King’s Speech

Lord Kakkar Excerpts

Wednesday 20th May 2026 Lords Chamber

[Lord Kakkar (CB)]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Nargund, and in so doing echo her remarks about the remarkable and customarily imaginative and enthusiastic way in which the noble Baroness, Lady Merron, introduced this debate. In so doing, I declare my interests as chairman of King’s Health Partners and the King’s Fund. It will be, of course, on the NHS modernisation Bill that I will contribute the majority of my remarks.

Before so doing, I would like to touch on one other Bill that has appeared in the gracious Speech, the peerage removal Bill. Here I declare my interest as chairman of your Lordships’ Conduct Committee and as a former chairman of the House of Lords Appointments Commission. This is an important Bill because it touches upon many important constitutional principles. It is designed to address an issue, as stated in the gracious Speech, with regard to the standing and reputation of your Lordships’ House. In its so doing, there will need to be careful consideration of how any statutory provisions touch upon the procedures and processes agreed by your Lordships’ House with regard to conduct and whether any such provisions will extend your Lordships’ provisions for assessment of conduct beyond conduct related to parliamentary activity to conduct outside your Lordships’ House.

Indeed, your Lordships will need to understand in some detail the mechanisms by which it is proposed that, if enacted, the Bill will function. Will it function as a function of your Lordships’ House—that is, a question of resolution by the House—or will it function through the creation of an additional body outside what would be normally considered the processes of a self-regulating Chamber?

In addition, it is going to be very important to understand what other opportunities might be reflected in the passage of such a measure, in particular, whether the provisions of the advisory House of Lords Appointments Commission are ultimately put on a statutory basis so that all nominations, be they political or to the independent Cross Benches, are subjected to the same evaluation in terms of individual propriety and suitability. These are important questions that, no doubt, your Lordships will be able to consider when the Bill comes for consideration in your Lordships’ House.

I now turn to the NHS modernisation Bill. As the noble Baroness stated, His Majesty’s Government began their term in office by undertaking a detailed and forensic examination of the condition of the NHS, which identified it to be in a state of some crisis. It is therefore important that any measure of such substance as those in this proposed Bill should be judged against the standard of addressing that crisis urgently, as I think all noble Lords would agree that time is now running out. We need to take serious, long-term decisions to achieve what was first described with eloquence and clarity in a report led by my noble friend Lord Patel. This was the 2017 report of a special Select Committee on the long-term sustainability of the health and care system in our country.

That report made a number of recommendations. I shall not rehearse all of them with your Lordships this evening, but two important ones regrettably do not appear to have been addressed in the measures proposed in the NHS modernisation Bill. The first was the need to bring together health and social care into a properly co-ordinated system to ensure the ultimate sustainability of our healthcare system. As we have heard earlier in this debate on the humble Address, it has not so far been easy to identify how the measures in this Bill will achieve that objective. The second recommendation was to secure an appropriate investment, not only in innovation and technology but in the development of the workforce, to ensure that innovation and technology could be adopted at scale and pace across the NHS and to achieve the objectives that we all recognise are vital to secure its sustainability.

I make one last point. The measures in the Bill once again centralise an awful lot of power, on the basis of a need for accountability, in the hands of the Secretary of State for Health and the Department of Health and Social Care. It is proposed thereafter to transfer some of those powers back to ICBs, which will become strategic commissioners of healthcare at a local level. Those important mechanisms, and indeed the willingness and determination of the Department of Health and Social Care to use those powers not to control but rather to facilitate, will need to be understood fully as we consider the Bill during its passage.

Queen’s Speech

Lord Kakkar Excerpts

Wednesday 11th May 2022 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I thank the Minister for the thoughtful way in which she has introduced this particular day of debate on the humble Address and, in so doing, declare my own interests as chairman of the King’s Fund and of the Office for Strategic Coordination of Health Research.

Her Majesty’s Government’s commitment to levelling up and the introduction of the Levelling-up and Regeneration Bill is, of course, broadly welcome, but there can be no more important manifestation of the inequalities that exist between different regions of the country and between different communities and populations than the inequalities in health outcomes that have so plagued the successful delivery of our National Health Service. Indeed, in the last Session of Parliament, Her Majesty’s Government introduced a new health Bill, which has now received Royal Assent, with the determination that there may be greater emphasis on local co-ordination for the delivery of healthcare. However, that emphasis has been principally on matters of health, of course, and engaging with local government, but not really providing sufficient definition with regard to how the most important determinants that drive inequalities in health outcomes—the social determinants of health—might be most appropriately addressed. Those are matters that fall outside the traditional delivery of healthcare and are questions that pertain to local communities and the delivery of local government, such as the provision of employment, housing and education, as three important examples.

So, in coming to consider the Levelling-up and Regeneration Bill, it is important for Her Majesty’s Government to ask themselves whether, in moving this important piece of legislation, they are doing everything they can to provide maximum opportunity to focus on health questions. These are vitally important for the local communities the Government are so determined to support and encourage. It is well recognised now that the difference in life span between the wealthiest and poorest communities in our country is some seven years, but, more shocking, the difference in healthy life expectancy—that life period without ill health—is 17 years, with the poorest communities having far more chronic ill health and dying earlier.

How might attention to the provision of healthcare and investment in local communities address this question? That is clear when it comes to investment in the health service, but beyond that there is the capacity to look at, for instance, the regeneration of the high street, which the noble Baroness mentioned, and to ask whether there might be imaginative ways, and indeed ways facilitated through legislation, to ensure that healthcare facilities are provided increasingly in the high street: that is, using real estate that has been previously neglected and abandoned for the provision of community-directed healthcare facilities or of ambulatory healthcare facilities —facilities that are closer to the populations, particularly those who live in inner cities and central to towns, who tend to have much more chronic ill health and would therefore be able to avail themselves more easily of those facilities. In investing in that fashion, one provides not only the opportunity for improved access to healthcare but the opportunity for regeneration, broadly, of the high street, with much more activity and therefore much of what has to be provided in out-of-town hospital facilities being present in the high street.

Beyond the opportunity to drive regeneration through investment in healthcare facilities, there is the important question of undertaking population health research in communities to understand their true needs and therefore to respond with interventions that will have the greatest impact on improving local health outcomes. In this regard, there is a greater need for local government and local authorities to participate in the health research agenda, something that does not happen effectively at the moment. This is an area where encouragement from government for cross-departmental engagement on these matters, beyond the Department of Health and Social Care, is critical.

Finally, there is the question of how investment in healthcare locally can drive the development of excellent employment opportunities. If provision is made for the training of local populations to participate in the health and care workforce, those populations should continue to be developed and encouraged over the duration of their professional careers. This would not only deal with important needs in local communities, but the upskilling of a population devoted to health and care, and ultimately the attraction of further investment and engagement with universities and other educational institutions, would provide the opportunity for broader investment in the life sciences ecosystem that will usually attend communities and institutions delivering high-quality healthcare.

This is an important opportunity for Her Majesty’s Government when considering the broader question of levelling up. It is not usually discussed as an element of the levelling-up agenda, but failing to use this important opportunity to bring together local government, to facilitate—indeed, to mandate—a focus on addressing social determinants of health, and to ensure that the planning system can provide the opportunity to create meaningful, local and locally focused healthcare facilities, would be critical.

In closing this part of the debate, I wonder whether the Minister might reflect on how Her Majesty’s Government can use their levelling-up agenda to address these issues.