Health Bill

Baroness Thornton Excerpts

Committee stage
Monday 9th November 2026 Lords Chamber

[Baroness Coffey (Con)]

My Lords, I tabled Amendment 34 to put the focus on patients. In my short time in health, working with brilliant civil servants and great Ministers, I created Our Plan for Patients. It tried to have a very specific focus that would address some of the concerns that have been raised about what a Secretary of State could do around provision.

The noble Baroness, Lady Bennett of Manor Castle, will be on her own in thinking that the only organisations that can provide this are state-run actors. This is not how the NHS was created. Most GPs are not state-run organisations; they take on a contract. The same is true of most primary care—opticians, pharmacists, the list goes on. In my time as an MP, I used to get infuriated with the local chief executive, because they resented using private provision, despite it potentially having been better to get more patients off the waiting list, because they were frustrated at paying the same consultants who were working in one hospital in the morning and then for a different provider elsewhere in the afternoon. The patients do not care. They just want to get their hip done or whatever it is.

We have to keep reminding ourselves why the NHS exists: it is to ensure that patients get access to the healthcare that they need regardless of their means. As for provision, there are things such as BUPA, which is the largest single provider of NHS dental care in the country; it is a non-profit organisation in that regard.

There is one thing worth exploring with the Minister. Having looked at the original clause, I think this already applies, with a few exceptions. I assume that two of the exceptions are due to the fact that, in the rest of the Bill, the Secretary of State is already taking the powers from NHS England. I want to be clear why procurement regulations in particular are effectively being rolled into this new power, whereas I think they are excluded in the original Act.

More broadly, I understand where the noble Lord, Lord Stevens, is coming from, but it comes down to this: if we can keep the focus on patients, it would reduce the opportunity for the Secretary of State to be arbitrary in how they go about their view and their running of aspects of the NHS, recognising the number of constituents right around the country. Otherwise, I am concerned that there could be some ideology that starts to squeeze out private providers. Sometimes that will be for good reason. A few years ago, Circle was saying, “Put up the tariff, or we won’t do NHS work any more”. I would say, “Circle, get lost—if you can’t do it for what the NHS is doing it for, then don’t worry”. There may be a broader challenge about what is going in—I will discuss the balance of primary care and so on later—but, in terms of NHS funding overall, if we keep the focus on patients as our guiding star, then, frankly, we will have done a good job in this Bill.

[Baroness Thornton (Lab)]

My Lords, the problem I have with this clause is that it is not nuanced enough. I say that as somebody who helped to found Social Enterprise UK and works with leaders of social enterprises, charities and mutual organisations that deliver public services, particularly in health and social care, and do a very good job indeed. My problem with this clause is that it is not nuanced enough, and that is also the problem I have with the amendments that the noble Baroness has put down.

The issue, pointed to by my noble friend Lord Hunt, is procurement. You should not be using the same rules of procurement to buy widgets, computers and office furniture that you use to procure human-facing services. That really seems to be the issue here, so anything that allows the commissioning of these services as people-facing services is to be welcomed. That is why the light-touch regime is so important, and it is underused in the NHS, to procure the services that we need for our patients.

Given the lack of nuance between public and private, where does the innovation that charities and social enterprises bring to the National Health Service sit in this amendment? That is not satisfactorily answered. My question to my noble friend the Minister is this: how can we make the commissioning of services more effective, more efficient and less bureaucratic, to end profit gouging where it exists but also allow the innovation that these organisations might bring?

[Baroness Nargund (Lab)]

My Lords, I agree with my noble friend Lady Thornton that the clause is not nuanced enough. I declare an interest as a former provider of care across three sectors—the public, charity and independent sectors. We talk about “public” and “private”, but it is not the case. I echo the comments from the noble Baroness, Lady Murphy. I am a former vice-chair and trustee of the British Red Cross; we were the largest partner to the National Health Service and provided health and social care across the country, compassionately, cost effectively and with good outcomes. The noble Lord, Lord Stevens, gave the example of pregnancy terminations. These are time-sensitive treatments, cares and surgeries for which you cannot wait. Women cannot wait; they need to have the care locally, swiftly, safely and to high standards.

