Health Bill

Debate between Lord Hunt of Kings Heath and Baroness Manzoor

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, following the review by the noble Lord, Lord Mann, I certainly hope that the regulators toughen up their act, and in accepting its recommendations the Government certainly expect them to. I agree with the thrust of where the noble Lord, Lord Blencathra, is coming from. Whether all discretion should be taken away from the regulators, I very much doubt, but it will be interesting to hear what my noble friend has to say on that.

In supporting the amendment tabled by the noble Baroness, Lady Gerada, I want to reflect on two points. First, I repeat what the noble Baroness said, which was striking, arising from the report of the noble Lord, Lord Mann. Drawing on the NHS staff survey, Jewish staff are the only religious group where discrimination from managers and colleagues exceeds discrimination from patients. This is a very serious indication of the stress and pressure on Jewish staff within the NHS.

I am afraid that, so far, the response from management has been pretty poor. We have seen that in relation to what we might call uniform policy. As the noble Lord, Lord Mann, described it:

“Examples such as the brandishing of badges, the display of uniforms on political marches or the co-branding of the NHS by staff or others with third parties has made it unclear what patients can expect from the NHS”.


Patients are entitled to be treated without seeing staff display any political leanings whatever or support for campaigns. Teachers are simply not allowed to do this. One has to ask, what is with NHS employers that they have failed to put across to their staff the behaviour that is expected of them?

The noble Lord, Lord Mann, clearly called for NHS England to review what we might call its uniform policy. It is not the standardised uniform, but what people wear and how they display it. My understanding is that that work is being undertaken, subject to consultation. I hope that, when it comes out, it is not going to be wiffly-waffly, leaving too much discretion to local employers. Now that the Government are taking this over—because I doubt it will be finished before 1 April next year—they should make it abundantly clear to NHS employers what should and should not be expected.

I know that Manchester has been cited as a very good example. As the noble Lord, Lord Mann, said, some trusts do not permit the wearing of political badges, of any item of clothing with a political message or of a uniform to political rallies. We need to see something firm about this so that employers are implementing what is required of them from the centre. For employers, this would be much easier than going through the agony of developing local policies that are subject to consultation and lead to variation. Patients and staff are entitled to be in an environment where somebody else’s political views are not displayed in a way which causes huge upset and concern.

[Baroness Manzoor (Con)]

My Lords, I understand and support the aims and sentiment behind this group of amendments—particularly Amendment 29 and 258. Any form of discrimination or racism is abhorrent. How one identifies oneself should not be a problem. Antisemitism is not acceptable.

It may be helpful to remind ourselves of some figures as, sadly, racism and discrimination remain embedded challenges within the NHS, affecting both staff and patients, as acknowledged by the noble Baroness, Lady Gerada. It is worth noting that 28.6% of NHS staff in 2024 were from ethnic-minority backgrounds. That was around 450,000 people, yet only 12.7% of senior managers came from those backgrounds. The 2025 NHS staff survey found that ethnic-minority staff were more likely to experience discrimination from managers and colleagues: that is 13.9% of ethnic-minority staff compared with 6.51% of white staff. Some 29.16% of ethnic-minority staff experienced harassment, bullying or abuse by patients and by the public, compared with 23.54% of white staff. It is important to further strengthen legislation as there are gaps.

The Equality Act 2010 prohibits racial discrimination, harassment and victimisation. However, significant weaknesses remain. The public sector equality duty requires organisations to “have due regard to” equality but does not guarantee measurable improvements. The NHS equality standards lack sufficient enforcement and meaningful consequences for persistent institutional discrimination. Will the Minister consider how the Government can strengthen this further, particularly as reporting, investigating and addressing racism remains inconsistent, with inadequate protections and support for whistleblowers? How will the Government address this? There is no sufficiently robust uniform accountability framework ensuring that perpetrators and senior leaders face consequences, as the noble Baroness, Lady Gerada, stated. Will the Government consider developing such a framework on all forms of discrimination? This would also support the 2026 review by the noble Lord, Lord Mann, which reinforces the need for stronger investigations, transparency and organisational accountability.

Health Bill

Debate between Lord Hunt of Kings Heath and Baroness Manzoor

Committee stage
Wednesday 28th October 2026 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Baroness, Lady Tyler, and the noble Lord, Lord Patel, made some important points about cross-government working. I was thinking back to what the noble Lord, Lord Patel, said, basically that what started under Tony Blair was continued under Gordon Brown. It was backed up by, first, a specific Cabinet committee, which underpinned the inequalities work, and, secondly, by what were called PSA targets, which tied different departments in. I think that was a good mechanism. In defence of the Government, though, the important work that is being undertaken in relation to health inequality by Alan Milburn, working with different government departments, is going to be pivotal because it embraces the terrible outcomes for so many people who come under the NEET category. It is also looking at the dreadful mental health support for children and adolescents, which goes to the heart of many of these issues. If we can pull this off, we can start to achieve some of the equality issues that we have been talking about.

