Health Bill

Debate between Lord Stevens of Birmingham and Lord Hunt of Kings Heath

Committee stage
Monday 9th November 2026 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I find myself in sympathy with the noble Baroness, Lady Coffey, in her approach to Ministers’ ability to determine what happens in the National Health Service. Many of the amendments tabled, particularly when it comes to specific services, call for the intervention of the Secretary of State. That is very simple, because integrated care boards do not have any mechanisms for being locally elected, so their accountability is to the Secretary of State, and we cannot run away from that.

We have had power of direction in the health service since 1948. The Lansley Act modified it, and, although the wording has changed, we are essentially moving back to the original position. The fact is that the power of direction has been used very sparingly over the decades the health service has been in existence. It has rarely been required because in general, when Ministers or their officials are on the phone to the chair or CEO of those bodies, they understand that they need to do something—although I accept, as the noble Baroness, Lady Coffey, says, that there are some occasions when the additional powers in the Bill are probably required.

We really cannot have it both ways. If we want the NHS to be a national service, we know that the public do not accept that there should be variation. The very idea of a postcode lottery in this country is simply not accepted. It must follow that Ministers are accountable to Parliament, and therefore they must have the tools by which to determine the general way the health service is being run. There is a counterbalance. The reason why I am so pleased about the Healthwatch decision is that we need mechanisms at local level to secure some form of local input. But, ultimately, if we want a national health service, we have to accept that, in the unique way the NHS is funded and organised, Ministers need the tools to ensure that their accountability to the public is discharged effectively.

[Lord Stevens of Birmingham (CB)]

My Lords, I find myself in sympathy with the thrust of Amendments 39 and 40, but I want to draw your Lordships’ attention to some specific changes to the exceptions to the legal powers that the Secretary of State will have that are contained in the Bill. In 2022, Parliament decided that the Secretary of State should have a general power of direction over NHS England, which in turn would cascade through the system. In coming to that decision, the Government of the day rightly inserted three exceptions to the use of that power: a politician could not direct the individual treatment that a patient would get, who individually would be employed or not by the National Health Service or individual treatment availability.

For those who perhaps have not studied the text of the Bill in as much detail as I am going to now bore you with, I have to tell you that a very significant change is lurking in Clause 11, at proposed new Section 14Z62, specifying the exceptions. That is that, whereas the 2022 exception said that the Secretary of State could issue a direction about a specific medicine, treatment or diagnosis if NICE had said it should be available on the NHS, this Bill flips that and says that the Secretary of State can now direct what should or should not be available—particular treatments, particular medicines—in any situation where NICE has not opined on the topic. Given that the vast majority of treatments available on the NHS are not subject to a NICE appraisal or recommendation, that means we are giving a politician the ability to say, ex cathedra, “This treatment will not be available on the NHS; this type of diagnosis will not be available on the NHS.” This is a massive infringement on the medical autonomy and clinical judgment that we expect clinicians to be exercising across the NHS.

When one looks in the Explanatory Notes to see why the provision to amend the 2022 version has been proposed, answer comes there none. So this requires very considerable scrutiny, potentially on Report. I am not in any way detracting from the wisdom of the Secretaries of State that the health service has had in its history to date, but, as we have previously discussed, one has only to look across the Atlantic to the current US Health Secretary, RFK Jr, who has some pretty interesting personal views on vaccines. I will not list them: you can google them yourself. Were we to find ourselves with a future Secretary of State with a similar opinion set, does Parliament really want to grant that person the ability to strike out whole treatments or tests from the National Health Service? I would suggest not.

So that exception needs looking at. The other exception through which a coach and horses has been driven by this Bill is the exception that limited the Secretary of State’s power to the appointment or employment of a particular individual. Clause 37 allows the Secretary of State to fire named individual nursing directors and medical directors of foundation trusts. Again, we must ask ourselves, looking forward, whether that is something that we want or whether it is political overreach: in my opinion, it is.

--- Later in debate ---

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have given notice of my opposition to Clause 10 standing part of the Bill to probe exactly how the Government intend to use the clause. Reflecting on the three amendments tabled in group 1 by the noble Baroness, Lady Bennett, she was arguing for greater discretion at local level for NHS bodies; here, though, she wants to constrain them quite extensively. We are all guilty to an extent of ambiguity in this central-local relationship, which shows how hard it is to get the balance right.

I do not take an ideological approach to the use of the private sector in the health service, because we have seen some of the benefits. I think of how waiting times were virtually eradicated in the 2000s—we used the private sector quite extensively. The noble Baroness, Lady Murphy, illustrated the impact on cataract surgery as one example. However, I bitterly oppose the proposals of the noble Lord, Lord Lansley, which were enacted, for compulsory contracting out and competitive tendering. I believe that it is horses for courses. Where we think the private sector can add value to what the NHS can provide, we should use it, but there should not be an edict that you have to contract out everything or go through the mechanisms of competitive tendering and all the rest of it, which have proven to be so expensive and, in many cases, destructive.

Clause 10 is a bit of a puzzle—you can read it any way that you want. It could be used to increase the amount of private sector provision or, equally, to reduce it. In what circumstances will it be used? Will there be any guardrails around its use in the future, by which I mean in the years ahead, when we may have Governments with a different approach? The Explanatory Notes do not make clear how it would be used.

