Health Bill

Lord Patel Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[The Deputy Chairman of Committees (Lord Faulkner of Worcester) (Lab)]

I should advise the Committee that if this amendment were agreed to, I would not be able to call Amendments 7 to 15 for reasons of pre-emption.

[Lord Patel (CB)]

My Lords, we are entering the phase of debate on the Bill which I personally consider to be the most crucial part. Why do I consider it to be the most crucial part? It is because tackling health inequality is central to the revival, if not the survival, of the NHS and the broader economy.

I will speak mainly to my Amendments 7, 13 and 19, but before I do so, I want to say something because I feel strongly about it. I regret that consultants have decided to go on strike. No doctor should ever, under any circumstances, withdraw their services from the sick and the vulnerable. I think any doctor, and I hope every doctor in this House, would support that idea. They might have grievances, but they could settle those without going on strike, and they should not withdraw services. I hope the professional bodies, including the royal colleges, will align with that comment.

Having said that, my amendments about reducing inequalities are there because what we have in the Bill is a direct transfer of the issue of reducing inequalities from what was part of NHS England’s duties and was already in the duties of ICBs. There is nothing new in the Bill about reducing inequalities. It is a great pity that an opportunity is being missed by this Government to put a mark on how to reduce inequality. Why do I say “this Government”? It is because in the last 30 years, it was only once that we succeeded in reducing health inequalities, and that was from 2000 to 2010. An academic review, which was a proper assessment, demonstrated that, in mortality, infant mortality and ill health, the strategy devised by the then Labour Government managed to reduce health inequalities. But we have now come to a point where they are all rising for all kinds of reasons.

Who were the people who were responsible at the time? Their names were Alan Milburn; John Reid, now the noble Lord, Lord Reid; Yvette Cooper, now Secretary of State for Health; the noble Lord, Lord Darzi of Denham, who produced a report on the NHS; and Andy Burnham, the last Secretary of State for Health in that Government, and now the Prime Minister. Surely the present Government can find people of same calibre who can tackle health inequalities—or maybe not.

The strategy was a cross-governmental public service agreement—PSA—which was a legally binding framework used by the Treasury in the spending review process. It was as simple as that. It could be argued that my amendment is too strong. It would make the Secretary of State responsible, and I might be told that cannot be, because it removes the Secretary of State’s autonomy and flexibility, and therefore putting that in the Bill is not appropriate. If it is not, it does not make the policy of inequality strategy development inappropriate. As demonstrated between 2000 and 2010, the then Government found a way—cross-governmental ministerial responsibility—where, although the strategy was based on ill health, all the other Ministers were responsible for making sure that their ministries contributed to that improvement in reducing health inequality.

Therefore, if the Minister does not like my Amendment 19, there might be other ways for the Government to decide how the same could be achieved through another strategy; for instance, the same kind of agreement that Government did in 2000-10 or through Cabinet Secretary responsibility, as the Cabinet Secretary is responsible for making sure that all the Ministers and different government departments contribute and are mindful of a strategy that reduces health inequality.

In my view, if we do not do this, and there is no strategy coming forward, nothing will change. We will be talking about the same things that we have been talking about for the last 15 years, quoting the same statistics that have already been given about life expectancy being reduced in disadvantaged populations, how the time people spend being unhealthy will increase, how infant mortality will go up, how maternal mortality will go up, as it is doing now, and all the other things.

I thank the noble Baroness, Lady Cass, who might speak after me on children’s issues, and the noble Baroness, Lady Manzoor, who added her name to my amendment. I hope the Minister might agree to four things that I will ask her. I am not asking questions but asking her to agree that health equality and health outcomes are key to the overall welfare of the NHS and the broader economy; that now, after two decades, there has not been any improvement; that the improvement that previously occurred was as a result of a cross-government strategy; and that the increase in health inequality is being driven by rising ill health in England, but the Bill does not have a plan for the Secretary of State, a Minister of the Crown or Ministers in other Governments to demonstrate how they will reduce inequalities.

[Baroness Cass (CB)]

My Lords, I will be very brief. I support the amendments from the noble Lords, Lord Patel and Lord Hunt, and the noble Baroness, Lady Tyler. It will not surprise noble Lords to hear that I plan to focus on children yet again, but, as my amendments on inequalities in children come much later in the Bill, I will defer to other noble Lords to speak on this group. However, I will give noble Lords a spoiler alert: the Royal College of Paediatrics and Child Health’s State of Child Health report shows that inequalities are widening, particularly in marginalised groups, such as those living in deprived circumstances, or minority ethnic groups. There will be more of that anon; meanwhile, I defer to my colleagues.

