King’s Speech

Lord Kamall Excerpts

Wednesday 20th May 2026 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank the Minister for the clear way in which she introduced the debate. We all know that our country faces profound and growing challenges in health and social care. As the leader of the Opposition made clear in her response to the gracious Speech in the other place, we are entering a period of deep structural pressure that will test the foundations of our system. His Majesty’s loyal Opposition will engage constructively with the Government’s proposed reforms, but it is essential that the Government reassure patients that any changes will improve the quality of care, protect patient safety and their privacy and avoid costly disruption.

Our system of healthcare, especially the NHS, is caring for more people than ever before. Although people may be living longer, too often they spend their later lives and later years in poor health. Increasingly, patients present not with a single condition but with multiple, complex and interlocking needs. Multimorbidity is no longer a challenge for the future, but a challenge for now. It is reshaping demand across primary care, hospitals, community services and social care. That pressure is compounded by the wider state of the nation’s health. Healthy life expectancy has fallen, meaning more years lived in ill health, a sustained greater demand for services and a heavier strain on an already stretched workforce.

In the drive to improve our health by reducing obesity, for example, successive Governments have relied heavily on top-down or trickle-down, state-led interventions, such as sugar taxes. But often this has not led to sufficient changes in behaviour. Often, the poorest families simply end up paying more, or swap their favourite brand of sugary drink or snack for a cheaper brand. What is amazing about this view is that, when I speak to public health academics, they agree with it, but they also agree that community led, bottom-up approaches are far more effective than top-down state interventions.

I should declare my interest as a professor of politics and international relations at St Mary’s University, where I teach an MBA module in healthcare policy and am helping with a new medical school, which will accept its first trainees this year. I also run seminars and supervise students at the Vinson Centre for the Public Understanding of Economics and Entrepreneurship at the University of Buckingham, which also has a medical school, but I have no relationship with that.

Unfortunately, successive Governments have failed to pay enough attention to the successes of community-led projects. An example is BRITE Box, which gives families ingredients and a recipe card with instructions to help them to cook healthy meals together. The recipe cards have been designed to be child-friendly, with more pictures and simpler wording. Often, it is the children who encourage their parents to join in preparing the meals as a family. BRITE Box aims for the box of healthy ingredients to cost around £5 to feed a family of four. This helps not only with budgeting but with changing eating habits and tackling obesity. So, while the Government repeat their mantra “From Hospital to Community”, on which there is obviously widespread agreement, can the Minister answering tell noble Lords what plans there are for the department to work more closely with existing projects that are already tackling many of these problems in their own communities? How can we expand the role of these projects in those communities?

At precisely the moment that the NHS needs resilience, it is constrained by workforce shortages, delayed discharge driven by fragility in adult social care and urgent and emergency care performance that reflects a system operating too close to the edge. The continual risk of industrial action, which the recently departed Secretary of State promised to end, only adds further to uncertainty for patients and staff alike.

The news last week that waiting lists had fallen is welcome in principle, and the Minister referred to this. However, I subsequently read in the Health Service Journal that the “majority of the improvement” in March was driven not by genuine progress but by a “record” spike in “unreported removals”. When I asked a Written Question on the reasons for patients being removed from the waiting lists, the Government replied:

“The Department does not hold the data”


showing the reasons why patients were removed from the waiting lists. Really? So how did the Government decide which patients to remove from the waiting lists if they did not have the data on why they were removed? There has to be a reason for these patients to have been removed. I urge the Minister to go back to the department and give a more credible response, so we can understand the reasons for the removals.

I turn to the King’s Speech and, in particular, the NHS modernisation Bill. On the face of it, some proposals are welcome: a single patient record, clear accountability in local systems and a simplified approach to patient safety. Any reform that reduces duplication, improves efficiency and, above all, improves patient care and outcomes deserves support. However, as successive Governments of all colours have found, good intentions do not by themselves guarantee better outcomes. The Government’s approach is not without risk. The history of NHS reform shows that structural change can impose substantial costs and disruption if not designed carefully and implemented safely. We have seen major programmes such as Epic create unforeseen problems in interoperability and access to information, and we have seen how cyber incidents can rapidly undermine clinical and operational capacity, as happened with the Synnovis cyber attack recently.

