Health Bill

Lord Kamall Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Baroness Pidgeon (LD)]

My Lords, I thank the noble Lord, Lord Patel, and my noble friend Lady Barker for their very personal and raw contributions, as recent carers, on the recent losses of loved ones.

I am grateful for the support from the noble Baroness, Lady Thornton, for my Amendment 230 in this group, which also has the support of Marie Curie and Hospice UK. At its heart is the principle that people approaching the end of life should be able to have their wishes, preferences and priorities for care understood, recorded and respected. Advance care planning enables people with terminal illness to express how and where they wish to be cared for. It supports more proactive and personalised care and, as we have heard, it has been shown to improve patient and family satisfaction while reducing the likelihood of crises, avoidable hospital admissions and the need for emergency care out of hours. I have seen at first hand how, in Devon, the system seems fairly well set up to support people in their own homes, and to have these very difficult conversations with a hospice at home service, with people who have real skill in communicating and talking about these difficult topics at a time when someone may have just learned that they have a terminal illness and when lots of things are going around their mind. It is important for them to be able to get some clarity, going forward, about what they wish for and do not wish for. As we have heard, other parts of the country do not work so well.

Importantly, the evidence suggests that advance care planning does not increase costs to the health and care system, and may in some cases reduce healthcare expenditure by ensuring that care is delivered in accordance with patients’ wishes. We will come on to the single patient record on a later date, but I flag here that advance care planning can be effective only if the information is available to those providing care when it is needed. The single patient record offers a significant opportunity to improve co-ordination and continuity of care, but its success will depend not simply on sharing data but on ensuring that advance care planning is routinely embedded in clinical practice so that people’s wishes can be accessed, understood and acted upon, wherever and whenever care is provided.

The other amendments in this group from the noble Baronesses, Lady Finlay and Lady Coffey, highlight the many issues with the current landscape of palliative care and specialist palliative care services, and the difficulty in getting access to those services. I look forward to the Minister’s response to that, and her response to the trick or treat challenge.

[Lord Kamall (Con)]

My Lords, this has been an important and timely debate, coming not long after the Terminally Ill Adults (End of Life) Bill and the Prime Minister’s remarks. While these amendments address a range of issues, they all point to the same conclusion: palliative and end-of-life care must have a central place in this conversation.

If the Government are serious about shifting care from hospitals into communities, supporting people to remain closer to home—notwithstanding the comments from the noble Baroness, Lady Barker—and delivering truly patient-centred care, palliative care must be part of that vision from the outset. The need for action is clear. Marie Curie estimates that each year around 170,000 people in England die with unmet palliative care needs, equivalent to almost one person every three minutes. We must ensure that those approaching the end of their lives can access the support they need, when and where they need it. This is closely linked to my noble friend Lady Coffey’s amendment. She spoke movingly of her mother’s experience and the need to ensure that patients have access to high-quality palliative care, wherever they happen to live and choose to die.

If the Government’s proposed national care service is to succeed, it cannot simply be a discussion about structures, responsibilities and reorganisations. It must be about the experience of those who rely on care. No group demonstrates that more clearly than people approaching the end of their lives. Palliative care is perhaps one of the clearest examples of where health and social care are inseparable. While clinical support may be provided by the NHS, the ability of a person to remain at home or close to home, to maintain their dignity and spend time with loved ones, often depends just as much on the availability of social care. For many families, social care provides the day-to-day support on which good end-of-life care depends. Evidence shows that when effective support is available in the community, people are more likely to be cared for and pass away in a place they choose, rather than in hospital. As the noble Baronesses, Lady Finlay and Lady Hollins, said, this will also reduce hospital deaths, save the NHS money and make more beds available.

Palliative care does not begin and end with the NHS; it depends upon social care providers, community services, carers, local authorities, hospices and voluntary organisations working together around the individual and their family. When those services are joined up, people are more likely to receive care in the setting they choose and with the support they need. When they are not joined up, it can profoundly affect those approaching the end of their lives.