[Lord Stevens of Birmingham (CB)]

My Lords, the noble Lord, Lord Hunt of Kings Heath, has nailed it. Essentially, Clause 10 says that the Secretary of State must not do something unless the Secretary of State thinks that it is a good idea—it does not matter whether a good idea is construed as being in the interests of the health service or patients. Any Secretary of State thinks that all their ideas are good, so that is an unrestricted new power.

If the Government do not like Section 12E of the NHS Act 2006 then they would be better zapping that section rather than introducing this clause amending it, which, for the reasons that the noble Lord, Lord Hunt, has given, would be an ideologue’s charter. Under these powers, a Secretary of State could determine that all elective surgery should be done only by private hospitals, and that would be consistent. Another Secretary of State could decide the exact opposite, or they could decide that no NHS-funded terminations of pregnancy will be done by the independent sector. Since that is 81% of terminations in this country, the NHS would not be able to cope, and that would then constitute a massive restriction on terminations of pregnancy.

You can have your own ideological view on whether these are good or bad things, but that is what this clause permits. Therefore, contrary to what the noble Baroness, Lady Bennett, says, it does not lock in the status quo but produces the possibility of quite extreme swings on the part of future Governments. This Government should remember that what is sauce for the goose will be sauce for the gander.

Health Bill

Debate between Lord Stevens of Birmingham and Lord Hunt of Kings Heath

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I take a rather different view from that of the noble Lord, Lord Patel. We need to look back at the foundation of the hospice movement—it was founded within the charitable sector. It has always been valuable that a lot of the funds to run them have been raised by hospices themselves. That has given them a certain degree of independence, which they clearly would not have if they were funded entirely by the state. It also meant that they brought innovation into palliative care in a way that directly funded services would have found difficult.

There is, however, a need now for more support from government. I acknowledge and welcome the resources the Government have put in in the last two years. I hope my noble friend can say when the framework is coming. As I understand it: one of the issues about hospice funding is that it is so hand to mouth. For some reason ICBs, and their predecessors, have seemed to be incapable of giving longer-term contracts and certainty—they always give short-term contracts and operate hand to mouth.

In a sense, this takes us to the heart of the Bill. So many of these amendments are really because we do not trust ICBs to do the job properly. Their main focus is on waiting times and financial performance. With the huge variation in the funding of palliative care, can we have any confidence that, even with the modern framework, we are actually going to get a more comprehensive package of long-term services for hospices?

Of course, there is a wider challenge of palliative care in the NHS itself, which the noble Baroness, Lady Finlay, referred to. Some reassurance on the hospice issue—that the framework, when published, will mean that ICBs have to sort this out, that they have to give long-term certainty and deal with some of the variation in funding that we see at the moment—would be welcome.

[Lord Stevens of Birmingham (CB)]

My Lords, the noble Lord, Lord Patel, spoke movingly and others spoke powerfully to make the case for palliative and end-of-life care, and I will not seek to repeat what they said. The whole of Parliament has expressed that view extensively over the last 18 months.

I will comment briefly on whether the provisions should be in the Bill or should rely on action by the Government. I anticipate that the Minister will make the case that this does not need to be specified in primary legislation; it can be done by an administrative or political act from the Department of Health and Social Care. I believe that to be the case. In principle, there is no need for new Secretary of State powers or administrative reorganisation to allocate funding to meet unmet need in palliative and end-of-life care. However, the question before the Committee is: are the Government actually going to do it? What we can do is give the Minister a bit of leverage inside the department between now and Report by perhaps sending a signal that if the modern service framework for palliative and end-of-life care has not emerged by then, it is possible that your Lordships’ House will take a more stringent view on the need for primary legislation.

The Minister told us in writing on 4 June that we will see this modern service framework for palliative and end-of-life care in the autumn—as the noble Baroness, Lady Coffey, pointed out. We are now in November: the nights are drawing in; the clocks have gone back; Guy Fawkes night is this week; and Halloween has been and gone. Is the promise of an autumn modern service framework trick or treat?

Health and Care Bill

Debate between Lord Stevens of Birmingham and Lord Hunt of Kings Heath

Lords Hansard - Part 1 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, would the noble Lord be surprised to hear the rumours that the Treasury has prevented the Minister from responding in a positive way to this amendment?

[Lord Stevens of Birmingham (CB)]

We await insight from the Minister himself on that point; it is indeed, of course, what the chairman of the cross-party Health and Social Care Committee, Jeremy Hunt, suggested in the House of Commons. We have an immediate litmus test before us, which should help us answer the question posed by the noble Lord, Lord Hunt. As your Lordships will remember, we noted in Committee the fact that, just 10 weeks before the start of the financial year, when it should have been planning 10 years out, Health Education England still did not have its operating budget for the year ahead. My understanding—I hope to be corrected by the Minister—is that, certainly, as of 10 am, Health Education England still does not have its workforce operating budget for just 29 days’ time. That is precisely because of a set of behind-the-scenes discussions—no doubt courteous, but nevertheless fervent—between the Department of Health and Social Care on the one hand and the Treasury on the other.

Health Ministers are more sinned against than sinning on this, frankly, and in that sense this amendment will strengthen their hand. I suspect that, privately, they will welcome the mobilisation of your Lordships to support their negotiating case. The very fact that Her Majesty’s Government oppose this amendment is proof positive that it is needed. We need it because we need to look beyond the end of our noses. To vote against this amendment would be to cut off our noses to spite our faces.