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[Baroness Merron (Lab)]

I am sorry to hear that it is cold, but I am glad the noble Baroness is here. I appreciated the useful distinction that she drew regarding what we are talking about when we talk about inequalities.

Amendments 18 and 19, tabled respectively by the noble Baroness, Lady Tyler, and the noble Lord, Lord Patel, have regard to new strategies for tackling health inequalities. I know that your Lordships’ Committee is aware, but it is worth saying again that we remain absolutely committed to our comprehensive 10-year health plan. It was drawn up with a very wide range of input and, importantly—as has been referred to on this group and elsewhere—it was underpinned by the independent investigation of the NHS by the noble Lord, Lord Darzi. Tackling inequalities is at the very core of the 10-year health plan, which dictates everything that we do. It is therefore important that we focus on practical action rather than diverting towards developing new strategies. To assure noble Lords, I repeat that tackling inequalities is what I call core business; it is not an add-on or a sidecar—it is absolutely key.

The noble Lord, Lord Patel, put a number of observations to me and asked whether I agreed with them. My answer is that I appreciate them all and agree with most. I particularly welcome the acknowledgement by the noble Lord, Lord Patel, the noble Baroness, Lady Manzoor, and a number of my noble friends, of the achievement of the last Labour Government—which was somewhat exceptional in the period we have been talking about. The only point I would make to the noble Lord, Lord Patel, is that when he was running off a list of Ministers at the time, I hoped he might mention me—but I am doing so.

[Lord Patel (CB)]

I was going to do so after I heard the Minister’s response.

[Baroness Merron (Lab)]

I was very proud to have been part of that as Public Health Minister, working with Andy Burnham. But it is not enough to just rest or delight on one’s memories; we must take what worked and bring it into the current time.

I agree with the noble Lord, Lord Patel, that tackling health inequalities is key to not just the NHS but the broader economy—and, of course, the well-being of people. I agree with all noble Lords who said that a cross-government approach is crucial. That is why we are taking that approach, underpinned by the 10-year health plan. Tackling inequalities, for example, informs the key initiatives of the 10-year health plan, such as neighbourhood health centres. On that, we are starting in the most deprived communities. We are not going to the communities that are easier to work with; we are starting where there is the most challenge. I welcome that radical approach.

I believe accountability is extremely important. I assure noble Lords that the department will continue to report on action taken to address health inequalities as part of its annual report, alongside a whole range of published metrics, including the health inequalities dashboard. The dashboard’s measures cover 20 indicators, including—I will give noble Lords a couple of examples —the prevalence of adult and childhood obesity, and healthy life expectancy at birth.

My noble friend Lady Nargund supported the call for a cross-government strategy, which we are already working on. Recent cross-government action in this area includes the warm homes plan, the Keep Britain Working review and the homelessness strategy—all of which speak to the points that noble Lords are calling for. That is one of the reasons why I caution against putting in the Bill a duty to develop some independent strategy, when in fact it is core to what we are already doing.

Amendments 13 and 14 were tabled respectively by the noble Lords, Lord Patel and Lord Patel of Bradford. My noble friend Lord Hunt asked whether I would meet the noble Lord, Lord Patel of Bradford; I would be very pleased to do so, and I open that meeting up to other noble Lords who are interested in coastal and rural areas. Amendment 20 was tabled by the noble Baroness, Lady Pidgeon. These amendments are concerned with tackling health determinants and inequalities in coastal and other areas.

Health is determined not just by our health and care system but by our wider environment. We know that geographical variation has grown over a number of years, and this Government seek to tackle it. That variation runs from housing and employment to education and our local high streets, to name just some. It has informed the content of our 10-year health plan and the overall guiding aim that we pursue: to halve the gap in healthy life expectancy between the richest and the poorest—to which noble Lords referred. That is why we are introducing the neighbourhood health centres, to which I referred, where they are needed most. We are now going further by devolving power to local communities so that those who know their areas best can make sure that the services are there for them. I remind noble Lords that ICB funding allocations, for example, are already adjusted for health inequalities and take account of factors such as an ageing population and deprivation. The Core20PLUS5 approach gives ICBs a range of tools to tackle inequalities, and we will—and do—hold ICBs to account for their progress.

