Health Bill

Lord Scriven Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Baroness Merron (Lab)]

I am not able to confirm the exact date, but I can say, as I said earlier, that the decision will be announced formally, so noble Lords will be made aware.

On the questions of security, resilience and sovereign capability, as raised in Amendments 53, 171 and 289 by the noble Lord, Lord Tarassenko, the Government share his determination to protect patient data and to support the strong UK digital health market. However, I am not able to commit to an NHS digital sovereignty strategy, nor additional legislation. Supply risk is not determined by nationality or jurisdiction alone. What matters is the data involved, who can access it, the supplies controls and the contractual protections in place. We already have robust safeguards. The Procurement Act 2023, about which much has been spoken, provides powers to exclude suppliers where appropriate, including on national security grounds. It also provides for setting data protection and cyber security requirements.

I note specifically the noble Lord’s concerns about the procurement of the single patient record, and I am looking forward to a more focused discussion, as I know all noble Lords are, on the SPR at a later Committee stage. I can confirm now that the procurement will have to ensure the resilience of our systems, how we keep within the UK jurisdiction and that the data remains under NHS control. The noble Lord, Lord Tarassenko, raised concerns that foreign laws could require an overseas supplier to give access to NHS data. We take that risk extremely seriously and aim to ensure that the legal, contractual and cyber-security safeguards are in place to avoid this.

I fully endorse encouraging domestic innovation, as I hope noble Lords are aware. As the Chancellor set out in the recent Budget, the Government will use public procurement strategically to back British firms to strengthen domestic capability and to build resilience in key supply chains. We will continue to promote international investment and trade and to open opportunities for British businesses at home and in markets around the world.

The noble Baroness, Lady Kidron, indicated her agreement with the noble Lord, Lord Tarassenko, in this area. The points on sovereign data being an asset will come back in the group beginning with Amendment 142, and again I look forward to debating that. We want a vibrant UK market for tech, and practical action is already under way. NHS England is engaging industry ahead of procurements, structuring opportunities to increase SME participation, and using social value to support good jobs and skills, which we all want to see.

I turn to Amendment 279A, tabled by the noble Lord, Lord Austin. He too raises the important question of accountability within this amendment, and we agree that contracting authorities should be accountable to the objectives of the Procurement Act, which already apply directly to covered procurement. The Act also provides transparency and oversight mechanisms, including powers to investigate compliance. The Procurement Act 2023 already requires publication of contract details for contracts worth over £5 million and, where applicable, key performance indicators and annual assessments of supplier performance against them. This makes a further NHS-specific annual reporting duty unnecessary in our view. For medtech, our value-based procurement approach further supports decisions focused on patient outcomes, total care costs, and longer-term value.

[Lord Scriven (LD)]

The amendment from the noble Lord, Lord Austin, refers to

“medical devices, consumables and services”.

There are two laws in place for procurement for the NHS: one for services and one for goods. What about the services? We have heard about the goods, but what about the accountability and feedback for services?

[Baroness Merron (Lab)]

I made reference to the Procurement Act 2023, and that is the guide by which we go.

[Lord Scriven (LD)]

It is for goods, but NHS services come under the 2022 health Act. There was discussion about whether it should have all fallen under one procurement law, but for NHS goods it is the 2023 Act, and for services it is the 2022 health Act that is applicable. If the Minister could write to me and place a copy in the Library, it would be helpful to see how the health Act also applies.

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[Baroness Cass (CB)]

My Lords, I am sorry that the noble Baroness, Lady Walmsley, is not able to be in her place this evening. I had the privilege of serving on the Childhood Vaccinations Committee, which she very ably chaired. I think it will produce a report which Members of the House will find informative and helpful, and I hope the Government will feel similarly. During the course of that report, we spent a long time talking about the relative impact of problems in access and in vaccine hesitancy. Within vaccine hesitancy, multiple different factors affect how parents feel about vaccinating their child. Among those is medical disinformation. We need to understand more about that and what vaccination and the risks mean to different communities and cultures. Much of that work happens on the ground, on the front line, with community leaders, health visitors and GPs working locally. However, that is not a reason for us not to take a national strategic approach.

The second reason I signed this amendment is that it uses the term “medical disinformation strategy” and talks about anti-vaccination and medical disinformation. The Government need to think about how we tackle medical disinformation much more broadly than just within the vaccine arena. I have talked often enough in this House about my review, but I have not on any occasion put on record what it felt like to do that review and, more particularly, what it felt like and has continued to feel like in the two years since.

