Health Bill

Lord Kamall Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Baroness Coffey (Con)]

My Lords, where do we start? Where did we end and where are we going? That is part of the challenge of a mid-group break, especially when this is a large group which covers a number of important areas. I am conscious that the noble Lord, Lord Austin of Dudley, has said a fair amount of what I had planned to say. I am concerned that a single company is being singled out and about comments made regarding wacky views of somebody who has an ownership in it. I think that the Church of Scientology is wacky. It does not stop me watching a Tom Cruise film. Wackier is the statement made by Green Party members that Zionism is racism. That is pretty wacky. Nevertheless, it is for them to decide and a matter of freedom of speech and freedom of thought.

Coming back to the substance of this group of amendments, I am conscious that we will come back in more detail to the single patient record. Looking at aspects of the amendment tabled by the noble Baroness, Lady Kidron, there is a lot of merit in thinking about how we put a shell around data in this country. I understand the sovereignty approach. For example, all the DWP data, on very vulnerable people, used to be held in Ireland because the data was held by Amazon Web Services. That saved money for the taxpayer. We had no problem at all, until we left the European Union and made the decision to bring all that very precious data back into the UK in case of other rule changes which may have restricted our access to that data or new laws applying because of where it was held. Therefore, there is a lot of merit in saying that it must be here.

It is worth noble Lords looking at the letter sent by the Health Innovation Minister, James Frith MP, to Layla Moran, who chairs the Health and Social Care Committee in the Commons. It tackles some of the issues that have been raised. People do not want their data to be all around the world. They are scared that it might expose them to something. That should be safeguarded against. That letter covers a lot regarding IP rights and how the NHS either owns it or has, effectively, a permanent licence or right to deploy the technology that was there.

However, I am concerned when we start getting into, “If this prioritisation of researchers is in the UK, that’s sort of okay and we prioritise public over private first” and so on. We are missing the point that this data is being released in an anonymised way for the benefit of patients. It is not a bad thing that a private company can make some money. It is not a bad thing that GSK or Pfizer may start to make tailored medicines and medications based on the evidence of what has been happening with patients in the UK. I accept that is a very rich dataset. Not then being allowed to develop new medicines and, therefore, make profits feels an unnecessarily Soviet-style approach when we are trying to ensure that a lot of this linking together is being done to improve the health of people in this country. Approaches could be modified.

I am also a bit of a purist. We should not be legislating about how the NAO should do its work or the work it should do. The NAO is a body of Parliament. Its chief executive is an officer of Parliament. It is not in legislation but under our Standing Orders it is responsible exclusively to the Public Accounts Committee and has a broader duty regarding understanding value for money and the use of taxpayers’ money. Some of the actions that are being referred to may well be stuff that it will wish to take forward in its analyses.

However, it would be helpful for the Government to appreciate that Minister Frith’s letter to the Commons Select Committee was targeted only in a particular response to certain points that had been made during that evidence session, correcting an important error that had been made in the DPIA. It would be helpful for the Government to have a more open approach in sharing how this will all work and how it is already working, and in giving assurances to parliamentarians of both Houses on how it will work in practice to quash this myth that, all of a sudden, stuff is being done that will expose vulnerable people.

This is the wider point about IT and digital sovereignty. We have a National Data Guardian, which has already been put in statute. By the way, I recall that, when NHS Digital was a separate legal entity, it refused to give information to the chief executive of NHS England when certain data was requested. At one point during the Covid crisis, it refused to give information to help the Government function more effectively. With these sorts of issues, it is almost as if what is perfect for privacy, or for this, that or the other, becomes the enemy of the good in what we are trying to achieve, which is the good use of technology and the federated platform to improve productivity.

I know that there have been disputes. It is important that the Office for Statistics Regulation, the parent organisation of the ONS, did that review. It pointed out issues that need to be addressed in future, but it did not say: “Actually, the information that the NHS has given out is largely wrong”. How do we try to improve from where we are right now and not miss out on the genuine opportunity of trying to work through, and make the most of, our technological advances?

I appreciate that there are also thoughts about whether it should just be a UK supplier. Again, this is the wrong approach and mentality. The DHSC and the NHS have got more sophisticated in their way of doing procurement, so to rule out any IT company that is not headquartered here in the UK would be a huge error.

