Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026

Wednesday 15th April 2026 Grand Committee

Considered in Grand Committee

16:15

Moved by

[Baroness Merron]

That the Grand Committee do consider the Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026.

Relevant document: 54th Report from the Secondary Legislation Scrutiny Committee

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, this statutory instrument makes an important change. It will amend the 2014 regulations so that the treatment of disease, disorder or injury, known as TDDI, is brought within the regulatory scope of the Care Quality Commission. This change will be for the treatment of disease, disorder or injury provided in sports grounds or gymnasiums, or under temporary arrangements at sporting or cultural events, where it is delivered for the benefit of those taking part in or attending those activities.

Let me start by clarifying what this is and what it is not. This regulated activity relates not to the task being carried out but to who is doing it. It is the assessment and treatment of physical or mental state when provided by a specifically defined list of healthcare professionals, as per the CQC’s website. The scope of this activity requires those carrying it out to be listed healthcare professionals registered with the appropriate professional body, such as the General Medical Council, the Nursing and Midwifery Council or the Health and Care Professions Council. When a healthcare professional uses their professional title, qualification and skills to assess and treat a person for a disease, disorder or injury, they must be registered with or employed by a company registered with the CQC.

Providers carrying out the treatment of disease, disorder or injury at events may include independent ambulance services that employ paramedics, doctors and nurses, and which are commissioned to attend an event such as a music festival, marathon or football match and be on hand in case anyone there experiences a medical emergency.

Perhaps I can give some context. Members will recall the tragic events of 22 May 2017, when the Manchester Arena bombing killed 22 people and injured more than 1,000 others. The subsequent inquiry uncovered serious failings, including inadequacies in the provision of healthcare services at the arena. The inquiry noted that these shortcomings may have been present at other venues across the country, in part because of the absence of appropriate regulation. A central finding of the inquiry was absolutely clear: the Department of Health and Social Care should consider changes to the law to enable the CQC to regulate healthcare delivered at events. The CQC has itself outlined additional concerns about the quality of care provided at events. It has heard serious allegations of unregulated provision resulting in severe patient harm.

The Government, as noble Lords would expect, are committed to acting on the inquiry’s recommendations and strengthening public safety. I recognise that these changes are overdue, but it was important that they be carefully considered in order to understand the impacts. I am pleased that they have now been laid before us.

To turn to what the amendment will do, the 2014 regulations exempted the treatment of disease, disorder or injury provided at sports venues or gymnasiums or under temporary arrangements from regulation. This SI removes this exemption. It will bring the provision of this treatment at events into line with provision in hospitals, clinics, ambulances, GP surgeries, community services and care homes where it is already registered. This means that any provider delivering the treatment of disease, disorder or injury at an event must register with the CQC and must comply with the same robust regulatory standards that apply elsewhere in the health system. Of course, some of the providers will already be registered to provide this treatment in other settings, which will make the process quicker for them.

I should say to noble Lords that there has been some misunderstanding about what is covered by

“the treatment of disease, disorder or injury”.

It includes a wide range of treatments, from emergency interventions to ongoing care for long-term conditions. I wish to be clear that the treatment of disease, disorder or injury does not include first aid. First aid remains outside the scope of CQC regulation.

By making these changes to the 2014 regulations, the Government will make true our commitment to fulfilling the recommendations of the Manchester Arena inquiry and the drive to improve patient safety. I beg to move.

[Lord Lansley (Con)]

I shall speak briefly to this statutory instrument and ask a number of questions, if I may, to which I hope the Minister will be able to respond. I think that I understand the structure of what is proposed and the exclusion of first aid so that it is not covered, but when I look at the providers that are likely to be affected, I am trying to work out carefully which are the providers concerned. I am assisted by a friend who is part of the Faculty of Sport and Exercise Medicine and who said that it had undertaken a survey.

It seems to me that many of the people who responded to that as healthcare professionals may well be working in registered providers already, so they may be concerned about the need to register in relation to the services that they provide at events but in fact they do not need to register. However, the event organisers themselves may need to register if they bring healthcare professionals on site in order to provide services that go beyond first aid at their event. I am trying to understand how, when the department went out and identified 89, or whatever the number was, potential providers that were not already registered, it ended up with a figure of 36, which seems very low. It certainly bears no comparison to what those who are working in the sector believe would be the number of presently unregistered providers. We need to understand who these 36 are, the character of those providers that the department has identified and why there is such a discrepancy between that and what others have been saying. I would be grateful if the Minister would tell us much more about that.

As a practical example, are all football clubs, or the major football clubs in the Premier League, the Championship and so on, already registered with the CQC? Clearly, they, as organisations, provide continuing healthcare to their players. Do we not need to worry about any of that? Is an event like one of the big festivals that take place already registered, because it has put a team together in order to provide more than simply first aid? Perhaps we are worrying about a need for registration when actually we do not need to worry so much.

I have only one other question. An essential part of the follow-up to the Manchester Arena inquiry was the preparation of an event healthcare standard. Would the Minister be kind enough to update us on that process? Where does it stand and when might we see its publication for consultation?

[Baroness Harding of Winscombe (Con)]

My Lords, I will also ask a few questions. I declare my interests as the senior steward—namely, the chairman—of the Jockey Club and as the mother of an elite athlete.