The disinformation about my review started six hours before the report was released. It was a funded disinformation campaign, and it continues to date. One of the extraordinary things that were said was that I did not speak to any trans people during the review. We spoke to the support and advocacy groups every four weeks and I spoke to the gender clinicians working at the Tavistock every two weeks. It was said that we threw out 98% of the papers on the subject, which was clearly nonsense. It was said that we did not publish the name of the author of the review—and what did “CASS” stand for, by the way? That was probably one of the most extraordinary ones. Then there are those that I take less seriously, which are more recent, on why I have supported the puberty blocker trial. These range from my being the victim of a Russian kompromat, having a trans child of my own, and—this is the best one—that somebody has kidnapped my cat and is holding it to ransom. I am not particularly concerned about the personal attacks, of which there are many, but I am concerned about the disinformation that misleads children, young people, families and clinicians who are looking after them.

During those last two years after the review, I worked first for NHS England. I declare that I am currently an independent adviser for the DHSC. Colleagues have been supportive, but the burden of what to do about the direct disinformation at the end of the day rested with me. DSIT, as it was, seemed to be the locus of how we dealt with disinformation at that time, but it did not own the strategy, and neither did NHS England or the DHSC—although the DHSC has been very supportive in trying to get a communication strategy in more recent times.

My point in going through all this is not as a “poor me” about my experiences, but because it should never come as a surprise to us that there is disinformation, which is going to be an increasing problem going forward. It is no more surprising than bed pressures and flu in winter. Therefore, I suggest to the Minister, who has been exceptionally supportive to me over these matters, that, in thinking about the structures of the NHS, we need to consider strategically how we will be prepared for disinformation strategies, not just in vaccine services or gender services but in many areas as they arise.

[Lord Scriven (LD)]

I will quickly talk about my noble friend’s Amendment 224, on the public health duty of Ministers of the Crown. I think most noble Lords would agree that, if we are going to deal with prevention and the determinants of health, it goes far beyond the department to deal with the issues there.

It is always interesting and actually vital to read final impact assessments, because you will find little gems in them. In the final impact assessment on abolishing NHS England, it says:

“The Secretary of State will retain existing public health”


duties. But the NHS England functions to be repealed are not given to the Secretary of State. It says:

“NHS England’s duty to consult with public health professionals to obtain advice on the discharge of its functions will be repealed and not transferred to the Secretary of State”.


I have a very simple question for the Minister. I declare an interest in that my husband is a former director of public health. Anybody in the medical world who comes into contact with a doctor from public health will say that they are a very strange creature; living with one, I can confirm that is the case—but professionally, they look at things very differently. They are not about one part of the body or one disease; they take a much more holistic approach to the determinants of health and population health. Why is the Secretary of State retaining public health functions but not taking NHS England’s function to sit down with, listen to and consult public health professionals when carrying out those directions? It seems a very strange system to take the functions but not have the duty to sit down with and listen to public health officials. If that duty is not transferred to the Secretary of State, what body in law does the Secretary of State have to sit down with and listen to that is composed primarily of public health professionals?

[Baroness Pidgeon (LD)]

My Lords, I shall speak to Amendments 223, 224 and 231 in the name of my noble friend Lady Walmsley, who cannot be in her place today.

Amendment 223 would require Secretary of State to lay before Parliament an annual report on the performance of routine, seasonal and targeted immunisation programmes, which sets out the action plan for the coming year to address areas of low vaccine uptake. The report must also cover all eligible cohorts within the national immunisation programme, use consistent measures across programmes and include data that enables inequalities in vaccine uptake to be tracked by geography and population group. It should be in addition to existing vaccination coverage reporting. This would enable vaccine accountability and make sure it remains visible following the removal of Section 7A, with clear reporting on how national oversight is being maintained and how delegated responsibilities to ICBs and providers are being delivered.

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[Baroness Scott of Needham Market (LD)]

My Lords, I have tabled Amendment 65 to Clause 15 on the topic of accessible patient involvement. It seeks to ensure that the arrangements for involving patients in commissioning decisions are accessible to those living with long-term, complex or fluctuating health conditions. I welcome the Government’s decision to retain and strengthen Healthwatch England and local Healthwatch organisations. It is an important recognition of the value of independent patient voice, and I am pleased that Ministers have listened to the concerns raised across both Houses and beyond. However, retaining that independent patient representation is only part of the picture. We must also ensure that the mechanisms through which patients are consulted and involved in the decisions which affect their care are genuinely accessible.