There are other broader elements around where we are heading. I will leave some comments for our later debate on SPR, but there is something here about making sure that there is privacy by design—I think that was the phrase used by the noble Lord, Lord Clement-Jones. I have been weighing this up, and I will come back to it on SPR, but it concerns me somewhat, because we might think that we will happily hand it over to this or that clinician, or it will be used more broadly, but who really gets to see it? All this data is being used in an anonymised fashion. If, for example, GSK was purchased by a foreign pharmaceutical company, some of these amendments—I appreciate that they might be probing, although their level of detail suggests that this is exactly what noble Lords want them to achieve—would start to allow legal challenges about how this could be done. As I say, do not let perfection in one aspect be the enemy of the good in another, which is making the best of NHS resources to improve people’s health. I am sure we will return to this on Report, but I encourage noble Lords who will be writing amendments to reflect on how far into that level of detail they need to go.

[Lord Kamall (Con)]

My Lords, I am grateful to all noble Lords who have brought forward amendments in this group. I well recall the debates that the noble Lord, Lord Clement-Jones, and I had during the Health and Care Bill in 2022. I think he was surprised to find that we agreed on far more than he thought we would. What was very helpful in that Bill, if I remember correctly, was that there was an official who had been seconded from the Cabinet Office to the Department of Health, whom we were both able to trust to find a solution that we were both happy with in the end. Sadly, having reached that really good solution, it has all been undone by this Bill. I therefore completely understand the reasons for the amendments tabled by many noble Lords in this group.

I will speak briefly to the amendments tabled by my noble friend Lady Neville-Rolfe, who is not in her place, and by the noble Lord, Lord Austin of Dudley. Although these amendments approach the question of NHS procurement slightly differently, they raise important questions about the principles that underpin the way in which taxpayers’ money will be spent. While NHS procurement should always support the delivery of safe, effective and high-quality care for patients, we know that the NHS is not only a provider of healthcare but one of the largest purchasers of goods and services in this country and a major employer. It has an enormous impact on the wider economy, with the potential to support British businesses, to encourage innovation and our domestic manufacturing capabilities, and to create skilled employment in areas such as medical technology and life sciences research, where the United Kingdom already possesses considerable experience.

My noble friend Lady Neville-Rolfe probes the Government on how we use that purchasing power intelligently, not only to secure the goods and services that the NHS requires but to support resilience, innovation and wider economic prosperity in the country while adhering to the principle of value for money. It also raises an important question about how we assess value for money. As the noble Lord, Lord Tarassenko, said, the cheapest initial purchase is not necessarily the best in the long term.

[Baroness Coffey (Con)]

Amendment 277 is not in this group, according to the list circulated today, unless there has been more than one of them.

[Lord Kamall (Con)]

My understanding is that it is in this group, but maybe other noble Lords can confirm. There is a slight disagreement between my noble friend’s and my understanding of that.

I repeat that important point made by the noble Lord, Lord Tarassenko: the cheapest initial purchase is not necessarily best in the long term. There is also a legitimate question about whether procurement requirements have become unnecessarily complicated, which the noble Lord, Lord Austin of Dudley, calls for in his amendment, around clarity and consistency about the objectives against which procurement decisions are assessed.

I turn to the wider concerns raised in this group about patient data, digital sovereignty and the security of NHS information systems. Patients need to have confidence that their data is secure and their privacy is respected. I quite often like to quote my favourite philosopher, Jimi Hendrix. I have cited this more than once. He talked about building castles made of sand that fall into the sea eventually. What we do not want is the single patient record or the federated data platform to be that castle made of sand that falls into the sea eventually because there is no confidence from patients and they want to opt out of the system. We have tabled our own amendments on the single patient record that speak directly to some of these concerns. I will return to those points when we reach that group.

The crux of the matter is Palantir, what people really think about Palantir and whether it should be here. When I was the relevant Minister, I was told quite clearly by my officials that Palantir had by far the best solution to deliver the federated data platform. We should acknowledge the contribution it has made in increasing discharges, reducing discharge times, identifying and contacting patients who need to come back, making sure cancellations are reduced, and all those sorts of metrics that we want to see.

