Health Bill

Debate between Lord Stevens of Birmingham and Earl Howe

Committee stage
Monday 9th November 2026 Lords Chamber

[Lord Stevens of Birmingham (CB)]

Certainly. The 2022 Act says that a direction

“may not be given”

by the Secretary of State

“in relation to the provision of any drug, medicine or other treatment, or the use of any diagnostic technique, unless NICE has made a recommendation or issued guidance as to its clinical and cost effectiveness and the direction is not inconsistent with that recommendation or guidance”.

NICE has to have set out its stall and, if it has, the Secretary of State can direct on the back of it. What the Bill says is that, in any case where NICE has not set out its stall, the Secretary of State has complete freedom to form a personal view about what should or should not be available on the NHS.

[Earl Howe (Con)]

My Lords, I am most grateful to the noble Lord, Lord Scriven, and other noble Lords who have tabled these amendments. They all raise important questions about the balance of powers and accountability within our health service. I listened carefully to the remarks of my noble friend Lady Coffey and will of course reflect on them appropriately. In general terms, I share the concerns that underpin these amendments, particularly around the danger of overcentralising power and what could become a distorted balance of responsibility between the Secretary of State, the Department of Health and Social Care, integrated care boards and local healthcare providers. The noble Lord, Lord Stevens of Birmingham, put his finger on some worrying features of these powers.

We have tabled amendments of our own that seek to address some of these concerns from a slightly different perspective, which we will debate in the next group. I will not therefore detain the Committee for too long, but I would like to make a few broad observations.

First, the relationship between national and local healthcare governance following the abolition of NHS England will be an enormously important one to get right. As my noble friend Lord Kamall and I emphasised at Second Reading, there is a question mark around accountability—not just the balance of accountability but the need for clarity on where accountability lies and where responsibility will ultimately lie when things go wrong. We cannot have a situation in which services are failing to meet their objectives or patients are not receiving the care they need and integrated care boards and the Secretary of State are pointing fingers at each other. If an integrated care board is expected to deliver particular services with well-defined outcomes but Ministers then exercise their powers to direct how the board exercises its functions, it is very difficult to see how anyone can be clear about where responsibility lies for the quality, accessibility or cost-effectiveness of those services.

There is also a wider tension at the heart of the Bill and a certain incoherence in how Ministers have presented the Bill as a whole. The Minister may enlighten me on this, but the Government have spoken at some length on the importance of localism and the benefits of allowing decisions about healthcare to be taken closer to the communities which those services exist to serve. I do not think anybody would argue against that as a sound principle.

Local healthcare leaders will usually be better placed to understand the needs of their populations, the pressures facing their services and the most effective ways of using the resources available to them. But if we believe that, we surely cannot simultaneously favour legislating for the kind of open-ended and all-encompassing power of direction such as that set out in Clause 11 of the Bill. Powers of direction are necessary on a limited basis as reserve powers. For example, I entirely see the case for them in a situation where an ICB may be failing to perform its legal functions or is at severe risk of doing so. I can also see the argument for a power of direction in relation to locally commissioned specialised services where unacceptable variation in provision occurs between different ICBs.