply not there, when they are needed to provide care that is missing? Without that commitment to act, we risk describing the problem again and again, without helping people get the care that they need. More widely, will the Government use the national framework developed by the Chief Dental Officer’s team to help other rural and coastal communities facing similar problems?

Finally, I would appreciate it if the Minister could ask officials to work with the Dorset partners to explore how the proposed oral health institute can move forward so we do not lose such an invaluable option.

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We need to keep a big focus on our day-to-day RDEL spending because 40% of that is going to the NHS. Where so much taxpayers’ money is being used—money, indeed, that we continue to borrow at pretty high interest rates—we need to make sure that it is well spent and not just building in the same issues that we face now. We should think forward to help the Government to achieve their legal obligations as set out in the Environment Act.

[Lord Hunt of Kings Heath (Lab)]

To follow on from the noble Baroness, Lady Coffey, we should acknowledge that the NHS has done an awful lot in its environmental and climate change policies, and we should pay tribute to the people who have led that. One of their problems is that some proposals—maybe to do with heating or lighting—that will not only reduce carbon usage but reduce costs long term need some up-front investment, but we still do not seem to have found a way to allow for the NHS to borrow against a fund for it to be repaid over the years ahead. I hope that we might think about this, particularly in relation to sustainability and climate change.

I was looking at advice issued by the CQC in the light of the 2022 legislation that the noble Baroness quoted from. It says:

“Trusts and ICBs meet this new duty”—


that was placed in the 2022 Act—

“through the delivery of their localised Green Plans. Every trust and ICB in the country now has a board-level lead for net zero and sustainability”.

Perhaps my noble friend the Minister might want to write to me about whether, despite the changes in legislation, that responsibility still lies with local NHS services. Will the CQC guidance still stand post the passage of the Bill?

Health Bill

Lord Hunt of Kings Heath Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, I have Amendments 57, 73 and 80 in this group and will also speak briefly to Amendment 58, which is about allergies. Natasha’s Foundation submitted thorough and useful information to the task and finish group that I ran for the Department for Transport on improving aviation for disabled people. There needs to be more consideration of this area. Obviously, there is much movement, but there are still many issues.

The principle behind my amendments is national protection for all specialised services regardless of whether they remain nationally commissioned or transfer to integrated care boards. Patients must not lose safeguards because the identity of the commissioner changes. Nationally consistent standards, oversight, quality assurance and accountability must be statutory safeguards, not optional administrative assurances. Local flexibility must not become local inequality.

Amendment 57 says that a national framework is needed. The current wording may be narrower than the intended protection for all specialised services, but I seek ministerial assurance on how the universal principle will be secured. Some highly specialised services require dedicated condition-specific national frameworks. Generic service specifications cannot always protect the expertise, pathways and critical mass that they need. Amendment 73 seeks annual reporting to Parliament, which must cover all specialised services irrespective of the commissioner, so that changes in access, quality, outcomes and variation remain visible. Amendment 80 seeks clear national assurance and Secretary of State accountability; these are needed, including where commissioning responsibility sits locally.

It is important to have a robust impact assessment before any transfer happens, looking at clinical risk, patient safety, equity, workforce, specialised networks, financial sustainability and the effect on smaller patient populations. I am specifically interested in those with spinal cord injuries. I do not have a traumatic injury; I have spina bifida. Spinal cord injury services illustrate the stakes. There can be complex lifelong needs, but there is a limited number of specialist centres and there are risks of fragmented pathways to rehabilitation and follow-up. Government-NHS England discussions about a wider framework are welcome, but policy commitments can change and Parliament should secure enduring duties. I thank the Minister for the letter we received this morning and look forward to more information on commissioning, but how will universal coverage, condition-specific protections, enforceable national oversight and transparent parliamentary reporting be guaranteed?

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have Amendments 58 and 71 in this group and I have added my name to Amendment 59 from the noble Baroness, Lady Pidgeon. I endorse everything that the noble Baroness, Lady Grey-Thompson, has said. At heart, the issue is that there is a lot of concern about ICBs’ ability to discharge the commissioning responsibilities they are being given. I refer my noble friend to a report on wheelchair commissioning issued this morning by the Public Service Ombudsman. She has used individual complaints to produce a thematic report on the effectiveness of ICBs in commissioning wheelchair service. She has found that ICBs are absolutely hopeless at doing this.

We will debate wheelchairs later in the Bill, but we then turn to allergies in my Amendment 58 and, again, one sees a depressing picture. It is a mammoth issue. More than 20 million people and approximately 40% of children have been diagnosed with an allergy. Any parent or grandparent knows the difficulty of getting access to the system. The National Allergy Strategy Group, to which I pay great tribute, has produced a framework which will ensure much better commissioning of the provision of services. It found that only 26 of England’s 44 ICB areas have a local adult allergy service. It makes you wonder why on earth we do not have an allergy service in each part of the country. Then you come to the specialist services, which are often represented by small NGOs that have no chance whatever of relating to ICBs. That is why they want a national commissioning process, because that is the only way that they can expect to be heard.

ICBs do not have the reputation of being open. They do not often respond to representations made to them. In fact, they have little contact with parliamentarians. This is at the heart of why there is concern about this process. The Government’s decision to reduce management costs also brings concerns about their capacity. In the end, we all want some assurance that ICBs will be beefed up and that the unit which the noble Lord, Lord Lansley, referred to is going to do the job for many of them, because what is the point of all these ICBs trying to reinvent the wheel? Why not produce some standardised commissioning and then help them commission and monitor it? That is where you get the benefit of what the Government are seeking to do, in delayering and reducing management costs and bureaucracy, but it has to be done in a way which does not leave all these services at the mercy of very varied ICBs.