Health Bill

Lord Kakkar Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I welcome the amendment from the noble Earl, Lord Howe, because it enables us to go to the core of what this legislation is all about. Light-touch amendment it is not, but I think it goes to the heart of what we need to talk about.

As I said at Second Reading, I really welcome bringing NHS England essentially into the department. It restores ministerial accountability to Parliament and, for a £200 billion service, that is very important. Essentially, it seems to me that we are going back to a 1948 Bevanite model of the NHS. Of course, we do not recall his dictum, but it is very famous—that when a bucket of slops is kicked over by a maid in hospital in Tredegar, its echo should sound in the corridors of Whitehall. Bevan also said at the time, because of course he backed off Morrison, who wanted local government to control the NHS, that he wanted lots of decisions to be made locally through the hospital management committees and regional hospital boards that were set up. Of course, the moment it started, the Ministry of Health, as it then was, started to issue circular after circular. That is perhaps an inevitability of the way you get there, when you have a national health service funded simply through taxation.

There are some genuine issues around the relationship between the centre and the local National Health Service which we need to tease out. We had a round table at which the chief executive of the NHS Alliance spoke about the concern that the alliance has that integrated care boards will find that their room for manoeuvre is very limited. One response to that is that ICBs’ accountability was solely going to be to the centre. The Government’s decision to keep Healthwatch is very important in terms of having more local accountability—that is why it is so welcome. I know that noble Lords are concerned about Ministers taking over responsibility for the appointment of chairs and non-executives, but I think that we should also keep councils of governors of foundation trusts. They are local people, elected by members of those trusts, who do the current round of appointments. We will come to this later on in our debate on Clause 30. I am really looking for the Government to look at this again.

There are some real issues about the future relationship of the centre to the locality. I commend the brief that we have had from the King’s Fund, which poses some key questions. What should the boundary be between legitimate national oversight and routine operational management? What would prevent this broad power becoming a mechanism for day-to-day management from Whitehall? How will you deal with bottlenecks, and the practical risk that moving a large number of functions and decisions towards the Secretary of State could slow the NHS down rather than speed decisions up, particularly around the appointment of chairs and non-executives? Which of the Secretary of State’s most consequential intervention powers will be subject to intervention, advice or scrutiny? In what circumstances would Ministers expect to intervene in local service reconfiguration? What safeguards will ensure decisions that are often best made locally and on clinical grounds? How is the greater role for local government and mayors to operate alongside stronger central powers and require the Secretary of State to have regard to local decision-making? What statutory safeguards will there be in relation to the powers of the Secretary of State to appoint, suspend or remove the chair and other non-executive directors? For the Secretary of State’s most consequential intervention powers, is there a case for putting relevant decision-making criteria on the face of the Bill?

I do not know the answer to that, but I think that, by Report, it would be helpful if my noble friend could explain in a little detail how the Government think the new arrangements are going to work and how you will prevent unnecessary micromanagement from the centre.

[Lord Kakkar (CB)]

My Lords, I have added my name to the amendment in the name of the noble Lord, Lord Kamall, and the noble Earl, Lord Howe. In so doing, I remind noble Lords of my own declared interests, as chairman of King’s Health Partners and the King’s Fund.

I believe this to be a very important amendment and fundamental to the purpose of the Bill. Your Lordships’ House has taken, quite appropriately, the explanation, reassurances and logic behind the abolition of NHS England provided by the Minister at Second Reading. As the report commissioned by His Majesty’s Government identified very clearly, further reorganisation on a major scale of the NHS should have, at all costs, been avoided, as noted by the noble Earl, Lord Howe. There are clearly in the Government’s mind important reasons why this reorganisation must proceed, and it is important for your Lordships to respect that. It is a fundamental element of His Majesty’s Government’s policy.

However, in proceeding down this route, the other side of the coin is that His Majesty’s Government must be clear, and provide reassurance about the implications, both in the period of transition and thereafter, with regard to the important functions that have sat in NHS England and will now be brought back under central Secretary of State control. We have heard a number of those, and it would be interesting if the Minister could explain to your Lordships how the transitional arrangements that are going to be applied will reflect the ultimate structure of the newly defined function for delivering NHS England within the Department of Health and Social Care. For instance, how will the Secretary of State powers be exercised? What degree of delegation is there going to be? How will that be reflected in the transitional arrangements?

