Health Bill

Baroness Finlay of Llandaff Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[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?

[Baroness Pidgeon (LD)]

My Lords, we welcome these Government amendments, which ensure that the devolved Administrations’ boundaries are protected and that there is proper consultation and agreement. But devolution must be integral to any legislation from the start, rather than an afterthought. Granted, there has been consultation with the devolved Governments, but these amendments were tabled very late and this is a worrying sign. It is an indication that aspects of the reorganisation and its governance implications had not been properly thought through at the start—through the lens of the devolved Administrations, rather than simply through that of Whitehall and civil servants centrally. The Minister’s words have provided some assurance, and I look forward to the devolved Administrations being at the start and the heart of legislation such as this in the future, rather than an add-on at a late stage.

--- Later in debate ---

Clearly, this is a little aside from the core aim of this legislation, but the way this is handled will be an indication of how future arrangements are going to be. NHS Supply Chain should, first, commit to pursuing value-based purchasing, and, secondly, recognise that, although it is owned by the Secretary of State, or will be, its job is to help the local NHS and so it should not treat it in an arrogant way but, basically, as its customers.

[Baroness Finlay of Llandaff (CB)]

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

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

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

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

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

[Lord Lansley (Con)]

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

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

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

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

Health Bill

Baroness Finlay of Llandaff Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

The term “health and care partner” may be unfamiliar, but it has been chosen after thoughtful discussion within the NHS, where senior nurses have been meeting with a range of stakeholders to develop a policy that is now ready for implementation. Where it has already been piloted, staff have found it supportive. Patient outcomes have improved and complaints reduced. I have seen a lot of case studies where visitors, relatives and friends, have raised concerns about the person who is resident then found themselves banned from visiting. This is really a very difficult situation. We have to shift the power imbalance in health and care settings. These amendments are one way in which I propose to do so, and I hope that the Government will be sympathetic. I beg to move.

[Baroness Finlay of Llandaff (CB)]

My Lords, I added my name to several of these amendments because I think they are crucial. I read them very carefully to make sure that, in the event of there being major safeguarding concerns, it would not cut across them, and I do not believe it would. I think it will improve care.

It requires a change of attitude on behalf of healthcare staff to accept the fact that sometimes the person who is the relative, the carer who has been looking after someone at home, knows only too well exactly how to communicate with them if they have communication difficulties and how to manage even complex equipment such as their ventilator, sucking them out or whatever. In the hospice where I was medical director, I clearly remember one lady with a horrible tumour; her children wanted to do her dressings for her, and she wanted the children to do them. It was important for those children to be able to help, and encouraged to care as they wanted to, so that they were with her right through her illness. We provided accommodation for them to sleep there when she was dying. We also provided a family room and even had beds that we could put together, so a relative could sleep next to somebody. It really transformed care. It took a lot of pressure off the nursing staff, because there was somebody there all the time and if they became agitated, they could ask for help.

The staff in many units, however, can feel threatened by relatives who say the person would prefer something done one way or another. It is important that if there is someone with a person who is the patient, they have access to food and drink and comfortable seating, not a hard plastic chair, and that it is clear where they can use the toilet or even take a shower and be accommodated. It does not cost anything, but it saves a lot of staff time.

I hope that these amendments will be adopted into the main Bill to bring about that change. Those of us who went to the meeting about DEBRA, which is epidermolysis bullosa, were very touched by the cases we heard in which the mother was doing the child’s dressing changes. It was essential that the mother could go with that child into hospital, and that even when they became an adult they could go on an adult ward, because they knew exactly the least painful way to do the dressing changes. The staff who did not know the person beforehand just did not have the same knowledge and therefore could not apply the same skills.

The noble Baroness, Lady Campbell of Surbiton, spoke very powerfully about the need for a personal health budget. I know she has extensive experience of having her husband with her on many occasions when she has been in hospital, and there have been occasions when he has saved her life. This is not minor. This is very important.

Corridor Care

Baroness Finlay of Llandaff Excerpts

Tuesday 20th October 2026 Lords Chamber

[Baroness Merron (Lab)]

The principle of assessing patient experience, as my noble friend described, is absolutely key to the Health Bill, and I know we will discuss this more. Since my noble friend was a young pup—as he described himself, in a different way—we now have the facilities to be much more transparent and to use data. It is important to say that the collection of data is new—it started only this year and did not exist before—and we are continuing to work with providers to improve the consistency and quality of reporting. That is absolutely key.

[Baroness Finlay of Llandaff (CB)]

My Lords, given that three-quarters of physicians report difficulties in accessing essential equipment, sometimes including resuscitation equipment, for patients in corridors, and even more report compromised care, what work are the Government now undertaking with the Royal College of Emergency Medicine to increase the provision of medical assessment units, particularly working with the clinical governance leads for those emergency departments?

