Health Bill

Earl Howe Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Baroness Pidgeon (LD)]

My Amendment 219 addresses the deeply concerning and increasingly common practice of corridor care. No patient should be left receiving treatment, assessment or prolonged care in a corridor simply because there is nowhere else for them to go. A friend of mine only a couple of weekends ago showed me a picture of a relative in hospital, who was in a corridor. This is absolutely unacceptable. As we heard from the noble Baroness, Lady Finlay, it was on the news again today. Corridor care undermines patient dignity, compromises privacy, increases clinical risk and places additional strain on hard-working NHS staff who are trying to deliver safe care in environments that were never designed for that purpose.

We all recognise the immense pressures our hospitals are facing, from rising demand to workforce shortages and delayed discharge, but corridor care must never become normalised, as I fear it has, as an acceptable feature of our health service. Dr Ian Higginson, president of the Royal College of Emergency Medicine, has described corridor care as

“dangerous, undignified, and a source of national shame”.

Survey data published by the royal college only on 20 July shows that 61% of clinical leads in England said that their trusts did not even capture corridor care accurately, with many saying that patients who were on chairs and in waiting rooms waiting for admission were not counted towards their corridor care figure.

There is significant variation in reporting between hospitals and emergency departments. Consultants are concerned about patients who wait on chairs in waiting rooms, off-the-clock assessment units and the repurposing of space as “non-corridor” places, where they put chairs so that patients can wait and not be counted. I have even been told of somebody being sat on a chair in a cupboard because that would not count towards corridor care figures. This is also not counting patients waiting in ambulances or on corridors on the way into departments. It is simply unacceptable. This amendment would help shine a light on the true scale of the problem and support genuine efforts to ensure that patients are treated in appropriate clinical settings with the dignity, safety and respect that every person deserves when they turn up to their hospital in their time of need. We need this to lead to the end of this practice.

My Amendment 229 seeks to address another visible symptom of the pressures that our National Health Service faces: the growing difficulty in securing timely admission from accident and emergency departments into appropriate hospital beds. When patients have been assessed and a clinical decision has been made that they require admission, prolonged waits in A&E not only are frustrating but can lead to poorer outcomes, increased risk to patient safety and greater distress for patients and their families. These delays also contribute to serious overcrowding in emergency departments, making it harder for clinicians to deliver care to all those who come through their doors. While we know that the causes are complex—bed capacity, workforce shortages, which we talked about earlier, and the difficulty of discharging medically fit patients into the community and social care settings, as we heard from the noble Baroness, Lady Finlay—we should be clear that long waits for admission are just not acceptable.

This amendment would provide greater transparency and accountability and help ensure that the health system focuses on reducing delays and delivering the safe, timely and dignified care that patients have every right to receive. Putting this right in the NHS constitution would focus efforts and make sure that we address this serious issue. We do not want patients avoiding A&E because they fear endless hours of waiting. We know that is happening; we hear about it. Sorting out admissions and ending corridor care would transform the patient experience and, most importantly, patient outcomes.

The amendment tabled by the noble Lord, Lord Patel of Bradford, on prohibiting minimum waiting times is important. We discussed this in a group only last week. We need to see waiting times minimised and patients receive the diagnostics and treatment that they need in a timely manner—one that is led clinically rather than by budget rationing, which we see too often today. The amendment from the noble Baroness, Lady Coffey, talks about ambulance services. I commend the recent work by the Public Services Committee, which looked at the response and reaction between ambulance services and emergency departments, but it only scratched the surface of that issue. A lot more could be done with that workforce and those teams to ensure that patients get to the right door for further clinical care. I look forward to the Minister’s response to this important group, as this is really on the minds of the public today.

[Earl Howe (Con)]

My Lords, I shall speak only briefly on this group of amendments, not because I am in any way lukewarm about their content—quite the opposite—but for the practical reason that, as a Committee, we are being urged to make faster progress, bearing in mind the number of debating hours allocated to us. Let me say how impressed I was by the speeches from the noble Baroness, Lady Finlay of Llandaff, and the noble Lord, Lord Patel of Bradford. I hope the Minister will take their very powerful points back to officials in the department. I also agree fully with all that the noble Baroness, Lady Pidgeon, said about the unacceptability of corridor care.

