Health Bill

Lord Patel Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Lord Patel (CB)]

My Lords, I have put my name to Amendments 26, 78 and 242, tabled by the noble Baroness, Lady Finlay, and support everything that has been said by the noble Baronesses, Lady Finlay and Lady Hollins, and others. They have highlighted the serious problem of the underfunding of palliative care, whether that is specialist, community or hospice palliative care.

To make my points, I need to personalise them, which I hope I can do successfully. What impressed me most when I had to experience the provision of palliative care was the personalised care plan that was written by the team who were going to look after my wife when she died last year. That was so fundamental for the family and for the patient. The other important bit was the compassion that was shown. I do not know of any other branch of medicine in which I personally feel that compassion is so paramount. It is a person who is dying. There can be nothing more final than death. If we cannot show compassion at that time, then we fail.

The next bit was communication: with the patient, with the team who were going to look after her, and with the family—and the inclusion of family in that communication was extremely important. The team was identified: it was the GP, the district nurses, and the specialist palliative consultant, who, in the end, did not need to provide her services but who none the less was available.

The other important bit was the co-ordination. There was total co-ordination of Macmillan nurses, district nurses and the GP, importantly to assess the medication that was required on a daily basis, 24 hours a day, seven days a week. What I learned, although I am a doctor of long standing, was that for patients who are dying, medication tends to change hour by hour, because their symptoms change. There are not just the symptoms of pain; there are other symptoms that make them uncomfortable, and they need to be relieved of those. In the middle of the night, that service was available. At 2 am, by phone call, somebody appeared five minutes later to provide that medication and care by the team.

The next factor was continuity of care. It was the same GP who visited every day, and the same district nurses, including at the weekends, day and night. That continuity of care was provided all the time.

The next bit was comfort. It is difficult to understand how much comfort is important to these patients when they are dying. They are uncomfortable because of pain, because of the disease that is killing them, and because they have developed symptoms that are difficult, such as retching, vomiting and other symptoms. That requires treatment at the time. If that is not available, the patient who is dying suffers.

Choice—patient autonomy—was another factor: that patients have a say, even though they are dying, as to what would help them. That was important. Furthermore, it was about control, that the patient was helped to achieve their goals. They do have goals, even though they are dying. They know what they want, in terms of comfort and other issues.

Any palliative care proposals and frameworks developed must address this issue, paramount in which should be compassion. If we fail to do this, then we fail. We should not rely on funding from charities organising fêtes and coffee mornings; we should fund the service appropriately and demonstrate that we are a compassionate society.

[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.

--- Later in debate ---

[Baroness Manzoor (Con)]

My Lords, I support the thrust of the amendments in this group, particularly Amendment 28 in the name of my noble friend Lady Shawcross-Wolfson. She has put her case forcefully and clearly, so I will not detain the Committee for long.

Poor long-term workforce planning creates significant challenges for NHS staff and patient care. Inadequate forecasting, insufficient investment in training and recruitment and poor staff retention contribute to persistent vacancies and skills shortages. This increases workforce loads, stress, burnout and sickness absence, resulting in low morale and higher staff turnover. The NHS becomes increasingly reliant on expensive agency workers and international recruitment, placing additional pressure on budgets. Consequently, services experience longer waiting times, reduced productivity, compromised continuity of care and potential risks to patient safety.

NHS England estimates an existing workforce shortfall of approximately 150,000 full-time equivalent staff, potentially rising to 260,000 to 360,000 by 2036-37 if there is no intervention. Effective long-term planning is therefore essential to develop a sustainable workforce, improve staff well-being, strengthen retention and ensure safe, high-quality patient care. I strongly urge the Minister to support this amendment. Ministers should be held accountable for the delivery of this workforce plan.

[Lord Patel (CB)]

My Lords, I strongly support the amendment in the name of the noble Baroness, Lady Shawcross-Wolfson, and I have added my name to it. She spoke so eloquently and made her case so strongly that I have put aside what I have written down because it would have been a repetition of what she had already said. I am going to take a slightly different tack but make the same point.

