Health Bill

Baroness Sater Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Baroness Chisholm of Owlpen (Non-Afl)]

My Lords, feeling invisible, constant uncertainty, high rates of distress, caregiver burnout: these are only four of many problems facing those suffering from rare disease. That is why my name is on the amendments from the noble Baroness, Lady Grey-Thompson, and the noble Lord, Lord Sharkey. We have heard from the noble Baroness, Lady Grey-Thompson, about the importance of impact assessments. I am vice-chair of the Specialised Healthcare Alliance, along with my fellow vice-chair, the noble Baroness, Lady Sater, and the noble Lord, Lord Sharkey, is chair. It plays an important role in specialised services. I support the requirement for an impact assessment before any specialised service is delegated to ICBs. All that the noble Baroness, Lady Grey-Thompson, said makes a brilliant case for this.

I am really concerned that we still lack an overarching assessment of what the Bill could mean for specialised services as a whole. We need to have assurances on how the Government will assess and monitor the cumulative impact of changes on specialised services. I hope the Minister can reassure us on this point.

I strongly support what the noble Baroness, Lady Grey-Thompson, said about the importance of annual reporting. In fact, that is already standard practice in other major areas of the health service—for example, the newly established National Cancer Board. Surely the Minister must see that how important the tool of annual reporting is for driving accountability and improvement in cancer services. In which case, surely the same principle should apply to specialist services.

My name is also on Amendment 74 in the name of the noble Lord, Lord Sharkey, on the importance of clinical leadership. Given the number of people affected and the complex conditions involved, there is a strong case for a senior clinical leadership to provide strategic oversight across care, research and policy. The Future for Rare campaign, which the SHCA supports, is calling for a national clinical leader for rare conditions in each UK nation. Given the Government’s commitments to appoint a dementia tsar and a national clinical head for brain cancer, does the Minister agree that a similar role for rare conditions merits consideration? I look forward to the Minister agreeing to these very small but very important amendments.

[Baroness Sater (Con)]

My Lords, I will speak briefly in support of Amendment 74, to which I added my name, and I fully support all that has been said by my friend, the noble Lord, Lord Sharkey, and my noble friend Lady Chisholm. I declare an interest as a vice-chair of the Specialised Healthcare Alliance. I also put on record my support for Amendments 57 and 73 tabled by my friend, the noble Baroness, Lady Grey-Thompson. She made some very compelling points, particularly on the importance of proper scrutiny, transparency and accountability as we move towards these new commissioning arrangements. It is vital that we understand the impact of these changes and have the means to monitor whether they are delivering the right outcomes for our patients.

On Amendment 74, there is just one further point I would like to raise: the importance of patient and public involvement. While much of this debate has focused on clinical expertise, it is important that we recognise that clinical reference groups are also a key mechanism for patient and public involvement. If they are removed without a credible alternative, that patient voice risks being diminished. These voices are incredibly important. Through my work with the Specialised Healthcare Alliance, I hear at first hand from our coalition of nearly 400 patient organisations, campaigning on behalf of people with rare and complex conditions, just how important this involvement is.

There is no substitute for hearing directly from those with lived experience. Their perspectives are invaluable, and it is important that they continue to be heard as these new arrangements take shape. Will the Minister therefore set out how the Government intend to maintain and, ideally, strengthen patient and public involvement in specialised commissioning? In particular, I would welcome clarity on what role the new offices for the pan-ICB commissioning will play in supporting that engagement and ensuring that the voices of patients and their organisations continue to be heard.

I hope the Minister can provide some reassurance on this because, ultimately, the voices of patients and those who represent them must remain at the heart of specialised commissioning. I look forward to hearing the Minister’s response.

[Lord Harlech (Con)]

My Lords, I have been listening with great interest, and I am still none the wiser as to why my amendment has been crowbarred into this group. But I suppose it is quite apt to be discussing the medical situation of Reserve Forces personnel on Armistice Day. I declare my interest as a serving officer in the Army Reserve.

Amendment 279QE would require a health body, when dealing with an individual, to make arrangements to establish and record whether that person is a serving member of the Reserve Forces and then to have due regard to that individual’s need to meet the medical and dental fitness standards required for call-out. This amendment was debated at the Committee and Report stages of the Armed Forces Bill and I bring it here because, with respect, the reasons given for not accepting it do not survive examination. I should add that those answers came from the Ministry of Defence rather than from this department. I saw the noble Baroness, Lady Antrobus, in her place earlier and thought that perhaps the MoD had put her up to knock this one back again.

The first reason given was that the amendment risks undermining the principle that National Health Service treatment follows clinical need rather than employment status. My proposed new section says the opposite in subsections (2) and (7). More concretely, this Bill does not itself proceed on that principle without qualification. Clause 12 substitutes a new Section 3B into the National Health Service Act 2006, allowing regulations to require the Secretary of State to arrange

“services or facilities for members of the armed forces or their families”,

and subsection (4) of that new section defines them as including the Reserve Forces. The Bill before this Committee, therefore, already contemplates commissioning by reference to service status and names reservists when it does so.

Nor is the principle novel in practice. On Report on the Armed Forces Bill, the noble Lord, Lord Stevens of Birmingham, reminded the House that from 1953 until at least 1997,

“certain classes of veterans from the First and Second World Wars received priority treatment for certain conditions”,

and that today

“merchant seafarers receive fast-track access for routine care under the Dreadnought Medical Service on offer at St Thomas’ Hospital so they can get back to sea”.—[Official Report, 20/10/26; col. 608.]