In terms of the broader government agenda with regard to devolution to a local level, is it consistent to have brought all these powers centrally and then expect, within a reasonable time period, proper devolved scrutiny and determination of local health needs to be reflected in the delivery of the NHS? What will be the arrangements for the operational management of the NHS in the intervening period between now and the final adoption of all measures? How is that going to work? What is happening at the moment? Is the Minister content that in the many issues on which there is, or has been, granular oversight within NHS England and its regional structures, that that kind of oversight is being, and will be, delivered in these transitional arrangements?

Neighbourhood Health Services

Lord Kakkar Excerpts

Monday 7th September 2026 Lords Chamber

[Baroness Merron (Lab)]

As this will be locally led, the priority groups will be those who are more excluded, and that may well include those who are digitally excluded. But the noble Lord makes an important point. It is not just about local care in a physical sense—indeed, we have already committed to over 120 neighbourhood care centres—but it is also about digital access, because that is how many people now access it. However, in every single case, if someone cannot, there is an alternative for them.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interest as chairman of King’s Health Partners. The Minister will recognise that, increasingly, pathways of care for the management of chronic diseases will extend across institutional boundaries, both in primary and secondary care, and will be delivered by multidisciplinary teams of different healthcare professionals. Is she content that the present regime for regulation, both institutional and professional, will facilitate that cross-institutional delivery of care and care delivered by multidisciplinary teams?

[Baroness Merron (Lab)]

As we develop neighbourhood provision, bring care closer to home and join up as the noble Lord suggested, it is key that the regulatory framework supports that as well as all the other work. We are ensuring that the regulators are able to do that. Dr Penny Dash recently did a review and we are looking at what more needs to be done.

National Maternity and Neonatal Investigation

Lord Kakkar Excerpts

Monday 6th July 2026 Lords Chamber

[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.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interest as chairman of King’s Health Partners. In addition to addressing workforce concerns and driving a much-improved culture in the delivery of maternity services, the physical environment in which maternity services are delivered is critically important. These are very frequently delivered in some of the worst parts of the NHS estate in such a way that the holistic nature of the services that need to be provided is not available at a single site. Can the Minister confirm that the NHS capital budget identified for this spending period is going to be protected so that these matters might be addressed?

[Baroness Merron (Lab)]

The noble Lord makes a very accurate observation. Perhaps I can go a bit further than he is asking me, because just last week we announced an additional £41 million of safety funding to improve the estate. That is on top of the £145 million that was previously announced, so that will give a great opportunity to really improve the estate, which is crucial for safety as well as experience.

Cancer Outcomes in the UK

Lord Kakkar Excerpts

Tuesday 21st April 2026 Grand Committee

[Lord Kakkar (CB)]

My Lords, I join other noble Lords in congratulating and thanking my noble friend Lord Patel for having secured this important debate and having introduced it, as he always does, in such a thoughtful and sensitive fashion. In so doing, I remind noble Lords of my own interests as the chairman of King’s Health Partners and of the King’s Fund.

I start by congratulating, through the Minister, His Majesty’s Government for having established such a thoughtful, comprehensive and forward-looking national cancer plan, and for having described a substantial ambition extending, as we have heard, over 10 years. It covers so much of what is essential in ensuring that we have a joined-up strategy that can potentially achieve the impact and ambition so rightly described.

In its initial description, the ambition covers the problem that we currently face: we experience, as a nation, untimely delays in diagnosis, access to imaging and access to a proper histopathological evaluation of biopsy samples; and an inability, therefore, to apply advanced diagnostic and characterisation techniques to targeting therapeutic intervention in an increasingly precise fashion. There are delays in establishing treatment for patients and in ensuring that patients are able to participate in clinical trials. We have done little of what needs to be done to drive a proper national programme for prevention in the area of cancer. It is of course vital, and there is a necessity—because, actually, we are making substantial progress and we must not be too gloomy—to start focusing on survivorship and how we are able to help patients beyond that initial therapeutic intervention when they are potentially not cured and have to continue to live with their cancer.

As we have heard, it is also very clear that previous Administrations have made substantial efforts to secure improved clinical outcomes for patients with cancer. Much of that innovative and imaginative approach to improving clinical outcomes in cancer has happened at a time in our national history when the NHS has benefitted, as have many other public services, from the so-called peace dividend—the period since the end of the Cold War. In 1990-91, NHS spending was some 4% of GDP, and in the year 2023-24, it was some 8%: a near doubling from £1 in every £25 of public expenditure some 30-odd years ago to £1 in every £12 of public expenditure.

