Health Bill

Lord Lansley Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Lord Stevens of Birmingham (CB)]

My Lords, I support the amendment in the names of the noble Earl, Lord Howe, the noble Lord, Lord Kakkar, and other noble Lords, because it draws attention to the fact that we are on the cusp of a huge reorganisation, yet there is a remarkable lack of clarity as to how it is going to be given effect.

First, can the Minister confirm to the Committee that it is still the Government’s intention that NHS England will be abolished on 1 April? There is a groundswell of discussion across the centre of government and the NHS which suggests that that is looking to be an increasingly impractical date. Can she confirm the Government’s concrete intentions on that? If she tells us that it is still going to happen on 1 April, then it ought to be entirely possible for the Government to accede to the amendment put forward by the noble Earl, Lord Howe, because, clearly, one could not, a mere matter of months away, be proceeding without already having the information that the amendment requests.

Dr Penny Dash, the outgoing chair of NHS England, was before the Commons Health and Social Care Committee five months ago, which was also exploring the question before us now. Dr Dash said that

“in a few weeks’ time a paper will be coming to the transformation oversight board, or whatever we call it, giving more detail”

on these questions. When asked whether the 50% reduction was a hard figure, she said:

“In terms of the NHSE and the DHSC … there was this sense that 50% was the right number to aspire to. The detailed work will get us to the point of determining what the numbers could and should look like”.


If 1 April is really the date, can the Minister tell us what those numbers will look like, whether it is 50% and how it is broken down, as requested in this amendment?

We already have signs that pragmatism is asserting itself in the Department of Health and Social Care, with the decisions on HSSIB and now Healthwatch. Will this be a further example of pragmatism or will the new Secretary of State stick to the plan, which is a perhaps a little half-baked, that she inherited? We already have the most centralised and politicised health service in the industrial world. Going down this path takes us yet further in that direction. If that is what we are going to do, it should at least be done well.

[Lord Lansley (Con)]

My Lords, I support my noble friend in his amendment. I do not want to revisit Second Reading issues, but will make one or two important points. First, along with other noble Lords, I say a big thank you to the Minister for some of the correspondence we have received and the way in which she and the Government have already been listening to the discussions in this House. I hope that we can continue to have a constructive discussion.

I do not entirely share the view of the noble Lord, Lord Kakkar, that the abolition of NHS England is a done deal and we should therefore accept it. It was not a manifesto commitment. Parliament has had no say in this matter. It is all the more important that, as we implement the Government’s intentions into law, we understand what we are doing and how. That is particularly true in so far as there is some speculation whether all these responsibilities will be incorporated into the department—the noble Lord, Lord Hunt of Kings Heath, sees it all as becoming engaged in the department and therefore accessible to Ministers. If many of these responsibilities are to be held in special health authorities outside the department, it is hard for some of us to understand what has been gained in accountability relative to the current situation between the department and NHS England. Of course, Ministers had powers under the previous legislation to exercise accountability over NHS England, not least through the process of a mandate, but often failed effectively to use them—sometimes the use of powers by Ministers is more important than other things.

The key point here is the transition. The Government have put into the legislation that there will be transition schemes, but we need to see what they look like and how the timing works. I recall that the gap between the passing of the 2012 Act and its implementation was almost exactly a year. That further strengthens the force of the questions that the noble Lord, Lord Stevens of Birmingham, just asked. We need to see what that timetable looks like.

From a curiosity point of view, I would be interested to know how these savings will be generated. Noble Lords often say that a great deal of money was spent on the 2012 reforms. The Written Ministerial Statement published on 21 July 2015, at the end of the 2010 to 2015 Parliament, told us what the outcome was: the cost totalled £1.38 billion, a little more than my noble friend Lord Howe said the Government anticipate that the overall cost of this reorganisation will look like, but not much more. By the end of the Parliament, the savings were £6.9 billion in cash. Not least in some of the debates, people tend to remember the cost but not the savings. It would be extremely useful for us to know in advance what is intended to be achieved, because that reorganisation, according to the data published in 2015, arrived in the final financial year of that Parliament at a £2 billion a year reduction in cost. The Government are not even attempting to achieve something as ambitious as that. Let us see what it looks like.

I make one suggestion, to which I hope the Minister will respond. It is not unknown for the National Audit Office to engage in a process of scrutiny not after the event but during the event. This is especially true for major projects. This is a major project, and over the course of the next year it would be good if the department volunteered itself to the National Audit Office for such a process of real-terms scrutiny of the value-for-money effectiveness of this reorganisation.

[Baroness Thornton (Lab)]

My Lords, I thought it would be appropriate for those of us who have been involved in this for the last 15 years or so to join in the debate a little. The noble Lord, Lord Lansley, is quite right: this is about transition. It is about a transition that affects two groups of people: patients and people who work in the NHS.

