Health and Care Act 2022 (Consequential Amendments) Regulations 2025

Debate between Lord Kamall and Baroness Blake of Leeds

Thursday 4th December 2025 Grand Committee

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

My Lords, these technical regulations will ensure that the Down Syndrome Act 2022 is up to date with current NHS structures. There are an estimated 47,000 people in the United Kingdom with Down syndrome. Despite existing legal duties, individuals with Down syndrome continue to face significant challenges in accessing the care and support they need. This Government are determined to break down barriers for people with Down syndrome and other disabled people. The Down Syndrome Act 2022, alongside the broader aims set out in the Government’s 10-year health plan for England, will help us to achieve this.

I will begin by outlining the requirements of the Down Syndrome Act. The Act requires the Secretary of State for Health and Social Care to issue guidance to relevant authorities across health, social care, education and housing on the actions they should be taking to support the needs of people with Down syndrome. On 5 November we launched a public consultation on draft guidance under the Down Syndrome Act. We recognise the importance of ensuring that our documents are accessible, and Easyread versions of the draft guidance and survey questions have been made available so that everyone is able to make their voice heard. People can respond to the survey online, via post or by email, according to their individual preferences and needs.

The draft guidance consolidates and raises awareness of the practical steps that relevant authorities should take to meet the needs of people with Down syndrome. Additionally, it helps to clarify the support and services that individuals with Down syndrome can expect to receive. We expect that the guidance will not only improve support for people with Down syndrome but benefit those with other conditions or a learning disability who have similar needs.

This Government are committed to working with disabled people to ensure that their views are at the heart of what we do. The development of the draft guidance involved significant engagement with people with lived experience, as well as organisations that support them. The consultation offers another chance for these communities to express their views.

For the guidance to deliver the improvements we want it to, effective local implementation will be essential. On 9 May 2023, NHS England published statutory guidance that says that every integrated care board should identify a member of its board to lead on supporting the ICB to perform its functions effectively in the interests of people with Down syndrome. The guidance also says that each ICB should have a designated lead for learning disability and autism, and for children and young people with special educational needs and disabilities. Collaboration between ICB leads and other partners across the integrated care system will be crucial. The ongoing legislation will help us assess whether the guidance is clear and informative for relevant authorities in meeting their legal duties to support people with Down syndrome. We will carefully consider all feedback to ensure that the final guidance is fit for purpose.

I will now explain the changes that these amendment regulations will make. The regulations are designed to bring the Down Syndrome Act in line with changes to NHS structures made by the Health and Care Act 2022. Under the Down Syndrome Act:

“Relevant authorities must have due regard”


to the final statutory guidance

“in the exercise of their relevant functions”,

but the Act does not create any new functions beyond this duty. The Schedule to the Act specifies which authorities must have due regard to the guidance and the functions to which it applies.

The regulations will amend this Schedule, replacing outdated references to clinical commissioning groups with integrated care boards and updating references to the National Health Service Commissioning Board with NHS England. This is an important technical change, as the Health and Care Act 2022 abolished CCGs, replacing them with ICBs, and renamed the National Health Service Commissioning Board as NHS England.

For authorities not listed as relevant authorities in the Schedule to the Down Syndrome Act, the guidance will not be statutory, meaning that they are not legally obliged to have due regard to it. These amendments will bring ICBs and NHS England within the scope of the Act’s requirements, providing clarity and helping to ensure effective implementation. The regulations also align legislation with NHS England’s statutory guidance on ICB leads for Down syndrome. ICB leads are responsible for implementing the guidance, and it is therefore essential that ICBs are referenced in the legislation.

It is important to note that the final guidance under the Down Syndrome Act will not be published until after these amendment regulations come into force. Our intention is to publish the guidance before the planned abolition of NHS England comes into effect. However, we recognise that other ongoing government reforms may affect the timing and content of the final guidance. To maintain accuracy and relevance, the guidance will be kept under review and updated to reflect new policy and legislative frameworks as necessary.

A practical consideration is the timing of these regulations. They are drafted to come into force the day after the day on which they are made. This will ensure that the Down Syndrome Act duty to have due regard will apply to the correct authorities as soon as the final guidance is published. The regulations will not have any material effect until the final guidance is published, so we do not believe that further public engagement or notification is needed at this stage.

By making these important and timely updates to the Down Syndrome Act, the regulations before the Committee will offer vital assurance that guidance is implemented effectively and in the spirit intended when the Act was passed. This supports our aim to improve life outcomes for people with Down syndrome and ensure that they receive the care and support they need to live the lives they want to. I beg to move.

[Lord Kamall (Con)]

My Lords, I thank the Minister for setting out the purpose of these regulations. I reflect that in politics there are times when you have some difficult days, but there are also days when you feel it is worth while. I remember when we passed the Down Syndrome Act. I was a Health Minister at the time, and it was one of the most rewarding days I have had as a politician. The credit was not to me; it was to all the legislators who got involved, as well as the many charities, but it is at such times that you feel the work we do here is incredibly worth while.

