Health Bill

Baroness Rafferty Excerpts

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Baroness Harding of Winscombe (Con)]

My Lords, it is a privilege to follow the noble Lord, Lord Mawson, and the noble Baroness, Lady Gerada, who between them have many decades more experience than I do of NHS and health and care reorganisation. I have only one major experience from the inside: the last time we were debating the restructuring of the NHS in 2021-22. At the time, as someone from the private sector, I was somewhat surprised to discover that the NHS got on with the reorganisation before the legislation was passed. It is even odder this time: the NHS has started before the legislation but without a plan itself.

Therefore, I welcome this amendment from my noble friend Lord Howe. It is essential that we understand the plan and the timetable, what it will cost and what benefits it will bring. It really is very straightforward. If that does not exist, the idea that it can be complete by 1 April next year is completely gobsmacking. Maybe I am just an innocent businesswoman who does not understand the ways of the NHS, but it just does not seem right. I think this amendment is basic common sense.

Much as I hear the words of wisdom from Don Berwick, I support merging NHS England with the Department of Health. I saw from the inside, particularly during Covid, how important it is to have clear political accountability. I support the basic premise, but I am very worried that the tendency will be to centralise rather than to push resource out to the regions and local communities. As the noble Lord, Lord Mawson, just said, it is at the local ground level that change really happens.

I am very supportive of seeing fewer people employed in organisations that bear the NHS brand but do not actually treat patients. There are tens of thousands of people who are all trying hard and doing valuable work, but they are a long way away from patients. As we bring NHS England into the department, I would love to see, as part of this amendment, a clear breakdown of the cost savings at the national, regional and local level, so that we have sight of whether we are really pushing accountability, and resource and capability, down to where change will bring the benefits that we all seek.

[Baroness Rafferty (Lab)]

My Lords, I will be brief. I support the point made by my noble friend Lord Hunt that the Minister should reconsider the abolition of governors. I have to declare an interest as a former governor of King’s College Hospital NHS Foundation Trust. I spoke at Second Reading about the value of governors and the extraordinary breadth and depth of feedback and accountability that they provide to trusts. We just ask the Minister to reconsider that decision, for I fear that, if governors are abolished, we will have to find some mechanism to reinvent them.