I am a veteran of the transitions that we have had so far, because I was abolished in 2020. I became a member of my local CCG, which I very much enjoyed serving on, having worked on the 2012 legislation that created it. I then took refuge as a non-executive director in my local hospital. I helped to create our local ICB, which is now being abolished with a super-ICB being created. I feel as if I have been at the governance coalface of the reorganisations for the last 15 years. This is an important debate, and I am in favour of the abolition of NHS England.

I intend to involve myself in Committee mostly with equality, social care, patient records and so on, but I have a question for my noble friend the Minister about the arrangements for the people who will move from NHS England into the department and where they stand right now. Those people are very precious to us, and many of them are very experienced. I would like to know how the TUPE arrangements are progressing, what the dates are for those arrangements and when we are likely to see some documentation about how that will actually happen.

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[Baroness Finlay of Llandaff (CB)]

My Lords, I added my name to the amendment tabled by the noble Lord, Lord Hunt of Kings Heath, because this goes almost to the heart of the way that we account for what we do and what we buy in the NHS.

One of the problems is the accounting lines. A piece of equipment that might appear, at face value, to look expensive in fact saves enormous expenditure and lessens patient distress and morbidity, from a different budgetary line. The saving is a fallacy. I would welcome value-based procurement. I acknowledge the work that is being done by the medical technology and innovation directorate in the department and encourage that this goes across the whole of the NHS and social care system.

It is the clinicians who know that the cheapest is not necessarily the best, but, at face value, that may not always seem adequate. NICE has produced examples of where the cheapest is certainly not the best. Let me give one specific example, relating to something that is quite expensive: namely, cardiac pacemakers. Most cardiac pacemakers have wires. There are some which are eight times more expensive, but they do not have leads on them. That might seem a lot of extra money but, if patients have had radiotherapy to their shoulder and the left side of the chest, or if they are at very high risk of infection because they are on immunosuppressives or because they have a condition where they are immunosuppressed, then actually they are at high risk of getting infection on the leads because the leads are a foreign body in their body. The cost of managing sepsis, with patients in ICUs, vastly outweighs the cost of using different pacemakers for a small number of patients.

Think about urinary catheters. Patients who self-catharise may find that one type is much easier for them to use than another, and if they use it well and properly then their risk of infection is much lower. Generally, self-catheterisation is easier for men than it is for women, but certainly women who have a disability may find that they have got used to manipulating one type of catheter to self-catheterise. It becomes very cost-effective.

The clinicians are the ones who know what the outcomes are for particular devices, so that needs to be embedded in the tendering process. I hope that the voice of the clinicians determining the overall outcomes will be considered ever more as this goes forward. In Wales, we have the Value-Based Health and Care Academy, at Swansea University, which produces interesting work and is internationally recognised as a leader in the field because of its different way of thinking. I hope that there will be reporting to us on how this works when the change has happened.

[Lord Lansley (Con)]

My Lords, I want to speak briefly in support of Amendment 211, in the names of the noble Lord, Lord Hunt of Kings Heath, and the noble Baroness, Lady Finlay.

I declare an interest in that I am an officer of the All-Party Parliamentary Group on Access to Medicines and Medical Devices, which has held meetings on the value-based procurement of medical devices. I chair a group looking at breakthrough implantable devices, which has taken an interest in the procurement of just the kinds of devices that the noble Baroness, Lady Finlay, was talking about and in the importance of clinical input to understanding the potential value of such innovative devices.

Some Members of the Committee will know that I have been an advocate of value-based procurement and, where medicine is concerned, value-based pricing as an approach in the National Health Service. There is some good work being done in the department on promoting value-based procurement; we just need to make sure that it is understood and implemented correctly. I have been worried by evidence from some early tenders that the attitude is that the assessment of value should be conditional upon the achievement of a pricing threshold. Sometimes the pricing threshold is set at a point where the calculation of potential value is effectively nullified. If we are serious about understanding value-based pricing, we cannot put in a pricing threshold. You may well attach greater or lesser weight to the pricing element, but you cannot attach a threshold and believe that you are implementing value-based pricing. Quite often, part of the value assessment is to look at issues of patient experience, the outcomes that are to be achieved, the long-term life of a product and how it is used, to arrive at the overall value of a product. This is perfectly normal in commercial procurement. I do not think we are talking about something that should be regarded as exceptional to the NHS. It should be something that is regarded as normal and best practice in procurement.