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There is a lot of talk in this area, but we need to combat medical mis- and disinformation. This amendment would place in the Bill specific duties on the Secretary of State to publish such a strategy. I hope the Minister will take on board my noble friend’s thoughts and respond positively to that suggestion and others in this group.

[Lord Kamall (Con)]

My Lords, I am grateful to all noble Lords who spoke to their amendments in this group. I will mainly touch on three points. First, on vaccines, I remember that, when I was the Minister who had to answer questions on vaccines during Covid, we were trying to work out how to tackle so-called vaccine hesitancy. One of the things we thought we had cracked was that we worked with local communities and faith organisations, which are trusted far more than whichever Minister happens to be on TV or even the Chief Medical Officer, even though he was a very trusted person. The interesting thing was that we tried to work with local communities, but we found that some churches were saying, “Don’t take the vaccine”. That was a challenge we faced. We thought we had cracked it by working with local organisations.

We have to be careful about distinguishing between misinformation and disinformation. They often have the same outcome. Misinformation, though, is quite often unintentionally spread, whereas disinformation is deliberately spread. We have to be aware of that.

Secondly on vaccines, there was a denial that anyone could come to harm from taking the vaccine, but any pill or therapeutic has risks. I remember when I went to take my first mRNA vaccine. I sat down with the nurses in my local surgery and asked, “How risky do you think this is?” They said, “Don’t worry, it’s safer than the pill”. That is not particularly reassuring for the women out there but, statistically, they were absolutely right. If you tell people that, for example, one in 10,000 might get heart inflammation or whatever then that will scare an awful lot of people but you are actually being honest about the statistics and the risk. There is a real challenge in being completely honest about the risks and the numbers, because everyone will think they might be that one in 10,000 so they will not take it. I really have not worked out how to crack that.

We then seemed to pretend that no one was harmed by the vaccine. It is true that, statistically, very few people—a very small percentage—were harmed or killed by the vaccine, but that gave rise to conspiracy theories about hiding the fact that people could be harmed by the vaccine. In reality, all medicines have a very small risk factor. It is about how we tackle that, because if we are too open about it then people will think they are the one in a million or the one in 10,000. That is a real challenge we all face.

The second thing I want to talk about is public health. Last year, I taught an MBA module on health policy. As part of that, I spoke to a lot of public health academics. One of the things I was astounded to hear from them was that they think that an awful lot of top-down public health does not necessarily work. We spoke about the example of sugar taxes. We feel good about them because there is less sugar in our drinks but, quite often, if people are not actually helped to change their behaviour then all they end up doing is spending more on their fizzy drinks, or they swap from the branded fizzy drinks to Asda or another supermarket’s own brand. We might feel good about it, but we have not actually changed their behaviour.

Far more effective is working with local community organisations. I have often mentioned one that I am very aware of, BRITE Box, which produces 38 meals a year for families. It gives them the ingredients, and it has tested the instructions and the menus. It has done a lot of academic research and found that what is very attractive to children and families are pictures with three or four bullet points. What quite often happens is that these families learn to eat and cook healthier meals together, which they love doing, and now that they have the 38 recipes, they carry on using them. As part of that, they learn to budget as well. That is something that top-down public health cannot do.

Our challenge is how to encourage more of these local community organisations, which understand the people whose behaviour needs to change to eat healthily on more of a budget, rather than always thinking that we should have a tax on something and that will change behaviour. Quite often, all it does is lead to people paying more for unhealthy food, rather than actually changing their behaviour.

I try to be consensual at times—maybe it is my 14 years in the European Parliament—but, for my third point, I agree with the noble Baroness, Lady Bennett of Manor Castle: we are not paying enough attention to AMR. Let us be honest about this. I remember that in the first Session after the General Election, when we swapped sides and Benches, I was asked to speak for the Opposition on a Question on AMR. The Minister at the time, the noble Lord, Lord Collins, said quite clearly that the Government were going to take a cross-governmental approach to tackling AMR, but we do not seem to have made any progress. I wonder whether the Minister has more information than I have to say what the Government are actually doing on AMR, particularly on a cross-government approach but also on international co-ordination.

All the amendments in this group raise important points. I look forward to the Minister’s response.

