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
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.

--- Later in debate ---

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.

People with Learning Disabilities: Acute Illness

Lord Hunt of Kings Heath Excerpts

Monday 20th July 2026 Lords Chamber

[Baroness Merron (Lab)]

There are financial sanctions for providers that could be brought into play. On accountability, delivery is monitored through NHS governance and assurance processes. This includes the NHS operating framework, annual assessment of ICB performance, regional oversight and review of local delivery plans.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the tragedy is that Lord Rix many years ago pointed out the same problems and no progress has been made. My noble friend is putting faith in ICBs, but she knows that their resources will be reduced in terms of headcount. Going back to the question by the noble Lord, Lord Harper, does she not think that accountability needs to be placed with NHS trusts? They need to be required to establish specialist teams, which we know lead to better outcomes, and have a response in relation to communications. Should we not be putting responsibility where it actually lies, rather than relying on ICBs to commission this?

[Baroness Merron (Lab)]

I have to vary a bit on that point from my noble friend, who I know brings a tremendous interest to this area. It is right that local services are locally provided, but I do not accept the analysis that this is handing it over to an unaccountable local provision. I outlined to the noble Lord, Lord Harper, the specifics of accountability. All the actions that are identified in the inquiry’s report will make major progress. I assure my noble friend that we will keep this continually under review. I am sure that there are always improvements that we can make, and we are committed to doing so.

IVF Treatment

Lord Hunt of Kings Heath Excerpts

Wednesday 1st July 2026 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness is quite right to identify that this is not an insurance policy to be relied on to guarantee a baby in the future, no matter what suggestion there may be to the contrary. It is also worth knowing that, while egg freezing is the fastest growing fertility treatment, it is proportionately still small—comprising about 5% of treatments. To her point, there is a responsibility on fertility clinics to ensure that anyone using their services understands the risks—which I must emphasise—as well as the long-term impacts of any treatment decisions that they make. It is quite right and proper that they do that.

[Lord Hunt of Kings Heath (Lab)]

My Lords, with the abolition of NHS England, ICBs will be given many more responsibilities in the future. However, does the Minister agree that their record on IVF, where they are not following the clear, specific guidance that they have been given, does not induce confidence in ICBs’ performance? Inevitably, Ministers will be drawn to make decisions more centrally. Does the Minister think ICBs understand that the kind of rationing that they undertake at the moment in relation to IVF is utterly unacceptable?

Nottingham Maternity and Neonatal Services

Lord Hunt of Kings Heath Excerpts

Monday 29th June 2026 Lords Chamber

[Baroness Merron (Lab)]

I certainly agree. Every woman, in the case of maternity services, deserves safe and compassionate maternity care. That is why we are so determined to drive urgent improvements in maternity services. It is worth noting that this review—the largest ever of its kind, as the noble Lord, Lord Kamall, said—considered the experience of more than 2,500 families and 830 staff. I think it is important that your Lordships’ House also remembers how many staff have found themselves in situations they would never have wanted to be in. I am sure that the noble Baroness, like me, pays great tribute to the many NHS staff who are in the majority in doing their work in a compassionate way—as the noble Baroness has experienced.

I cannot comment on whether it is specific to society but, from Donna Ockenden’s conclusions, there was something deeply wrong here. Whether it was not listening, culture or racism and discrimination towards women, families and staff, and between staff, we cannot have it.

[Lord Hunt of Kings Heath (Lab)]

My Lords, to continue this theme, the report describes a bullying and toxic culture, with junior midwives not being sufficiently supported when dealing with complex cases. It was a culture that did not allow them to refer such cases up the chain. There was a constant turnover in senior midwifery leadership and those they appointed were not given proper induction, mentoring or even guidance about their roles. In the work that the Minister is taking forward with the Secretary of State, will there be a concerted national programme of training and development for senior midwives so that there is a real opportunity to try to grip these issues?

[Baroness Merron (Lab)]

My noble friend’s analysis is quite right. One of the reasons we are developing an anti-discrimination programme is that cultural change across maternity and neonatal services is much needed. I use that as one example; all NHS trusts are to have completed that programme by 2027, and that is already under way.

I found it absolutely shocking that so many senior people at Nottingham did not give evidence to Donna Ockenden’s investigation. That is why, once the Hillsborough law Bill receives Royal Assent, we will extend the duty of candour to the Leeds and Sussex reviews so that the chair, Donna Ockenden, will have the powers to find the truth from organisations and staff. On the earlier point, it is quite shocking and totally unacceptable that they refused to participate.