It is slightly dispiriting in a sense, as I have seen an awful lot of progress on procurement in the NHS. Some 30 years ago, I was working with Unipart—before I came into Parliament—in trying to encourage the NHS, for example, to have just-in-time delivery and barcode-based procurement. That was an awfully long time ago and we have progressed a long way. It seems to me that, if we are keeping pace with the best procurement practices —and I hope the NHS will do that—we should be looking at a value-based system. I very much support what the noble Lord, Lord Hunt, said about that.

[Lord Scriven (LD)]

My Lords, I speak for these Benches on this short but important group. I thank the noble Earl, Lord Howe, for the amendment on Supply Chain Coordination Ltd and the noble Lord, Lord Hunt of Kings Heath, for his important amendment on value-based procurement.

These amendments may look technical, but they go to something that matters in every clinic and every operating theatre: how the NHS buys what it needs and who is accountable when things go wrong. NHS Supply Chain manages an estimated £8 billion a year of NHS spending on products, and, since 2022, it has carried out the department’s PPE programme. Yet under Clause 2, its shares can be moved by a transfer scheme at the Secretary of State’s discretion. There is no requirement to tell Parliament where they are going, who will exercise the shareholder role, or how continuity of supply will be protected.

Asking for a plan first seems modest. If the pandemic taught us anything, as the noble Lord, Lord Hunt, suggested, it is that supply chain resilience is first and foremost a patient safety issue.

However, a report is not a safeguard in itself. The real risk is that the transfer happens in the middle of a reorganisation, cutting the central headcount by half. The very people who understand how the company works may be gone before the scheme is made. The National Audit Office found that Supply Chain Coordination Ltd was meeting only seven of its 18 key performance indicators and that trusts spend more than £3 billion outside it. A company with that record needs careful handling, not a transfer done in a rush.

On value-based procurement, we welcome the direction of travel. As the noble Lord, Lord Lansley, just pointed out, this is not novel. We do not even have to take his experience of Unipart as an example. We can look at value-based procurement elsewhere: in Denmark, Canada, Italy and even Indonesia. There are models which the Government could use to look at how it is done.

The national guidance published in June is a genuine step forward, asking what delivers the best outcome across the whole patient pathway, rather than simply what the cheapest price is. But with NHS financial pressures, the temptation will always be to grab the lowest price today, without the skills, the capacity, and a finance regime that rewards long-term value. So I ask the Minister: what thinking is being done, not just for the pilots but as part of the new powers that the Secretary of State will have from the transfer of NHS England, on rewarding long-term value in the financial regime? What changes, if any, will the Government make to the financial regime?

There is a wider point that both amendments expose. NHS procurement still sits apart from the rest of the public sector. When the Procurement Bill passed through this House, my noble friend Lady Brinton, with support from all sides, including from the noble Lord, Lord Hunt, asked why the NHS should be treated differently. She warned that the NHS arrangements were not visible and that they were

“SIs at the discretion of any Secretary of State for Health”.—[Official Report, 28/11/22; col. 1578.]

Today, we have one regime for healthcare services and another for goods. NHS buyers are told to take legal advice on how the new value guidance fits both. With NHS England abolished, all that discretion will sit with the Secretary of State, and my noble friend’s warning has become even more relevant.

Therefore, I ask the Minister four simple questions. First, where will the shares in Supply Chain Coordination Ltd go, and when, and will Parliament see the plan before the transfer is made? Secondly, what independent assurance has been commissioned on the continuity of supply during the transition? Thirdly, after NHS England’s abolition, who will own value-based procurement and make sure that it is built into national service frameworks? Fourthly and finally, will the Government now review whether two separate procurement regimes for NHS services and goods still make sense, or will they at least publish how the boundaries between them will be policed, once the Secretary of State holds the pen on both? These are modest amendments, asking for sensible things, and I hope the Minister can give the Committee reassurance.

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[Baroness Lister of Burtersett (Lab)]

My Lords, I am honoured to follow my noble friend Lady Nargund. I have added my name to a number of the amendments in this group calling for a clear duty on the Secretary of State to take action to reduce health inequalities and produce a cross-government health inequalities strategy. I also support the other amendments on this theme, including that in in the name of the noble Baroness, Lady Bennett of Manor Castle. As we have heard, her amendment makes specific reference to inclusive health groups, including Gypsy, Roma, and Traveller communities, who experience some of the poorest health outcomes of any group in England, as the noble Baroness, Lady Jones of Moulsecoomb, spelled out.

As Just Fair points out, there is a right to health under the International Covenant on Economic, Social and Cultural Rights. In its 2025 concluding observations, the UN Committee on Economic, Social and Cultural Rights raised a number of concerns about the provision of health services in the UK, including inequalities in access to care, as we have heard about.