I spent last weekend at two quite different sporting events, juggling my time between the Grand National and the Home Internationals lacrosse competition, as my daughter played for England for the first time— I did check with her that I was allowed to mention that in the Grand Committee. I mention them both because while one is really a grass-roots sporting event—it has a small crowd, but none the less there is an ambulance in attendance because it is a potentially dangerous sport—the other, the Grand National, is the second largest attended sport in the country and the second most watched sporting event on television. As I understand it, both are captured by the same changes being proposed today.

I express my condolences to everyone who was affected by the tragedy at Manchester Arena. In no way do I want to suggest that the questions I am posing negate the need to address the recommendations of the public inquiry. It is hugely important that we learn the lessons.

First, I took some time to speak to a former chief medical adviser of the British Horseracing Authority, Dr Jerry Hill, who told me that a clear standard of healthcare for events is an extremely positive move. I put on record that I wholeheartedly support the event healthcare standard. I understand that there has been good consultation on the draft and that, in Dr Hill’s view, it will help event medics fight their corner for resource. He told me that, at the moment, event medics often feel that they are behind Portaloos and security in priority at events. It is important that we recognise that we need that standard.

However, in moving from that standard being guidance to putting it on a statutory footing—I appreciate that this SI does not do that, but it sets us on that path—we need to evaluate formally whether the draft is effective. As I understand it, the DHSC was somewhat swamped by people wanting to participate in evaluating the draft, and that it was perhaps not following the more scientifically robust approach that a number of sports suggested—I think two focus groups were planned to evaluate the draft. Can the Minister assure us that that event healthcare standard will be evaluated to a scientifically robust standard rather than that of a more politically normal focus group? It is very important that we get it right.

Secondly, I also understood that, as my noble friend Lord Lansley says, the CQC’s initial impact assessment had claimed that only 36 healthcare providers would need to register. Horseracing alone thinks that we have 350 individual clinicians who would need to register, even allowing for the fact that each clinician tends to work in three different sports. Potentially, the Faculty of Sport and Exercise Medicine UK’s estimate of 23,000 is an overestimate. Even if it is one-third of that, it is still massively more than the CQC expected.

I also understand that, in November 2024, the CQC said that it had a maximum capacity to register new providers of 1,000 per year. If we are not very careful, with all the best intentions we will be setting up a bureaucratic quagmire, which will mean that events, big and small, will not be able to find suitably registered clinicians to support them. What assurances can the Minister give us that the CQC can cope with the workload? Has the CQC recruited, or does it intend to recruit, anyone from the sports or cultural events sector? In the past, the CQC has had, in maybe more traditional healthcare settings, a bad habit of sending non-specialist inspectors—my noble friend Lord Lansley is laughing at that, but it is serious business. The best example I have is of occupational therapists being sent to inspect ambulance services.

What assurance can the Minister give us that the CQC is going to recruit the suitable expertise to deliver on this important obligation? Where will it sit in the priorities of the CQC which, after all, has an awful lot of important work to do? It currently has an interim chief executive and a chairman who wants to leave, so I am nervous about quite so much going on to the CQC. I support others who have called for pragmatism in the implementation of these regulations to allow time, if the CQC is struggling to put the resource to them that they need.

16:30

I sit on the Industry and Regulators Committee, which recently did an inquiry into the building safety regulator. Your Lordships may think that is completely off topic, but it is not. That regulator was set up because of the tragedy at Grenfell Tower, for all the right reasons and with the very best of intentions, but this Government had to intervene six months ago because the building safety regulator was not equipped, either financially or from a skills perspective, to deliver on its mandate. As a result, since it began not a single high-rise building has been approved or built in London. To give credit where credit is due, the Government have addressed that. I really do not want us to be complicit in doing the same thing here.

There are very good intentions in this measure. I think we all agree that we want to put in place the best possible healthcare provision at both small and large events but, if we are not careful, we are going to put a huge cost burden on grass-roots sports and cultural events—

16:31

Sitting suspended for a Division in the House.

16:40

[Baroness Harding of Winscombe (Con)]

My Lords, I will be very brief. The Explanatory Notes say that a full impact assessment was not completed because

“no significant impact on the private, voluntary or public sector is foreseen”.

I think it entirely foreseeable that there could be significant cost and complexity, as well as an inability to deliver the healthcare benefits that we all seek, for two important sectors of society that provide important glue as well as economic value. Whether we are talking about grass-roots or world-class sporting and cultural events, if we implement this SI badly, there will be substantial negative consequences.

I am aware that I have asked an awful lot of questions. May I be presumptuous and ask the Minister for a meeting with the department and the CQC so that a number of us can properly understand how this measure will be implemented?

[Baroness Grey-Thompson (CB)]

My Lords, I declare an interest as the chair of Sport Wales; with that, I sit on the board of UK Sport. I am also a board member of Active Travel England.

I reiterate the comments made by others about how horrendous and horrific the Manchester bombing was, as well as how significant an impact it had on so many people. The recommendations are important. I absolutely understand why we want to protect people and improve the system. I am also going to ask a number of questions, so I would be very happy for a follow-up afterwards.

I have spoken to a number of organisations in the wider sport industry. It is fair to say, I think, that there is a level of concern about the statutory instrument that we are debating today and the impact that it could have on the wider sports industry. I understand that the Sport and Recreation Alliance has written to the Minister; I would be interested in the reply and to know what further work has been undertaken.

