Health Bill

Baroness Thornton Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Lord Lansley (Con)]

My Lords, I support my noble friend in his amendment. I do not want to revisit Second Reading issues, but will make one or two important points. First, along with other noble Lords, I say a big thank you to the Minister for some of the correspondence we have received and the way in which she and the Government have already been listening to the discussions in this House. I hope that we can continue to have a constructive discussion.

I do not entirely share the view of the noble Lord, Lord Kakkar, that the abolition of NHS England is a done deal and we should therefore accept it. It was not a manifesto commitment. Parliament has had no say in this matter. It is all the more important that, as we implement the Government’s intentions into law, we understand what we are doing and how. That is particularly true in so far as there is some speculation whether all these responsibilities will be incorporated into the department—the noble Lord, Lord Hunt of Kings Heath, sees it all as becoming engaged in the department and therefore accessible to Ministers. If many of these responsibilities are to be held in special health authorities outside the department, it is hard for some of us to understand what has been gained in accountability relative to the current situation between the department and NHS England. Of course, Ministers had powers under the previous legislation to exercise accountability over NHS England, not least through the process of a mandate, but often failed effectively to use them—sometimes the use of powers by Ministers is more important than other things.

The key point here is the transition. The Government have put into the legislation that there will be transition schemes, but we need to see what they look like and how the timing works. I recall that the gap between the passing of the 2012 Act and its implementation was almost exactly a year. That further strengthens the force of the questions that the noble Lord, Lord Stevens of Birmingham, just asked. We need to see what that timetable looks like.

From a curiosity point of view, I would be interested to know how these savings will be generated. Noble Lords often say that a great deal of money was spent on the 2012 reforms. The Written Ministerial Statement published on 21 July 2015, at the end of the 2010 to 2015 Parliament, told us what the outcome was: the cost totalled £1.38 billion, a little more than my noble friend Lord Howe said the Government anticipate that the overall cost of this reorganisation will look like, but not much more. By the end of the Parliament, the savings were £6.9 billion in cash. Not least in some of the debates, people tend to remember the cost but not the savings. It would be extremely useful for us to know in advance what is intended to be achieved, because that reorganisation, according to the data published in 2015, arrived in the final financial year of that Parliament at a £2 billion a year reduction in cost. The Government are not even attempting to achieve something as ambitious as that. Let us see what it looks like.

I make one suggestion, to which I hope the Minister will respond. It is not unknown for the National Audit Office to engage in a process of scrutiny not after the event but during the event. This is especially true for major projects. This is a major project, and over the course of the next year it would be good if the department volunteered itself to the National Audit Office for such a process of real-terms scrutiny of the value-for-money effectiveness of this reorganisation.

[Baroness Thornton (Lab)]

My Lords, I thought it would be appropriate for those of us who have been involved in this for the last 15 years or so to join in the debate a little. The noble Lord, Lord Lansley, is quite right: this is about transition. It is about a transition that affects two groups of people: patients and people who work in the NHS.

I am a veteran of the transitions that we have had so far, because I was abolished in 2020. I became a member of my local CCG, which I very much enjoyed serving on, having worked on the 2012 legislation that created it. I then took refuge as a non-executive director in my local hospital. I helped to create our local ICB, which is now being abolished with a super-ICB being created. I feel as if I have been at the governance coalface of the reorganisations for the last 15 years. This is an important debate, and I am in favour of the abolition of NHS England.

I intend to involve myself in Committee mostly with equality, social care, patient records and so on, but I have a question for my noble friend the Minister about the arrangements for the people who will move from NHS England into the department and where they stand right now. Those people are very precious to us, and many of them are very experienced. I would like to know how the TUPE arrangements are progressing, what the dates are for those arrangements and when we are likely to see some documentation about how that will actually happen.

[Baroness Nargund (Lab)]

My Lords, I understand and support the general thrust of this amendment. I have worked in the NHS for nearly 40 years and have worked very closely with NHS England. Having experienced all the transitions that have happened with local health boards, PCTs, CCGs and ICBs, and having worked with CCGs and ICBs across England as a provider and doctor and with NHS England, as I said at Second Reading, I wholeheartedly support the abolition of NHS England. It will cut the bureaucracy and the unnecessary layer. I support the Secretary of State taking back the power to give it away to ICBs where patients are treated. It also fits in with the neighbourhood health plan, because they are best placed to develop and deliver that.

--- Later in debate ---

[Baroness Thornton (Lab)]

My Lords, I do not intend, by and large, always to follow the noble Lord, Lord Lansley, if I make a remark to your Lordships’ House, and I will not go into the reasons for health inequalities, because they have been spoken to very adequately by the noble Lord, Lord Patel, and my noble friends Lady Royall, Lord Hunt and Lady Nargund. However, I want to say something about social care because, although the noble Lord, Lord Lansley, is quite right about public health and the need for prevention, none of this is going to work or be delivered—I make no apologies for saying this and I will keep saying it—including the 10-year plan and integrated care, unless we also address the issue of social care inequalities. As I am chair of the Social Care Institute for Excellence, the Committee would be expecting me to talk about that.