I will make a couple of points on my noble friend Lady Coffey’s amendment on equitably available ambulance services. This is a tremendously important issue. As she will remember, I had to grapple with it as a Health Minister, not least as regards services in her then constituency. It is sadly the case that the category 1 response target of seven minutes has not been met nationally since April 2021. The Government have made big investments in emergency response services since coming to office; that is excellent, but since July 2024 the dial on category 1 and category 2 response times has not moved appreciably, if at all. That is not meant as a criticism but simply as another indication of how difficult a challenge this is.

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[Baroness Pidgeon (LD)]

My Lords, I am grateful to the noble Baronesses, Lady Hayman and Lady Boycott, and all noble Lords who have put their names to these amendments, including my noble friend Lady Sheehan.

The central question is straightforward: as the Bill proposes changes to the organisation of the health service, how do we ensure that its responsibilities for climate change, environmental protection and—from all that—patient safety are strengthened rather than simply diminished and reduced?

We absolutely support Amendment 52. As the noble Baroness, Lady Hayman, has clearly set out, in 2022 the House established climate and environmental duties for NHS England integrated care boards and trusts but not for the Secretary of State. As functions move into the department, responsibilities for this must not disappear. The amendment is modest; it talks about “have regard” to the duty. It would not prevent the Minister balancing competing priorities but would make sure climate change was absolutely on the agenda.

Can the Minister explain who will report progress to Parliament once NHS England’s annual reporting responsibilities are lost? How will Parliament be able to scrutinise this in future? Just because there is an organisational change—and we see that a lot in the NHS—it should not then lead to a huge accountability gap and a potential reduction in work in this area.

We also support Amendment 248 and its requirement for each NHS trust and foundation trust to publish an assessment of climate risks to its premises, workforce and services, together with plans to address them. This is a practical and proportionate requirement; we should not wait until wards are overheating or hospitals flood before asking whether there was a plan and doing something about it. Adaptation is about patient safety, as we have heard, and, given the extreme weather that we are now living through, it is essential. It is about resilience, as the noble Lord, Lord Crisp, said.

The final point made by the noble Lord, Lord Hunt, was important: this is about investing to save in terms of tackling sustainability issues. That is spot on. Years ago, there was an “invest to save” fund. We need to look at that if we are going to be able to make savings in the future to invest in the capital works that are needed. I hope the Minister will be able to respond positively to this group.

[Earl Howe (Con)]

My Lords, again, if the Committee will forgive me, I will speak only briefly. I start by expressing my support for the remarks made by the noble Baroness, Lady Hayman, in speaking to her Amendment 52. It seems impossible to argue that the Secretary of State for Health and Social Care should be exempt from a duty to be mindful of the climate change agenda in everything they do, especially as we remember that the Secretary of State for Health and Social Care presides over an organisation with a very large carbon footprint. It was very much with that in view that Section 9 of the Health and Care Act 2022 included duties on NHS England to have regard, in the exercise of its functions, to the Climate Change Act 2008. Therefore, the noble Baroness was entirely right that the duties that apply currently to NHS England in this area should now logically apply to the Secretary of State.

Having said that, I would be surprised if the Minister did not respond by saying that the first part of Amendment 52 is unnecessary, for the very dull reason that Section 15 of the Climate Change Act 2008 already places a duty on “the Secretary of State”, in exercising his or her functions, to have regard to

“the need for UK domestic action on climate change”;

the section spells out what that means in practice. It has long been drummed into me that an Act of Parliament conferring duties on “the Secretary of State” should be read in law as applying to any Secretary of State. That is a very legalistic point, and I do not think that it constitutes a sufficient reason for the Minister to resist this amendment, for all the reasons set out so well by the noble Lord, Lord Crisp.

Personally, I feel the need for something declaratory and specific in this area. The duty to issue detailed guidance seems a very definite omission from the Bill. As we heard the Minister say in response to the previous group of amendments, climate change is becoming a highly relevant factor for ICBs and trusts in the planning of service delivery. As the noble Baroness, Lady Boycott, was right to emphasise, it is equally relevant in the public health context and to the design of buildings, including hospitals. With all that in mind, I hope that the Minister will feel able to give the noble Baroness’s amendment a positive response.