[Baroness Merron (Lab)]

All of this is important, as the noble Baroness said. We are already undertaking a number of actions and one is about additional urgent care capacity; for example, in total some £2 billion is going into urgent care, particularly capital projects, which the noble Baroness did not specifically mention. The improvement of facilities, which is part of this, is absolutely key, as is getting care closer to home. With the kinds of improvements we are already seeing—for example, the emergency departments at Basildon and North Tees have had refurbishments—and by working with clinical leads, we will improve a long-standing situation that should never have been normalised and should only be exceptional.

Patient Data: Research

Baroness Finlay of Llandaff Excerpts

Thursday 10th September 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My noble friend Lord Patel, in introducing this important debate, spoke about health data secure systems. I will speak about the Secure Anonymised Information Linkage system—the SAIL database—based in Swansea and funded by the Welsh Government, which runs on the mantra of “public data for public good”. It has been going for almost 20 years and has data reaching back a quarter of a century. The SAIL Databank was highlighted in the Health Data Research Service (HDRS) Digital Ecosystems Analysis report, because it has expertise in data pipelines, advanced data linkages and secure research infrastructure, powered by the Secure eResearch Platform, or SeRP. These capabilities are essential for the future of health data research.

The SAIL database is very widely trusted, because it was so carefully set up and is so carefully managed. The report identifies it as one of the UK’s established examples, with

“documented transformation logic and quality assurance”

built in. The database has an extensive number of research projects internationally, and it reinforces the importance of trusted research environments, TREs, and secure data environments, SDEs, where approved researchers analyse sensitive data within secure settings, rather than downloading or transferring information. That model has maintained public trust while enabling high-impact research.

Professor Simon Thompson, a co-director of the SAIL Databank and SeRP, has pointed out that they have been

“recognised as a benchmark for the UK”

and that their work linking

“Welsh population data across health, education, housing, justice and beyond shows what’s possible when secure, person-level linkage is done properly and at scale”.

It is one of the leading environments.

Sharon Heys, the head of legislation and due diligence at SeRP, has discussed the difficulties in defining the lines of anonymisation and whether data is likely to be identifiable. I am grateful to my noble friend Lord Tarassenko for talking about the Biobank data. I had the privilege of being on the ethics committee as Biobank was being set up. The durability of Biobank and of SAIL represents the importance of considering all aspects before you even get started.

Funeral Directors: Regulatory Regime

Baroness Finlay of Llandaff Excerpts

Wednesday 9th September 2026 Lords Chamber

[Baroness Merron (Lab)]

This is the way that we are conducting ourselves. It would be a bit premature to draw conclusions on any funding requirements—we are, of course, talking about private businesses. However, we are looking—as we always do, but particularly in this area—at the costs, benefits and the impacts of different approaches before decisions are taken. Within that, we are working with the full range of funeral providers and not just the large funeral providers.

[Baroness Finlay of Llandaff (CB)]

My Lords, this is much to be welcomed, because a funeral is a very important part of marking the passing of, and respect for, a person. So, in the consultation, will the Government ask hospice bereavement counsellors—specifically those who see people on the ground face to face—for their comments? Often, managerial people higher up in the bereavement service may not know some of the details that have been extremely important to families and that may have caused great offence or may have been particularly helpful, and they can get lost in the retelling as things are passed up the chain.

[Baroness Merron (Lab)]

The noble Baroness is quite right that funerals are very personal matters—personal to the deceased, who may or may not have left their wishes, and personal and affecting for those left behind. So hospices and other groups will be worked with closely in the way the noble Baroness describes, as they are important stakeholders for us.

Integrated Care Boards: Access to Services

Baroness Finlay of Llandaff Excerpts

Tuesday 8th September 2026 Lords Chamber

[Baroness Merron (Lab)]

I understand why change creates worry, but I reassure the noble Baroness that the 10-year health plan set out the role of ICBs and, as I mentioned, for the strategic commissioning of health services and neighbourhood providers. I believe it will help to move towards fewer integrated care boards; there are currently 36. That will mean a pooling of budgets, greater efficiency, a reduction in running costs and more resources going to the front line. In all those ways, I intend for the change to deliver a better service locally.

[Baroness Finlay of Llandaff (CB)]

My Lords, what are the criteria that ICBs plan to use to monitor 24/7 access to services in the community? At the moment, the pressures are on emergency departments, where ever more patients arrive, because that is where the lights are on. We have heard about the governance problems of clinical errors occurring where staff are under extreme pressure and patients are in corridors.

[Baroness Merron (Lab)]

One of the major shifts for the NHS now and in the future is about moving services from hospitals to communities; we had a Question on that just yesterday. It is important to say that the fundamentals of oversight, which we are improving, will be through the NHS oversight framework, which will be clear about delivery and approach. I should add that NHS England will be able to focus on helping the most challenged organisations with their performance and capabilities. If there are problems such as those that the noble Baroness described, they will be identified.