The healthcare landscape is now an extraordinarily complex network of providers, partnerships and systems with interdependent responsibilities, so reform driven from the centre must reflect that reality and diversity. A single patient record may have real potential, but it will succeed only if it is delivered with clear standards, accountability for implementation and robust cyber resilience. It must also earn the trust of patients, especially in how their data is protected. Failing to do so would incur the wrath of civil liberties organisations and reduce patient trust. In my time in the department, I supported the initiative of officials to consult organisations such as medConfidential. Although I expected the officials to be sceptical, they said, “We actually agree with many of medConfidential’s asks. They are reasonable and deliverable”. Let us make sure that we have that same relationship of trust between the civil liberties organisations and the department.

While many noble Lords will support the reduction of duplication between the Department of Health and Social Care and NHS England, abolishing an institution is often more difficult than creating one—especially since NHS England currently co-ordinates a vast range of activity that underpins clinical practice and the patient experience and outcomes. When the NHS modernisation Bill reaches this House, we will look to the Government to provide clarity on three points: the timetable and cost of transition; the continuity of national functions, including planning, performance of oversight, specialised services, digital delivery and how they will be maintained without interruption; and how the stated ambition of decentralisation and devolution is reconciled with the transfer of substantial powers to a central department.

I will set out a few areas where we will seek greater engagement from the Government between now and the introduction of that Bill. First, on the shift from treatment to prevention—which noble Lords also agree with—we support the idea that the most effective way to reduce pressure on the health system is to tackle problems at source, to prevent ill health where we can, intervene earlier where we must, and reduce demand on GPs, hospitals and emergency care providers where it is appropriate and safe to do so. While public health has a role to play, it will be important for the Minister’s department and local authorities to work with many of the local community organisations that I referred to. When it comes to healthier diets, I have already mentioned BRITE Box, but many noble Lords will be aware of local community projects, wherever they live, that work in social prescribing, including on music and well-being.

During debate on the Mental Health Bill, we discussed the increasing incidence of mental-health issues across the population. Sometimes medication is appropriate, but not always. Another option could be social intervention, such as music or art therapy. We know that these can help people feel much better, without the need to go to hospital in the first place. There are many such organisations up and down the country. I urge the Government to seek the solution in prevention, by increasing well-being, and not always through treatment.

We also need a credible workforce and staff retention plan: sadly, this is something we realised too late when in government. The continued risk of industrial action—combined with growing concerns that shortages in some clinical roles are putting patient safety at risk—creates a deeply worrying picture. Across the country, patients who choose to use the NHS live with the fear that a long-awaited appointment, operation or procedure may be cancelled at short notice. Against the backdrop of an ageing population leading to increased pressure on the public purse, the UK faces a challenge: while we probably have more doctors and nurses than before, is it realistic and affordable to keep recruiting more staff to try to keep pace with demand?

One way that the former Secretary of State wanted to address this issue was through the increased use of technology. During my time as Minister for Technology, Innovation and Life Sciences, one of my frustrations was that much of the technology to improve prevention and diagnosis was already available. This could be better use of a mobile phone camera to send high-definition photos or scans to be analysed by health professionals, or wearable technology to monitor patient health. But one problem is that there is no front door for start-ups and scale-ups in medical technology with the potential to transform healthcare. We need a front door, a one-stop shop, to distinguish the sales talk from those who claim to have a solution but actually have nothing more than a minimally viable product, from those who have a potentially transformative tech solution that could be adopted and make huge changes across our system of healthcare.

Another problem is that current suppliers of technology are often reluctant to work with start-ups, and quite often erect technical barriers to the adoption of solutions they did not invent. When I was a Minister, I had many emails on this subject; I still do now, as a shadow Minister. People offer real solutions that could potentially transform healthcare, but the existing suppliers find an excuse not to interoperate. We also need the department to be wary of vendor lock-in, especially in the development of a federated data platform.

