Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026

Considered in Grand Committee

Moved by

That the Grand Committee do consider the Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026.

My Lords, this statutory instrument makes an important change. It will amend the 2014 regulations so that the treatment of disease, disorder or injury, known as TDDI, is brought within the regulatory scope of the Care Quality Commission. This change will be for the treatment of disease, disorder or injury provided in sports grounds or gymnasiums, or under temporary arrangements at sporting or cultural events, where it is delivered for the benefit of those taking part in or attending those activities.

Let me start by clarifying what this is and what it is not. This regulated activity relates not to the task being carried out but to who is doing it. It is the assessment and treatment of physical or mental state when provided by a specifically defined list of healthcare professionals, as per the CQC’s website. The scope of this activity requires those carrying it out to be listed healthcare professionals registered with the appropriate professional body, such as the General Medical Council, the Nursing and Midwifery Council or the Health and Care Professions Council. When a healthcare professional uses their professional title, qualification and skills to assess and treat a person for a disease, disorder or injury, they must be registered with or employed by a company registered with the CQC.

Providers carrying out the treatment of disease, disorder or injury at events may include independent ambulance services that employ paramedics, doctors and nurses, and which are commissioned to attend an event such as a music festival, marathon or football match and be on hand in case anyone there experiences a medical emergency.

Perhaps I can give some context. Members will recall the tragic events of 22 May 2017, when the Manchester Arena bombing killed 22 people and injured more than 1,000 others. The subsequent inquiry uncovered serious failings, including inadequacies in the provision of healthcare services at the arena. The inquiry noted that these shortcomings may have been present at other venues across the country, in part because of the absence of appropriate regulation. A central finding of the inquiry was absolutely clear: the Department of Health and Social Care should consider changes to the law to enable the CQC to regulate healthcare delivered at events. The CQC has itself outlined additional concerns about the quality of care provided at events. It has heard serious allegations of unregulated provision resulting in severe patient harm.

I shall speak briefly to this statutory instrument and ask a number of questions, if I may, to which I hope the Minister will be able to respond. I think that I understand the structure of what is proposed and the exclusion of first aid so that it is not covered, but when I look at the providers that are likely to be affected, I am trying to work out carefully which are the providers concerned. I am assisted by a friend who is part of the Faculty of Sport and Exercise Medicine and who said that it had undertaken a survey.

It seems to me that many of the people who responded to that as healthcare professionals may well be working in registered providers already, so they may be concerned about the need to register in relation to the services that they provide at events but in fact they do not need to register. However, the event organisers themselves may need to register if they bring healthcare professionals on site in order to provide services that go beyond first aid at their event. I am trying to understand how, when the department went out and identified 89, or whatever the number was, potential providers that were not already registered, it ended up with a figure of 36, which seems very low. It certainly bears no comparison to what those who are working in the sector believe would be the number of presently unregistered providers. We need to understand who these 36 are, the character of those providers that the department has identified and why there is such a discrepancy between that and what others have been saying. I would be grateful if the Minister would tell us much more about that.

As a practical example, are all football clubs, or the major football clubs in the Premier League, the Championship and so on, already registered with the CQC? Clearly, they, as organisations, provide continuing healthcare to their players. Do we not need to worry about any of that? Is an event like one of the big festivals that take place already registered, because it has put a team together in order to provide more than simply first aid? Perhaps we are worrying about a need for registration when actually we do not need to worry so much.

My Lords, I will also ask a few questions. I declare my interests as the senior steward—namely, the chairman—of the Jockey Club and as the mother of an elite athlete.

I spent last weekend at two quite different sporting events, juggling my time between the Grand National and the Home Internationals lacrosse competition, as my daughter played for England for the first time— I did check with her that I was allowed to mention that in the Grand Committee. I mention them both because while one is really a grass-roots sporting event—it has a small crowd, but none the less there is an ambulance in attendance because it is a potentially dangerous sport—the other, the Grand National, is the second largest attended sport in the country and the second most watched sporting event on television. As I understand it, both are captured by the same changes being proposed today.

I express my condolences to everyone who was affected by the tragedy at Manchester Arena. In no way do I want to suggest that the questions I am posing negate the need to address the recommendations of the public inquiry. It is hugely important that we learn the lessons.

First, I took some time to speak to a former chief medical adviser of the British Horseracing Authority, Dr Jerry Hill, who told me that a clear standard of healthcare for events is an extremely positive move. I put on record that I wholeheartedly support the event healthcare standard. I understand that there has been good consultation on the draft and that, in Dr Hill’s view, it will help event medics fight their corner for resource. He told me that, at the moment, event medics often feel that they are behind Portaloos and security in priority at events. It is important that we recognise that we need that standard.

However, in moving from that standard being guidance to putting it on a statutory footing—I appreciate that this SI does not do that, but it sets us on that path—we need to evaluate formally whether the draft is effective. As I understand it, the DHSC was somewhat swamped by people wanting to participate in evaluating the draft, and that it was perhaps not following the more scientifically robust approach that a number of sports suggested—I think two focus groups were planned to evaluate the draft. Can the Minister assure us that that event healthcare standard will be evaluated to a scientifically robust standard rather than that of a more politically normal focus group? It is very important that we get it right.