I am grateful to my noble friend Lord Hunt for tabling Amendment 11 on accessing GP services—an area raised by other noble Lords, including the noble Baroness, Lady Gerada. I agree that equitable distribution of GPs is crucial to ensuring that people in all areas get timely access to care. When I say that, I mean not that every area should have exactly the same number but that the distribution should be sensitive to the needs of an area. Progress is being made: there are 2,600 more GPs than in July 2024—the highest figure since 2015; the average number of patients per GP practice is improving; and we continue to boost recruitment through the practice-level GP reimbursement scheme in 2026-27. Because GPs—like other professions —are more likely to practise where they trained, we are delivering 1,000 more GP training practices by 2028, targeted towards the areas of greatest need. We are also reviewing the Carr-Hill funding formula because, to reduce health need, we have to ensure that resources are allocated much more accurately—as noble Lords expect.

The noble Baroness, Lady Hodgson, also commented on this area. We are uplifting the GP contract by £601 million for 2026-27, which builds on last year’s £1.1 billion of additional investment. In the year to August 2026, 15.8 million additional appointments—including Covid vaccinations—were delivered, compared with the previous 12 months. This is the way we are going. When I make these points, I am not saying that the job is done, but I am showing movement and improvement.

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We have had a wide-ranging debate, and I will of course reflect on the points raised. This Government are committed to practical action, and I have given some examples of that and of the way we are moving. This primary legislation, as currently drafted, gives us the necessary legislative basis for what noble Lords seek. I actually think that our biggest challenge is to deliver that.

[Lord Patel (CB)]

The Minister did what I thought she would do: point to areas in the legislation that might help reduce inequalities in health and in outcome, and therefore inequalities in healthcare provision. She mentioned the 10-year health plan, but she was not able to point to where it says the gap is, which is around cross-government action. Neither did she mention examples in the Bill that demonstrate that there is cross-government action. She said she did not agree with me in one area—maybe it was that one.

[Baroness Merron (Lab)]

Oh, no—I agree with the noble Lord about the need for cross-government action. I simply part company with the idea that it needs to go into primary legislation. That would not be usual, because that is a process. I also referred to examples of where we already have cross-government action to deal with health inequalities, as distinct from healthcare inequalities—the noble Baroness, Lady Gerada, referred to that.

[Lord Patel (CB)]

Why not, when, as she mentioned, the Minister was previously so successful as part of the Government who demonstrated how they could implement cross-government action and reduce inequality?

[Baroness Merron (Lab)]

I am not sure we are that far apart on this. I am just picking up the point about primary legislation, rather than the intent of the noble Lord, which I agree with.

Health Bill

Lord Patel Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[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.

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[Baroness Manzoor (Con)]

My Lords, I support the thrust of the amendments in this group, particularly Amendment 28 in the name of my noble friend Lady Shawcross-Wolfson. She has put her case forcefully and clearly, so I will not detain the Committee for long.

Poor long-term workforce planning creates significant challenges for NHS staff and patient care. Inadequate forecasting, insufficient investment in training and recruitment and poor staff retention contribute to persistent vacancies and skills shortages. This increases workforce loads, stress, burnout and sickness absence, resulting in low morale and higher staff turnover. The NHS becomes increasingly reliant on expensive agency workers and international recruitment, placing additional pressure on budgets. Consequently, services experience longer waiting times, reduced productivity, compromised continuity of care and potential risks to patient safety.

NHS England estimates an existing workforce shortfall of approximately 150,000 full-time equivalent staff, potentially rising to 260,000 to 360,000 by 2036-37 if there is no intervention. Effective long-term planning is therefore essential to develop a sustainable workforce, improve staff well-being, strengthen retention and ensure safe, high-quality patient care. I strongly urge the Minister to support this amendment. Ministers should be held accountable for the delivery of this workforce plan.

[Lord Patel (CB)]

My Lords, I strongly support the amendment in the name of the noble Baroness, Lady Shawcross-Wolfson, and I have added my name to it. She spoke so eloquently and made her case so strongly that I have put aside what I have written down because it would have been a repetition of what she had already said. I am going to take a slightly different tack but make the same point.