People with Learning Disabilities: Acute Illness

Baroness Finlay of Llandaff Excerpts

Monday 20th July 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, the report highlights that, for almost two-thirds of these patients, there was no assessment of mental capacity. However, when people are ill and frightened, mental capacity is incredibly important for being able to communicate with people, to make a diagnosis and to monitor a response to treatment. Without communication, of course the outcomes are worse than they might otherwise be. How will the Government improve the assessment of mental capacity across the board and implement the recommendations in the report?

[Baroness Merron (Lab)]

Guidance was issued not many months ago on this point, and I expect to see improvements. The report found that well under 50% of patients or their carers were asked about reasonable adjustments. It is not acceptable, but that is why we have brought in the mental capacity assessment guidance and the reasonable adjustment digital flag. These will make a major difference.

Children’s and Young People’s Mental Health Services

Baroness Finlay of Llandaff Excerpts

Thursday 2nd July 2026 Lords Chamber

[Baroness Merron (Lab)]

Important though they are, we are accelerating the rollout of mental health support teams, because we now want to meet a more ambitious target of achieving full national coverage by 2029. We have already made progress. As of March this year, some 60% of pupils in schools and learners in further education were covered by a mental health support team. That is up from 52% the year before. The principle of integration where young people and children are is absolutely right. That is why we are not just investing in but accelerating the coverage of mental health support teams.

[Baroness Finlay of Llandaff (CB)]

Do the Government recognise that, as the report said, school staff often see the antecedents of mental health? Two areas where there is strong evidence are parental alcoholism, with a threefold increase in children considering suicide and a fivefold increase in eating disorders, and repeated physical punishment, particularly of children under the age of seven, resulting in emotional harm, so that simply intervening on the child may be too late, and intervention must be earlier to prevent problems.

[Baroness Merron (Lab)]

I agree with the noble Baroness’s observations. Early intervention is key. That is what our entire focus is on, in the ways we have already discussed, and also on developing a children and young people’s modern service framework because we want to reduce variation and ensure that children get the right support at the right time.

Foetal Alcohol Spectrum Disorder

Baroness Finlay of Llandaff Excerpts

Thursday 25th June 2026 Lords Chamber

[Baroness Merron (Lab)]

In addition to the ring-fenced funding I spoke of, we are going further on alcohol labels to get across the important points. In 2022, NICE produced and published a quality standard, which the noble Baroness referred to, so that the system can help diagnose but also support those affected by FASD. I am not aware of there being widespread difficulties with its adoption, because it is so fundamental to pre-pregnancy and pregnancy care, but, if the noble Baroness has particular examples, I would of course be pleased to look into them.

[Baroness Finlay of Llandaff (CB)]

My Lords, the Government’s initiatives on alcohol prevention in pregnancy are to be welcomed and are very impressive, but can the Minister assure us that the industry itself will not be involved in consultations and in designing public health programmes? To date, the tiny pictograms on bottles, particularly of wine and other alcohol products, are so small that they are ineffective. We really need consistent messaging in a much broader sphere where people eat out, drink out and socialise, and in all public health measures.

[Baroness Merron (Lab)]

I take the noble Baroness’s point, which is why I am glad that we committed in the 10-year health plan to making it a legal requirement—therefore strengthening it—that alcohol labels display health warnings and consistent nutritional information. That is something else that noble Lords have raised. As was referred to in the previous question, it is also important that we note that part of care for pregnant women is dealing with alcohol consumption.

Compassionate Use Medicine Schemes: VAT

Baroness Finlay of Llandaff Excerpts

Tuesday 16th June 2026 Lords Chamber

[Baroness Merron (Lab)]

Cancer charities are important in this area, and we are certainly engaging with them; they are very invested partners. I understand why people are concerned. This is not instead of the NHS. NHS medicines are provided on the advice and guidance of NICE, and that absolutely continues. As I say, what we need to do, and what we will do, is work with everyone concerned to find a solution quickly, because we want to support the pharma companies that continue to donate what are very important medicines.

[Baroness Finlay of Llandaff (CB)]

My Lords, do the Government recognise that it has been estimated that, for each pound invested in research, there is an approximate 25p return on that in perpetuity. Therefore, we should avoid anything which disincentivises research investment in this country, which would include the inability to recruit patients if they have to be told that, even if the treatment is successful, they will not be able to access it on the NHS afterwards because the NICE approval processes are too slow for many of these substances. Will the Government therefore undertake to speed up the NICE assessment processes to make sure that patients are not disadvantaged and research is not disincentivised?

[Baroness Merron (Lab)]

Indeed, we will. I can tell the noble Baroness how important speeding up access to medicines is. That is why, in April, we introduced the joint MHRA-NICE pathway for medicines, which will speed up access to new medicines by some three to six very valuable months. We have also brought in the early access to medicines scheme, the Innovative Licensing and Access Pathway, and the innovative medicines fund. All these mean that, across the regulatory and access system, innovative treatments will be available to patients who need them earlier, as the noble Baroness rightly called for.