I know from speaking to a wide group of people who work in the sports industry that they generally feel as though His Majesty’s Government have failed to engage with the sector properly and have not understood the significant, negative effect that this measure may have on the provision of medical care at events. There is a real risk of this preventing some sports events and activities from going ahead, or going ahead without the medical cover that they currently have, in order to avoid the consequences of the proposals.

The noble Baroness, Lady Harding, made some interesting points on registration. Medics often work in a voluntary capacity across a number of events of various sizes. It is important that these people are not registered multiple times. We should try to avoid some of the failings of DBS checks, where people are registered on lots of different systems. That does not solve the problem that we are trying to solve.

The Sport and Recreation Alliance has called for a commitment to create a specific exemption for all treatment provided to athletes, performers and officials. This is also an important area for us to look at. We should include spectators in that as well, because some events have lots of spectators and some have absolutely none. Many believe that this would not be contrary to the recommendations of the Manchester Arena inquiry and could solve many of the issues that the regulations might cause.

Can the Minister explain what further considerations have been given to understanding the impact on sport and sporting events? I wonder if clarification is needed on the definition of different events and the sizes, because they are very different. Also, what is understood by “injury” and “first aid”? People working on the ground might struggle to understand that. I was also wondering whether the Department for Culture, Media and Sport has provided a view on this and on its impact.

16:45

It is important that we understand who will be required to register, the cost of regulation and the wider impact on industry bodies. Also, what about non-compliance? We might be in a situation where some of the larger events are equipped and able to deal with this and have funding available. I understand that it puts sports medics in, possibly, a stronger position to argue for more support, but there could be a number of events that are already right on the knife edge of being able to carry on and this might stop them taking place. I am interested in understanding the impact on smaller sporting events and community sports events. We could end up in a situation where we have quite a gap in what that provision might look like.

The noble Lord, Lord Lansley, talked about some of the Premier League football clubs. I am less concerned about those. It is the lower leagues, the non-professional clubs, the rugby clubs and the local community events at which medics may stop volunteering because it is not worth the risk of them being there. Then we throw in the complicated picture of employment status, not just of the medics but of the athletes and everyone else involved. The system for lottery-funded athletes was absolutely set up so that the athletes do not have employment contracts—there has been at least one court case to look at that. This can add a further complication to the system that we are looking at, as does the fact that sport and health are devolved. I am interested in what conversations have been had with either the Welsh or the Scottish Governments, or with UK Sport, on the impact that this might have.

Looking back, 2012 was an amazing Olympics and Paralympics. We continue talking in the UK about an aspiration to host again, but bidding for those Games does not take place in a bubble. It is important that a number of different size events are hosted in the UK, and large and small events are part of that process. I am keen that England should not become a less attractive place to host sporting events. One exciting example for next year is that the UK is hosting the Grand Départ of the Tour de France, which goes through Scotland, England and Wales. What happens there as the teams cross the border between those countries?

The noble Lord, Lord Lansley, mentioned the survey by the Faculty of Sport and Exercise Medicine, which came up with some interesting data. It surveyed thousands of people: half of them said that this statutory instrument would have a major or moderate effect on their work; a third of organisations anticipated cancelling events; and over a third of individuals said that they may stop working in sport. That should give us pause for thought.

There is a debate about whether all sports and cultural events should be a regulated activity. I know from speaking to FSEM yesterday that it still feels that there are a number of sticking points in terms of the anticipated numbers affected and the cost, time and money of regulation. I have already talked about the enforcement process. The current lack of a standard to measure against is important—the proposed event healthcare standard is close to completion, but it needs further work—as is the wide variety of events measured against each other when they are completely different. I would also like to understand whether further discussions have taken place with FSEM.

I assure the Minister that the industry is ready to help. It wants to get this right and provide appropriate care, but there is more that we need to do to make sure that that happens.

[Lord Markham (Con)]

My Lords, I declare my interest as the founder and director of Cignpost Express Test, which did a lot of Covid testing for sports events and currently does health screening at PGA golf events and Mercedes Formula 1 testing, so I have quite a bit of experience in health screening. As other noble Lords have said, what we are trying to do here is very well intentioned. Ours hearts go out to all those affected by the Manchester Arena bombing. This is designed to try to correct many of those ills. The fact that we have two Ministers here shows the important stress that the Government put on this, and I know that Minister Ahmed has been engaged on this, too.

There are good intentions here but, as other noble Lords have pointed out, the devil is in the detail and implementation. Everyone thinks of big events in this context but, as the noble Baroness, Lady Grey-Thompson, mentioned, the small events are the real concern. I have had volunteers at mini rugby tournaments asking, “How are we going to cope with this?” There is a confusion, which perhaps the Minister can clear up, about doctors who are currently CQC-registered through their practice and volunteer at, for example, weekend point-to-point racing events or mini rugby tournaments, who feel that they will no longer be able to do that without being CQC-registered separately for those events, which costs almost £1,000 a time. That drives a lot of the discrepancies we seem to have in the numbers: are we talking about 36 events or many thousands? It would be helpful to get an understanding of that because there is a lot of concern out there.

As a former Health Minister, I know that the CQC already has a lot on its plate. The 1,000 limit on new registrations was mentioned earlier, and this could be the straw that breaks the camel’s back, to be honest. I am very concerned about this. Event organisers and chief medical officers have told me that if it becomes too burdensome, we will employ first-aiders instead of having volunteer doctors, because they do not have to be CQC-registered. That, of course, will mean that the care is less good. They gave an example: apparently, during Wimbledon, 4,000 people saw the medical support services during the whole tournament, and only 1% of them ended up being referred onwards to the NHS or hospital services, because good volunteer doctors and medics were there. Clearly, if they were just first-aiders, a lot more of those people would have been pushed straight on down to Kingston Hospital or wherever, which would have put a large burden on the local NHS services, which I am sure we all want to try to avoid.