As the Minister explained, these are technical measures, and we understand that they update references in the Down Syndrome Act 2022 to reflect the changes in the Health and Care Act. As the Minister said, this particularly concerns the establishment of ICBs, or integrated care boards, to replace the clinical commissioning groups. Clearly, the current wording is out of date. For that reason these are sensible regulations, and we are obviously happy to support them. We also welcome the Government’s commitment to help those with disabilities and learning disabilities, which the Minister outlined.

While the changes are technical, they take place against a backdrop of significant structural change. Only yesterday I was contacted by the Minister to discuss some of the changes that will happen when NHS England is abolished and where some of those responsibilities will lie—I understand that there will be a Bill before Parliament.

The Government have announced plans to abolish NHS England by April 2027, but there is as yet no clarity on when the required health Bill will be introduced—I hope we can get something on that—and how the statutory functions under the Down Syndrome Act will be transferred or continued. I completely appreciate that these are early days, but I wonder whether the Minister can answer now or in writing what input there has been and what the thinking is behind transferring some of these statutory functions when that restructure takes place. We would welcome some reassurance that the duties currently held by NHS England ICBs in relation to the Down Syndrome Act will be maintained until the future health Bill provides a new framework. I think that is obvious, but we need some sort of reassurance. We believe that people with Down syndrome and their families deserve that certainty and want to make sure that they are not disrupted by the organisational change.

We also note that the Explanatory Memorandum confirms that there is no statutory review clause for these regulations and, while the technical amendments themselves are straightforward, the absence of a formal review means that there is no mechanism to ensure that these provisions are revisited. I understand that the Minister said that they have come to a stage where they do not necessarily believe that further consultation is required, but I just wonder about some of the reviews. The absence of a formal review could mean that there is no mechanism to ensure that these provisions continue when they are revisited, such as when NHS England is abolished or when the ICBs’ responsibilities are altered. We want to ensure that the statutory duties continue and so we would welcome some clarification on that. Also, how do you monitor the continued effectiveness of statutory guidance and make any more adjustments if required?

Finally, we note that the consultation is ongoing and welcome the fact that the Government have continued to engage with stakeholders throughout this period, ensuring that the guidance remains practical and responsive. I understand that it might be felt that there is no need for any further consultation because all views have been heard, but I think that would give some reassurance in case there are views that need to be heard and have not been. We may say with certainty that there are no more views, but we just do not know what will happen in the future. Also, both the Health and Care Act 2022 and the Down Syndrome Act mandated responsibilities for the ICBs but there is a difference between having responsibilities and ensuring that they are carrying out those responsibilities, and how we monitor that.

Aside from those questions, we support these regulations. We recognise their technical purpose and necessity. At the same time, we hope that the Government will provide reassurance regarding the transitional arrangements and the ongoing oversight of statutory functions so that the objectives of the Down Syndrome Act 2022 are fully realised for the people it is designed to support. We recognise that when the Act was passed it was only the first step to make more people in the system aware and make sure that they are aware of their statutory duties. I am not going to comment on the merits of the changes that are coming—some are positive and some will cause concerns—but we have to ensure that those statutory functions continue so that people with Down syndrome continue to be served in the way that the Act was originally intended. I look forward to the response from the Minister.

[Baroness Blake of Leeds (Lab)]

I thank the noble Lord, Lord Kamall, for his very constructive comments. I completely agree that we have some difficulties with Bills moving across but we are absolutely committed to improving services for people across the country who have significant needs and we are pleased to update noble Lords on our progress. He quite rightly reflected that we are going through a period of structural change, but I hoped I outlined in my opening remarks that that should not get in the way of progress on this. I think that there are enough checks and balances in place to make sure that we have an open door for comments to come in.

In particular, we have a set process for the current legislative framework. A clear consultation framework has been laid down with specific timings, explaining how that will all fit together with the legislative changes. The most important reassurance that the noble Lord asked for is that we will keep the guidance under review and ensure that we accommodate any changes or lessons learned. In my view, consultation needs to be a live experience; it cannot be done just once and put in the history books. I hope that that gives him the reassurance that he needs.

I also take this opportunity to reaffirm that our absolute aim, which I know is shared by the noble Lord, is to improve the lives of people with Down syndrome and people with other conditions. Of course, this is a Private Member’s Bill, which brings its own strictures around how it can be covered. I emphasise again that we will achieve this by publishing guidance under the Down Syndrome Act. We hope that the guidance and the process around the consultation will continue to raise awareness and improve our understanding of the needs of people with Down syndrome. The progress that has been made has been significant and I place on record our thanks to all the organisations and people who have raised the profile of Down syndrome and done such an incredible job. It is important that all relevant authorities are brought together to continue to deliver that effective care and support, regardless of NHS structures.