[Baroness Hyde of Bemerton (Lab)]

My Lords, I thank all noble Lords who took part in the debate on this important group of amendments. I will address Amendments 52 and 248 together.

I turn first to Amendment 52, tabled by the noble Baroness, Lady Hayman. The Government remain committed to tackling climate change and ensuring that the NHS continues to play its part. I agree with the noble Lord, Lord Crisp, that this is an overarching priority. However, we do not believe that this amendment is necessary. I am indeed going to say that the climate change target and environmental targets referred to in the amendment already apply to the Secretary of State through the Climate Change Act and the Environment Act. The 10-year health plan was clear that we will continue to support the NHS’s climate ambitions. The reforms in this Bill do not remove or weaken that commitment.

The amendment also provides for guidance on the discharge of climate duties. However, the Bill already enables the Secretary of State to issue such guidance to integrated care boards, alongside transferring NHS England’s existing guidance powers for NHS trusts and foundation trusts to the Secretary of State. Importantly, integrated care boards, NHS trusts and foundation trusts will retain their existing statutory climate duties. We will continue to support the aims of the NHS’s climate ambitions in a way that improves delivery of care, returns savings to front-line services and drives wider economic growth. I say to the noble Baronesses, Lady Coffey and Lady Bennett, that I look forward to debating in full the use of single-use plastics in the NHS in the group of amendments on medicines and medical devices beginning with Amendment 111, but I will not pre-empt a fulsome discussion of that by delving into that content here, so we can all look forward to that.

I turn to Amendment 248, in the name of the noble Baroness, Lady Boycott. NHS trusts and foundation trusts have to consider the need to adapt to the current and predicted impacts of climate change. All trusts and foundation trusts are already required to have green plans in place. In reply to the noble Baroness’s point about how we will ensure that this happens, following the abolition of NHS England, the Secretary of State will issue guidance to support the system in discharging their duties, building on the existing Green Plan Guidance published by NHS England. There are statutory guidance-making powers in the NHS Act 2006 for ICBs, trusts and foundation trusts, under which the Secretary of State expects to issue guidance to support that system in discharging its duties.

As many noble Lords raised, including the noble Baroness, Lady Hayman, we know that the impacts of climate change are already being felt across the NHS, including disruption from heat in particular, flooding and other types of extreme weather. That is why the 10-year capital plan committed to renew that focus on climate resilience. We have strengthened adaptation planning with green plans to prepare for severe weather events and improve climate resilience of local sites and services, and plan to conduct an adverse weather emergency response exercise in every NHS region by 2030, so strengthening that whole system preparedness for extreme heat through UKHSA-led planning, co-ordinated alerts and mandatory local response arrangements across the NHS.

All trusts are required to have adverse weather plans to ensure service continuity during major events, such as heatwaves. Beyond planning for acute incidents, trusts also undertake climate change risk assessments to identify and reduce overheating risks and their potential impacts. There is already, therefore, a clear framework for trusts to plan and respond to climate risks. I humbly suggest that the Government do not have their head in the sand but that our focus should be on delivering against these existing duties and plans. The 10-year health plan also committed to supporting the NHS’s existing net-zero targets and climate objectives as set out in Delivering a “Net Zero” National Health Service, published in 2020. I am sure noble Lords are aware that, since the publication of that strategy, NHS carbon footprint emissions have indeed fallen by 17%.

To address the point raised by the noble Lord, Lord Hunt, I have covered some of the local duties points. The CQC guidance will remain, but I will write in full laying that out. On the point from the noble Baroness, Lady Pidgeon, about how this will be reported to Parliament, information on annual NHS emissions will continue to be published in the DHSC’s annual report and accounts, which are also laid before Parliament annually. That will ensure that Parliament continues to receive that regular information on the NHS’s progress towards those environmental objectives. I hope that this reassures noble Lords that the Government recognise the importance and, as many noble Lords have raised, ongoing salience of this issue.