I take a close interest in ME. I have a family member with it and I am a member of the all-party group. For people living with severe or very severe ME, conventional forms of consultation can be extremely difficult and quite often impossible. Attending meetings, participating in lengthy phone calls or completing detailed questionnaires can worsen some symptoms considerably. I have spoken about ME, but there are many other conditions for which the same can be said. If patient involvement arrangements are not designed with these limitations in mind, there is a real risk that those people with the greatest need will have the least opportunity to influence the services which should be supporting them.

This concern is particularly relevant given the evidence of poor access to services now. Action for ME’s 2026 big survey gathered responses from more than 5,000 people living with ME and long Covid. They found that 83% of respondents reported barriers to accessing NHS ME services. I was also struck by the large number in the survey who were not able to access any kind of healthcare at all, including routine screening. This is totally unacceptable. We cannot expect services to meet the needs of these patients if they are effectively excluded from the decisions about how those services are designed and commissioned.

My amendment is very modest. It would require the Secretary of State to take reasonable steps to ensure that patient involvement arrangements are accessible and inclusive, with particular regard to disabled people and those with long-term, complex or fluctuating conditions. This could mean greater flexibility in how people contribute and how they are consulted. It needs to recognise the particular circumstances in which patients can participate. It will require a little imagination and quite a lot of empathy, but it ought to be possible. I would therefore welcome the Minister’s assurance that these patients will not be overlooked in the Government’s arrangements for patient involvement and ask whether she would consider putting something in the guidance to make sure that it happens.

[Lord Scriven (LD)]

It is a pleasure to follow my noble friend. I want to come back to the points that the noble Lord, Lord Hunt, made. I believe we are coming to a point in this Bill for us to make reasonable amendments and suggestions. Either we can continue to go down the road without the detail and let the service reorganise itself, or we can start to get some serious detail, particularly regarding specialised commissioning and the capacity of ICBs.

Just to understand, there are about 154 specialised services that are commissioned. Already, around 70 of those are commissioned via ICBs under delegated direction from NHS England, and the rest are commissioned centrally by NHS England. What the Government are asking is for the cuts to be made to staff, for the staff to go, and then for the detailed skills and knowledge that are required for the specialised commissioning to come after that process. The National Audit Office has put out a report which questions, even on existing duties, whether ICBs have the skills, knowledge and breadth to carry out what the Government want.

With these extra services, it could be that ICBs, the delegated strategic commissioners, cannot commission what Government wish them to commission. The noble Lord, Lord Hunt, and I both got quite cross with the then Minister, the noble Lord, Lord Kamall, during the passage of the 2022 Act, that things were happening in the system before Parliament had made the decision. That is what is beginning to happen again; things are happening. The offices for pan-ICB commissioning are not new; they were asked to be determined in April 2026. They were in the impact assessment for the abolition of NHS England, so they are already known about. The key issue is: what services are they going to have to give a joint response for? Will we have the list of specialised commissioning services carried out by ICBs and the Secretary of State by Report? Is that a commitment the Minister can give? If not, we cannot make a reasonable decision on Report about specialised commissioning with the depth and breadth of knowledge that is required. Can the Minister give us that commitment?

As the offices for pan-ICB commissioning—OPICs—were selected in April, can the Minister commit to giving us their duties and the budgets they will have, or will be able to direct, in writing before Report? What powers of direction will the Secretary of State have for consistency of ICB specialised commissioning, and can those be with us by Report? These are important questions that need to be answered because, if not, we will be getting to Report, being asked to support specialised commissioning with two bodies—the Secretary of State and ICBs—and, particularly for ICBs, we will not know whether they have the capacity to do it. I do not think that this House will be able to make a decision about whether it is reasonable, safe or justified for us to continue suggesting that this is a route for ICBs to commission.

[Baroness Cass (CB)]

Briefly, I support the comments of my noble friend Lady Grey-Thompson and the noble Lord, Lord Hunt, and thank the noble Baroness, Lady Pidgeon, for Amendment 59, which I fully support. It is all right for me to support all of these people, because according to the best disinformation sources, I am in the pay of the Tories, but not the other parties. I did hesitate over whether I should allow a friend on the Opposition Benches to buy me a cup of tea the other day.

On a serious note, I worry, as others do, about ICB capabilities, and my noble friend Lady Finlay and I have spent years struggling with a postcode lottery on the commissioning of specialist palliative care services for children. They are commissioned at the wrong level, and therefore vary hugely from ICB to ICB, and should be commissioned at a higher level. The notion of greater devolution fills me with anxiety, so I fully support that amendment.