When it comes to tech, the obvious phrase on everyone’s lips is the potential of AI. It does have huge potential to help analyse datasets and enable clinicians to make more informed decisions. But we must ensure that there is a human backstop immediately available when there are problems. I am sure many noble Lords have been caught up in online or telephone customer service—what people call “doom loops”—where they are unable to reach a human. While some companies may get away with this sort of customer service, or lack of customer service, timely human intervention in healthcare could make the difference between life and death.

During my time in this House, I have heard noble Lords on the Government Benches say that the state cannot do it all. The role of partnerships with non-state providers will be crucial. While our system of healthcare is often used as a political football to score points, I hope that, particularly in your Lordships’ House, we may be able to find some room for consensus.

I think back to when my father was a bus driver and a member of the Transport and General Workers’ Union. My father’s subscription included treatment at the independent Manor House Hospital, so when my mother had to wait to be seen by a specialist on the NHS, she was able to be seen by a specialist there. Today, we know that many trade unions offer private health insurance or health plans as part of their membership package. In seeking to improve the supply of healthcare in a sustainable way, I wonder if we can find some consensus and agree across the political divide on an increased role for non-state providers, including mutuals, such as Benenden Health, and charities, friendly societies, co-operatives and private non-profit providers. I recognise that there will be some political disagreement over private for-profit providers, but I wonder if even there we could find agreement where they have been used to increase capacity and reduce pressure on the National Health Service.

Let me be clear: this is not to diminish the role of the NHS, which is treasured across the country by people of all political persuasions. However, we need to consider how we reduce pressure on the NHS and the public purse, while increasing capacity and patient choice. I have tabled Written Questions on the role of mutuals in healthcare, and hope that I will be able to work with noble Lords on all Benches to encourage more of these organisations to play a greater role in our system of health and care.

We also need to be realistic about labour shortages. We know that, after the war, it was mostly Commonwealth citizens who came to this country to rebuild our public services. However, we live at a time when the Government, the Opposition and a populist party are making sceptical noises over immigration. Given this, we need to have a serious, grown-up conversation about where we find the young people to fill the vacancies in health and social care and pay taxes to fund the public services for an ageing population. Is it realistic to find them from only among the current UK population, or do we need to acknowledge that we need some immigration? How do we do that in a sensitive way, without invoking accusations of domination being made by some national politicians?

I come back to today’s debate, where we are considering housing and transport, as well as health. My noble friends Lady Scott, Lord Jamieson and Lord Moylan will say more on housing and transport, but I hope that the Minister and the Government recognise the connection between health and place. I saw that the noble Lord, Lord Mawson, was in his place earlier; he talks about this a lot. The Government had an opportunity in the King’s Speech to go much further in reflecting that relationship by adopting a genuinely place-based approach that looks at not only healthcare services but the environments in which people live, work, travel and age. The evidence is clear: sustained improvements in health will not be delivered by the Department of Health and Social Care acting in isolation. It requires a rounded approach across housing, transport, planning, education, work, local government, and perhaps other departments too.

Finally, we have heard time and again how the pressures in social care are directly affecting secondary care capacity. I look forward to the contribution of the noble Baroness, Lady Pitkeathley, who talks about this often. Delayed discharges, poor hospital flow and workforce shortages in adult social care all feed back into the NHS, leaving beds occupied by patients who are medically fit to leave but cannot be safely discharged. If the Government’s modernisation agenda is to rely on local integration through ICBs and more joined-up patient records, then that must be matched by a clear and credible plan for social care. If we do not fix social care, we do not fix the wider health system. Without such a plan, social care will remain one of the most limiting factors in the NHS’s ability to recover.

I will end by taking a step back from policy. As ever, the patient has to remain at the centre of our concern. His Majesty’s Opposition will work with the Government when it comes to improving outcomes and the quality of patient care, creating a system of health and care that is responsive, responsible and effective. We need a system that is robust, efficient and accessible—a service in which people feel empowered to seek help, are able to do so when they need it, and feel confident that they will receive their treatment in a timely and effective way. We need to move away from the 1940s model of trying to get hold of your GP so that they can sign a prescription or refer you to a hospital. Technology and a diversity of health and social care organisations can help with this transition. These Benches stand ready to support reforms where they remove needless duplication or bureaucracy, improve outcomes and the experience of patients, and strengthen our system of health and care to meet the demands of the future.