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[Lord Weir of Ballyholme (DUP)]

My Lords, as the noble Baroness, Lady Ritchie, has said, I and the noble Lord, Lord Blunkett, have co-signed her amendment, I think rightly. It would provide a proper prioritised focus on dementia, as it is very significant within our society. Mention has been made of the estimated 1 million people suffering from it. That is very much an estimate, because roughly one in three people who have dementia is not diagnosed at present.

I suspect that there is nobody in this Chamber who does not have a family member who has suffered from dementia or, at the very least, a friend of the family who suffered from dementia. It is something that touches all our lives. For those families and individuals who have dementia, we know this can be an incredibly painful experience and a very difficult time for them.

As the noble Baroness, Lady Ritchie, indicated, this condition has much wider implications for the NHS as a whole. The statistics suggest that, at present, one in six hospital beds are occupied by someone with dementia. We know that this is a condition which is going to simply expand over time. Part of that is largely because of our ageing population, which itself is a testament to the success of our health service. We are seeing, with many terrible conditions, much greater levels of survival rates and much greater levels of increased lineage because of that, but it also means that we have an increasingly aged population. Even Northern Ireland, from where the noble Baroness, Lady Ritchie, and I hail, which has traditionally always had a very young population, will reach the tipping point next year, when the number of pensioners in Northern Ireland will outweigh the number of children. We can see that this is going to be an expanding problem.

Secondly, the amendment is important, because there is a lack of consistency around the country in tackling dementia in terms of care, although this is not unique to dementia. There are inconsistencies over the speed of diagnosis, over the advice given on pathways for those with dementia and over the level of provision of social care. I know the Government are very much right, when they look at inconsistencies, to tackle health inequalities. I do not think any of us would disagree with that, but this goes even beyond health inequalities. It is a certain level of postcode lottery where what you get can be very different according to the luck of geography. With a national report, on an annual basis, based very firmly on data, shining the light on the data could itself act as an incentive towards improving performance. Where we can see geographical areas lagging behind each other, it will be an incentive for them to improve. Where we perhaps see improvements on one side of things with dementia but not on another, having that data could act as a driver for that.

There is a race against time, given the increase in the number of people who are likely to suffer from dementia. Much more positively, we know that it appears that we are on the cusp of great breakthroughs in the treatment of dementia, perhaps through drugs that can slow it down and ultimately put us in a position, we hope, to provide a cure for various forms of dementia. However, a key barrier to that breakthrough has been the lack of consistent data, both in terms of quantity—we know that approximately only 1% of those with dementia are involved in any form of trials to push for solutions—and in terms of quality, because we do not necessarily have it on a consistent basis. Again, an annual report could help do that.

The amendment is well-timed, and it is very compatible with the proposed publication of the dementia side of the modern service framework. The amendment goes to a lot of the Government’s rightful aspirations to integrate social care within the system and to move beyond the idea of rhetoric and good intentions towards delivery.

Finally, the amendment, importantly, tries to provide a solution to one thing that sometimes, as legislators, we are not as focused on as we should be—I do not mean this as a criticism of this Government or, to be honest, of this Parliament, because it could happen in any legislative forum. As legislators, our tendency is to see a problem, find a solution through legislation, get that legislation passed and then we feel the problem is solved. The reality is that legislation should be simply the start of a process rather than the end. It is the implementation of that legislation and the follow-through into people’s lives that are critical. To put it another way, we often fall into the trap of seeing legislation as the full stop; we should see it as the comma and simply part of a continuum of a process.

Whether it is through this amendment or something similar, we need a clearer focus on dementia. We need something that is much more nationally based and data-driven. That could be a very useful tool in combating something which we are all on the same page on and in trying to provide better care for those with dementia and better support for their families.

[Baroness Thornton (Lab)]

My Lords, I will make one or two remarks and probably ask some questions of the supporters of Amendment 180. I regard these amendments as what one might call the “moving parts” amendments. We are all trying to work out how on earth we are going to get reform in the NHS and get social care and all those things, which is why the questions from the noble Baroness, Lady Watkins, were particularly pertinent. It is reasonable that, during the course of the Bill, we should be asking how social care is going to be pushed forward and whether we need to put measures in the Bill which will help that process, even though we know we are in the middle of the Casey review and we have the determination of our Prime Minister to deliver long-term change to our social care system.