The noble Baroness quite rightly linked education, training and workforce planning. You have to know what workforce you might require for the health service you plan to have. I guess one can say that the Government’s 10-year health plan and the 10-year cancer care plan outline the kind of health service that the Government wish to see develop over the next 10 years. If that is the case, we need to address what kind of training and education and what kind of people we will need to deliver that plan.

I am guessing now that the reason why the 10-year workforce plan is delayed is because the premise on which it was to be formulated was that technology such as AI and digital technology would free a lot of clinical time, and hence the headcount need not be so high. That is a false assumption. It is false because we need to train people to use AI and digital technologies. The assessment is that, if you use these technologies, you might free about 40 minutes a day for front-line clinicians. With the pressure that the NHS now faces and the needs of the workforce it now faces, that time will be used to deliver better care to patients, particularly as the 10-year health plan identifies that technologies such as genomics and personalised medicine will be the way healthcare will go. There is an ambition by 2040 to have 50% of patients with some idea of their genomics, and the treatment is therefore based on that.

If you add all these together, and the Secretary of State now has responsibility for education, training and workforce planning, you ask the question: why is the workforce plan delayed? It is delayed because maybe the penny has dropped that, if you do not count the numbers and do not present a case about how technologies will reduce front-line clinical time, then you cannot plan the workforce.

Furthermore, I wonder whether the Bailie review of productivity in the NHS is based on the premise that greater productivity will be delivered in the NHS because of using technologies such as AI and digital technologies. We do not know that that will happen, but we have to wait until the Bailie review comes out. I wonder whether that is another reason—the Minister might comment on that—why the workforce plan is delayed.

It might be political pressures, it might be fiscal pressures or it might be the pressures from not knowing how to get the workforce numbers that we would require to deliver the 10-year plan and the cancer care plan that are holding up workforce planning. However, as the noble Baroness, Lady Shawcross-Wolfson, pointed out, if we do not have a plan, things will get worse. We will introduce technology, which will not be across the board, and we will then look for workforce that is not trained to deliver it. I hope the Minister will give us some answers about where we are going.

[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.

Health Bill

Lord Patel Excerpts

Committee stage
Monday 9th November 2026 Lords Chamber

[Lord Patel (CB)]

My Lords, I have Amendment 47 in this group. I have others that were related—Amendments 241 and 83—but I am not speaking to them today as the Bill team did not like them being grouped together, so I have been kind and let them go. However, they all concern one thing: a total absence in the Bill of any public health and prevention safeguards, despite that being the key theme of the Government’s 10-year health plan.

I will speak briefly to Amendment 47, which is neither a probing amendment nor a way forward, but concerns a no doubt unintentional omission on the part of the Government regarding the Secretary of State’s statutory duty to consult public health professionals. Of significant concern is the repeal of the existing statutory duty on NHS England to consult public health professionals in the discharge of these functions. The duty removed by the Bill is not explicitly transferred to the Secretary of State. The BMA says that although the Bill’s Explanatory Notes state that

“the Secretary of State should continue to seek public health advice, relying on ministerial discretion”

—we should note the phrase “ministerial discretion”—

“rather than a statutory requirement weakens an important safeguard and risks further politicising”

public health decision-making. I hope that the Minister will agree that that duty needs to be reinstated.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I find myself in sympathy with the noble Baroness, Lady Coffey, in her approach to Ministers’ ability to determine what happens in the National Health Service. Many of the amendments tabled, particularly when it comes to specific services, call for the intervention of the Secretary of State. That is very simple, because integrated care boards do not have any mechanisms for being locally elected, so their accountability is to the Secretary of State, and we cannot run away from that.

We have had power of direction in the health service since 1948. The Lansley Act modified it, and, although the wording has changed, we are essentially moving back to the original position. The fact is that the power of direction has been used very sparingly over the decades the health service has been in existence. It has rarely been required because in general, when Ministers or their officials are on the phone to the chair or CEO of those bodies, they understand that they need to do something—although I accept, as the noble Baroness, Lady Coffey, says, that there are some occasions when the additional powers in the Bill are probably required.

We really cannot have it both ways. If we want the NHS to be a national service, we know that the public do not accept that there should be variation. The very idea of a postcode lottery in this country is simply not accepted. It must follow that Ministers are accountable to Parliament, and therefore they must have the tools by which to determine the general way the health service is being run. There is a counterbalance. The reason why I am so pleased about the Healthwatch decision is that we need mechanisms at local level to secure some form of local input. But, ultimately, if we want a national health service, we have to accept that, in the unique way the NHS is funded and organised, Ministers need the tools to ensure that their accountability to the public is discharged effectively.

