Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026

Lord Lansley Excerpts

Wednesday 15th April 2026 Grand Committee

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

My Lords, this statutory instrument makes an important change. It will amend the 2014 regulations so that the treatment of disease, disorder or injury, known as TDDI, is brought within the regulatory scope of the Care Quality Commission. This change will be for the treatment of disease, disorder or injury provided in sports grounds or gymnasiums, or under temporary arrangements at sporting or cultural events, where it is delivered for the benefit of those taking part in or attending those activities.

Let me start by clarifying what this is and what it is not. This regulated activity relates not to the task being carried out but to who is doing it. It is the assessment and treatment of physical or mental state when provided by a specifically defined list of healthcare professionals, as per the CQC’s website. The scope of this activity requires those carrying it out to be listed healthcare professionals registered with the appropriate professional body, such as the General Medical Council, the Nursing and Midwifery Council or the Health and Care Professions Council. When a healthcare professional uses their professional title, qualification and skills to assess and treat a person for a disease, disorder or injury, they must be registered with or employed by a company registered with the CQC.

Providers carrying out the treatment of disease, disorder or injury at events may include independent ambulance services that employ paramedics, doctors and nurses, and which are commissioned to attend an event such as a music festival, marathon or football match and be on hand in case anyone there experiences a medical emergency.

Perhaps I can give some context. Members will recall the tragic events of 22 May 2017, when the Manchester Arena bombing killed 22 people and injured more than 1,000 others. The subsequent inquiry uncovered serious failings, including inadequacies in the provision of healthcare services at the arena. The inquiry noted that these shortcomings may have been present at other venues across the country, in part because of the absence of appropriate regulation. A central finding of the inquiry was absolutely clear: the Department of Health and Social Care should consider changes to the law to enable the CQC to regulate healthcare delivered at events. The CQC has itself outlined additional concerns about the quality of care provided at events. It has heard serious allegations of unregulated provision resulting in severe patient harm.

The Government, as noble Lords would expect, are committed to acting on the inquiry’s recommendations and strengthening public safety. I recognise that these changes are overdue, but it was important that they be carefully considered in order to understand the impacts. I am pleased that they have now been laid before us.

To turn to what the amendment will do, the 2014 regulations exempted the treatment of disease, disorder or injury provided at sports venues or gymnasiums or under temporary arrangements from regulation. This SI removes this exemption. It will bring the provision of this treatment at events into line with provision in hospitals, clinics, ambulances, GP surgeries, community services and care homes where it is already registered. This means that any provider delivering the treatment of disease, disorder or injury at an event must register with the CQC and must comply with the same robust regulatory standards that apply elsewhere in the health system. Of course, some of the providers will already be registered to provide this treatment in other settings, which will make the process quicker for them.

I should say to noble Lords that there has been some misunderstanding about what is covered by

“the treatment of disease, disorder or injury”.

It includes a wide range of treatments, from emergency interventions to ongoing care for long-term conditions. I wish to be clear that the treatment of disease, disorder or injury does not include first aid. First aid remains outside the scope of CQC regulation.

By making these changes to the 2014 regulations, the Government will make true our commitment to fulfilling the recommendations of the Manchester Arena inquiry and the drive to improve patient safety. I beg to move.

[Lord Lansley (Con)]

I shall speak briefly to this statutory instrument and ask a number of questions, if I may, to which I hope the Minister will be able to respond. I think that I understand the structure of what is proposed and the exclusion of first aid so that it is not covered, but when I look at the providers that are likely to be affected, I am trying to work out carefully which are the providers concerned. I am assisted by a friend who is part of the Faculty of Sport and Exercise Medicine and who said that it had undertaken a survey.

It seems to me that many of the people who responded to that as healthcare professionals may well be working in registered providers already, so they may be concerned about the need to register in relation to the services that they provide at events but in fact they do not need to register. However, the event organisers themselves may need to register if they bring healthcare professionals on site in order to provide services that go beyond first aid at their event. I am trying to understand how, when the department went out and identified 89, or whatever the number was, potential providers that were not already registered, it ended up with a figure of 36, which seems very low. It certainly bears no comparison to what those who are working in the sector believe would be the number of presently unregistered providers. We need to understand who these 36 are, the character of those providers that the department has identified and why there is such a discrepancy between that and what others have been saying. I would be grateful if the Minister would tell us much more about that.

As a practical example, are all football clubs, or the major football clubs in the Premier League, the Championship and so on, already registered with the CQC? Clearly, they, as organisations, provide continuing healthcare to their players. Do we not need to worry about any of that? Is an event like one of the big festivals that take place already registered, because it has put a team together in order to provide more than simply first aid? Perhaps we are worrying about a need for registration when actually we do not need to worry so much.