I sit on the Industry and Regulators Committee, which recently did an inquiry into the building safety regulator. Your Lordships may think that is completely off topic, but it is not. That regulator was set up because of the tragedy at Grenfell Tower, for all the right reasons and with the very best of intentions, but this Government had to intervene six months ago because the building safety regulator was not equipped, either financially or from a skills perspective, to deliver on its mandate. As a result, since it began not a single high-rise building has been approved or built in London. To give credit where credit is due, the Government have addressed that. I really do not want us to be complicit in doing the same thing here.

There are very good intentions in this measure. I think we all agree that we want to put in place the best possible healthcare provision at both small and large events but, if we are not careful, we are going to put a huge cost burden on grass-roots sports and cultural events—

My Lords, I will be very brief. The Explanatory Notes say that a full impact assessment was not completed because

“no significant impact on the private, voluntary or public sector is foreseen”.

I think it entirely foreseeable that there could be significant cost and complexity, as well as an inability to deliver the healthcare benefits that we all seek, for two important sectors of society that provide important glue as well as economic value. Whether we are talking about grass-roots or world-class sporting and cultural events, if we implement this SI badly, there will be substantial negative consequences.

I am aware that I have asked an awful lot of questions. May I be presumptuous and ask the Minister for a meeting with the department and the CQC so that a number of us can properly understand how this measure will be implemented?

My Lords, I declare an interest as the chair of Sport Wales; with that, I sit on the board of UK Sport. I am also a board member of Active Travel England.

I reiterate the comments made by others about how horrendous and horrific the Manchester bombing was, as well as how significant an impact it had on so many people. The recommendations are important. I absolutely understand why we want to protect people and improve the system. I am also going to ask a number of questions, so I would be very happy for a follow-up afterwards.

I have spoken to a number of organisations in the wider sport industry. It is fair to say, I think, that there is a level of concern about the statutory instrument that we are debating today and the impact that it could have on the wider sports industry. I understand that the Sport and Recreation Alliance has written to the Minister; I would be interested in the reply and to know what further work has been undertaken.

I know from speaking to a wide group of people who work in the sports industry that they generally feel as though His Majesty’s Government have failed to engage with the sector properly and have not understood the significant, negative effect that this measure may have on the provision of medical care at events. There is a real risk of this preventing some sports events and activities from going ahead, or going ahead without the medical cover that they currently have, in order to avoid the consequences of the proposals.

The noble Baroness, Lady Harding, made some interesting points on registration. Medics often work in a voluntary capacity across a number of events of various sizes. It is important that these people are not registered multiple times. We should try to avoid some of the failings of DBS checks, where people are registered on lots of different systems. That does not solve the problem that we are trying to solve.

It is important that we understand who will be required to register, the cost of regulation and the wider impact on industry bodies. Also, what about non-compliance? We might be in a situation where some of the larger events are equipped and able to deal with this and have funding available. I understand that it puts sports medics in, possibly, a stronger position to argue for more support, but there could be a number of events that are already right on the knife edge of being able to carry on and this might stop them taking place. I am interested in understanding the impact on smaller sporting events and community sports events. We could end up in a situation where we have quite a gap in what that provision might look like.

The noble Lord, Lord Lansley, talked about some of the Premier League football clubs. I am less concerned about those. It is the lower leagues, the non-professional clubs, the rugby clubs and the local community events at which medics may stop volunteering because it is not worth the risk of them being there. Then we throw in the complicated picture of employment status, not just of the medics but of the athletes and everyone else involved. The system for lottery-funded athletes was absolutely set up so that the athletes do not have employment contracts—there has been at least one court case to look at that. This can add a further complication to the system that we are looking at, as does the fact that sport and health are devolved. I am interested in what conversations have been had with either the Welsh or the Scottish Governments, or with UK Sport, on the impact that this might have.

Looking back, 2012 was an amazing Olympics and Paralympics. We continue talking in the UK about an aspiration to host again, but bidding for those Games does not take place in a bubble. It is important that a number of different size events are hosted in the UK, and large and small events are part of that process. I am keen that England should not become a less attractive place to host sporting events. One exciting example for next year is that the UK is hosting the Grand Départ of the Tour de France, which goes through Scotland, England and Wales. What happens there as the teams cross the border between those countries?

The noble Lord, Lord Lansley, mentioned the survey by the Faculty of Sport and Exercise Medicine, which came up with some interesting data. It surveyed thousands of people: half of them said that this statutory instrument would have a major or moderate effect on their work; a third of organisations anticipated cancelling events; and over a third of individuals said that they may stop working in sport. That should give us pause for thought.

There is a debate about whether all sports and cultural events should be a regulated activity. I know from speaking to FSEM yesterday that it still feels that there are a number of sticking points in terms of the anticipated numbers affected and the cost, time and money of regulation. I have already talked about the enforcement process. The current lack of a standard to measure against is important—the proposed event healthcare standard is close to completion, but it needs further work—as is the wide variety of events measured against each other when they are completely different. I would also like to understand whether further discussions have taken place with FSEM.