Migraine Care: 10-year Health Plan

Lord Hunt of Kings Heath Excerpts

Monday 23rd March 2026 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, my noble friend the Minister, very welcomely talked in her first response about widening access to treatment. My understanding is that NICE guidelines can be very tight for some of those treatments. As part of the work she has put forward, can my noble friend ask NICE to review its guidelines to make sure they are absolutely up to speed?

[Baroness Merron (Lab)]

As I know my noble friend is well aware, the eligibility criteria are set independently by NICE. They are based on clinical evidence and cost-effectiveness, rather than being set by Ministers. However, it is worth saying that the introduction of oral CGRPs, which do not require specialist initiation, will significantly widen access through primary care and reduce the bottlenecks in the system. We are very keen that people can access effective drugs, and I take on board the point my noble friend made.

Medical Training (Prioritisation) Bill

Lord Hunt of Kings Heath Excerpts

Report stage
Monday 23rd February 2026 Lords Chamber

[Lord Patel (CB)]

My Lords, I will speak to my amendments listed in group one. My amendments should be underpinned by the status of UK medical graduates. The competition to get into medical schools in the United Kingdom is one of the toughest of any country. The ratio of success is about 4:1, with the highest A-level grades obtained, including many at A*, but requirements are higher than that.

At completion, on average, a UK medical graduate has a loan of about £72,000, and it is important that we debate this Bill in that context. I have retabled my amendments from Committee for two reasons. The first is that the debate that we had in Committee concentrated—rightly, maybe—more on international medical graduates or graduates from UK university campuses and not so much on the UK medical school graduates, who seem to be losing out on getting training posts. We have all received many emails from UK graduates and international medical graduates. I, presumably because I had amendments in my name, seemed to receive many more from UK medical graduates. Some noble Lords may have seen a petition on the internet addressed to us, Members of the House of Lords, to pass this Bill unamended, from UK medical graduates. I gather that there are over 4,500 names attached to that petition now.

So why am I putting forward these amendments again? Most other countries—the USA, Canada, New Zealand, Australia, Singapore and the EU—prioritise their graduates for further training and even employment. Data from the GMC, NHS England, the royal colleges, the BMA and professional journals shows—I accept there is variation, including in how the data could be interpreted—that graduates from the UK find it difficult to get into core and specialist training programmes, for a variety of reasons. They include: increased output from medical schools, which will increase even more in future years; an increase in post-2019 visas for international medical graduates; and training slots have not increased, with the workforce plan increased to accommodate more doctors.

In the UK doctors’ pay negotiations, one of the primary reasons that they gave was that training was an issue. A second issue was working conditions and a third was pay. I have said publicly in this Chamber before, and I repeat now, that I do not subscribe to any doctor at any time withdrawing their services from patients, for no matter what reason. I therefore do not agree with junior doctors going on strike. Despite the fact that they may have a legitimate reason to complain about their training issues, it is still no reason, as far as I am concerned, to withdraw services from patients.

UK training of doctors has three stages: foundation years 1 and 2; core training; and specialty training, including GP training. The GMC informs me that foundation year one training is available to all graduates who graduate from UK universities, although sometimes they find it difficult as the slots are not available until the last minute. Usually, that ought not to be a problem. In my case, it was two weeks before I had to start the job that I secured a position to do surgery in Penzance, having qualified in St Andrews. It was not a place that I had visited before, but I got through it.

In a 2024 report, the GMC says that, in 2023, 77% of doctors completing foundation year 2 did not or could not enter core training. A lot of them, around 13%, had decided not to, I gather, and may have gone overseas. In 2017, international medical graduates whose primary medical qualification was overseas were 47% of those registered with the GMC; in 2023, this was 68%. The 2023 GMC report said that 40% of doctors entering specialty training were international medical graduates.

It is important that we have opportunities for international medical graduates to come to train in the United Kingdom and have employment status in the NHS. But UK doctors should have a fair shot at being able to compete fairly. UK doctors comment that, after foundation year 2, entering specialty training is like falling off a cliff; it is difficult for them to get into specialist training.

NHS England, in annex 3 of its briefing on the Medical Training (Prioritisation) Bill, says that the potential impact will be an application total of 21,000 for about 10,000 posts, a ratio of 2:1. In 2025 round 1, 28,000 of the 80,000 applications were deemed appointable, according to that document. On competition, annex 4 says that, despite lower competition ratios, over 2,000 appointable UK graduates did not receive an offer in round 1 of 2025.