There are two questions I want to ask the noble Lord, Lord Kamall. Why does Amendment 180 exist without any reference to what is happening at the moment, which is that we are in the middle of a social care review that will bring forward some proposals about what a national care service should look like? Also, perhaps the noble Lord would like to talk a little bit about the commitment that his party will make to that social care reform and the need for there to be consensus and cross-party review to take it forward. In that way, I kind of welcome what the amendment says, but I am slightly puzzled as to why it sits there in the Bill and does not really relate to what is actually taking place.

[Lord Scriven (LD)]

My Lords, these amendments seem small but they are slightly the elephant in the room in terms of dealing with real people who have complex needs, and who do not fall into administrative boxes called “health” and “social care”. They have needs that sometimes cross both care and the NHS.

At Second Reading, a noble Lord—I cannot remember who—said that the problem with this Bill is that it is not really a Health Bill; it is an NHS Bill. It is about the structures and how the NHS works. It is a bit more complex than saying there are two potential things—a Bill and a review—going on. There is the social care review, from which we expect the national care service, and possibly legislation will be required for that. There is this Bill going through Parliament. Yet there is also the context of rewiring the state, which will have a significant impact on health and social care, and therefore how services are commissioned and provided.

I ask the Minister a simple question: how do all three fit together? Do she and the Government foresee any changes to provisions in the Bill once those two other pieces—the review and the legislation—go through about how funding, commissioning and services will be provided to people who require health and social care?

Health Bill

Baroness Thornton Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

When we talk about palliative care, if we do not include carers in it, we are not really having a proper conversation. I would like us to take some of the principles included in these amendments, and stop being hung up on the location where palliative care takes place.

[Baroness Thornton (Lab)]

My Lords, I had not intended to speak in this debate—I was saving myself for social care and those other issues—but I was very moved by the interjection by my friend, the noble Lord, Lord Patel, and I disagreed with the noble Baroness, Lady Coffey. This is an important suite of amendments, because comprehensive integrated care has to include end of life—of course it does. I know that the noble Lord and the Minister will be discussing how best to do that; it may not be to put it on the face of the Bill, but it definitely has to be included in this legislation. The amendment from the noble Baroness, Lady Pidgeon, is a very good one, and I completely agree with it.

[Baroness Pidgeon (LD)]

My Lords, I thank the noble Lord, Lord Patel, and my noble friend Lady Barker for their very personal and raw contributions, as recent carers, on the recent losses of loved ones.

I am grateful for the support from the noble Baroness, Lady Thornton, for my Amendment 230 in this group, which also has the support of Marie Curie and Hospice UK. At its heart is the principle that people approaching the end of life should be able to have their wishes, preferences and priorities for care understood, recorded and respected. Advance care planning enables people with terminal illness to express how and where they wish to be cared for. It supports more proactive and personalised care and, as we have heard, it has been shown to improve patient and family satisfaction while reducing the likelihood of crises, avoidable hospital admissions and the need for emergency care out of hours. I have seen at first hand how, in Devon, the system seems fairly well set up to support people in their own homes, and to have these very difficult conversations with a hospice at home service, with people who have real skill in communicating and talking about these difficult topics at a time when someone may have just learned that they have a terminal illness and when lots of things are going around their mind. It is important for them to be able to get some clarity, going forward, about what they wish for and do not wish for. As we have heard, other parts of the country do not work so well.

Importantly, the evidence suggests that advance care planning does not increase costs to the health and care system, and may in some cases reduce healthcare expenditure by ensuring that care is delivered in accordance with patients’ wishes. We will come on to the single patient record on a later date, but I flag here that advance care planning can be effective only if the information is available to those providing care when it is needed. The single patient record offers a significant opportunity to improve co-ordination and continuity of care, but its success will depend not simply on sharing data but on ensuring that advance care planning is routinely embedded in clinical practice so that people’s wishes can be accessed, understood and acted upon, wherever and whenever care is provided.

The other amendments in this group from the noble Baronesses, Lady Finlay and Lady Coffey, highlight the many issues with the current landscape of palliative care and specialist palliative care services, and the difficulty in getting access to those services. I look forward to the Minister’s response to that, and her response to the trick or treat challenge.

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.