In that context, I welcome the amendment from the noble Baroness, Lady Finlay, which recognises that good palliative care depends not on any single organisation but on effective collaboration across the NHS, adult social care and the voluntary sector. Too often, services that support people approaching the end of their lives are commissioned, funded and delivered separately, despite the fact that patients and families experience them as part of a single journey. The amendment would help to ensure that integrated care boards take active steps to bring those services together, whether through access to specialist hospice care, shared equipment, medicines, workforce development or closer collaboration between providers.

Crucially, the amendment recognises the vital contribution of hospices and charitable organisations to the delivery of palliative and end-of-life care. These organisations are not peripheral to the system; they are an essential part of it. If the Government are serious about creating a national care service and a neighbourhood health service that are genuinely joined up for patients, the expertise and capacity of the voluntary sector must be properly integrated into the way care is planned and delivered.

Indeed, some of the most important services available to people at the end of their lives are delivered by hospices and charitable organisations. For decades, as the noble Lord, Lord Hunt, said, the voluntary sector has not merely supplemented statutory services but has been fundamental to the provision of specialist palliative care. But too often it is forced to operate at the margins of the system, dependent on local arrangements, local funding decisions and local fundraisers, and subject to tax rises, such as employers’ national insurance, from which state providers are understandably exempt. The noble Baroness, Lady Bennett, shared examples of recent hospice closures.

If the Government wish to build a neighbourhood health service and develop a national care service, integration must mean integration not only within the NHS but between the NHS, adult social care and the voluntary sector. Ultimately, the measure of success will not be the structures we create but whether individual patients receive seamless support at one of the most difficult moments of their lives and for their families.

The issue of patients having a conversation about their end-of-life care, addressed in the amendment in the name of the noble Baroness, Lady Pidgeon, was illustrated by the very moving stories from the noble Lord, Lord Patel, the personal experience of the noble Baroness, Lady Barker, and the concerns raised by the noble Baroness, Lady Grey-Thompson. These amendments seek to move us towards that goal. I hope that the Minister will give careful consideration to the issues that have been raised during the debate.

[Baroness Merron (Lab)]

My Lords, I can certainly confirm to the noble Lord, Lord Kamall, that I will give complete consideration to the points raised.

As other noble Lords have acknowledged, I thank the noble Baroness, Lady Barker, and the noble Lord, Lord Patel, for bringing their loved ones’ stories into the Chamber for the benefit of others, and for their willingness to share with us such a painful but realistic time. I believe that many people will identify with what the noble Baroness and the noble Lord said, and it will mean so much to so many.

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Moved by

[Lord Kamall]

27: After Clause 6, insert the following new Clause—
“Access to health innovation networks(1) The Secretary of State must make arrangements for a wide single national point of access to the health innovation networks in England.(2) The arrangements must enable a person to—(a) make a single request for support,(b) be directed to the appropriate health innovation network or networks, and(c) receive coordinated support where an innovation has potential application in more than one region.(3) The Secretary of State must publish information about the operation and performance of the arrangements.”Member's explanatory statement
This new clause would require a single national point of access through which innovators and other organisations could obtain coordinated support from the health innovation networks in England.

[Lord Kamall (Con)]

My Lords, let me make it clear that I recognise that what I am asking for does not need to be in the Bill and does not need legislation. However, my frustration at the lack of progress, both when I was the relevant Minister and as shadow Minister, has forced me to table this probing amendment.

I often meet entrepreneurs and tech companies who claim that they have an innovative product or solution that could transform healthcare. They ask me how they can have a conversation with the relevant person within the NHS. When I was a Minister and I asked my officials about this, they would give me an email address I could share. However, two things stayed with me. First, why was this email address not widely advertised and known by more people? Secondly, when I asked such entrepreneurs whether anyone from DHSC or NHS England had replied, the answer was no.

In opposition, I began thinking, “How can I help more innovators into the NHS?” It was suggested that I meet the Health Innovation Network, which told me that it is the front door for innovation. However, once again, many tech entrepreneurs have never heard of it. I was surprised to read on the Health Innovation Network’s LinkedIn page that it has “501-1K employees”. How about that for precision? Speaking to noble Lords and others interested in health innovation, I have heard a range of opinions about the local networks—that some are good, some are bad and some are in the middle. While some regional health innovation networks are good, others are not so good and coverage is patchy. This brings me to my question. What is the Health Innovation Network’s remit, and what assessment have the Government made of local networks’ effectiveness? What plans do the Government have for the networks in the reorganisation?