I have three suggestions, if I may, the first of which is an athlete exemption. Will athletes be exempt from this, since their medical treatment is quite different, as the noble Baroness, Lady Grey-Thompson, said? Secondly, there is a feeling among the chief medical officers that it would be useful to get the event healthcare standard finalised in the way that the noble Baroness, Lady Harding, talked about, before we do this. It would be useful to have this standard, but it is hard to talk about implementation until we know exactly what that standard will be.

Thirdly, I, too, would like to be involved in the meeting, if I may, but a round table with the CQC and all the chief medical officers would be useful. I know that Minister Ahmed said that he was in favour of that and suggested to the CQC that it should meet with all four chief medical officers. However—I appreciate this is hearsay—I have heard from the chief medical officers themselves that the CQC refused to meet them all together and wants only to meet them separately. I do not know why that is, but the meetings would be more valuable as round tables, with everyone in the room, so that the CQC can get the full flavour of the things we are hearing about today.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare an interest, in that I am president of the Chartered Society of Physiotherapy, so it is partly with that hat on that I am asking these questions.

The Manchester Arena inquiry makes harrowing reading, and I expect that there will be some bereaved people watching this debate, because they are aware that these regulations have come out following that inquiry. The deficits that the reports highlighted are really worrying, but I was struck that many of them are in the domain of so-called first aid: the failure to use tourniquets when people were bleeding, and the fact that the tourniquets were locked up in a first aid room anyway, compound the distress and the memories with which people who lost somebody in that event have to live.

So, one of my questions relates specifically to where the boundary defining first aid sits. The initial response of qualified doctors and physiotherapists may be first aid, but they may also start to instigate longer-term treatment for whatever happened at the event that could not be instigated by somebody who was trained in first aid only as a volunteer from a charity or group. I was thinking about the Glastonbury Festival, an event that is extremely well organised for medical emergencies. It is set up to do a lot of treatment on site, but some things mean that people have to be airlifted out sometimes. They go from the very minor—the joke is rashes from all the wellies rubbing on people’s legs—right through to life-threatening adverse reactions to the most bizarre cocktails of drugs. That needs a highly specialised knowledge. If emergency medicine consultants had not been working there, lives would have been lost because this is so complicated.

One of my other questions relates to the people who are to be used or employed. A level of first aid could happen anywhere, but what is needed at a sporting event may be very different from that at a large event where a lot of illicit substances are being used and the expertise required to avoid loss of life will be quite different.

My other main question relates to the boundaries around an event. How big and organised does an event have to be to qualify, or how small not to qualify? What about a local children’s football league that happens on a Saturday morning with lots of different clubs competing? The kids are traveling around with parents, and may cross from Wales to England, England to Wales, into Scotland or wherever. As amateur participants, their risk of a really bad injury is no lower —in fact, it may even be higher—than if they were playing as fully trained professionals with a full support team.

I am also slightly concerned about where the boundaries are around the person. For some of these smaller events, people will have volunteered as doctors. I know one who volunteers to work at football matches: he is employed by a large hospital and is not a sports medicine person, but he brings a lot of experience that you could say all falls within the realm of first aid, or you could say is tipping over the boundary, because general medical emergencies arise from time to time.

Both the national boundaries and the size of the event concern me. I am not quite clear where those physiotherapists sit who are in private practice—possibly solo private practice—but who are then providing support at a sporting event. If they are to register with CQC as a single worker, it might be quite a lot of money out of their practice pocket. They may therefore feel that they are not incentivised to carry on but they have a great deal of skills. The danger is that the skills available on-site at an event might, inadvertently, be lower than one is anticipating. I realise that there have been a lot of questions to the Minister, but we look forward to the answers.

17:00

[Lord Herbert of South Downs (Con)]

My Lords, I want to add to the comments and questions made by my noble friend Lady Harding about the potential impact of this regulatory change on horseracing. It is a very important sport, as the Minister responsible knows, and a sport that is already under considerable financial pressure, despite its tremendous popularity. There is concern about what the unintended consequences of this significant change may be, the bureaucratic burden that could be created by the extension of the CQC’s jurisdiction into event medicine and the cost, so I seek reassurance that Ministers are alive to these issues.

I want to raise a particular issue, which has also been raised by other noble Lords, about the possibility of exempting from registration the healthcare that is provided to athletes, performers and officials, as opposed to the healthcare provided to the public. I understand that that exemption exists already for treatment provided under arrangements between employers and employees, but not more widely. However, much medical provision might not be on an employer-employee basis and therefore would not be covered by the exemption. That would create an anomaly.

Ministers are of course right to draw attention to the importance of this issue, given the terrible events in the Manchester Arena nearly a decade ago, the awful loss of life and the very large numbers of people injured. But the extension of the CQC’s remit, as a consequence of the inquiry’s recommendation, was precisely to improve healthcare provision for the public. I am not aware that there was any perceived problem with healthcare provided for athletes and competitors—a much narrower group of people. That was not, of course, what the inquiry was thinking about when it proposed this extension, but the extension at the moment covers them, so there may be significant unintended consequences.