Neighbourhood Health and Social Care

Baroness Thornton Excerpts

Tuesday 15th September 2026 Lords Chamber

Asked by

[Baroness Thornton]

To ask His Majesty’s Government what plans they have for the integration of neighbourhood health and social care, and on what timetable.

[Baroness Thornton (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I draw the House’s attention to my register of interests.

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

My Lords, this Government support the integration of neighbourhood health and social care. Our approach to neighbourhood health brings services together so that people experience more joined-up and person-centred care, including from integrated neighbourhood teams. In March, we published the Neighbourhood Health Framework, promoting joined-up partnership arrangements between ICBs and local authorities and asking health and well-being boards to develop neighbourhood health plans for implementation from 2027-28 at the latest.

[Baroness Thornton (Lab)]

I thank my noble friend for that Answer. I felt moved to put this Question because there seems to be more hope today than for many years that local integration of social care, health and primary care might happen. With so many moving parts in the reform agenda—the Casey review, the 10-year plan and so on—there may be a danger of reform steaming ahead without the voices and views of patients, carers and those with lived experience being properly baked into the design process. I seek reassurance from my noble friend that those voices will indeed be heard and heeded.

[Baroness Merron (Lab)]

I certainly can give that reassurance to my noble friend. I am glad she recognises that our move towards neighbourhood health is not just a shift on paper but a real turnaround in how we see people and services. Coproduction is required for neighbourhood health plans, which would be all the poorer if we did not include the voices to which she refers.

National Maternity and Neonatal Investigation

Baroness Thornton Excerpts

Monday 6th July 2026 Lords Chamber

[Baroness Merron (Lab)]

I am fully aware of—I will put it tactfully—the difference of opinion in this regard. This morning, I was speaking with one of our main advisers, who did not feel it was necessarily an answer to go down the road of midwives being nurses—I know the noble Baroness did not say that—and I bow to that experience, but for me it raises the complexity.

It is important to emphasise a point about which I have been concerned for some time: about a third of student midwives have no role to go to. The noble Baroness is right, but some of it is about basic experience, and nobody can gain experience without putting the years in—that is a fact. That is why getting the new funding, up to £10,000 per post, means we will keep students in the profession and give them the chance to develop the very important expertise to which the noble Baroness refers. Further, having multidisciplinary teams and the right people means that you can manage whatever complexity. There is no way that any one person can deal with all complex cases. Every case has a high degree of individuality, as I know the noble Baroness is aware.

[Baroness Thornton (Lab)]

My Lords, “welcome” is not quite the right term to use about these reports, but they are indeed absolutely essential. I need to declare that I am the maternity lead, as a non-executive member, at the Whittington Hospital, and I will be at the conference as a member of one of the reference groups tomorrow.

Several years ago, when Donna Ockenden produced her first reports, we set up what we called the Ockenden cafes in the Whittington, to which we invited all the multidisciplinary teams, plus mums and patients and people who had been involved over a period of time; it was an enormously valuable and uplifting experience for all of us involved in the maternity care of the women in our area.

However, I want to ask my noble friend about MIS, the Maternity Incentive Scheme, which is now in its eighth year and, as she will know, is designed to get maternity units to improve year by year and through that win some investment in their hospitals. Has that been factored into what might happen next?

[Baroness Merron (Lab)]

I thank my noble friend and all her colleagues for the work they do. We have many examples across the country of first-rate care and great initiatives like the one my noble friend spoke of, which really takes on board one of the problems the noble Baroness, Lady Amos, found: that the voices of women and their families, and of staff, were just not heard or acted on. That is the one thing that comes through.

To the question, would the abbreviation be MIS in this case?

[Baroness Thornton (Lab)]

Yes, MIS.

[Baroness Merron (Lab)]

We have two “MISs” that we often talk about: MHIS and MIS. I will ensure that MIS is considered, but it is probably worth saying that we are already developing a tool for assessing the quality and experiences of care being provided for women using maternity services, through the patient reported experience measure. To the point made earlier by the noble Lord, Lord Kamall, that is one of the ways we will ensure that women and their families can actually see, feel and know the difference.