I recognise that there is a fantastic clinical entrepreneurs programme led by Tony Young, an NHS surgeon and clinical entrepreneur. He has always been very open and has encouraged me to send on to him clinical entrepreneurs who have approached me, in order to have further conversations. The question relating to this amendment is: what about entrepreneurs who are not clinicians, but who have an innovative solution that could transform health or social care? For them, there is no obvious front door to the NHS or one-stop shop. What do they do? They spend ages trying to get into the system at primary care, trust or ICB level, sometimes wasting their time but also clinicians’ precious time. Sadly, they then give up or go abroad, meaning that the UK loses out on British innovation.

In July, during an Oral Question, I asked the Minister to ask the DHSC Minister for technology and innovation to create such a front door or one-stop shop to triage those who approach it. That front door could distinguish those salespeople who have no minimum viable product, telling them what they need to come back with to be taken seriously. Secondly, what about those who have a solution but need more support, so that they can be signposted to someone who can advise them on coming up with a more feasible approach? Thirdly, there are those who have potentially a fantastic solution that could transform healthcare and need to be piloted as quickly as possible.

I was grateful when noble Lords from all Benches later told me that they agreed that this was a practical idea. Has any progress been made since I asked that question in July. If not, what are the reasons why? Time and again I hear the same concerns from entrepreneurs, researchers and businesses: the system is difficult to navigate, and numerous organisations are involved in supporting innovation, all with different remits, processes and points of entry. Expertise clearly exists throughout the system, but identifying the right door to knock on can be a challenge in itself.

This amendment seeks to address that problem through a simple but important principle: that there should be a single national point of access through which innovators and other organisations can obtain co-ordinated support. The purpose is not to create another bureaucratic layer; on the contrary, it is intended to reduce complexity, improve co-ordination and ensure that innovators spend less time navigating the system and more time developing solutions that could benefit patients. The principle behind the amendments mirrors one that the Government have embraced elsewhere in the health service. The concept of a single point of access, or a single front door, is designed to simplify routes into services, triage inquiries effectively and direct people to the most appropriate expertise at the earliest opportunity. Rather than forcing patients to navigate multiple pathways, the system assumes responsibility for guiding them to the right destination.

My Amendment 27 applies precisely that same logic to innovation. Instead of requiring innovators to work their way through a maze of organisations and programmes, a single front door would provide a clear route into the system, supported by intelligent triage to the most appropriate person in the Department of Health and Social Care or the NHS. It could be, but not necessarily, one of the 501 to 1,000 people who work for the Health Innovation Network. I beg to move the amendment.

[Lord Scriven (LD)]

My Lords, I thank the noble Lord, Lord Kamall, for moving this amendment and for the very short debate that has followed. I believe that the frustration is real, but the Committee deserves answers to two questions: what is in place now and would the proposed new clause make it better?

As the noble Lord, Lord Kamall, said, there are 15 health innovation networks, each serving its own region, but there is already a national point of access. The NHS Innovation Service, as the noble Lord, Lord Kamall, said, has been running since 2022, when it was set up by a very forward-thinking junior Health Minister—the noble Lord, Lord Kamall. NHS England describes it as a single entry point. An innovator completes one record. Experts from within the network review it within 10 working days, give tailored advice and can refer the innovator to one or more local networks. More than 2,000 innovations have had support through that service.

Proposed new paragraphs (a) and (b) of proposed new subsection (2) in this amendment largely describe something that already exists. Does it work? As a front door, it appears to do so in some regions for some people. The problem is that if the amendment from the noble Lord, Lord Kamall, was accepted, it would create two front doors for people to come through, which would probably not be a wise thing to do.

I believe that the front door is not the main problem here; the problem is spread. Adoption is one trust taking up a good idea; spread is that everything gets to the patient, no matter where they live. The Health Innovation Network’s own evidence to Parliament says adoption is

“slow, uneven and overly dependent on local early adopters”.

It describes what it calls

“a postcode pattern of spread”,

and warns that

“proven technologies do not spread through evidence alone”.