I hope that I have given the necessary assurance that the guidance will be implemented as intended. With that, I thank noble Lords for their attendance and the noble Lord, Lord Kamall, for his contribution.

NHS Industrial Action

Debate between Lord Kamall and Baroness Blake of Leeds

Tuesday 2nd December 2025 Lords Chamber

[Lord Kamall]

To ask His Majesty’s Government what assessment they have made of the effects of upcoming industrial action in the NHS.

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

My Lords, strikes are disruptive and costly. The strikes in July cost around £240 million. Thanks to the heroic efforts of other NHS staff during the recent November strikes, the NHS was able to maintain 95% of planned care, while still maintaining critical services. I urge the BMA to reconsider its plans for more damaging strikes before Christmas, and to work with the Government to improve the working lives of resident doctors and to rebuild the NHS in partnership.

[Lord Kamall (Con)]

My Lords, I thank the Minister for that Answer and also pay tribute to those hard-working doctors who kept going, despite the feeling for industrial action by many in the BMA. The timing of the BMA’s announcement is surely no coincidence. Is it not the case that last week’s Budget, which displayed the Chancellor’s readiness to increase the burden on taxpayers in order to fund public spending, will have sent a clear signal to the BMA that there is scope for it to squeeze even more money out of the Treasury than it did last year, with the 29% pay rise that was awarded? Will the Minister take this opportunity to confirm the Government’s position? Do they agree that a further massive pay rise for resident doctors at this time is completely unaffordable?

Tobacco and Vapes Bill

Debate between Lord Kamall and Baroness Blake of Leeds

Committee stage
Monday 3rd November 2025 Grand Committee

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

My Lords, I thank noble Lords for the amendments in this group.

I note the comments from the noble Lord, Lord Kamall, that the noble Lord, Lord Mott, is not in his place to speak to his amendments, but I will just touch on them briefly, if I may. Basically, his amendments seek to require licensing regulations to be made within three months of the relevant provisions in the Bill coming into force. The amendments would also extend the existing retailer register in Northern Ireland. I emphasise that, of course, the Government share the noble Lord’s desire to move as quickly as possible to implement the licensing scheme. That is why we have recently launched the call for evidence on the range of issues that we have laid out, including questions on the design of the retail licensing scheme. The feedback received will be absolutely critical, and we want to get on and launch this as soon as possible. However, it is also important that the Government have sufficient time to ensure that the regulations are properly thought through. I hope that the noble Lord, Lord Mott, when he hears the discussion, will be reassured and understand that three months is not sufficient time to run a consultation, analyse the feedback received and prepare well-considered regulations. That is as much as I shall say on his amendments.

Turning to the amendments in the name of the noble Lord, Lord Kamall, I hope to give him the reassurance that he seeks, as we discussed in last week’s Committee, that I understand these particular concerns. His amendments would similarly require Ministers to publish draft regulations implementing a retail licensing scheme for England and Wales within six months of the Bill achieving Royal Assent.  The Government are committed to ensuring that those impacted by regulations and those with expertise have the opportunity to contribute their views. We want to minimise additional costs and burdens as far as possible, while ensuring that the scheme is a success and achieves our aims of supporting legitimate businesses as well as tackling those that disregard the law.  Again, the recently published call for evidence seeks input on a range of topics, including the implementation of the retail licensing scheme. As I have said, this will inform the consultation, which we will launch as soon as possible.

To respond directly to the noble Lord’s comments, our call for evidence also asks about the implementation of the scheme and how long will be required to implement the policy. We will, of course, work through the appropriate channels to ensure that businesses have the necessary guidance to implement the changes. I cannot emphasise enough that this is for all businesses, regardless of their size or the organisations that represent them. We want to make sure that we get that message out loud and clear, so that they have confidence that their views will be regarded with the same importance as all those who contribute to the policy.

I note the noble Baroness’s comments about making sure that we get this right, so we cannot be beholden to specific timeframes on the face of the Bill. We all acknowledge that this is a complex policy and, while we want to move swiftly, it is important that there is enough time to ensure that the policy is properly thought through before developing regulations. I repeat that requiring the Government to publish draft regulations before adequate consultation may risk creating a flawed policy. For the reasons that I have outlined, bringing together previous comments, I hope that the noble Lord will feel able to withdraw the amendment.

[Lord Kamall (Con)]

My Lords, I am grateful to the Minister and to all noble Lords who spoke in the debate on this group of amendments. The intention was always that these would be probing amendments; whether it was three months, as from my noble friend Lord Mott, or six months, as from us, we wanted to get some certainty and find out whether, at this stage, any thought has been given to an outline timetable. This is so that the retailers that will have to face this new licensing regime can understand the different stages—the Minister laid out some of the consultation stages—and the overall timetable. Here we are, getting towards the end of the 2025, and they are wondering, “When will this new licensing regime be in place? Will it be sometime in 2026 or in 2027?” That is the sort of outline assurance they want.

