Wednesday 28th October 2026
(1 day, 17 hours ago)
Lords ChamberHealth Bill 2026-27 View all Health Bill 2026-27 Debates Read Hansard Text Watch Debate Amendment Paper: HL Bill 52-I(Rev)(a) Amendments for Committee (Supplementary to the Revised Marshalled List) - (28 Oct 2026)
Baroness Merron
“(1A) The Secretary of State may not make a transfer scheme transferring anything to—(a) a Scottish public body, without the consent of the Scottish Ministers;(b) a Welsh public body, without the consent of the Welsh Ministers;(c) a Northern Ireland public body, without the consent of a Northern Ireland department.”Member's explanatory statement
This amendment would require the Secretary of State to seek the consent of the appropriate devolved nation before making a transfer scheme which transferred property, rights and liabilities from NHS England to a Scottish public body, Welsh public body or Northern Ireland public body.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, as I said at Second Reading, the abolition of NHS England is being taken forward with the interests of patients firmly at its core. It will provide greater clarity for the system. It will restore democratic accountability and free up resources to be reinvested in the front line. It will also bring greater clarity about where responsibility lies, ensuring that Ministers are accountable for national decisions while devolving more power to local NHS organisations. Patients will benefit from faster and clearer decision-making, with less duplication and red tape, with staff being allowed to spend less time navigating bureaucracy and more time focused on care and delivery.
I will address the government amendments to Clauses 2 and 28 together. Amendment 1 and consequential Amendments 2 and 3 make additions to Clause 2, which empowers the Secretary of State to establish transfer schemes. These clauses provide a structured and transparent means of moving property, staff, rights and liabilities from NHS England to the Department of Health and Social Care, integrated care boards and other relevant bodies.
Following engagement with the devolved Governments, these amendments have been tabled to require the consent of the relevant devolved Government should a transfer be made to a Welsh, Scottish or Northern Ireland public body. Amendment 1 does not change the purpose of Clause 2 but provides assurance to devolved Governments that any transfers to their bodies can take place only with their agreement. I emphasise that there are currently no plans for transfers to be made to devolved Governments’ public bodies, but this amendment provides a proportionate safeguard if such circumstances arise in the future.
Likewise, Amendments 103 and 104 are technical amendments to Clause 28, this time in response to engagement with the Welsh Government. They make clear the territorial limit of the clause to ensure it could not be used to establish, or delegate functions to, a Welsh special health authority. I believe these to be sensible and proportionate amendments, and I beg to move Amendment 1.
Baroness Finlay of Llandaff (CB)
My Lords, I welcome the Minister’s discussions with the devolved Governments and her saying that nothing is going to be potentially imposed on them, particularly having had those discussions. But can she clarify what will happen to some of the prevention agendas that have been in place—such as the Couch to 5K programme, for which I understand no outcomes have been collected, but which has been part of NHSE and the department’s promotion of exercise—and whether these programmes will be increasingly promoted across England as part of the prevention agenda, and in discussion with the devolved Governments, so that we get consistency in prevention across the United Kingdom?
Earl Howe (Con)
My Lords, it is a pleasure to begin our Committee consideration of the Health Bill, and I look forward to the discussions over the coming days. I am grateful to the Minister and to the Government for bringing forward these amendments, which we understand to be principally technical in nature, although there are questions we shall want to ask in later groups about cross-border patient referrals and related issues. We welcome the clarification these amendments provide regarding the consent of the devolved Administrations and the exercise of powers by devolved health bodies, and we are content to support them.
I hope the Committee will allow me to take this opportunity to acknowledge the letter sent by the Minister this morning concerning Healthwatch. Noble Lords across the House will welcome the Government’s decision not to proceed with its abolition, and I am grateful to the Minister for listening to the concerns raised in this House and elsewhere. This is a very positive example of the Government engaging constructively with the scrutiny of this Bill and showing a willingness to reconsider their proposals where legitimate concerns have been raised. That is precisely the spirit in which I hope we can continue our consideration of this legislation, and I welcome the approach the Government have taken on this occasion. I look forward to the Minister’s response.
Baroness Merron (Lab)
My Lords, I am grateful for this brief but important debate, and in particular for the support for these amendments. As the noble Earl, Lord Howe, says, they are technical amendments. I say to the noble Baroness, Lady Pidgeon, that this is absolutely nothing to be worried about: we work closely with the devolved Governments, and this is an extra layer of reassurance to them that we felt was helpful, because it is what they sought. These technical amendments are brought forward not as an afterthought but because that is what conversations have led us to think is the right thing to do. I know they very much welcome this, and I am grateful for their assistance.