We recently did research, which has been published, about the inequities experienced by people who use social care. I thought it might be useful to remind the House what that said, because it will sound very familiar when we are talking about health inequalities. It was about people with lived experience, because our work in SCIE is based on people with lived experience, and co-production. It said:

“These policy and practice implications are reflected … by participants: a named point of contact to help them navigate the complex system … better continuity of carers to improve the quality of care and reduce the burden of having to explain one’s needs”,


as we hear time and again,

“clearer and more proactive information to ensure everybody is aware of their entitlements … investment in the workforce to encourage greater professionalism and retention … more consistent provision across areas to reduce the postcode lottery”.

We could be talking about the inequalities we have just been debating; the same applies in social care. The reassurance I seek from my noble friend the Minister is that that will be recognised as we go through this legislation.

[Lord Mawson (CB)]

My Lords, I found this an interesting debate, and I am sympathetic to the amendment of the noble Baroness, Lady Bennett, and particularly that of the noble Lord, Lord Patel, because he is right that very little is actually being learned. My colleagues and I have listened, over the years, to lots of conversations about health inequalities. When you spend your life in very challenging housing estates and see very little changing, you know about the distance between all the words and the practice.

That is why, many years ago, we decided to focus on practice and the doing of things, rather than the talking about things. We began to realise what every parent knows: that you only really learn by doing. When I started to work with GPs, originally in east London, they began by telling me that was how you became a GP. You saw one, you did one and then you taught one; it was a very practical matter. Businesses and entrepreneurs nowadays know that you learn by doing things. Yet in the state, which often feels so out of date in the NHS, there is no learning by doing culture. There is a learning by writing very fine reports, often at 60,000 feet, that seem very unengaged with practice.

Over the years, it has been interesting to observe what happened through practice. The Bromley-by-Bow model is well known, so I will not use it, but the noble Earl, Lord Howe, knows that I was also responsible for the transformation of a street following a murder and 10,000 illegal injections being given out in a housing estate. There were some terribly violent circumstances going on at the time. When I brought the first key people on the street together, all of them—the GP, the school and the housing association—were saying, “We cannot deal with this on our own. We need to do it together. These things are so interconnected”, and we built together the St Paul’s Way Transformation Project, which started with nothing and led to a new £40 million school, a £16 million health centre, 600 homes and now a new primary school.

We joined it up, and Professor Brian Cox and I led our 14th science summer school in June this year, with a masterclass at the end of it on quantum physics, for the children from the same housing estates. It is the same children and same families, and now they have one of the best performing schools in Tower Hamlets. The noble Earl, Lord Howe, helped us greatly at one key point with learning by doing, when he met the whole group—housing, health and education—when the NHS was getting in the way of us completing on the deal for the health centre. He was very helpful in enabling that to actually happen.

It was Duncan Selbie, the chief executive of Public Health England in 2015, who gave me £20 million and said, “Andrew, take this culture that you’ve been developing into the north of England”. We built 10 learning by doing innovation platforms in Rotherham, Bradford, Doncaster and Bootle, all of which were about bringing people together to learn about these matters. It was interesting that when I met the public health officials in each of these places, who were lovely people quoting all the same data that I had heard many times before, and said to them, “What are you actually going to do about that data?”, there was absolute silence. It was not their fault. They did not have the skills to know how to turn fine words into practice for some of the most challenging communities in this country.

It is my view that one of the things being missed in this moment is the serious need to get real about innovation and learning by doing. My colleagues and I—I declare my interests—are at the moment creating at place, on the ground, with local people and professionals, what we call these learning by doing innovation platforms, so that we bring together the actual GP, business person and local resident, and you begin to explore these issues together because in the modern world, health is everybody’s business. It is not just a matter for GPs. It is interconnected and we need to explore what that means.

My concern about where we are at the moment in discussing this Bill, which is a fantastic opportunity for this Government, and this country, to move into a form of health that is of this century and not last century, is that we are going to end up building a lot of biomedical boxes around this country that do not explore these interfaces in some of our most challenging communities. The noble Lord, Lord Patel, is right; we need to worry about why he is right and why things are not being learnt.

I finish with the thought that it is our experience over the years that, sadly, we have to say that, in so many respects, the NHS is not a learning organisation. We must have hosted 70 Government Ministers to our work over the years. They all come and say, “Wow, this is fantastic, we need to do more of it”. I can name the four who did anything practical about that, and the other 66 sit on a list in this pocket. This is not to do with bad people. It is about whether, as a nation, we are now going to get upstream into prevention and health creation and create a learning by doing environment in which we all learn together, and in which local people are part of all of that process.