The expectation, therefore, is that there will be 16,000 UK graduates, a slight increase from last year, applying for core and specialty training, and 26,000 international medical graduates, also a slight increase from last year. That is 42,000, although the NHS England number is 47,000. There is always a variation in the numbers, for reasons I cannot explain. Nonetheless, the ratio is 4:1 for 10,000 slots. The estimate is that 8,000 UK graduates may be forced out of the coming rotation year as they may not have appointments.

The passage of the Bill will mean that priority groups of doctors will also apply for these training slots. I could not find a number for what effect that will have, but maybe the Minister has numbers on how many more doctors will be able to enter specialist training if the priority groups in the Bill are included. So UK graduates, with the expansion of priority groups, will have further competition.

An NHS England publication, with a foreword from Dr Powis and the Chief Medical Officer, says that

“the current bottlenecks in training do not benefit anyone; while some competition has always been a necessary part of medical training and career progression … the current ratios are making sensible career planning and assessment”

for, in my words, UK doctors

“very difficult”.

That is why I put my amendment where I have. I know the later amendments will discuss graduates from other UK campuses being eligible for the priority group, but I will refer to that later. I beg to move.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord, Lord Patel, made some very interesting points, and I am interested in hearing my noble friend the Minister’s response to his amendments. I doubt I have had as many emails as the noble Lord, in view of his expertise in the whole area of medical training and development, particularly at postgraduate level, but it is hard not to feel sympathetic to both sides of the argument. I feel for those doctors trained overseas who thought they were on a pathway to being accepted for specialty training in this country and have had the rules of the game changed half way through.

Equally, though, as the noble Lord, Lord Patel, pointed out, we have the ridiculous situation of growing competition from overseas doctors while UK-trained doctors are finding it very hard to get specialist training. This goes to the wider question about this country’s overreliance on doctors from overseas, and the current recruitment from Africa gives me particular concern about the ethics of this process.

--- Later in debate ---

[Baroness Gerada (CB)]

My Lords, as probably the only person in this Chamber who has headed up a royal college not once but twice—the Royal College of General Practitioners—I feel the urge just to defend them and correct what is been said three times in this Chamber. The royal colleges set the standards and the curriculum; they do not oversee workforce planning, funding, or what the actual training looks like once you get into an organisation. I have to correct those speakers by saying that that is not the job of the Royal College of GPs. I do not disagree that there needs to be reform; absolutely, it is a complete mess—

[Lord Hunt of Kings Heath (Lab)]

My Lords, does the noble Baroness accept that the royal colleges certainly can give moral leadership? I also refer her back to the last junior doctors dispute, about 10 or 11 years ago. As she will remember, the Academy of Medical Royal Colleges, I think it was, set up a group to look at all these issues, and the outcome of that was very disappointing in terms of tangible results in improving the situation.

[Baroness Gerada (CB)]

I thank the noble Lord very much. I have to also tell your Lordships that for the last 20 years I have led what is called the practitioner health programme, which has looked after the mental health of the medical workforce—I no longer lead it. To date, about 40,000, mainly doctors, have passed through that service, most with mental health issues relating to burnout, depression and anxiety, and some with a new diagnosis which I call NHS-itis.

I know about the endless reviews that were done. It is not just the Academy of Medical Royal Colleges, Health Education England, the General Medical Council and the CQC; many of the individual royal colleges looked at the issues of the decline in mental health. Some of these have been raised here, around firms, loss of control, training and the intensity of the workload. Fundamentally, we do not make it easy for any of these doctors—and, by the way, we do not make it easy for the international medical graduates either, who have always fared worse. I agree with the noble Lord that there are solutions, so we do not need another review. The answer is blowing in the wind—we have the solutions—and I am very happy to discuss that at a further time.

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[Lord Patel (CB)]

My Lords, I might end up sounding like a broken record, but I hope it is still playing well. I will declare my interests, although they are probably irrelevant. I am an emeritus professor at the University of Dundee and have previously been its chancellor. I am a fellow of the several royal medical colleges, and I am associated with several universities in the United Kingdom that have medical schools.

I congratulate the noble Baroness, Lady Gerada, on her most eloquent and powerful argument for Queen Mary, Malta to be considered a special case—and she just about succeeded in doing so. Besides that, the broken record bit about me goes back to UK medical graduates. Some 7.6% of graduates of United Kingdom universities are overseas citizens, but they are all trained in the same curriculum and with the same degree as from UK universities. There are several universities that take these students; there are too many to list them all. The overseas campuses of UK universities of course have the same curriculum because the GMC has recognised the institution and therefore its curriculum. The GMC does not give recognition to any training programmes that do not have the same curriculum for graduates. Whether it is a campus or it is associated with the university, the curriculum is what the GMC approves and, in doing so, it therefore approves the institutio;n.