It was very helpful of the Minister to mention some of the consultation stages, but it would also be helpful if, perhaps in writing, she could give us a timetable that relates to real dates in the next two or three years—and, in doing so, avoid “in due course” or “as soon as possible”—so as to reduce the uncertainty for those retailers that will have to prepare for this measure. I also welcome the acknowledgement from the Minister of the importance of consulting small retailers—that point has already been made in our debates on previous groups—as well as her understanding of the role that these small retailers play. The burden for them is very different and disproportionate as compared to that for some of the larger retailers.

In general, we welcome the tone from the Government and understand that there must be consultation stages. However, we are asking for some sort of outline timetable in writing, if possible, on when the Government envisage the licensing regime being in place—with the usual caveats, perhaps, depending on what comes back from the consultation. Some certainty would be really welcome at this stage.

Having said that, and having reflected on the comments from the Minister, I beg leave to withdraw the amendment in my name and that of my noble friend Lord Howe.

Tobacco and Vapes Bill

Debate between Lord Kamall and Baroness Blake of Leeds

Committee stage
Thursday 30th October 2025 Grand Committee

[Lord Kamall (Con)]

I thank noble Lords who have contributed to this debate, and the Minister for her response. With these probing amendments, we were trying to make sure that the consultation was as wide as possible. We completely understand the WHO requirements, but we sometimes worry about some of the more specialist cigar manufacturers, which are not big tobacco but much smaller specialist organisations.

I seek some clarity from the Government at this point. Are they saying that the WHO guidelines mean that they cannot speak to these small, specialist manufacturers? We understand not consulting the big Philip Morris Internationals of this world, and others, but is it the Government’s understanding that they cannot speak to the small specialist cigar manufacturers because WHO guidelines preclude them from doing so? Or are they saying that they can speak to those small manufacturers?

Clarification on that from the Minister would be welcome. Is she able to give an answer, or shall I witter on a bit and hope that the officials can give her an answer in that time? I will do that; I am trying to be helpful. That clarity is essential. I am not asking that they call in the likes of the big firms, such as BAT and Philip Morris, every time they want to do a consultation; we know what their business models are. This really is about the small specialist manufacturers who feel that they are excluded and lumped in with big tobacco all the time. Their demographic is very different. It is an ageing demographic; perhaps literally a dying demographic —who knows?

The newspaper that came to see me told me that its readership was not consulted even though their trade associations claimed that everything was fine. Therefore, we need to understand those nuances. In my experience, I have seen some trade associations claiming to represent a wider membership than they do. They are not the ones who are damaged.

I welcome the sentiment behind the noble Baroness’s response. I had a conversation with the Minister only yesterday about a particular organisation not feeling that it had been consulted. Immediately, she said, “Let’s meet with that organisation”, so I recognise the sentiment. However, I would like that clarification now if it is available.

[Baroness Blake of Leeds (Lab)]

We require all those with links, direct or otherwise, to the tobacco industry to disclose them when answering consultations. I hope that is the clarification that the noble Lord requires.

[Lord Kamall (Con)]

Just to understand, they can be consulted—that sounds reasonable; I do not think anyone would say otherwise. It is important that they do not hide where they are from.

If there are organisations that have written to me about this in the past and I have had conversations with them, I am sure that the Minister will be open to having conversations where appropriate. With those reassurances, I beg leave to withdraw the amendment.

--- Later in debate ---

[Baroness Blake of Leeds (Lab)]

I am at the mercy of the Committee, but we have some more time and the ability to go on until 5.15 pm. If noble Lords agree, we have one more group to do to get to the target. Shall we continue?

[Lord Kamall (Con)]

My Lords, my noble friend Lord Mott is not here to move Amendment 29 and has obviously not sent a substitute to speak on his behalf. What is the procedure from here?

Unpaid Carers

Debate between Lord Kamall and Baroness Blake of Leeds

Wednesday 15th October 2025 Lords Chamber

[Baroness Blake of Leeds (Lab)]

I thank the noble Baroness. I do not have the precise figures to hand, but the more work we do in this area, the more we are exposing what needs to be done. The fact is that the confidence of carers is quite low, and we need to make sure that all the support comes together to wrap around them. All the evidence that is gathered by the different agencies on the ground is exceptionally welcome and will inform the routes forward. I will get the precise information she has asked for to her after this discussion.