Like the noble Baroness, Lady Tyler, I am here to say a few words about coastal health because the noble Lord, Lord Patel of Bradford, told us we must. Five years ago, the Chief Medical Officer devoted his 2021 annual report to health in coastal communities. He identified high levels of poor physical and mental health, an ageing population with increasingly complex needs and serious challenges in recruiting and retaining the healthcare workforce. The noble Lord, Lord Patel, basically has three asks, on which I want to reinforce what the noble Baroness, Lady Tyler, said. Five years after the CMO’s report, we have no strategy. First, will the Government publish a substantive account of progress against his recommendations? Secondly, how will the Government ensure that coastal populations are separately identified? Unless we do that, we do not have the data on which to plan and strategise and see whether improvements can be made. Thirdly, will the department work across government to develop and test commissioning prevention workforce models suited to the distinctive geography and needs of coastal communities? I would be very grateful if my noble friend would agree to meet the noble Lord, Lord Patel of Bradford, to discuss this further, because it is an important consideration.

My Amendment 11 relates to the terrible distribution of GPs in England currently and asks for a much more equitable distribution. I am grateful to the noble Baronesses, Lady Gerada, Lady Hodgson and Lady Manzoor, for their support. Last week I was very fortunate to have a meeting with Minister Dame Diana Johnson and her officials, which I found extremely helpful, and I was grateful to her officials for the way they have been prepared to communicate on this.

This morning, the RCGP published the State of General Practice 2026 report. Chapter 4, about fair and sustainable general practice care—equitable care—makes clear that action is needed. One area where I believe we need action is what the noble Lord, Lord Darzi, described as

“huge and unwarranted variations in the number of patients per GP”.

Data from the NHS general practice workforce team shows that the national average list size of fully qualified full-time equivalent GPs hovers at around 2,200 patients. John Gooderham, a retired civil servant who once worked for me, undertook a number-crunching exercise showing that the differences in average list sizes are almost unbelievable. His evidence, which was published by the Institute of Health and Social Care Management, showed at least 20 areas with an average list size ranging from 8,300 to 4,400 patients, almost four times as many as the national average. All of them are clearly severely underdoctored. At the other end of the scale, there are 20 areas with an average list size ranging from 1,000 to 1,444 patients.

The trouble is that there seems to be no approach or system to rectify this. We used to have the Medical Practices Committee, which was set up by Nye Bevan in the 1946 Act and lasted until 2001. I have to confess that I took through the legislation abolishing the MPC. Mea culpa—it was a mistake. At the time, the line that I took—I looked it up—was that area health authorities would sort it all out. Where are area health authorities? They did not, and none of their successors has. I think we need to go back to a system that identifies areas that are overdoctored or underdoctored to consider how we can justify this situation. It cannot be allowed to continue. I know that officials feel that the kind of MPC system we had is not fit for today’s more modern circumstances, but one way or another, either through financial incentives or through some restrictions, we have to do something about this. I hope the Government will be sympathetic.

[Baroness Manzoor (Con)]

Noble Lords will know that I am passionate about improving the health of all. The National Health Service is the National Health Service, not the ill service. So many disadvantaged, marginalised groups are not receiving the care or the health that they need. I will not go back into the disparities and the health inequalities. I have put my name to the amendment from the noble Lord, Lord Patel, who spoke very clearly. It is a simple amendment but would be a pivotal, key amendment to the Bill.

I also support the amendment in the name of the noble Lord, Lord Hunt, because without having the first line of defence of GPs, marginalised groups do not have the access to doctors that they desperately need. Everybody knows the effects of inequalities on the economy, the NHS and individuals. The Government have a great opportunity to enhance the Secretary of State’s power and strengthen it, rather than transfer the current power.

As I indicated earlier, in my region we had a duty to bring down inequalities in a deprived area. I worked closely with Alan Milburn and other Ministers, including the then Prime Minister, Tony Blair. It worked when that key emphasis, monitoring, duty and strategy were put in place. We need a health strategy, as the noble Lord, Lord Patel, indicated. I leave the question on the table for the Government. This is a fantastic opportunity. It is not about all the structural change that we have been talking about; this is about making a real difference to people’s lives and to the health of our nation.