An innovation proven in one place can face the same hurdles all over again in the next, so I do not believe that we have a front door problem.

Therefore, I must be honest. As drafted, this proposed new clause would help only at the margins and it could hinder. It could create a second door beside the one we have, unless it simply puts a statutory label on the existing service. It would write an operational arrangement into primary legislation, when the way innovators are supported should be one that changes quickly. It would place duties around networks that neither the Bill nor the proposed new clause define.

There are two parts that I welcome. Proposed new subsection (3) would require published information on performance, and we should be told how many innovations spread beyond their first site and how far. Proposed new subsection (2)(c), on co-ordinated support across regions, goes closer to the real issue, but the network says that spread needs systems with

“the resource to redesign pathways, train staff and evaluate impact in practice”.

A referral service does not provide that.

The amendment’s most important contribution is the question it raises. NHS England runs the innovation service. The network’s national commission comes from NHS England, with the Office for Life Sciences. However, the Bill abolishes NHS England. Clause 6 gives the Secretary of State a duty to promote innovation and a power to award prizes, but it says nothing about the networks. A prize will not help a company stuck between a successful pilot and its second trust.

I have a few questions for the Minister. Who will run and fund the innovation service, and commission the networks, once NHS England has gone? Can she guarantee that there will be no gap? Will the Government publish performance data, including on adoption and spread, which is lacking, whether this amendment is accepted or not? Who, after abolition, will be responsible for making sure that proven innovation spreads across the whole NHS, not just to the early adopters?

A single door is a reasonable aim and we largely have one. What patients need is for it to work in one part of the NHS and then to reach all of it. I look forward to the Minister’s reply.

[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Lord, Lord Kamall, for bringing this debate before the Committee. I commend his honesty that this is born out of frustration and a wish to improve things, rather than seeking a legislative response—something the noble Lord, Lord Scriven, also observed in looking at the amendment. I agree with the noble Lord, Lord Scriven, that the amendment raises important points to be considered more broadly, so I assure the noble Lord, Lord Kamall, of that consideration.

I will make a few points that may be helpful. The NHS Innovation Service already provides a wide national point of access. The way it works is that an innovator makes one request, creates one product record and is referred according to product type, maturity and location. More than 2,200 products have been registered with and have received support through the service, including 710 innovations in the 2025-26 financial year. All health innovation networks participate alongside 11 other organisations. That means that innovators have access to a broad range of expertise through a single service. Almost all products reach at least one health innovation network and are referred to four organisations on average. Innovators may also approach a network directly. Support can span several networks and regions, with onwards referral requiring no new application. Uptake is already reported at a high level while, of course, protecting commercial confidentiality.

I hope that the noble Lord, Lord Kamall, will understand that funding a second route—or, as I believe the noble Lord, Lord Scriven, said, a second front door, which would confuse us—where an effective national service is already in place may not exactly represent what we might call the most effective use of public resource. The amendment’s core aims are therefore already met. Prescribing an operating model in legislation could limit its ability to evolve—something I know the noble Lord understands.

The noble Lord, Lord Kamall, asked about health innovation networks. I can confirm they are subject to performance and impact monitoring. They also produce impact reports to show what their local impact is. The noble Lord, Lord Scriven, asked what would happen following the abolition of NHS England. Nationally funded health innovation networks’ work will continue and will be overseen by the Secretary of State. I will look at the other points that have been raised, because they are all certainly relevant and will be drawn to the attention of my colleague, the relevant Minister, Chris McDonald.

[Lord Kamall (Con)]

My Lords, I am grateful to the very many noble Lords who queued up to speak in this debate—I obviously raised a very important point. I am also grateful to the noble Lord, Lord Scriven, for reminding me how innovative I was when I was the Technology and Innovation Minister. In fact, I set up the very service that I am now asking for many years later. It does beg a question, because even I, as the person who set it up, still did not know that this service existed. When I speak to people in NHS England and elsewhere and say, “You know what you need? You need a front door for innovators”, they say, “You’re absolutely right; we haven’t got one”. So even people in NHS England do not know that this exists.