[Lord Kamall (Con)]

My Lords, we all know that being an unpaid carer is a profoundly challenging role that can take a serious toll on people’s physical and emotional health as they care for someone else—often, a relative, as we heard from my noble friend, or a young person. They are selfless individuals who put their own needs last. Can the Minister set out what steps the Government are taking to ensure that carers are made aware of their rights, as alluded to by the noble Baroness, Lady Pitkeathley, and the existence of the support available to them, so that it can be accessed easily? This is perhaps a question for a written reply, but have the Government given any thought to the challenge set out in the amendments to the Renters Rights’ Bill concerning access to accommodation for carers supporting a landlord or their family?

[Baroness Blake of Leeds (Lab)]

The noble Lord highlights a crucial point. We are saying all the way through that there needs to be greater coming together at a local level. NHS England is taking this exceptionally seriously, working with local authorities, GPs and ICBs, for example, to make sure that they come together. One of the most important aspects of its work—for example, the conference it is setting up—is that the voices of carers themselves are heard, that the incredible importance of their experience is recognised, and that no assumptions are made about what should be done on their behalf. It is critical that they are at the centre of all the work going forward. I will indeed write to the noble Lord on his last point.

Independent Commission on Adult Social Care

Debate between Lord Kamall and Baroness Blake of Leeds

Wednesday 17th September 2025 Lords Chamber

[Baroness Blake of Leeds (Lab)]

In many ways, despite all the challenges, we are entering an interesting and exciting phase in terms of new technologies, digital awareness and understanding how we can better engineer communication, for example. The noble Baroness is of course absolutely right that everyone deserves to have access to those opportunities, but we need to make sure that everyone is known, their needs are known, and the support is there so that they can thrive.

[Lord Kamall (Con)]

My Lords, I just continue the theme that the noble Lord, Lord Laming, referred to about not writing people off. Quite often, when we try to help people into work, we talk about work, but there are many entrepreneurs who may not be able to get into work because of a mental or physical disability but are able to start businesses. Is the noble Baroness aware of an organisation called Purple Shoots? It offers loans of between £500 and £3,000 and mentoring to people to help them to start businesses. I met one person who had been helped; they were wheelchair bound, they took themselves off benefits, took eight other people off benefits and showed the positive role of entrepreneurship. The problem is that such organisations do not get any lottery funding. Can she speak to her colleagues in DWP and DCMS to make sure that organisations such as Purple Shoots and Trust Leeds, which she may know, get that sort of funding?

[Baroness Blake of Leeds (Lab)]

The noble Lord has made me aware of Purple Shoots on other occasions and, to broaden things out slightly, this links to the NHS 10-year plan in terms of shifting more resources into the communities so that organisations can thrive and benefit and reach people who need them. I am absolutely happy to pass on that information.

Minimally Invasive Cancer Therapies

Debate between Lord Kamall and Baroness Blake of Leeds

Thursday 24th July 2025 Lords Chamber

[Baroness Blake of Leeds (Lab)]

The noble Baroness makes an incredibly important point. It is not just in this area that we have shortages in specialisms. The Government are committed to creating a much better environment for resident doctors moving through the process into specialisms and to giving them support. There is a whole raft of work, which I cannot go into now, on how we can make sure that those programmes are smoother, speeded up and more equitably spread around the country—to pick up on the important point regarding this type of specialism.

[Lord Kamall (Con)]

My Lords, I also thank the noble Lord, Lord Aberdare. I pay tribute to him and wish him a happy retirement. Only yesterday, he managed to offload two single-use defibrillators on to me as part of his clear-out. I thank him for introducing me to the world of defibrillators.

In speaking to charities that represent those with less survivable cancers, I am told that one reason why they are less survivable is that they are spotted only at stage 3 or stage 4—quite often too late to survive. However, there are a number of tests which could spot some of those cancers; for example, I was told about a trial of a breathalyser test that could identify certain biomarkers and has huge potential. As the APPG on Less Survivable Cancers says, that early diagnosis could save thousands of lives a year. What is the department doing to ensure that trials of such tests that are promising are conducted as quickly and as widely as possible so they can be introduced sooner if they prove safe and appropriate to identify these cancers?

[Baroness Blake of Leeds (Lab)]

The noble Lord has identified an unexpected spin-off of being a Minister or shadow Minister in this place.

The noble Lord makes a very important point. The fundamental basis of the 10-year plan is how we move to earlier diagnosis, with the three shifts, including moving treatment into the community. I have had personal experience; for example, where men who have been shy about going to a GP with concerns about their breathing have been taken out the GP route and allowed to go straight to a local X-ray department, where early stages have been picked up. All those innovative means already being used need to be rolled out. That is why the 10-year strategy is focusing on early prevention, shifting services to the community and making sure that we free up space within the acute sector for specialist services.

Independent Commission on Adult Social Care

Debate between Lord Kamall and Baroness Blake of Leeds

Tuesday 22nd July 2025 Lords Chamber

[Lord Kamall (Con)]

To make it easy, I will resolve it.

