Health Bill

Lord Kakkar 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?

Health Bill

Lord Kakkar Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I was very pleased to add my name to the two amendments tabled by the noble Baroness, Lady Hollins, Amendments 92 and 252, regarding the mental health workforce. More generally, I was very taken by the way this important group of amendments was introduced by the noble Baroness, Lady Shawcross-Wolfson, because she is right that all the things that we have been talking about in this Bill so far—all the things we all want to see to improve the health of this country, and all the things we want the NHS to be able to do with, yes, efficiency and increased productivity but also with great care and compassion—will none of them be achieved unless we have the right workforce with the right skills and the education and training in place. That is why I think this is such an important group of amendments.

As I said, I was very pleased to add my name to the two amendments tabled by the noble Baroness, Lady Hollins, on the mental health workforce. She set out the case clearly, so I do not need to do it again. I simply reiterate that, once we have the long-awaited NHS workforce plan, this will be vital. I would be grateful if the Minister could make some commitment here about how quickly we will see a follow-up mental health workforce plan. We need to see some detail about how the mental health workforce will be recruited and retained and will be able to meet the scale of the mental health demand, which we have debated so many times on so many occasions. That is critical. Both those amendments are important in that respect.

My final point is that, during the passage of the Mental Health Bill, in which many noble Lords here were involved, we all quite rightly thought how important it was that as many mental health services as possible should be located in the community. We all agreed with that; it was the premise, as it were, on which the rest of that legislation was built. As important as the consultants and psychiatrists and so on are—of course they are; it is a wide-ranging workforce and includes mental health nurses and others as well—unless we have that workforce in the right place, in the community, appropriately skilled, educated and trained, we will never be able to deliver those community mental health services, which are so vital. So I was very pleased to support these amendments.

[Lord Kakkar (CB)]

My Lords, I support the amendment in the name of the noble Baroness, Lady Shawcross-Wolfson. It is an important amendment raising two fundamental questions, which I hope the Minister will be able to answer. The first is this: ultimately, in preparing a workforce plan that will enjoy broad confidence, there must be external scrutiny of that plan. It would be most helpful if the Minister could confirm how His Majesty’s Government’s healthcare workforce plan will be independently scrutinised. Also, how will His Majesty’s Government be able to reconcile potential differences generated as part of that independent scrutiny with what they consider to be deliverable at this particular moment in time?

The second issue is how a mechanism will be secured—now that the functions independently exercised in NHS England will become the responsibility of the Secretary of State for Health—in respect of long-term workforce needs and short-term financial pressures. As we have heard, investment in the workforce is a long-term investment, and Ministers will always be faced with short-term financial problems and crises. Historically in the NHS, the education and training budget has been periodically sacrificed when there have been other service, access and delivery demands on NHS institutions.

In providing an opportunity now with this Bill, how will the Government address that fundamental tension and secure a mechanism both for independent scrutiny and to ensure—with all the powers now lying in the hands of the Secretary of State for Health—that the education and training budget that secures the long-term development of the workforce cannot be sacrificed for short-term exigencies?

[Lord Scriven (LD)]

My Lords, I will speak mainly to Amendment 252 in the name of the noble Baroness, Lady Hollins. I apologise for not putting my name to it; I wish I had.

But I wish to speak first on two other amendments. The amendment from the noble Baroness, Lady Shawcross-Wolfson, is useful, and I thank her for the way that she presented it. An independently verified assessment and a 10-year plan is exactly what is needed. But I do have a word of caution. Publication within one month of Royal Assent could be a real challenge, even considering the amount of time that we have been waiting. Also, a plan that is produced that quickly risks being inaccurate, and an inaccurate workforce plan is worse than none at all, because people will make training and funding decisions on it. The amendment from my noble friend Lady Pidgeon offers a better timescale of 12 months from Royal Assent as well as an assessment of the staff needed, a funded plan to close the gap and an annual report to Parliament.

Amendment 252 matters because it names people who are easily forgotten in workforce planning: that is, the staff who care for people with a learning disability. Let me start with why that matters. The latest—in fact the last ever—national LeDeR report found that the median age at death for adults with a learning disability was 62.8 years, compared with 81.8 years for the general population. That is a gap of 19 years. Many noble Lords will know that my own wonderful nephew, Myles, who was 31 years old, is part of that terrible, tragic statistic. Some 39% of deaths of these adults were judged to be avoidable, against 21% for the general population. No workforce plan can fix that alone, but no plan that ignores it is worth having.