We know that one survey suggests that over a third of the doctors who currently provide medical cover for racing may not continue if required to register, because of the bureaucratic burden. There is obviously a tremendous reassurance job that has to be done, at the very least, but it seems that we also need to address the fundamental issue. I wonder whether the Minister would accept that there is a difference between the care that is provided for the public, which is what the inquiry was all about, and the arrangements for athletes and competitors, which are different and where there was not a problem that needed to be addressed. However, accepting that an event healthcare standard is a good thing, and that Ministers will look at the potential for exempting from registration healthcare provided for athletes, performers and officials on that basis, this instrument would seem to be commonsensical.

[Lord Addington (LD)]

My Lords, this is one of those debates where you think, “Who do I disagree with?” I am afraid that I have not disagreed with anything from anybody. As I speak for my party, it is important for me to restate that things went wrong with the treatment of the Manchester Arena disaster. We should do something about it—that would be great.

The problem here is that we seem to have gone far too wide. As the noble Baroness, Lady Finlay, asked, how far down do you go when covering an event? For instance, for small rugby union clubs—my own sporting background—you are lucky if there are three men and a dog watching. That is your crowd, but a local cup game could have a couple of thousand. Where does that support structure kick in? That is something that all amateur sport will confront from time to time. This is merely the first opportunity for the Minister to correct these perceptions. We need to have some cut-off points, going from when it is enough simply to have a first-aider within earshot to when we need better medical support and structure. When that changes and how they interact is really what the discussion here is about.

When it comes to sport, please let us not do anything that stops sporting events happening. There is a fear that we will do so inadvertently by providing a greater bureaucratic burden on providing help. We hope that the Government will not do that. I hope that the Department of Health will not do something that will make the country intrinsically less healthy. That is really what we are looking at.

Let us look at other specialist events. This is not an interest, but I live in the village of Lambourn so, even if I did not want to be, I am very aware of things to do with equestrian sport and particularly races. Anything to do with horses is intrinsically dangerous; indeed, we have a rehabilitation centre for neck and back injuries in Lambourn. When it comes to racing, as my wife has often pointed out to me, there are not many events when an ambulance follows you down the course as you are taking part—so there are structures there. If something that organised is raising concerns—it is not because they want it to be there but because it has to be there—there might well be something worth listening to. We must make sure, when we deliver this, that we do not throw the baby out with the bathwater and that good intentions are erased out. We should go through all those things.

The Government need to start doing something to get better information out there about exactly what they are doing, where the barriers are and what will happen. A series of meetings might help—possibly with parliamentarians and certainly with larger groups—and they should get the information out quickly. It will dramatically help to let the information out in dribs and drabs—as and when they see fit as they go forward—setting out their intentions, and we will bring in stuff behind it. That way, if there is a real fault-line here, as opposed to a fear of one, we will find out. Then we can start to do something about it.

Can the Government give us something that reassures us on our worries about the extra bureaucratic burden, given that people are terrified? They are one newspaper report and a few tweets away from people having a panic about everybody being sued every time anybody gets cuts in an amateur football game. What are they doing? Where are the structures going? That is what is required here.

We all want the big events to be safer, but they will have got it wrong if they apply this to an open mic night at a pub and a Sunday league football game at the same time. We must make sure that people know where those fault-lines are. The exemption for people taking part in sports events is a no-brainer. Can we make sure that this happens and that people know about it? It is clear that they do not, at the moment, and that is a fundamental flaw in the Government’s approach.

[Lord Kamall (Con)]

My Lords, as other noble Lords were declaring their interests, I thought, “Oh, that’s good; I have no relevant interests”. But, the last time I thought that, a number of people tweeted at me for not declaring my interests, so I will bore all noble Lords with them. I am a professor of politics and international relations at St Mary’s University, Twickenham. I teach an MBA module on healthcare policy and strategy. I also work with the medical school that it is starting and have started co-operating with colleagues in the Faculty of Sport, Technology and Health Sciences. I also teach at the University of Buckingham, but I have no contact with its medical school. I just wanted to touch all the bases.

I thank the Minister for setting out these draft regulations in her usual clear manner. Obviously, they arise from the tragic events of the Manchester Arena attack and the subsequent inquiry. Like other noble Lords, my heart goes out to those who were affected; we offer our condolences to the victims and their families, some of whom are probably still in a state of bereavement. Clearly, that inquiry called for a review of healthcare provision at events, as well as clearer standards for public safety, which I think everyone who has spoken is in favour of.

Most of the people who have contacted us said that they support the principle that those attending sporting and cultural events should have access to safe, high-quality medical care—there is no disagreement there—but the question before your Lordships is one not of principle but of implementation and delivery. It is right, therefore, that the detail be scrutinised carefully.

In removing the previous exemption and requiring providers of event healthcare to register with the CQC, the SI clearly extends the CQC’s regulatory remit to a sector that is complex and, in many cases, heavily reliant on volunteers and small providers. You cannot just transplant knowledge from the hospital or mental health sectors into sports events; noble Lords have referred to the range of events that would be covered. This removal, while understandable, has given rise a number of concerns—I am sure that the Minister has heard them—among, but not limited to, small organisations and volunteer-run sports clubs. Like the noble Lord, Lord Addington, I share the concerns of the noble Lords on different Benches who have spoken. There is no disagreement here.