PATHWAYS Study: Puberty Suppression

Baroness Thornton Excerpts

Wednesday 24th June 2026 Lords Chamber

[Baroness Merron (Lab)]

I am sure that the noble Lord will understand from my earlier comments that I do not accept the characterisation of the trial. I urge all noble Lords to look at the facts on the safety provisions, requirements and stringency, which have massively increased—perhaps since some noble Lords originally looked at the matter. Implicit in the noble Lord’s query is to question why we are having a clinical trial when there are a number of children who have already taken puberty blockers. That is a fair question, but I remind the noble Lord that the conclusion of the noble Baroness, Lady Cass, was that there was not enough evidence, for all the reasons I referred to.

It might be helpful to make clear that the information collected by the linkage study, to which the noble Lord referred, is much more limited than the detailed information that the research team will be able to collect on the relative benefits and the risks. I confirm that NHS England, which is responsible for the data linkage study, is taking the time to ensure that data is shared by the relevant organisations—which, after all, is exactly what we are all after.

[Baroness Thornton (Lab)]

My Lords, it is such a shame that the party opposite resiled from cross-party agreement on this research. It is fair to question its motivation for doing that and possibly reach the conclusion that it is unsympathetic to trans people. I welcome the Statement and my noble friend’s calm approach, which contrasts sharply with some of the language that has been used around this important issue. When it comes to the PATHWAYS trial, does my noble friend agree that we must follow the science and avoid vilification, polarising language and politicisation, for the good of young people and our communities?

[Baroness Merron (Lab)]

I certainly do agree with my noble friend. Indeed, her observations apply to any matters in respect of health, which should be evidence-led, based on fact, and based and rooted in scientific evidence. What we are dealing with here, as I said, is effectively a choice: a choice to do nothing and continue not providing the right healthcare in a safe and correct manner or to seek the evidence, as an independent review by the most esteemed paediatrician—as I said, it started under the previous Government, and rightly so—has advised us to do. I must emphasise that, if anybody listened, as I did, to the Secretary of State making his Statement in the House of Commons, I hope they will have got a sense that, actually, no one has jumped into this decision. What the Secretary of State said was that it was important to step back and look at the evidence. He himself told the Chamber how challenging he felt that was. I ask noble Lords never to underestimate how challenging this is, no matter what Government, what party, or what individual.

NHS Adult Gender Identity Clinics

Baroness Thornton Excerpts

Wednesday 15th April 2026 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I remain grateful to the noble Baroness for her work and her expertise in this area, which I know has been acknowledged both by the previous Government and this Government. I will certainly take on board what she has said and ask my officials to discuss this further with NHS England.

[Baroness Thornton (Lab)]

My Lords, I would like to seek some clarification from my noble friend the Minister about this matter, because the Mental Capacity Act 2005 presumes adult capacity and the Care Act 2014 defines safeguarding thresholds, which my noble friend has outlined in some detail already. Can my noble friend the Minister confirm that adults aged 18 to 25 referred to gender identity clinics are treated as autonomous patients without additional safeguarding measures beyond those which she has already outlined and apply to any competent adult?

[Baroness Merron (Lab)]

Yes, I can assure my noble friend that patients are treated as individuals and their care is personalised. It is important, as my noble friend says, to recognise that the law presumes that patients aged 16 and over have capacity to consent to medical treatment. I can also give the reassurance, acknowledging as I have already that patients may have co-existing conditions that warrant additional safeguarding measures, that this will be determined on a case-by-case basis.

Terminally Ill Adults (End of Life) Bill

Baroness Thornton Excerpts

Committee stage
Friday 20th March 2026 Lords Chamber

[Lord Empey (UUP)]

My Lords, I think everybody must have been affected by the comments from the noble Baroness, Lady Nicholson. She made very sobering revelations about her experience, which is very broad and much to be admired.

This group of amendments brings into sharp focus the sheer scale of the complexity of bringing assisted suicide into the NHS context. We have heard pleas from the movers of some of the amendments that specific provision be considered because of the needs of those with complex communication difficulties, including hearing, language and cultural challenges.

I will draw the House’s attention to other matters that have not been addressed in the context of a busy hospital with overworked staff. In addressing other groups of amendments, I said that many people seem to view the operation of the current NHS through rose-tinted glasses. Hospitals these days are not as they are portrayed in the TV series “Heartbeat” or “Call the Midwife”, which are set in the 1960s. Gone are the days when consultants had time to come round for friendly chats at their leisure with patients and family. Parliament and Governments have demanded that targets be met because of increasing demand and a relentless growth in our population. Meeting targets means throughput, and throughput means patients going in and out as quickly as possible. I struggle to see how the Bill, if enacted, can be safely implemented in current hospital settings.