That was a period of substantial plenty, when strategies and plans were presented but, regrettably, did not achieve absolutely what was intended and expected. As a result, this new cancer plan now lands at a time when our fiscal situation in the country, with the demands for increased defence expenditure, makes it highly unlikely that the substantial increases in public funding that have previously been devoted to healthcare will be available in the future.

It is therefore right that in this Grand Committee debate so many noble Lords have identified the question of how this plan will be implemented. What are the potential restrictions, not only financial but organisational and structural, that are likely, regrettably, to ensure that much of this great ambition that is absolutely necessary for the future health and well-being of our fellow citizens will not come to pass?

In this respect, it is very important, as we heard from the noble Lord, Lord Patel, to look at examples from other national experiences. The International Cancer Benchmarking Partnership has looked at these questions. As we have heard, the jurisdiction of Denmark represents an important example of what can be achieved: the clear lesson is that there has been consistency after a national cancer plan was adopted. That consistency manifests itself over many decades in political consensus. At a time when there was substantial opportunity for various Administrations to make further and increasing commitments to healthcare expenditure, it was possible that our country could live without consensus about the long-term delivery of health strategies, but we are no longer in that luxurious position.

I would therefore be interested to hear from the Minister how, in taking forward this impressive plan, His Majesty’s Government propose to achieve the substantial consensus—not only political but professional and, more generally, among the general public—that will see this strategy live through its 10 years, modified if it requires modification, but without wholesale dismissal. Those who deliver have to be in a position to do so with some certainty.

Secondly, in the circumstance we find ourselves with the economy and our fiscal constraint, how do His Majesty’s Government propose to find the substantial additional investment that is inevitably required when one looks at the ambition of this plan? As we have heard from other noble Lords, there are so many areas that we would all support, but each will require substantial investment—beyond the investment that is already made in delivering the day-to-day care that is required for cancer patients today and the increasing demands on that care through the adoption of already available innovation—to be provided at scale and pace across the entire country. Therefore, we need clarity about the approach to funding, the approach that will be taken in the Department of Health and Social Care now that it has incorporated the functions of NHS England back into the department and the approach that will be taken to prioritise funding on cancer over other priorities that will inevitably be identified for other disciplines and for the management of other clinical conditions.

Finally, so much of what is described in this impressive plan is predicated on the basis of ensuring that research is no longer an adjunct to the delivery of cancer care, but central to it. One of the points that we have heard, which is absolutely correct, is about accelerating the opportunity for clinical trials. We know that patients managed on clinical trial protocols, or in the clinical environment where they can access clinical trial protocols, have improved clinical outcomes. There is a need to drive broader equity in access to those clinical trials.

In addition, it will be vital to ensure that there is consensus on the use of data. Data will be critical to drive the innovation agenda and the implementation agenda. Can the Minister give a view on the approach of His Majesty’s Government to ensure that there is broad societal consensus on the use of data, on a routine and regular basis, to achieve so much of this ambition?

NHS: Heart Valve Disease

Lord Kakkar Excerpts

Thursday 12th March 2026 Lords Chamber

[Baroness Merron (Lab)]

My noble friend is right and, certainly, as we move through our 10-year health plan, the opportunity to make every contact count is very important. I refer my noble friend to the advances that we have made in services available in community pharmacies, because measuring blood pressure is hugely important. Our pharmacies, I am glad to say, have delivered nearly 4.2 million blood pressure monitoring checks since October 2021. We have more than 7,500 pharmacies now available in our high streets delivering this service. That is the kind of thing that my noble friend is looking for.

[Lord Kakkar (CB)]

My Lords, I declare my interest as chairman of King’s Health Partners. The Minister made reference to AI stethoscopes aiding in the diagnosis of patients with heart conditions. The evidence for this was established in a very large trial—the TRICORDER trial—involving some 1.5 million patients and more than 200 general practices in our country. What it demonstrated was, compared to the use of the ordinary standard of care, a doubling of the rate of diagnosis for heart failure and a tripling of the rate of diagnosis for heart arrhythmias. The problem was that, subsequent to the trial, the diagnostic rate did not increase, suggesting that it is necessary to invest in training and the establishment of new working pathways to ensure that innovation can be properly established in routine clinical practice. Is His Majesty’s Government funding such activity?

[Baroness Merron (Lab)]

The noble Lord is right to make the point that innovation research is one part of it, but it is actually its implementation that matters. However, the faster and more frequent detection of cardiovascular conditions is the key thing and training is certainly a part of that.