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[Lord Patel (CB)]

My Lords, I have put my name to several of these amendments. Much has been said already, so I will try to be brief. I will focus on two or three main things. One is where the developments are likely to lead us, which will complicate the issues even more than what we are talking about today.

Let me come to cancer outcomes first. It has rightly been pointed out where England stands internationally in terms of cancer outcomes. Cancer outcomes are the ultimate truth: the truth in terms of one-year and five-year survival rates of any cancer. They are often what we use for international comparisons, but there is a system-wide reflection to be had. Poor survival outcomes are, often, a failure of several other processes, including when the diagnosis was made, the aggressive nature of the tumour—the later it is identified, the more aggressive it is likely to be—and whether the treatment was given at the right time. As was mentioned, delayed treatment increases the risk of mortality.

Although the outcome, survival-wise, is an important parameter, there are other issues that need to be considered when assessing cancer outcomes, and they often relate to the processes. The balance metrics of measuring cancer outcomes may well include process indicators; operational timelines, in terms of how many days’ treatment the patient has; patient-centred outcomes, which are not often mentioned; and risk-adjusted clinical outcomes, based on the nature of the cancer. The core outcomes that are reported should include not only survival rates, but mortality rates, stage of diagnosis and operational and access metrics. The purpose of reporting—that is the important part for commissioning issues—is that accountability be taken into consideration. It should hold regional health services and Governments responsible for funding allocations and clinical performance, highlighting the gaps, and guiding policies and clinical improvements. Unless we have these measurements of outcomes, measuring survival rates only will not be enough.

I will briefly mention genomics and radiotherapy. On radiotherapy, I get a daily, or sometimes weekly, bulletin from a medical oncology consultant whom I know extremely well; I will not name her. The important point has already been mentioned: it is not that we do not have the expertise in clinical capabilities, as Cancer Research UK has mentioned in its report; it is that bottlenecks occur in the processes afterwards. The surgery might be good, but there are bottlenecks in other forms of treatment. On radiotherapy, we have already mentioned the unmet needs, waiting times, regional disparities and workforce and equipment pressures. They will multiply with the advances that are coming in radiotherapy, which not all centres in England have implemented. It is good that NHS England announced a major rollout of stereotactic ablative radiotherapy, which reduced treatments for prostate cancers, for instance, from 20 to five. However, only a few centres now use advanced technology and AI together to further assist the planning of radiotherapy treatments, which can sometimes take days.

There are developments occurring in radiotherapy that will put further pressures on patient access. With FLASH radiotherapy, for instance, radiotherapy is given in a concentrated way in a millisecond—not minutes, not hours, not days, but in a millisecond. Through biologically guided radiotherapy, integrated PET scanners, mentioned by the noble Baroness, Lady Finlay, are combined with linear accelerator scanners. They can immediately diagnose the nature of the cancer and deliver the appropriate therapy on the spot. Through generative AI adoption, AI is used while the patient is on the treatment table to identify the nature of the tumour and whether it can take higher-dose radiotherapy. There is also radiogenomics, whereby personalised genomics are associated with the behaviour of the tissue and the machine can decide whether it can give a higher dosage at a concentrated level. All these developments will put further pressure on our capacity to deliver to cancer patients, which needs to be addressed.

There are lots of issues to be addressed but, finally and briefly, the Science and Technology Committee is about to produce a report on AI, genomics and personalised medicine, which identifies the role of genomics not only in cancer but in other areas too. Cancer, in particular, will require the rapid genomic analysis that the noble Baroness, Lady Finlay, mentioned. It is good that NHS England established seven genetic hubs that now do mutation screening and genomic screening, looking at the mutations in each and every cancer to see whether it will react to a particular treatment or not. They are building up a library, and it is important to continue building that library.

Importantly, the only way to develop personalised medicine vaccines for delivery to individual patients is to do the genomics mutation study as rapidly as we can. The cancer genomics 10-year plan has identified all the issues, but it has not identified a way forward for implementation. This debate has emphasised that we need to know how we are going to deal with all the developments, deliver the cancer treatments and improve outcomes globally.

[Lord Evans of Rainow (Con)]

My Lords—