My Lords, I take this opportunity to pay tribute to the late noble Lord, Lord Lipsey. He was on the Royal Commission on Long-Term Care of the Elderly in 1998. Many noble Lords may not know this but, before he passed away, we were working on a cross-party proposal to raise awareness of existing later-life insurance products offered by mutuals and private insurance, so that taxpayers fund only those without sufficient assets or those who lived beyond the coverage of the insurance—usually five years. Can the Minister assure us that, whatever the Casey commission proposes, given that we are looking at solutions in the short term, the Government will raise awareness of later-life insurance products currently offered by mutual and for-profit insurers, especially for those who cannot wait for the Casey commission to report?

[Baroness Blake of Leeds (Lab)]

I thank the noble Lord for making reference to the work of our noble friend Lord Lipsey, who will be greatly missed on all sides. I cannot pre-empt what the noble Baroness, Lady Casey, will say—I have made that point repeatedly; it is absolutely right. The noble Lord raised an interesting point of view. I am sure he will take every opportunity to feed that into the work that is ongoing.

Duchenne Muscular Dystrophy: Givinostat

Debate between Lord Kamall and Baroness Blake of Leeds

Tuesday 22nd July 2025 Lords Chamber

[Baroness Blake of Leeds (Lab)]

The noble Baroness raises a very interesting point. The drug companies will provide the drugs for free, but it is down to individual trusts to pay the administrative costs. She highlights that one boy in one trust is being supported, while another boy is not. It is a difficult situation; I completely understand that, and my heart goes out to all the young people who suffer from this dreadful disease. It is critical that the trusts work together and look at other practice. It is not for the Government to intervene and force trusts to do as the noble Baroness proposes. However, if they choose to do so, companies can provide funding to enable the clinical administration of their products in advance of the NICE decision. Perhaps the noble Baroness could go back and recommend that as a course of action.

[Lord Kamall (Con)]

My Lords, we heard from the noble Baroness, Lady Kramer, that there is an early access programme for a new treatment of Duchenne muscular dystrophy in the UK. Can the Minister share any intermediate observations or results from the early access programme? As the noble Baroness, Lady Kramer, asked, are there any plans to extend or expand it?

NHS England: Staff Costs

Debate between Lord Kamall and Baroness Blake of Leeds

Monday 21st July 2025 Lords Chamber

[Baroness Blake of Leeds (Lab)]

My Lords, the evidence for that is becoming only too clear. That is why the Government have taken the action that they have to move at pace towards dealing with the situation. Too much money is going into bureaucracy and therefore not enough into front-line services. That needs to change, and this has been welcomed from all sides of the House.

[Lord Kamall (Con)]

My Lords, following the previous questions, I am sure that many noble Lords would agree with reducing staff, especially where there is duplication or where it may make more resources available for front-line staff. However, given that there was no impact assessment before the announcements were made—as the noble Lord, Lord Scriven, said, and as the noble Lord, Lord Hunt, has called for—will the Minister tell the House how the Government will ensure that front-line services will not be impacted, especially in areas of high deprivation?

[Baroness Blake of Leeds (Lab)]

There is an absolute commitment running throughout this that front-line services will not be affected by the work that continues. The decision was taken to move swiftly, and impact assessments will be done as we go through the journey. The Government have also committed that this will be as transparent a process as possible. Parliament will be kept fully apprised of the work that is done, particularly of how front-line services are being protected.

Weight Loss Medication

Debate between Lord Kamall and Baroness Blake of Leeds

Monday 21st July 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I want to follow up on what the Minister has just said and the previous question from the noble Baroness. As we have heard from the personal testimonies of noble Lords, these medications have the potential to reduce obesity and the long-term cost to taxpayers. Unfortunately, a recent study by the MHRA has found that a group of these drugs, including Mounjaro, Wegovy and Ozempic, may be associated with health problems such as inflammation of the pancreas.

Given that, and some of the previous questions, first, what assessment of the long-term impact on health have the Government made of these weight-loss medications? What data do they have as of now, and what data are they waiting for? Secondly, as the noble Baroness, Lady Boycott, said, how do we ensure that, when patients come off these medications, they do not just put all the weight back on? How do we make sure that they are part of a wider programme to keep the weight off?

[Baroness Blake of Leeds (Lab)]

Quite a few points were made there. I think the noble Lord is referring to reports about acute pancreatitis, for example. The MHRA has done a thorough review of the suspicions around these medicines. No new safety concerns were identified but, every time something comes up, it will be looked into. The noble Lord is absolutely right that we need to support the longitudinal studies that are happening, but going on beyond the initial licensing will also be critical. As I answered previously, work in other areas to encourage healthy lifestyles will be ongoing, and this will need to be taken seriously by patients from a very young age.