At Second Reading, I and a number of other noble Lords spoke in favour of a clear duty on the Secretary of State to tackle health inequalities and a cross-government health inequalities strategy that would underpin the preventive approach that the Government, rightly, initially favoured and, indeed, that the Chancellor referred to in his Budget speech today. Our interventions reflected calls from a wide range of health and other bodies, many of which support the Health Equals campaign to put tackling health inequalities on a statutory footing and to reboot the Government’s emphasis on a preventive approach. It also reflected the position of the Health and Social Care Committee in its scrutiny report on the Bill.

The Government themselves have emphasised the importance of addressing health inequalities in their child poverty strategy, as I pointed out at Second Reading. Indeed, the strategy declares that addressing healthcare inequality is at the heart of their health mission. Moreover, in September, the Minister for Women and Equalities, in announcing the establishment of a new class unit, described it as

“a pivotal step in embedding a focus on socio-economic inequality into the heart of government”,

as part of their drive to tackle entrenched inequality. Given all that Ministers have said about inequalities, I am puzzled as to why they seem so reluctant to translate this commitment to tackle entrenched inequality into a statutory duty in this key legislation.

In the Commons, Minister Smyth failed to give a convincing explanation as to how mere empowerment is more effective than a duty to address health inequalities, which she herself said remained a government priority. However, it might not be a priority for a future Government, so warm words are not enough. In the Second Reading debate in your Lordships’ House, my noble friend the Minister reiterated the Government’s commitment to working for greater equality but did not engage with the arguments put by a number of us and explain why a power is better than a duty to achieve this. I therefore hope that she has been able to reflect on what was said and on the growing pile of evidence on health inequalities, especially among children, some of which we have heard about today, and that she will be able to respond more positively and commit to bringing forward a government amendment on Report that meets the objectives of the various amendments debated today.

[Lord Lansley (Con)]

My Lords, I may be the first speaker not to have signed any of these amendments, but that does not mean that I do not agree with them; a great deal has been said with which I agree. The importance of this debate can hardly be overstated.

I just want to contribute one thought, which is that in taking all these issues and understanding how they relate to this Bill, we have to put it in the context of what is already in the National Health Service Act. I want very quickly to outline that.

The Bill before us is an improvement on what is in the NHS Act as far as the Secretary of State’s duties are concerned, because it extends the duty from equal access to healthcare services and facilities to seeking to reduce inequalities and securing equity in outcomes from healthcare services. That is what is in the Bill; I think that is a significant improvement. The Bill focuses at this point on what the National Health Service is doing to secure the prevention of illness and the promotion of successful treatment. It is not about the improvement of public health at that point.

The noble Baroness, Lady Tyler of Enfield, talked about the Bill transferring a duty to the Secretary of State. In fact, the NHS Act has the same duty on both the Secretary of State and NHS England: they are concurrent duties. Therefore, we are not transferring the duty; this is not part of a transfer from NHS England to the Secretary of State.

Under Section 2A of the NHS Act, the Secretary of State has a duty for the protection of public health, which are all those things to do with vaccination, immunisation, et cetera. Section 2B, which was inserted by the 2012 legislation, as my noble friend on the Front Bench will recall, inserted into the Act a duty as to the improvement of public health, and that is on both local authorities and the Secretary of State. It is not, I think, phrased as we would want it to be; more needs to be done to look at that.

I suggest—and this picks up the point made by the noble Baroness, Lady Royall of Blaisdon—that when we talk about wider determinants of health, we are looking at a strategy that relates not only to the Secretary of State—i.e. to the Government—but to local authorities, and she made that point very rightly. But it is in the NHS Act. Local authorities have a duty to improve public health in their area and take such appropriate steps as they can to achieve that, and the Secretary of State has such a duty to improve public health in Section 2B—unaffected, as I understand it, by this Bill. Therefore, when we come to look at it on Report, I hope that those who are thinking about how we might create the right strategy for the improvement of public health do not just think that it is done by attaching it to the responsibilities of the Secretary of State in relation to the NHS but also look at Section 2B.

[Baroness Royall of Blaisdon (Lab)]

My Lords, I am grateful to the noble Lord for giving way. I recently read Section 2B of the NHS Act. I think one would find that it states that local government and strategic authorities “must” improve health and reduce inequalities, but the Secretary of State only “may” improve health. I think that is very interesting to look at. Perhaps that is a wrong that we ought to right.

[Lord Lansley (Con)]

The noble Baroness is absolutely right: local authorities “must” take such steps as they consider appropriate; the Secretary of State “may” take such steps as they consider appropriate. I think I was right in saying—and she has illustrated it—that we can improve what is in Section 2B. I would just make the point that, when we come to Report, it is necessary not only to look at what is in this Bill but to look at how the improvement of public health is promoted through the NHS Act, including Sections 2A and 2B.