I have only one other question. An essential part of the follow-up to the Manchester Arena inquiry was the preparation of an event healthcare standard. Would the Minister be kind enough to update us on that process? Where does it stand and when might we see its publication for consultation?

[Baroness Harding of Winscombe (Con)]

My Lords, I will also ask a few questions. I declare my interests as the senior steward—namely, the chairman—of the Jockey Club and as the mother of an elite athlete.

I spent last weekend at two quite different sporting events, juggling my time between the Grand National and the Home Internationals lacrosse competition, as my daughter played for England for the first time— I did check with her that I was allowed to mention that in the Grand Committee. I mention them both because while one is really a grass-roots sporting event—it has a small crowd, but none the less there is an ambulance in attendance because it is a potentially dangerous sport—the other, the Grand National, is the second largest attended sport in the country and the second most watched sporting event on television. As I understand it, both are captured by the same changes being proposed today.

I express my condolences to everyone who was affected by the tragedy at Manchester Arena. In no way do I want to suggest that the questions I am posing negate the need to address the recommendations of the public inquiry. It is hugely important that we learn the lessons.

First, I took some time to speak to a former chief medical adviser of the British Horseracing Authority, Dr Jerry Hill, who told me that a clear standard of healthcare for events is an extremely positive move. I put on record that I wholeheartedly support the event healthcare standard. I understand that there has been good consultation on the draft and that, in Dr Hill’s view, it will help event medics fight their corner for resource. He told me that, at the moment, event medics often feel that they are behind Portaloos and security in priority at events. It is important that we recognise that we need that standard.

However, in moving from that standard being guidance to putting it on a statutory footing—I appreciate that this SI does not do that, but it sets us on that path—we need to evaluate formally whether the draft is effective. As I understand it, the DHSC was somewhat swamped by people wanting to participate in evaluating the draft, and that it was perhaps not following the more scientifically robust approach that a number of sports suggested—I think two focus groups were planned to evaluate the draft. Can the Minister assure us that that event healthcare standard will be evaluated to a scientifically robust standard rather than that of a more politically normal focus group? It is very important that we get it right.

Secondly, I also understood that, as my noble friend Lord Lansley says, the CQC’s initial impact assessment had claimed that only 36 healthcare providers would need to register. Horseracing alone thinks that we have 350 individual clinicians who would need to register, even allowing for the fact that each clinician tends to work in three different sports. Potentially, the Faculty of Sport and Exercise Medicine UK’s estimate of 23,000 is an overestimate. Even if it is one-third of that, it is still massively more than the CQC expected.

I also understand that, in November 2024, the CQC said that it had a maximum capacity to register new providers of 1,000 per year. If we are not very careful, with all the best intentions we will be setting up a bureaucratic quagmire, which will mean that events, big and small, will not be able to find suitably registered clinicians to support them. What assurances can the Minister give us that the CQC can cope with the workload? Has the CQC recruited, or does it intend to recruit, anyone from the sports or cultural events sector? In the past, the CQC has had, in maybe more traditional healthcare settings, a bad habit of sending non-specialist inspectors—my noble friend Lord Lansley is laughing at that, but it is serious business. The best example I have is of occupational therapists being sent to inspect ambulance services.

What assurance can the Minister give us that the CQC is going to recruit the suitable expertise to deliver on this important obligation? Where will it sit in the priorities of the CQC which, after all, has an awful lot of important work to do? It currently has an interim chief executive and a chairman who wants to leave, so I am nervous about quite so much going on to the CQC. I support others who have called for pragmatism in the implementation of these regulations to allow time, if the CQC is struggling to put the resource to them that they need.

--- Later in debate ---

In bringing my comments together, I emphasise that point on which there has been a lot of concern. We have been working with stakeholders and will continue to do so; we understand the principle but we want to get this right.

[Lord Lansley (Con)]

I am grateful for the offer of further discussions and a round table, but there are several numbers relating to the number of providers that might be anticipated to require registration. We keep coming back to this figure of 36 in the impact assessment, but I do not understand exactly who those providers are. For example, I imagined it would probably be football clubs but it turns out that it is not. Who are they exactly?

The Minister and the department in their impact assessment have moved from that figure of 36, which presumably had some substance, to a guess of somewhere between 100 and 1,000, which, as my noble friend said, is a very high degree of uncertainty. I still do not know—if there were to be as many as 1,000—who these providers are and how many, for example, would be small charitable organisations or small, sporting voluntary organisations for which £1,000 is not a small matter.