Advertising Restrictions on Less Healthy Food

Debate between Lord Kamall and Baroness Blake of Leeds

Monday 14th July 2025 Lords Chamber

[Baroness Blake of Leeds (Lab)]

The noble Baroness is right, and I have alluded to this in my previous answers. The issue of tackling obesity is multilayered and complex. We have the evidence based on experience that working with families and creating excitement around healthy food is incredibly important. One of the most important things we have done, just in the last week or so, is announce mandatory healthy food sales reporting, making sure that shops take responsibility. It is heartbreaking walking into big supermarkets and seeing the amount of shelving space dedicated to attracting young people that, quite frankly, does not live up to healthy eating standards.

[Lord Kamall (Con)]

My Lords, as a number of noble Lords have said during this Question, there have been many top-down efforts over the years to reduce unhealthy eating and obesity, but they have all had variable levels of success. Noble Lords have said that it is important that we work with local families. Some of the best organisations, such as BRITE Box or FEAST With Us, which work with local families to help them eat healthily on a budget, are doing fantastic work in our local communities. Rather than always top-down solutions and bans, what are the Government doing to work with local community organisations to ensure that they get to families to help them to budget and eat healthily?

[Baroness Blake of Leeds (Lab)]

I completely agree with the noble Lord and I have personal experience from my background. It is empowering when a parent presents at a community organisation with a child who has an eating disorder or who is becoming obese, and they work together through cooking, education and shopping. All those things are fundamental and they need to be reinforced in schools, and I agree with the noble Lord that we need to tackle this on all levels. We obviously have to have the top-down measures that we were talking about earlier, but changing habits is going to be transformational.

NHS 10-Year Plan

Debate between Lord Kamall and Baroness Blake of Leeds

Wednesday 9th July 2025 Lords Chamber

[Lord Scriven (LD)]

My Lords, we on these Benches welcome the Minister to her place. I know that, when I say that we hope that she is not too long in her place and that the noble Baroness, Lady Merron, is with us again soon, she will understand that I say it in the nicest possible way.

From these Liberal Democrat Benches, our unwavering commitment to the NHS remains absolute. We welcome any stated ambition to improve the health service, particularly with a focus on prevention, leveraging technology and moving care closer to people’s homes. However, our support is contingent on plans being genuinely deliverable, properly funded and, crucially, addressing the interconnected crisis in social care. We have long championed that you cannot fix the NHS without fixing social care.

I confess that, as I read the Government’s new 10-year plan, a familiar echo resonated through my mind. Having started my career in the early 1990s as a manager in the health service, much of what is proposed sounds eerily familiar. This plan speaks of a network of new neighbourhood-based care that provides services between general practice and traditional general hospitals. This mirrors strikingly similar initiatives from previous governments—echoing, for example, the advocacy of the noble Lord, Lord Darzi, for polyclinics in 2007.

What does history teach us about such wholesale shifts of care from hospital? It tells us that this inevitably involves running the old and new systems simultaneously, which is, without exception, expensive. Hospitals will continue to perform their essential functions, and their fixed costs will remain. The new community service demands significant new investment in buildings, staff and technology, and there are no immediate savings to fund the shift. Let us not forget the stark reality: we currently lack the capital simply to repair our existing crumbling health estate, let alone build numerous new hubs.

Crucially, for any plan that speaks of shifting care out of hospitals, the most frequent users of the NHS are our elderly population. Keeping them well and out of acute settings profoundly depends on effective social care, yet this essential pillar remains largely absent from this new plan. We search in vain for a decade-long funding and development road map for social care, or for a stand-alone, fully resourced social care strategy. This is a crucial strategic failure, undermining the very foundation upon which this shift to community is based.

Moreover, while the enthusiasm for digital transformation is understandable, the detailed implementation plan of how to do it is absent. The app is a diagnostic tool; it does not provide direct care, it does not give the jabs and it does not provide the treatment. The King’s Fund has shared its concern on this:

“AI scribes can only transform the productivity of the NHS if staff don’t need to spend 30 minutes every morning logging into multiple out-of-date IT systems”.


The fundamental question remains unanswered: how will this be delivered? The plan is ambitious, but it has been launched into an incredibly chaotic delivery environment marked by significant structural change within the health system bureaucracy. The key question for the Government is how this will be delivered. I therefore have a few questions for the Minister.

What precise funding strategy is embedded within the 10-year plan to deliver the necessary reform and integration of adult social care? Given the dual running costs of new neighbourhood health facilities, can the Minister provide a year-by-year financial breakdown of expenditure and demonstrate how these investments will lead to overall system efficiencies and net savings? Will the Minister commit to publishing within the next four months a comprehensive, independently overseen delivery road map for this 10-year plan that details specific year-by-year objectives and names leads and mechanisms for public reporting on progress? While we wish the ambitions well, the key challenge for this Government is how they will deliver and being open and transparent on that.