[Baroness in Waiting/Government Whip (Baroness Hyde of Bemerton) (Lab)]

My Lords, I am grateful to noble Lords who have tabled amendments in this group and want to take the opportunity to thank all the directors of public health across the country who are doing excellent work, close to the ground, day in and day out, as mentioned by some noble Lords. I also add my thanks to the noble Baroness, Lady Cass, for sharing her personal experiences on disinformation and misinformation. It is much appreciated.

I turn to Amendment 224 tabled by the noble Baroness, Lady Walmsley—with thanks to her colleagues for speaking to it—and to Amendment 267 tabled by the noble Baroness, Lady Bennett. We agree that improving health and reducing inequalities requires actions beyond the NHS, across housing, education, employment and environment. Indeed, this was raised in an earlier group, where we discussed the fact that good health cannot be the sole preserve of DHSC. Ministers and officials already work across government to ensure that health evidence informs decisions. That includes some things mentioned by the noble Baroness, Lady Bennett, including action on poor-quality housing through the fuel poverty strategy, the decent homes standard and Awaab’s law, on work and health through the Keep Britain Working review—as alluded to in our first group of amendments today—and on air pollution through the environmental improvement plan. On Amendments 267 and 224, we are not persuaded that prescribing internal government structures or introducing a broad duty on Ministers in primary legislation is necessary. The Secretary of State already has a statutory duty concerning public health protection and powers to improve the health of people in England. Ministers also routinely consider the health implications of their decisions and work collectively in the public interest. Furthermore, through the English Devolution and Community Empowerment Act, we have introduced a duty for combined authorities, combined county authorities and mayors to have regard to the need to improve health and reduce health inequalities in the exercise of their functions. This duty complements that pre-existing local authority health improvement duty and role.

On the topic of public health, the noble Lord, Lord Scriven, raised a specific question about the small print in the impact assessment. As a statutory arm’s-length body, NHS England’s powers and duties are necessarily set out in statute, and it has a different legal role and responsibilities from the Secretary of State and the Department of Health and Social Care. While it was appropriate for NHS England to be bound by a duty to seek advice to ensure that it effectively discharged its functions, it is not necessary to bind the Secretary of State in that way. However, I can assure the House that the Secretary of State will continue to seek advice as appropriate.

The noble Baroness, Lady Walmsley, tabled Amendments 231 and 223. Although she is not in her place, I want to thank her for her work as chair of this House’s Childhood Vaccinations Committee. As other noble Lords have mentioned, inaccurate information can undermine confidence, but uptake also depends on access, deprivation and awareness. National communication, support for front-line professionals and monitoring of emerging narratives already address misinformation alongside these wider barriers. A statutory strategy focused solely on disinformation risks duplicating activity and reducing flexibility. The Government are acting to improve uptake more broadly, including by making it easier for families to get vaccinated, giving families more information about vaccination, investing in new digital services for vaccination and organising the NHS to promote improvements in uptake. To give an example, we have reformed incentives for general practice to incentivise improved uptake in areas with low uptake, rather than rewarding only those with high uptake. That can then support best practice among general practice and address the inequities in uptake.

On Amendment 223, UKHSA and NHS England already publish extensive, timely data on routine, seasonal and targeted immunisation programmes. Requiring consistent measures in primary legislation could impose artificial standardisation where programmes are not comparable. Instead, our priorities are to improve existing reporting and act on the evidence. This Government take seriously the fact that misinformation and disinformation does and can undermine confidence, but it is one factor among several. We would also include in that the role of social media, which the noble Baroness, Lady Pidgeon, mentioned. That is why we are working across a number of measures, around marketing campaigns, supporting health professionals to have those conversations with people who are vaccine-hesitant, as well as monitoring and responding to emerging narratives and trying to debunk, by “prebunking”, if I may, that kind of misinformation and disinformation.

I turn to Amendment 274 on antimicrobial resistance from the noble Baroness, Lady Bennett. As she said, this is being addressed through the United Kingdom’s 2024 to 2029 AMR national action plan. A stand-alone review of annual AMR-related deaths could duplicate the work already under way in that plan. UKHSA undertakes continuing surveillance and is developing a mortality metric to improve our understanding across different infections and settings. I hope that noble Lords will agree that continuing surveillance, modelling and reporting will provide more durable insight than a one-off statutory review.