There are other UK university campuses overseas. Newcastle has 107 trainee doctors in Malaysia. I am told by the GMC that Barts London has a university association in Malta that has 69 graduates—and, as we have heard, Queen Mary in London has had a total of 147 graduates from there. Southampton medical school is approved for a medical course in Germany with 23 candidates. St George’s London, as we have heard, had quite a small number; I was told it was nine, but the noble Baroness, Lady Gerada, said it was seven. There are two more schools that are seeking GMC approval: Swansea in Mauritius and Exeter in Athens. I have no doubt that other medical schools will also jump on the same bandwagon and that, after today’s debate, they will make sure that their curriculum is similar to those followed in the UK so that the degrees from their overseas campuses are also recognised.

I have no objections to any of those—as I said, the noble Baroness, Lady Gerada, made a very strong case for Queen Mary in Malta—but I do point out that, if we add these all up, we will increase the priority groups that will challenge UK medical graduates further. That is the only case I am making.

[Lord Hunt of Kings Heath (Lab)]

My Lords, like the noble Lord, Lord Patel, I apologise for coming back to the substance of the debate on the first group.

We should pay tribute to the noble Baroness, Lady Gerada, for how she has approached these issues. Her amendments, which I agree with, are very tightly drawn to Malta and Newcastle. She has been engaged with my noble friend the Minister and has asked for certain assurances from her; I hope my noble friend will be able to respond to them.

This identifies the madness of the situation that we have. UK universities with campuses abroad often have students coming from the UK; they go over there to study in the hope that they can then come back to the NHS and apply for specialty training places. If ever one wanted a reason for why we need a fundamental, wholesale review and reform of the gamut of medical training, this is it.

I chided the noble Baroness, Lady Gerada, about the royal colleges’ leadership in this area, because the colleges should take leadership. Through her leadership of her college, and that of the noble Lord, Lord Patel, we have examples of the kind of leadership that we desperately need now from the medical royal colleges.

Resident Doctors: Industrial Action

Lord Hunt of Kings Heath Excerpts

Monday 15th December 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness has just made a very good case as to why the offer which has been rejected would have been so helpful. On the issue of pay, our door has remained open to the BMA and to reasonable, realistic solutions to resolving the dispute, on which we have been repeatedly clear. I know the noble Baroness did not say this, but I say more broadly that there can be no suggestion that the BMA was not aware that we can go no further on pay this year. Resident doctors have already had a good deal on pay—an average 28.9% rise over the last three years—but pay expectations have to take account of the fiscal position and the impact across the whole of the NHS and beyond. I am glad to hear that noble Lords are in agreement with that approach.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the BMA pay claim has been ridiculous right from the start, and I share my noble friend the Minister’s outrage at the decision to carry out these strikes at a moment when the health service is on its knees, certainly in Birmingham. We are in a critical situation: the service is working under huge pressure, and ambulances are finding it very difficult to discharge patients at A&E because we cannot get the flow of patients through the system.

Listening to the noble Lord, Lord Kamall, I wondered if my noble friend the Minister shares my view. I remember the 2014 junior hospital doctors’ dispute. Although that was ostensibly about pay, what came through was frustration at the way training and working lives were organised, with inflexible placements and utterly insensitive rota allocations. It made junior doctors’ working lives increasingly difficult. This was 2014. Does my noble friend the Minister think that part of the reason we are here now is that nothing was done to respond to the substantive issues juniors raised at the time, and that at some point, there will be a constructive way forward? I am convinced that tackling the way junior and resident doctors are treated in the health service will have to be at the heart of what we do.

[Baroness Merron (Lab)]

I am grateful to my noble friend, and I share his view. I am sure he will be very familiar with this, but it is worth reminding ourselves that in the Statement we are debating, the Secretary of State said last week:

“On jobs, I have much more sympathy with the BMA’s demands. I have heard the very real fears that resident doctors across the country have about their futures; it is a legitimate grievance that I agree with”.


As the Secretary of State outlined and my noble friend referred to, we have inherited

“training bottlenecks that … leave huge numbers of resident doctors without a job … UK graduates”

used to compete

“among themselves for specialty roles; now, they are competing against”

the rest of the world.

“That is a direct result of the visa and immigration changes made by the previous … Government post-Brexit, and … compounded by the”


then Government’s

“decision to increase the number of medical students without also increasing the number of specialty training places”.—[Official Report, Commons, 10/12/25; col. 429.]

This has not just come about, and I am grateful to my noble friend for reminding us of the history of this.