Health Bill

Baroness Grey-Thompson Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, I have Amendments 57, 73 and 80 in this group and will also speak briefly to Amendment 58, which is about allergies. Natasha’s Foundation submitted thorough and useful information to the task and finish group that I ran for the Department for Transport on improving aviation for disabled people. There needs to be more consideration of this area. Obviously, there is much movement, but there are still many issues.

The principle behind my amendments is national protection for all specialised services regardless of whether they remain nationally commissioned or transfer to integrated care boards. Patients must not lose safeguards because the identity of the commissioner changes. Nationally consistent standards, oversight, quality assurance and accountability must be statutory safeguards, not optional administrative assurances. Local flexibility must not become local inequality.

Amendment 57 says that a national framework is needed. The current wording may be narrower than the intended protection for all specialised services, but I seek ministerial assurance on how the universal principle will be secured. Some highly specialised services require dedicated condition-specific national frameworks. Generic service specifications cannot always protect the expertise, pathways and critical mass that they need. Amendment 73 seeks annual reporting to Parliament, which must cover all specialised services irrespective of the commissioner, so that changes in access, quality, outcomes and variation remain visible. Amendment 80 seeks clear national assurance and Secretary of State accountability; these are needed, including where commissioning responsibility sits locally.

It is important to have a robust impact assessment before any transfer happens, looking at clinical risk, patient safety, equity, workforce, specialised networks, financial sustainability and the effect on smaller patient populations. I am specifically interested in those with spinal cord injuries. I do not have a traumatic injury; I have spina bifida. Spinal cord injury services illustrate the stakes. There can be complex lifelong needs, but there is a limited number of specialist centres and there are risks of fragmented pathways to rehabilitation and follow-up. Government-NHS England discussions about a wider framework are welcome, but policy commitments can change and Parliament should secure enduring duties. I thank the Minister for the letter we received this morning and look forward to more information on commissioning, but how will universal coverage, condition-specific protections, enforceable national oversight and transparent parliamentary reporting be guaranteed?

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have Amendments 58 and 71 in this group and I have added my name to Amendment 59 from the noble Baroness, Lady Pidgeon. I endorse everything that the noble Baroness, Lady Grey-Thompson, has said. At heart, the issue is that there is a lot of concern about ICBs’ ability to discharge the commissioning responsibilities they are being given. I refer my noble friend to a report on wheelchair commissioning issued this morning by the Public Service Ombudsman. She has used individual complaints to produce a thematic report on the effectiveness of ICBs in commissioning wheelchair service. She has found that ICBs are absolutely hopeless at doing this.

We will debate wheelchairs later in the Bill, but we then turn to allergies in my Amendment 58 and, again, one sees a depressing picture. It is a mammoth issue. More than 20 million people and approximately 40% of children have been diagnosed with an allergy. Any parent or grandparent knows the difficulty of getting access to the system. The National Allergy Strategy Group, to which I pay great tribute, has produced a framework which will ensure much better commissioning of the provision of services. It found that only 26 of England’s 44 ICB areas have a local adult allergy service. It makes you wonder why on earth we do not have an allergy service in each part of the country. Then you come to the specialist services, which are often represented by small NGOs that have no chance whatever of relating to ICBs. That is why they want a national commissioning process, because that is the only way that they can expect to be heard.

ICBs do not have the reputation of being open. They do not often respond to representations made to them. In fact, they have little contact with parliamentarians. This is at the heart of why there is concern about this process. The Government’s decision to reduce management costs also brings concerns about their capacity. In the end, we all want some assurance that ICBs will be beefed up and that the unit which the noble Lord, Lord Lansley, referred to is going to do the job for many of them, because what is the point of all these ICBs trying to reinvent the wheel? Why not produce some standardised commissioning and then help them commission and monitor it? That is where you get the benefit of what the Government are seeking to do, in delayering and reducing management costs and bureaucracy, but it has to be done in a way which does not leave all these services at the mercy of very varied ICBs.