I was up front that I knew this was not meant to be in the Bill. I just wanted to get discussion. It probably helped to prompt my memory as well—my thanks to the noble Lord, Lord Scriven—but it is really important that more people know about the NHS Innovation Service. Perhaps the Minister could write to me and the many other noble Lords who are interested in this topic to let us know what the Government intend to do to promote the NHS Innovation Service, so that more people are aware and so I do not ask for the same thing next time we have a health Bill.

[The Deputy Chairman of Committees (Lord Young of Cookham) (Con)]

Does the noble Lord wish to withdraw his amendment?

[Lord Kamall (Con)]

I thought the logical conclusion would be that I beg leave to withdraw my amendment.

Amendment 27 withdrawn.

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[Baroness Pidgeon (LD)]

My Lords, since taking over as our spokesperson, I have lost count of the number of times the Minister has talked about the workforce strategy that will at some point emerge from the department. I am not sure whether we will be given a season this evening, but hopefully it will be published soon.

My Amendment 253, which the noble Lord, Lord Stevens of Birmingham, and the noble Baroness, Lady Gerada, have added their names to, would require the Secretary of State, within 12 months of Royal Assent, to publish

“a health and care workforce strategy for England”.

I have included “care” on purpose because the two are so importantly linked. It must assess the staff needed to meet current and projected demands, expressly including registered nurses and primary care practitioners, and it must contain a funded plan to close staffing gaps. Annual progress reports would be laid before Parliament, keeping that issue on the agenda for us all. Putting staff in is an important marker too. We need to properly plan and invest in our workforce, both health and care, hand in hand.

The Royal College of Nursing supports this amendment, as do a number of representatives of primary care. Too often, primary care seems to be forgotten in the debate on workforce, but it is critical: GPs and district nurses—we have just heard passionately from the noble Baroness, Lady Gerada, about their role—as well as optometrists, dentists and pharmacists. As the Government look to shift services into neighbourhoods and hospitals—something I think we all support—this is really important. The early years workforce is important as well, as are health visitors.

The other amendments in this group, including that of the noble Baroness, Lady Shawcross-Wolfson, all require similar reports, perhaps on different timescales. Some are focused on really important areas such as the mental health workforce, the education and training that is needed alongside a workforce plan, and continuing professional development. Noble Lords have flagged the current vacancy rates in a number of roles, as well as skills shortages and the need for independent scrutiny of the workforce plan.

My noble friend Lord Scriven rightly stressed, using his personal family experience, the need for nurses for people with learning disabilities and the investment in that workforce, as well as the need to understand the whole workforce, looking at models in, for example, the Netherlands. The noble Lord, Lord Stevens, and the noble Baroness, Lady Gerada, talked about the complexity around primary care and the challenges with part-time workers, with perhaps more women coming into the workforce, as well as the challenges of work-life balance. Some people want to work part-time rather than full-time. These are key questions for the Government on this issue of workforce. I look forward to a comprehensive response from the Minister, and possibly a date, a season or a hint of when we might at last see that workforce strategy.

[Lord Kamall (Con)]

My Lords, this has been a crucial debate, and I am grateful to noble Lords for tabling and speaking to their amendments, which raise fundamental questions about the future of the NHS workforce, the quality of care patients can expect and the Government’s ability to deliver health service reform.

The amendments from my noble friend Lady Shawcross-Wolfson and the noble Baroness, Lady Pidgeon, go to the heart of a simple but vital question: how can this Government, or indeed any Government, credibly plan for the future of the NHS without an independently verified assessment of the workforce that we need? As my noble friend said, the previous Conservative Government, albeit belatedly, recognised the importance of this challenge when we published the first NHS Long Term Workforce Plan in 2023. This was a baseline step in establishing a long-term approach to workforce planning, with clear ambitions to expand domestic training, improve retention and reduce our reliance on international recruitment.

We recognised then, as we must recognise now, that workforce planning cannot be conducted from one spending review to the next. Training doctors, nurses and other healthcare professionals takes years, and decisions made today will determine the quality and availability of care for patients a decade, or decades, from now. Yet we are still waiting, as other noble Lords said, for the Government’s new 10-year workforce plan. The noble Lord, Lord Patel, offered some possible reasons for the delay.