I hear what the noble Earl, Lord Howe, said about the letter I sent out and the announcement in respect of Healthwatch. I am most grateful to noble Lords for their engagement as we have approached this point in the Bill. As the noble Earl acknowledged, we are always keen to listen. We cannot always do exactly what every noble Lord would want, but I am glad that the noble Earl welcomes the way in which the Secretary of State and the Prime Minister have approached this.
On the point raised by the noble Baroness, Lady Finlay —who also gave her support—about particular programmes, I am very happy to look into that. However, as I have set out, we intend for the programmes to which we are committed to be transferred to the department. What happens in the longer term on the prevention agenda is another consideration. We work very closely with the devolved Administrations on prevention, but, ultimately, healthcare is a devolved matter. I commend the amendment to the Committee.
Baroness Merron
Member’s explanatory statement
This is consequential on my amendment to Clause 2, page 2, line 21.
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.
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.
Earl Howe (Con)
My Lords, I am grateful to the Minister for her wide-ranging response, and to all noble Lords who have contributed to this important debate, which has been very useful.
The Committee has spoken with one voice in underlining the scale and complexity of the task which lies ahead and the importance of ensuring that the abolition of NHS England, or its transformation, as the noble and right reverend Lord, Lord Sentamu, put it, is managed carefully, transparently and with proper accountability.
As I said at the outset, we are not opposed to efforts to reduce bureaucracy or to improve efficiency in the health service. However, we have to be confident that the Government have a clear understanding of the costs involved, the savings which can realistically be achieved and the risks associated with a reorganisation on this scale. Above all, we must not lose sight of the people whom these reforms are intended to serve. The ultimate measure of success must be whether patients receive better, safer and more timely care, rather than simply whether we have succeeded in changing the administrative structure of the NHS.
Despite what she said, I hope the Minister recognises that my amendment was put together as a giant probe of the Government’s transition plans, rather than as a model form of words to be written into the Bill. I therefore welcome her assurance that she will reflect carefully on the concerns that have been raised today, particularly around the need for a clear and independently assessed transition plan. We will consider the Minister’s response ahead of Report. However, for now, I beg leave to withdraw my amendment.
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.
Baroness Merron (Lab)
My Lords, I am grateful to the noble Baroness, Lady Jones, for opening the debate on this group, starting with the amendment laid in the name of her noble friend, the noble Baroness, Lady Bennett. I am grateful to all noble Lords for their consideration on a topic that is key to this Bill and to all our work. I will return to this, but it includes the 10-year health plan, which provides the framework for all that we do.
I start with Amendments 6 to 11 and 13 to 20. I assure your Lordships of our commitment to tackling inequalities. We have debated this several times in this Chamber and rightly so. I certainly agree with the comments made, including those from the noble Baroness, Lady Cash. This is about people’s ability not just to access services but to achieve the right outcomes for them regardless of who they are, their background or where they live.
I turn to Amendments 8 to 10, tabled by the noble Baroness, Lady Walmsley, and spoken to by the noble Baroness, Lady Tyler, and Amendment 7 in the name of the noble Lord, Lord Patel. These test whether the duty on the Secretary of State is strong enough. It is right to discuss that point. I appreciate the intention—which was emphasised by my noble friends Lady Royall and Lady Lister, and the noble Lord, Lord Lansley—to ensure that we are taking action, because that is ultimately what we are here to do. However, I would caution against amending the Bill in the way that the amendments seek to do. As a number of noble Lords will be aware, the “have regard” formulation in legislation has a number of precedents across the statute book, and it is familiar to government departments and to decision-making in the public sector.
There was an exchange between the noble Lord, Lord Lansley, and my noble friend Lady Royall over Sections 2A and 2B of the NHS Act. I tread with some trepidation at this stage, but we do not believe that it is necessary to change “may” to “must”, certainly for the duty in Section 2B. This is for the reason I have just outlined about risking confusion because it is moving away from the usual way of doing things. It would also potentially reduce the ability of Ministers to make decisions about priorities. There is no practical intention to reduce the importance of tackling inequalities. The noble Baroness, Lady Gerada, has moved from her place.
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.
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.
Baroness Jones of Moulsecoomb (GP)
I will stand up before anybody else does.
I thank the Minister for her replies; I really admire the positivity in there. I have been using the NHS since 1949, and it is absolutely amazing. My working-class parents were incredibly delighted by its introduction, but I rather suspect that my age cohort has had the best of it—I hope that that is not true. I would love to respond to a lot of the points, including on coastal communities, which often suffer from huge environmental pollution in rivers, along seashores and so on. This has been a fascinating debate, and I can see an exciting Report stage in the offing. In the meantime, I beg leave to withdraw my amendment.