Rare Cancers Bill

Lord Kakkar Excerpts

2nd reading
Friday 16th January 2026 Lords Chamber

[Lord Kakkar (CB)]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Browning. In so doing, I congratulate the noble Baroness, Lady Elliott of Whitburn Bay, on the very thoughtful way in which she has introduced this important Bill. I must remind noble Lords of my own registered interests as chairman of King’s Health Partners, chairman of UK Biobank and chairman the Office for Strategic Coordination of Health Research.

We have heard that rare and less common cancers represent a substantial burden of disease—some 47% of diagnoses and some 55% of deaths. This is striking, because the poor clinical outcome has been attributed to a lack of research, a lack of co-ordination in care and a lack of application of resources to ensure that clinical outcomes can be improved. The Bill before your Lordships today addresses all these matters by ensuring that there is greater accountability, that regulation is improved and, most importantly, that we can drive forward a meaningful research effort for a series of cancers that represent, by themselves, small numbers of patients but collectively represent, as I have said, a substantial burden.

It is very important, and indeed we have heard it this morning, that the appointment of a national specialty lead for rare cancers is achieved quickly. We have seen in other areas and domains of clinical practice the impressive results achieved through the appointment of such leadership. For instance, the appointment of a national specialty lead for cardiovascular disease some 20 years ago was attended by a substantial reduction in cardiovascular mortality. We have also seen the impact that such individuals can have on the research agenda.

Regulation is vital in incentivising innovation. Numerous reviews and assessments have determined that, in many areas, our regulation is wanting. In this area, the regulation has the potential for a substantially negative impact on innovation, and it is innovative therapies that are going to improve clinical outcomes, so review of regulation is critical. I share the view of my noble friend Lord Patel that the three-year window for delivery of the review of the regulatory framework appears far too long and should be addressed by His Majesty’s Government.

The final part of the Bill is to enhance and promote the research effort. This is critical. The mandate that the National Institute for Health Research, as part of its Be Part of Research initiative, establishes special opportunities for registers for rare cancers is critically important.

However, beyond that, as we heard from my noble friend Lord Patel, it is important that we go beyond just knowing where the patients are and providing patients with the opportunity to participate in clinical research. The register should go beyond and provide the opportunity for appropriate genotyping and phenotyping of rare cancers as a resource to drive future research effort.

In that regard, the sharing of data within the NHS for research purposes is critical. We saw the benefits of that during Covid, when the Secretary of State issued a COPI notice that allowed the sharing of primary care data with UK Biobank and allowed researchers therefore to use that important resource to identify many treatment options and a better understanding of Covid-19.

The sharing of data that will be facilitated as part of this Bill is probably one of the most important elements that will drive forward the opportunity for improving clinical outcomes for those suffering from rare cancers.

Breast Cancer

Lord Kakkar Excerpts

Monday 15th December 2025 Lords Chamber

[Baroness Merron (Lab)]

Part of the 10-year plan, as we move from analogue to digital, will be ensuring that digital exclusion will not be a barrier. As I mentioned in response to my noble friend, it is indeed the case that women aged 71 and over can have screening every three years, and that can happen by women calling their local breast screening service to ask for an appointment. In other words, analogue is still possible, not just digital.

[Lord Kakkar (CB)]

My Lords, I draw the House’s attention to my registered interest as chairman of King’s Health Partners. Is the Minister content that sufficient resources are applied to the molecular characterisation of screen-detected breast cancer in such a way that those over the age of 70 who have breast cancer detected are appropriately treated?

Genome Screening: Newborn Infants

Lord Kakkar Excerpts

Thursday 18th September 2025 Lords Chamber

[Baroness Merron (Lab)]

My Lords, the Generation Study is particularly designed to inform policy of the type that my noble friend is rightly concerned with. These are extremely important issues, and I am glad to have spoken to our noble friend Lord Winston about these matters. Perhaps I could give the assurance that the study will test only for treatable conditions, where there is robust evidence that the condition is highly likely to develop within the first five years of life, and suspected positive results are then reviewed and confirmed through further tests. If genomic testing is used within future screening programmes, informed consent will still be required.

[Lord Kakkar (CB)]

My Lords, I draw attention to my interest as chairman of UK Biobank. The value of large-cohort studies is not only in the collection of baseline data, and indeed, in this case, the genome sequences of the 100,000 newborns, but in the opportunity to secure the long-term longitudinal follow-up of participants, so that there is a broader understanding of the change in health and health dynamics.