The noble Baroness quite rightly linked education, training and workforce planning. You have to know what workforce you might require for the health service you plan to have. I guess one can say that the Government’s 10-year health plan and the 10-year cancer care plan outline the kind of health service that the Government wish to see develop over the next 10 years. If that is the case, we need to address what kind of training and education and what kind of people we will need to deliver that plan.

I am guessing now that the reason why the 10-year workforce plan is delayed is because the premise on which it was to be formulated was that technology such as AI and digital technology would free a lot of clinical time, and hence the headcount need not be so high. That is a false assumption. It is false because we need to train people to use AI and digital technologies. The assessment is that, if you use these technologies, you might free about 40 minutes a day for front-line clinicians. With the pressure that the NHS now faces and the needs of the workforce it now faces, that time will be used to deliver better care to patients, particularly as the 10-year health plan identifies that technologies such as genomics and personalised medicine will be the way healthcare will go. There is an ambition by 2040 to have 50% of patients with some idea of their genomics, and the treatment is therefore based on that.

If you add all these together, and the Secretary of State now has responsibility for education, training and workforce planning, you ask the question: why is the workforce plan delayed? It is delayed because maybe the penny has dropped that, if you do not count the numbers and do not present a case about how technologies will reduce front-line clinical time, then you cannot plan the workforce.

Furthermore, I wonder whether the Bailie review of productivity in the NHS is based on the premise that greater productivity will be delivered in the NHS because of using technologies such as AI and digital technologies. We do not know that that will happen, but we have to wait until the Bailie review comes out. I wonder whether that is another reason—the Minister might comment on that—why the workforce plan is delayed.

It might be political pressures, it might be fiscal pressures or it might be the pressures from not knowing how to get the workforce numbers that we would require to deliver the 10-year plan and the cancer care plan that are holding up workforce planning. However, as the noble Baroness, Lady Shawcross-Wolfson, pointed out, if we do not have a plan, things will get worse. We will introduce technology, which will not be across the board, and we will then look for workforce that is not trained to deliver it. I hope the Minister will give us some answers about where we are going.

[Baroness Tyler of Enfield (LD)]

My Lords, I was very pleased to add my name to the two amendments tabled by the noble Baroness, Lady Hollins, Amendments 92 and 252, regarding the mental health workforce. More generally, I was very taken by the way this important group of amendments was introduced by the noble Baroness, Lady Shawcross-Wolfson, because she is right that all the things that we have been talking about in this Bill so far—all the things we all want to see to improve the health of this country, and all the things we want the NHS to be able to do with, yes, efficiency and increased productivity but also with great care and compassion—will none of them be achieved unless we have the right workforce with the right skills and the education and training in place. That is why I think this is such an important group of amendments.

As I said, I was very pleased to add my name to the two amendments tabled by the noble Baroness, Lady Hollins, on the mental health workforce. She set out the case clearly, so I do not need to do it again. I simply reiterate that, once we have the long-awaited NHS workforce plan, this will be vital. I would be grateful if the Minister could make some commitment here about how quickly we will see a follow-up mental health workforce plan. We need to see some detail about how the mental health workforce will be recruited and retained and will be able to meet the scale of the mental health demand, which we have debated so many times on so many occasions. That is critical. Both those amendments are important in that respect.

My final point is that, during the passage of the Mental Health Bill, in which many noble Lords here were involved, we all quite rightly thought how important it was that as many mental health services as possible should be located in the community. We all agreed with that; it was the premise, as it were, on which the rest of that legislation was built. As important as the consultants and psychiatrists and so on are—of course they are; it is a wide-ranging workforce and includes mental health nurses and others as well—unless we have that workforce in the right place, in the community, appropriately skilled, educated and trained, we will never be able to deliver those community mental health services, which are so vital. So I was very pleased to support these amendments.