Health Bill

Lord Scriven Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

We have fantastic staff in these lovely hospitals where we have been treated, but they are given a management that I do not think often works. This is the opportunity we have to grasp. We have to deal with it and not be the sort of people who are always very difficult and behave like turkeys that do not want Christmas to come.

[Lord Scriven (LD)]

My Lords, I thank noble Lords who have spoken in this rather revealing debate. I particularly thank the noble Earl, Lord Howe, for introducing this amendment in his normal calm and measured way. Importantly, he has given us all the chance to ask the most basic question of the Bill: where is the plan? It is pleasing that the Minister and the Government have been in listening mode, particularly regarding the Health Services Safety Investigations Body and Healthwatch. I hope that during Committee the Government will continue to listen and make other important changes to the Bill.

At Second Reading, I said the Bill was a power grab. The Nuffield Trust’s October briefing for this Committee puts it more politely. It describes new powers for the Secretary of State as being well beyond those that NHS England holds, which it says enables “more political control” and limits real devolution. The Government are entitled to decide whether they want NHS England’s functions in the department, under political hands. We on these Benches would caution on that, but the Nuffield Trust accepts that some duplication between the department and NHS England is real; the Minister must specify exactly what that duplication is. But if that is the aim, it has to be planned and costed.

I would also caution the noble Lord, Lord Hunt of Kings Heath, and the noble Baroness, Lady Harding, for suggesting that putting NHS England’s functions in the department will bring accountability to the Secretary of State. When we get to Clause 11, we may see that the accountability is missing but the powers are about to be transferred.

Noble Lords will know the architect’s maxim that form follows function, but not here—

[Lord Hunt of Kings Heath (Lab)]

Is the point not that at the moment, parliamentarians can raise issues with Ministers only to be told that something is the responsibility of NHS England? I accept what the noble Lord says about how this is going to work but, ultimately, now the finger is absolutely pointed at Ministers for everything that happens.

[Lord Scriven (LD)]

When we get to Clause 11, the noble Lord, Lord Hunt, will see that some of the powers that the Secretary of State now takes, beyond NHS England, will not come before this Parliament. They will just be at the signature of the Secretary of State’s pen.

In this Bill, form comes first and function will follow in due course. We have the demolition notice but are still to see the drawings of the new structure. Let me say how far behind the Government are. The Nuffield Trust, working with the Institute for Government, compared past public sector reforms and NHS abolitions. It found that the key factors for success are not in place here. The abolition was announced without plans to explain its goals to staff and without redundancy funding, which led to months of delay. Detailed planning for the new department began only in early 2026, almost a year after the announcement. Nuffield’s verdict is that the process has been “poorly handled”.

We are still short of very basic information. At Second Reading and in this Committee, the noble Lord, Lord Stevens, who I admit must know something about running the NHS, pointed out that the costs and benefits in the impact assessment are still marked as “not available”. There are also still a number of questions about the timing of when this reform will come in. We have the Government’s estimates that redundancy exits—across the department and NHS England, ICBs and the commissioning support units—will cost between £1 billion and £1.3 billion, to be met from existing allocations, but we must ask which allocations. Which services pay?

Then there is the timetable. On 15 October the Health Service Journal reported that abolition will have to be formally delayed beyond April 2027 unless decisions on future national structures are made within days. Have those decisions been made? Are staff now aware of where they will be transferred? The new operating model has been waiting for ministerial sign-off for months. Ministers are still weighing whether thousands of staff will go to the department or potentially, as we read, into a new stand-alone agency. This Bill sends nearly every function of NHS England to the Secretary of State, yet the Government have not decided where the people who will perform those functions will sit. The department says that it continues to plan for 1 April 2027, but planning a date is not the same as being able to meet it.

The planned 50% job cuts in the department appear to require moving the large majority of central policy and analytical staff. Or is it about cutting operational staff? As the noble Lord, Lord Crisp, said, we need clarity about which staff and which functions will be in the department. It is not clear that the figure is rested on rigorous assessment of who is needed and why. History tells us how this ends: after previous reforms that moved managers from commissioning bodies, the department consultancy spend peaked at over £600 million a year and the number of managers within five years was higher than going into the reorganisation. I fear that this will be another case of “cut first, rehire later and call it efficiency”.

As the noble Earl, Lord Howe, has said, we need not simply rely on the words of noble Lords in this debate. The Darzi review, commissioned by the Government and updated in May, concluded that a top-down reorganisation of NHS England and ICBs is “neither necessary nor desirable” and added:

“Constant reorganisations are costly and distracting”.


We have had six statutory major reorganisations in 30 years, none with clear evidence that the restructure has brought about improvement. The Government commissioned that review; they should read it and learn from it.

I have six questions for the Minister. When will the target operating model be published, and will that be before Report? Is the latest thinking to put transferred NHS England functions and staff into the department, or will the Government set up a stand-alone body? Will the Government publish a full, costed impact assessment, including benefits, and explain where the £1 billion to £1.3 billion comes from? What are the expected costs of disruption, and how will any further delay be limited? Are the Government confident that the 50% cut will not drive up consultancy spending by the end of this Parliament? If the Government do not accept the amendment from the noble Earl, Lord Howe, will they commit to laying a transition plan before Parliament and before Report? In substance, that is what this amendment is asking for.

We on these Benches are not defenders of the status quo. I started in the NHS in the early 1990s and lived through more reorganisations than I care to count. Every one promised less bureaucracy and a freeing up of the front line; none delivered it. If the Government want to put NHS operational matters into political hands, that is their choice, but they owe this House a plan and then a price and then a Bill, in that order. At present we have a Bill and we are still waiting for the other two. I look forward to the Minister’s reply.

[Baroness Merron (Lab)]

My Lords, I am most grateful to the noble Earl, Lord Howe, for moving this amendment, and to the noble Lord, Lord Kamall, for tabling it. As other noble Lords have observed, it is comprehensive and thorough. It makes the point, which a number of noble Lords have made, about the importance of ensuring that the right processes and assessments are undertaken as we move towards the abolition of NHS England—one of the key things in the Bill. As we are at the beginning of our deliberations, I say to noble Lords that I listen, and have listened, very carefully to the points that are made. I will endeavour to answer a number of points, but I will take some away and write to noble Lords. As ever—and as noble Lords will recall from previous Bills—those letters will be available to all Peers, because I want to do justice to those points.

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I am most grateful to noble Lords who have engaged with me, through round tables and directly, and who have received the correspondence that I sent. I will be glad to continue to do that as we go through Committee and beyond. I reassure noble Lords that we remain committed to parliamentary scrutiny throughout the transition, and we will continue to publish updates as we move forward.

[Lord Scriven (LD)]

I asked one specific question, which the Minister may not be able to answer at this moment, but perhaps she could put it in writing. As the Minister has just pointed out to the noble Lord, Lord Stevens, is it the Government’s intention to transfer all the staff into the department or is a stand-alone body being looked at as a potential route for those staff?

[Baroness Merron (Lab)]

The intention is the former, but I will gladly write further to the noble Lord on this point.

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[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.

[Baroness Merron (Lab)]

My Lords, I most grateful to noble Lords for their observations and the way they have dealt with this. At the outset, I pick up the point that my noble friend Lord Hunt started with and others, including the noble Baroness, Lady Finlay, developed further. We are particularly concerned with personal products and products that need to be personalised. The illustrations that noble Lords have given have been most helpful. The reason for the changes is to see more of that.