[Baroness Blake of Leeds (Lab)]

My Lords, I also start by sending my very best wishes to my noble friend Lady Merron. No one more than me is looking forward to her making a very speedy recovery. I am very pleased to hear from her that she is making good progress, so we look forward to her return. I think it is appropriate that I declare an interest: my son is a GP, which I think is perhaps slightly relevant to the debate before us today.

To recap before I go into more of the details, I emphasise that this plan is different in so many ways to the NHS plans that have come before it. As we have heard, it is a road map for radical reform that is built on three fundamental shifts. Those of us that have been around the health agenda for a while recognise the past aspiration for some of these measures, but there was never a bold, innovative, collaborative plan to take our ambitions forward.

From hospital to community care, bringing care closer to home and making access to GPs faster and simpler is absolutely fundamental, particularly in the current climate—and from analogue to digital, giving staff modern tools and patients the kind of convenience and control they expect elsewhere in their lives. All of us have heard heartbreaking stories of patients who go from one specialist to another, and there is not that join-up. This has to be changed. There is no reason why this cannot apply across all the experiences the public have, regardless of where they are seeking services.

Many of us have been talking about the need to move to prevention in so many areas of life. Where better than people’s health, looking at the root causes of poor health and making healthy choices? It is the easy choice, but at the moment it is not that easy.

The new NHS has patients at its heart, will deliver equity and quality, is devolved and decentralised so that we are more responsive to local community needs and the front line is freed up to harness innovations, and the rules and incentives in the system support clinicians and lead us locally to be able to make the right decisions. This means that there is no simple chapter or section within the plan for individual conditions or groups setting top-down actions. The impact on particular services and outcomes will be through successfully transforming how our health ecosystem works. As we will come on to with the more specific questions, this is very much a work in progress. I am delighted by the reach the consultation has had over the last year. That has informed the debate and the outcome that is seen in the plan, so there have been no surprises. Many people who have been involved recognise what is in the plan.

The plan is backed by £29 billion per annum of extra investment by the end of the review period and, crucially, by a drive to cut unnecessary bureaucracy and empower front-line staff, giving them the tools to do what they do best: caring for patients.

I thank the noble Lord, Lord Kamall, for his very constructive comments; they were exceptionally helpful. Across the House, we all look forward to taking this extremely seriously and moving forward.

Turning to the comments of the noble Lord, Lord Scriven, on social care, he and I share a very positive background in local government, and nothing could be closer to our hearts than working out how we are going to bring the two together. That is fundamental. Both noble Lords made the point very clearly, and we welcome that.

Over the next three years, we will focus on the neighbourhood health approach to those most let down by the current system. That includes older people with frailty and those in care homes. Social care professionals will work alongside NHS staff in local teams, supporting recovery, rehabilitation and independence. We have examples from around the country where this is already happening: services are joined up and the cultural differences between the NHS and local government have been successfully broken down. We need to make sure this is replicated and spread to every part of the country. We need to enable care professionals to take on many more health-related responsibilities, such as blood pressure checks and reducing avoidable hospital administrations. Of course, pay terms and conditions have to be improved through fair pay agreements.

In the longer term, the noble Baroness, Lady Casey, will produce an interim report next week, but it is very much a work in progress.

[Lord Kamall (Con)]

It will be next year.

[Baroness Blake of Leeds (Lab)]

Sorry, I meant next year—I was just testing that everyone was still with us—in anticipation of the in-depth work she is already involved with. There will be cross-party discussions and a real engagement with stakeholders.

On the single patient record, I will have to write to the noble Lord about how the merging of the different systems will be achieved, but it will very much be about the patient being in control and giving a full picture for staff moving forward. The digital red book for children is absolutely fantastic.

On the shift to the community, as we have made clear, we will initially prioritise those living in areas of greatest deprivation. We will be opening neighbourhood health centres in places where life expectancy is low. There will be principles that we will follow, bringing all the multidisciplinary teams together.

On the fracture liaison service, I will have to respond in writing. I am sorry but I do not have the specific details in front of me.

Returning to the noble Lord, Lord Scriven, and his comments about social care, it is critical that we get this right and make sure that local leaders are right in there, responsible for delivery, proactive, providing a co-ordinated response and building on the work already being done.

On the funding, £29 billion is quite a significant amount of resource to work from. We recognise that there are challenges, and it would be wrong of me to pre-empt the work of the noble Baroness, Lady Casey. But I know she has been encouraged to work with the best of the best, and I look forward to the outcomes.

I have to finish—I am sorry; there is never enough time. Our health system is in crisis, and we need to act now. We must make sure that the NHS continues as a publicly funded service free at the point of use. We need to seize the opportunities provided by all the new technologies and medicines outlined in the plan, go forward with innovation and make sure that the patients are at the heart of everything we do.