The department’s own impact assessment acknowledges the increased costs associated with registration and ongoing compliance, but one of my concerns arose when I saw the estimate for the registration fee. It said that, for newly regulated providers, it will be between—

[The Deputy Chairman of Committees (Baroness Healy of Primrose Hill) (Lab)]

I am sorry to interrupt but there is a Division in the House. The Committee will adjourn for 10 minutes.

17:11

Sitting suspended for a Division in the House.

17:21

[Lord Kamall (Con)]

A number of noble Lords have raised concerns, and I am going just to outline or repeat a few of them. The first is that the department’s own assessment acknowledges that the costs associated with registration and ongoing compliance are estimated, for newly regulated providers, as being between £99,400 and £994,000 per annum. They are quite accurate figures, but let me rephrase that: it could be nearly £100,000 or nearly £1 million. We know that most forecasts are wrong, but a factor of 10 is rather a wide range. I have to admit that that raises concerns about the understanding of these regulations.

But more concerning is the evidence from the Faculty of Sport and Exercise Medicine suggesting that many clinicians working in event medicine may reconsider their involvement if these regulations are implemented as proposed—as the noble Baroness, Lady Grey-Thompson, raised. As other noble Lords have said, events medical providers support the principle of these regulations but warn that they could lead to a reduction in workforce capacity, with the potential unintended consequence of reducing safety. My noble friend Lord Herbert referred to that unintended consequence.

There are also concerns that, where providers withdraw from delivering this regulated medical care, events may instead have to rely on first aid provision, as we have heard from a number of noble Lords. That falls outside the scope of CQC regulation. Well-run events such as Wimbledon, Royal Ascot, the Silverstone Grand Prix and the Glastonbury Festival currently manage most medical incidents on-site. But we could see a shift away from properly staffed medical provision, which risks increasing demand on already stretched NHS services off-site.

Stakeholders, including the Sport and Recreation Alliance, have highlighted a lack of comprehensive engagement with the sector to date. Given the unique characteristics of event medicine, it is essential that any regulatory framework be developed in close consultation with those who deliver care on the ground. However, I have been told by some medical professionals that the CQC is being selective in who it wants. I was told a similar story to that told to my noble friend Lord Markham: when three or four CMOs asked for a joint meeting, the CQC person refused and insisted that they wanted to meet only one of the CMOs. When I hear this, frankly, it gives me no confidence in the CQC or its consultation process. Let me be clear: I do not use those words lightly, but the CQC should be doing proper consultation and not refusing meetings.

I recognise the efforts by the previous and the current Government and the CQC to fix its previously poor reputation. Last year, in the mental health debates, these Benches supported the Government in resisting the appointment of a separate mental health commissioner, because we agreed that the mental health part of the CQC was getting its house in order. Indeed, I met today with some people from the CQC on transitional care, and I was very impressed with them.

However, when I am told that for this regulation the CQC suggested that an additional 36 organisations would require registration, compared to an estimated 25,000 in the survey by the Faculty of Sport and Exercise Medicine, this, as my noble friends Lord Lansley and Lord Markham, and the noble Baroness, Lady Grey- Thompson, said, demonstrates a massive gap in understanding that needs to be addressed. Once again, I am sorry when I say this, but it gives the impression of the CQC being out of its depth.

I am sorry if that is not exactly the ringing endorsement that the Minister was hoping for, but I also know that she has been willing in the past to meet to discuss legislation, and we have worked constructively together in the time we have both been on our respective Front Benches. So, in that constructive spirit, I will make three suggestions, which in fact touch upon those that that were made by other noble Lords.

First, we need to see meaningful CQC engagement with sector representatives, our national governing boards, the chief medical officers in sports groups, the Faculty of Sport and Exercise Medicine and the Faculty of Pre-Hospital Care to ensure that any inspection framework is sector-specific and not simply lifted from the hospital sector. Imposing a CQC regulatory framework suitable for hospitals is inappropriate for pop-up clinics at park runs, cycle races or pitch-side at rugby. Let us be frank: the CQC does not have any existing knowledge of working in these sectors at that level, and it should be listening rather than seeking to impose.

Secondly, we should consider expanding the current employer/employee CQC exemption to athletes, performers and officials whose healthcare providers meet strict occupational health standards regardless of the patient’s contractual arrangement, as other noble Lords suggested.

Thirdly, although I understand that the Secondary Legislation Scrutiny Committee has raised concerns about the time taken to bring forward these regulations, given that the CQC is not exactly inspiring confidence from those who organise sports and other events, could the Government possibly ask the CQC to wait until the event healthcare standard being led by the Faculty of Pre-Hospital Care has been published? In addition, if and when it becomes apparent that the CQC has indeed underestimated the size of this and the cost to the sector, would they be prepared to perhaps extend that December 27 deadline, if appropriate?

However, really to emphasise the point that the Government are listening, I know we have asked for individual meetings, but a much better suggestion would be a round table with interested noble Lords, with the relevant Minister from the department—obviously we would love to have the noble Baroness, Lady Merron, there as we always enjoy her consultations— and the CQC, so it can stop being selective about who it speaks with and can actually listen to CMOs and other medical experts from across the sector. They are not doing this to score points; none of us is doing this for that reason. We agree with the principle, and we want this to work, whichever party and whichever Bench we work on, but we are concerned that the CQC’s approach will lead to the unintended consequence of the withdrawal of appropriate medical provision at these services.