In a busy NHS ward, consultants doing their ward rounds in the mornings have only a few minutes, maybe once or twice a week, to assess a patient and give instructions to registrars and nurses as to what treatment is to be applied. Introducing complex processes involving safety, providing the means by which patients can take their lives with poisonous substances, and co-ordinating all the relevant personnel at the right time to oversee this, will be a mammoth task in our overstretched NHS.

Let us look at some of the realities to which this group of amendments draws attention. We have discussed language. I was astonished to learn that, in London alone, 300 languages are spoken. Some 1.7 million Londoners do not have English as their first language, and 300,000 or more do not speak English at all. That is equivalent to the population of a city such as Cardiff or Glasgow.

[Baroness Thornton (Lab)]

I declare an interest as a non-executive director of the Whittington Hospital, where we serve many of these communities. I can assure the noble Lord that we put a lot of resource, very successfully, into supporting our clients and patients, from whichever group they come and whatever capacity problems they may have. You have to live in these communities to understand that the NHS is completely aware of the need to do that.

[Lord Empey (UUP)]

I am delighted to hear that, but I am also very aware of the pressures on an NHS hospital—perhaps not in London but in other places—where the staff are run off their feet day and night. We are imposing—

[Baroness Thornton (Lab)]

I also note that I come from Bradford, where all my family live, and we do the same there, too.

[Lord Empey (UUP)]

I am delighted to hear that, but I can assure the noble Baroness that it is not a universal situation. As I was saying, 1.7 million Londoners do not have English as their first language and 300,000 do not have English at all—that is equivalent to a significantly sized city. According to the 2021 census, only 63.8% of households consisted of members who all had the same main language—I think that the noble Baroness, Lady Berridge, also mentioned the 2021 census. Some 6%, or 1.5 million households, consisted of people who had different main languages in the same house. Those figures are five years out of date, and with the surge in immigration since then, I am sure the figures are much greater.

The noble Baroness, Lady Nicholson, highlighted the circumstances of people with hearing difficulties. Added to that, in a traumatic situation of discussing whether a person wishes to be assisted to die, how will a patient be able to absorb such difficult information from a medical practitioner who perhaps does not have English as his first language or vice versa—a medical practitioner may have a patient whose first language is not English?

Better Start Longitudinal Programmes

Baroness Thornton Excerpts

Tuesday 10th February 2026 Lords Chamber

Asked by

[Baroness Thornton]

To ask His Majesty’s Government whether, and if so when and how, the learning from the results of the Better Start longitudinal programmes will become pregnancy and early years policy and be implemented.

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

My Lords, we welcome the valuable learning that is emerging from the five Better Start partnerships and we look forward to the national evaluation report in the spring. The programmes provide important insights into early-years support in highly disadvantaged areas. Best Start Family Hubs and Healthy Babies already deliver a place-based prevention focus model. We will consider Best Start evidence, alongside other evaluations, as we develop policy to deliver a new neighbourhood health service and raise the healthiest generation of children ever.

[Baroness Thornton (Lab)]

I thank the Minister for that and declare an interest: my sister, Gill Thornton, is the director of Better Start Bradford, which is part of the £250 million programme funded by the National Lottery, with local funding too, for the last 10 years. The model, which places children and family at the heart of service design, focuses on the first 1,001 days, which is critical because of the developmental window from conception to a child’s second birthday. I would like to hear how the Government will integrate this into their Best Start for Life programme.

[Baroness Merron (Lab)]

The work in Bradford is to be commended. I can assure my noble friend that, through Best Start Family Hubs and Healthy Babies, local authorities will be expected to do exactly what the noble Baroness says is happening in Bradford: that is, to establish very inclusive and diverse routes for parent and carer participation. We want families to shape how services are set out and I absolutely agree that the first 1,001 days of a child’s life is a crucial and critical developmental window.