The Minister mentioned the question of consent with regard to genetic testing, but there is another question of consent, with regard to long-term access to the primary care data of those individuals who have participated in the study. Is the Minister content that there are appropriate arrangements in place with regard to consent to ensure long-term access to primary care data for those individuals?

[Baroness Merron (Lab)]

The noble Lord raises a very good point. Certainly, it is part of how we develop the use of data. I am aware that he did not directly ask me this, but perhaps I might use the opportunity to say that data safety, which I know is a matter of concern to many noble Lords, is absolutely paramount here. We also have absolute regard to conducting studies ethically, but the point about primary care data, its use and its value, as well as its safety, is very well made and one which we are certainly developing still further.

Pharmacy Opening Hours

Lord Kakkar Excerpts

Thursday 20th March 2025 Lords Chamber

[Baroness Merron (Lab)]

I will of course discuss the right reverend Prelate’s request for publication of information with Minister Stephen Kinnock, who has been working very hard with the sector in resolving matters on funding.

On opening hours, as I have said, there are core hours, but there are also additional supplementary voluntary hours that community pharmacies can choose to do. There is also a whole range of ways in which people can access pharmacy services—notwithstanding the point the right reverend Prelate made about his personal experience—including being able to contact distance pharmacies, which can provide things through online contact, by telephone call or by other means.

Pharmacies are key to making healthcare fit for the future, but we want to make sure that they are completely accessible. We will work with them to make sure that they, as largely private businesses, do so.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my interest as chairman of King’s Health Partners. Just to build on the point made by the right reverend Prelate, what assessment have His Majesty’s Government made of the impact on population health outcomes of the intersection between limited access to primary care services and diminishing availability of pharmacy services?

[Baroness Merron (Lab)]

I know the noble Lord talked about primary care more generally, but the assessment on pharmacies is that there is quite a good coverage. Some 80% of the population live within a mile of a pharmacy and, as I say, there are other online and not-in-person ways of contacting pharmacies. The Pharmacy Access Scheme provides financial support to pharmacies in areas where there are fewer pharmacies. Local authorities, along with ICBs, continue to monitor changes, look at provision and have the ability to intervene where necessary. On all these counts, in respect of primary care provided through pharmacy, which is so important, we continue to monitor the impact across ICBs. With regard to a particular assessment, I will gladly write with more details to the noble Lord.

NHS England Update

Lord Kakkar Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Merron (Lab)]

I am very pleased to give the reassurance that the noble Baroness seeks. When we reflect, the disastrous 2012 top-down reorganisation certainly did not depoliticise the NHS—it made it less efficient and less able to treat patients on time.

This is not about politicisation; this is about responsible government. I add—without embarrassing anybody—that a number of former Conservative Health Ministers have said to me, and to my colleague Ministers and the Secretary of State, how much they welcome this and how they wish that they had taken this step. That, for me, as well as the tone of the contributions from the Front Benches today, provides the reassurance the noble Baroness seeks.

[Lord Kakkar (CB)]

My Lords, I draw the House’s attention to my registered interest as chairman of King’s Health Partners. In the announcement made by the right honourable Secretary of State for Health in the other place, there was particular emphasis on identifying that in this period of transition, NHS England will focus on ensuring that local providers are better able to cut waiting times and to organise their finances appropriately. But NHS England has many other functions beyond those two important ones, and they will need to be delivered in what is a substantial transformation in reabsorbing NHS England into the Department of Health and Social Care. What reassurance can the Minister give your Lordships’ House that functions such as the recently integrated Health Education England function into NHS England, the NHS Digital function and many others, are going to be properly supervised and delivered during this period? They are as essential, in many ways, as delivering on waiting times and organising finances.

[Baroness Merron (Lab)]

The noble Lord is right to talk about NHS England in all its functions. Bringing it together with the department will not diminish those functions but will allow them to be delivered rather more effectively than they are currently. At the head of the transformation team is Sir James Mackey, the new chief executive of NHS England, working with Dr Penny Dash as chair. Both individuals are well respected across the sector for their outstanding track records, not least on turning round NHS organisations, in Jim’s case, but also on balancing the books, driving up productivity and driving down waiting times—exactly what is needed. But I agree totally with the noble Lord, and we are going to ensure that the necessary functions are continued; it is the way they are delivered that we are changing.