It is quite clear that all noble Lords support the goal of improving public safety at events. All noble Lords have heard the concerns from public events medical experts, and all noble Lords hope that the Minister has listened to their concerns and will agree to the modest requests they have made in today’s debate.

[Baroness Merron (Lab)]

My Lords, I am most grateful for the debate today. I will make a few general points.

I very much welcome the points and the concerns that noble Lords have been willing to outline. I also want to acknowledge that I have heard the understanding of why we are doing this. I know that we all understand the intent, and I understand the numerous questions— I make that as a comment, not as any criticism—trying to understand the workability. I very much welcome them. What I take from this debate and what I will share with Minister Ahmed as the Minister for Patient Safety is that clearly there is considerable concern. To refer to what the noble Lord, Lord Addington, said about fault lines, I think this is about fear of fault lines, but even fear of fault lines is fear enough, so I absolutely take that point.

Let me say at the outset that, if noble Lords had not asked for it, I would have suggested having a round table for interested Peers. It will indeed include officials from the department and the CQC. Ministerially, because it is Peers, I would want to be there in any case. I am sure that Minister Ahmed would want to be there too, but my anxiety is to get on with the meeting, so I will happily have a discussion with him, but I certainly want to be there. If noble Lords remain concerned about a lot of the points, we can tease them out there.

17:30

I will endeavour to answer a number of the points, but I am sure that I will miss some, so I will be pleased to write as well. I hope that the combination of this debate and writing will set noble Lords up for the meeting referred to. This is no criticism of noble Lords, but I observe that there is probably a number of misconceptions. I understand what the noble Lord, Lord Addington, said: that whatever the rights, wrongs and detail, nobody wants scaremongering or concerns that are not founded. I absolutely agree, and I am grateful that Peers will assist with that by being involved. Broadly, I can say that there is a CQC consultation planned. It will take place between 8 May and 12 June and will include an online survey and stakeholder focus groups. A number of these issues will be raised, I am sure, and the consultation will be concerned with dealing with them.

I also know that all noble Lords—a number have rightly said it—join together in extending our heartfelt condolences to everyone who was affected by the barbaric act at the Manchester Arena. It was an event that should have been enjoyed by families, friends and communities in the same way as the events that we are talking about should be enjoyed, but it turned into a tragic and unforgettable night for all the wrong reasons. I sense that noble Lords share with me the wish to implement the learnings and the views of the inquiry in order to keep all the events that we have talked about safe. I have no doubt about the intention of what noble Lords are saying.

Let me pick out—in no particular order, if noble Lords do not mind—some of the questions that were raised. I should add that it is no accident that my noble friend Lady Twycross is sitting here. Noble Lords may wish to know that there is an official-led working group on this matter at DCMS. My noble friend has already asked for an update. We are working together across departments.

The noble Lord, Lord Lansley, asked about the number of providers, as did the noble Baroness, Lady Harding, and the noble Lord, Lord Kamall, and made reference to the number of 36. I place on record that we absolutely recognise that this is an unregulated market. The truth is that it is challenging to pinpoint the exact number of organisations that may need to register. The department, along with the CQC, has therefore considered a scenario of between 10 and 1,000 providers when developing this SI. I should say—this is perhaps the main thing—that this concern, which we very much recognise with regard to how many and who is impacted, is why the CQC will further consider the impact on groups as part of its consultation. It will also include seeking further information on the potential numbers that will seek to register with the CQC. This is work in progress. It was an estimate based on modelling in the first instance.

The noble Lord, Lord Lansley, also asked about football clubs being registered with the CQC. I believe that other noble Lords had similar questions on other sectors. I just give the assurance that professional football clubs that provide healthcare to their players— ie, their employees—are not in scope of CQC regulation due to an exemption within the current regulations that stipulates that healthcare organised by employers for their employees is exempt.

The noble Baroness, Lady Harding, the noble Lord, Lord Kamall, and other noble Lords asked for reassurances on the CQC’s workload and workability. I am advised that the CQC currently assesses 72% of applications within 10 weeks. It has agreed on a dedicated resource to process the new TDDI regulations, but I should add that the responses to the CQC consultation will also inform the approach to how it will work and be resourced.

The noble Baroness, Lady Harding, asked whether there is an intention to recruit anyone from the cultural events sector to the CQC. The CQC has already introduced four chief inspector roles and is currently recruiting specialist advisers. Again, after the consultation has taken place, the CQC will be in a much better position to plan its resources further.

Someone asked where this measure sits on the CQC’s list of priorities. It is a key priority. As I have already said, it has agreed on a dedicated resource to process the registrations.

The noble Lord, Lord Lansley, and the noble Baroness, Lady Harding, rightly asked about the event healthcare standard. It will initially be launched this summer around the same time, it is intended, as the registration opens up. Next week, the DHSC and NHSE will start hosting focus groups with stakeholders from across the sporting and cultural worlds, which will inform the development of the standard; we will act on their feedback.

Reference was made to Dr Jerry Hill. Dr Hill has already contributed to the development of this standard, as I understand it, but I can say that the workshops to which I referred are not the totality of the evaluation—they are simply a start. We are working with the National Institute for Health and Care Research to develop and deliver the robust scientific evaluation sought by the noble Baroness, Lady Harding, in order to inform any proposed amendments to the event healthcare standard in 2028.