Medical Training (Prioritisation) Bill

Baroness Thornton Excerpts

2nd reading
Wednesday 4th February 2026 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, it is wonderful to follow the great maiden speech of my noble friend Lord Duvall—Len, to the rest of us—and I am proud to welcome another Labour and Co-op member to your Lordships’ House.

Len and I were trying to remember how long we had known each other. It is certainly since the mid-1980s, when I was the political secretary of that venerable institution, the Royal Arsenal Co-operative Society, based in Woolwich, and young Len, as he said, was born and grew up in Woolwich with close connections to the Royal Arsenal; his father and grandfather served as gunners in the Royal Artillery, and he was a local member.

It was clear to me that this young activist was clearly going places, and indeed he did. He was elected to Greenwich council in 1990 and became its leader in 1992, standing down when he became a London Assembly member. Remarkably, my noble friend—although he did not say this—has held his seat of Greenwich and Lewisham for the last seven GLA elections and is the only member of the GLA to serve since it was founded in 2000. During that time, he has held many positions, including chair of the Metropolitan Police Authority.

But the measure of a person is not just the positions they hold; it is what they do and achieve. I think we can safely say that my noble friend has served his Greenwich community and London magnificently over the years, with the regeneration of the Thames Gateway, the Greenwich waterfront, campaigning and getting investment in local communities, and much more. I understand that my noble friend has been and will continue to be chair of the Labour group in the GLA and, close to my heart, he also has an unmatched record of support for equality and human rights.

Finally, I think it is likely that my noble friend and I are the only Members of your Lordships’ House who have both been chairs of the Greater London Labour Party. I became chair in 1986 and served for several years, and my noble friend became chair in 2002. I think it is safe to say that we both bear the honour and the scars of that position. I welcome my noble friend to our Benches and I know we have much to look forward to in his contributions.

I thank the Minister for her introduction to the Bill, and the noble Lord, Lord Roe, for his wonderful maiden speech. In the debate, I had a sense of déjà vu because, as I look around the Chamber, I see that many of us have been here before. I was in a different position at that time, but it gave me a great deal of pleasure to look round and listen, even to the noble Earl, Lord Howe, opposite whom I have been for about 20 years in various forms, discussing health.

It does not seem so long ago that, during the course of what became the Health and Care Act 2022 which established ICBs, many of us across the House were begging the then Secretary of State to include a commitment in the Act to have a workforce strategy, to no avail. However, as the noble Earl said, the work- force strategy then appeared in 2023.

It seems to me that a key moment in 2026 will be the publication of the new long-term workforce plan for the NHS. The plan, due this spring, will be the first for our Labour Government and is expected to set out how the workforce will be developed to underpin the 10-year health plan. It has of course been built on earlier workforce strategy work and will set out how staffing needs can be matched to the future model of care.

As the Minister said in her opening remarks, delivering that plan depends on our staffing. Therefore, improving NHS staff recruitment and retention will be central to delivering this plan. This small and important Bill should be seen in that wider context. It addresses an immediate problem and offers an immediate solution with its main functions, which have been outlined to us: for medical foundation training, the prioritisation of graduates of UK medical schools; for medical specialty training posts starting in 2026, prioritisation at offer stage of graduates of UK and Republic of Ireland medical schools; and for medical specialty training posts starting in 2027 onwards, prioritisation at interview and offer stage of graduates of UK medical schools.

I am aware that many of us have received letters about this from students who feel sometimes aggrieved and, certainly, concerned—particularly students from Malta, and I know the noble Baroness, Lady Gerada, will be addressing this, as others have. There are three things that have been identified, as outlined by the noble Lord, Lord Patel, and other noble Lords.

We will need to address, and solve, in the Bill whether or not we are ensuring fairness as the Bill progresses. I have two nephews who have qualified in recent years—one in Liverpool, one in London—and I recall from both of them the uncertainty they faced about where they might end up. It seems to me that, if we are increasing the number of places available, we must ensure that it is done in a way that addresses regional issues and regional needs. I ask the Minister to confirm that that is one of the things that will be taken account of as this progresses.

This Bill is welcome, and I welcome the rapidity with which we have responded to this issue. We can be sure that the House will resolve the issues facing us—fairness, our overseas graduates and all the others that have been outlined—because there is good will to take the Bill through the House. I think that means that it will fare well.