The noble Baronesses, Lady Grey-Thompson and Lady Finlay, made some very legitimate points about what is to be understood by “injury”, “assistance”, “first aid”, et cetera. I reiterate that the TDDI does not include first aid, as I know noble Lords are aware; clearly, that remains outside its scope. In the SI, there is a reference to what those things mean, and there are already definitions in terms of who we are talking about on, for example, the CQC’s website. That site describes first aid as an immediate

“response to a sudden illness … or injury”

aimed at evaluating the problem or preventing deterioration

“until professional medical help is available”.

It also says that first aid can be provided in a range of circumstances by both healthcare and non-healthcare responders. I say this not to tell those with considerable experience of healthcare what first aid is but to quote what is already defined.

The noble Baroness, Lady Finlay, asked about boundaries around the person doing the treatment. The CQC’s new guidance will be published following the consultation to make the expectations clear in the way the noble Baroness seeks. We will also ensure that this is taken account of in the event healthcare standard.

The noble Baroness, Lady Finlay, and the noble Lord, Lord Addington, asked about the boundaries. This refers to big and small events. The determinant will be what healthcare is needed. As noble Lords will know, the truth is that, for small events such as a fete or the equivalent, first aid is likely to be more adequate. However, for another event, TDDI may be more appropriate and therefore in scope. It will vary, but the event healthcare standard is the important thing here because it will help providers better understand how to carry out assessments at the appropriate level. The standard has been developed by providers, expert clinicians and those involved in event health delivery. We recognise concerns about the potential impact on smaller providers and events if this happens. We will look at this point further in the CQC consultation, because we understand the concerns that noble Lords have.

Noble Lords may have heard views from stakeholders that the existing exemptions in the legislation need to be clear on the treatment provided to athletes, performers and officials. I believe that was referred to. The guidance from the CQC will outline the existing exceptions. The department, working with the CQC, will also monitor the impacts of the implementation of the changes and continue engagement—it has already been going for some time—with stakeholders, including through the consultation that will commence next month, to ensure that there is no undue impact on these groups. The noble Lord, Lord Herbert, raised bureaucratic burdens. We completely understand the need to get this right and not create inappropriate burdens, so the consultation will consider the impact on volunteers and small providers, as he referred to.

I assure the noble Baroness, Lady Grey-Thompson, that we have engaged with the Scottish and Welsh Governments on a range of issues, including how the health sector can support building resilience and improve healthcare provision. That will include raising the delivery of this statutory instrument. We will continue our work and meetings with the devolved Governments. I will ensure that my officials have a formal meeting with the Faculty of Sport and Exercise Medicine UK. I have heard two references to discussions that the noble Lords, Lord Kamall and Lord Markham, hoped would take place with all Chief Medical Officers together. I do not know where the concerns raised have come from—noble Lords may wish to let me know—but, to be clear, the department and the CQC would be very happy to meet with all the CMOs together.

In bringing my comments together, I emphasise that point on which there has been a lot of concern. We have been working with stakeholders and will continue to do so; we understand the principle but we want to get this right.

[Lord Lansley (Con)]

I am grateful for the offer of further discussions and a round table, but there are several numbers relating to the number of providers that might be anticipated to require registration. We keep coming back to this figure of 36 in the impact assessment, but I do not understand exactly who those providers are. For example, I imagined it would probably be football clubs but it turns out that it is not. Who are they exactly?

The Minister and the department in their impact assessment have moved from that figure of 36, which presumably had some substance, to a guess of somewhere between 100 and 1,000, which, as my noble friend said, is a very high degree of uncertainty. I still do not know—if there were to be as many as 1,000—who these providers are and how many, for example, would be small charitable organisations or small, sporting voluntary organisations for which £1,000 is not a small matter.

17:45

[Lord Kamall (Con)]

I can add to that. What is the process for notifying those who will come under this regulation? That would be helpful to know as well.

[Baroness Finlay of Llandaff (CB)]

If I may add to the list of questions, I think it might be helpful for the Minister to explain how the decisions over the size relate to the Purple Guide that the Health and Safety Executive produced, because I understand from page 114 of volume 2 of the Manchester Arena inquiry report that the Purple Guide for an event of that size set things out quite clearly, but was not adhered to at all. I have a slight concern from the responses that we have had that we may have two completely separate things going on. The Minister may not be able to answer that now, but it would be helpful in this meeting that we are all anticipating if there is a cross-reference to the Purple Guide and if the discussions could include how that would impact and be used by the CQC in regulating.

[Lord Markham (Con)]

If I may, I hope this may be helpful: the confusion that I have heard is over whether a doctor, for a CQC registration at their GP surgery, can use that to volunteer on a point-to-point racecourse, as an example, or whether they have to separately register with the CQC to be a volunteer on the racecourse and pay the £1,000. Again, if that comes in the letter, that is fine, but that is one of the main points of confusion.

[Baroness Merron (Lab)]

On all these areas, as I said, I am happy to meet with noble Lords in person. To be honest, I think that that would be more helpful, not least because we are talking about scenarios and we have a note of the questions that noble Lords are raising. I would be delighted to go through them. Again, in the responses today, I am probably going to be repeating some of what I said earlier and I am not sure that that will take us forward, so I would rather that we held those points for a meeting, if noble Lords are agreeable.

With that, I thank noble Lords. This has been a very valuable debate. It shows the work that needs to be done and we will be pleased to do that. I thank all noble Lords for their considered contributions and support of the principle of why we are here.

Motion agreed.