King’s Speech

I welcome, as I hope noble Lords will, the Health Bill outlined in the gracious Speech, which is an important part of the delivery of our 10-year plan. In summary, the Bill will cut bureaucracy; it will improve patient safety through a single patient record; it will ensure that patients receive care that is better tailored to their needs, when and where they need it; and it will help us to make the shift from sickness to prevention, while improving patient safety and patient experience. Importantly, it will put more resources into the front line through the abolition of NHS England.

Noble Lords know only too well that, far too often, patients experience care that is fragmented and inaccessible. Patients and carers find themselves telling their story time and again, every time they meet a new clinician or a new healthcare professional. That is not just an inconvenience; it actually adds to the strain on people when they least need it. It also risks the safety and quality of services.

Alongside this, without integrated data the NHS misses opportunities to diagnose and treat people early, leaving too many seeking urgent care once their health has deteriorated. It is common sense to note that, when clinicians do not have all the facts to hand, they simply cannot make the best decisions to support the interests of patients. Equally, we cannot sensibly expect patients and carers to keep track of all the different documents, from all the different specialists, for all the different appointments in all the different providers. The Health Bill creates the statutory basis for the NHS to bring patients’ health and social care records into one place, enabling people to access their own health record, securely, through the NHS app. We are actively shifting the NHS from analogue to digital, empowering patients to take informed decisions and giving them more choice and control.

Putting patients at the heart of care means devolving decisions to a local level to meet the specific needs of the local population, where different services can better integrate around the needs of the patient. That is why integrated care boards will directly commission a greater proportion of NHS services. However, some aspects must be and are best done nationally. Where that is the case, we need to ensure that arrangements are efficient and have clear and strong accountability to Parliament.

The current system of two national bodies overseeing the NHS—the Department of Health and Social Care and NHS England—fails both those tests. That is why responsibility for all but the most specialised commissioning functions will be transferred to integrated care boards, including primary care, dentistry, ophthalmology and pharmacy commissioning. Integrated care boards are best placed to integrate care as local strategic commissioners, and we are empowering providers through foundation trust reform, giving them more flexibility to design and deliver healthcare around local needs. We will bring the functions of NHS England within the department. In other words, we are abolishing NHS England.

Through and across other departments of government, we are acting to continue to make the country fairer. Through MHCLG, we have already taken decisive action to fix the foundations of the housing system. Through the Renters’ Rights Act, we are strengthening security for 11 million tenants. We have ended the unfair system of no-fault evictions and given people greater stability in their homes. Alongside this, the Planning and Infrastructure Act is making it faster and simpler to build the homes and infrastructure our communities need. The English Devolution and Community Empowerment Act ensures that power moves away from Whitehall, giving people the right to make decisions about the things that matter to them, where they matter. We have made £78 billion available in the latest local government finance settlement, which is a 6.1% increase from the previous year.

This year’s gracious Speech brings forward reforms that make it easier for people to have a say, to own and stay in their homes, and to see their local areas and local voices improved. As outlined in the gracious Speech, the Representation of the People Bill will protect the integrity of our elections and inject a new vigour into our democracy by tightening the rules on political finance, improving transparency, introducing tougher measures to tackle the intimidation of candidates and electoral staff, and by extending the right to vote to 16 year-olds and 17 year-olds—the biggest expansion of the franchise in over half a century.

We are not just giving young people a greater say in our democracy. Through the commonhold and leasehold reform Bill, we are protecting their rights when they take their first steps on the property ladder, by fixing abuses and ensuring commonhold replaces leasehold by default. This Bill will make owning a home fairer and the provisions more transparent. Far too many leaseholders face unregulated and unaffordable ground rents; they face unjustified permissions and administration fees, unreasonable or extortionate charges, and conditions imposed with little or no consultation. The Bill will cut unfair charges, give people more control over how their buildings are run and ensure that they cannot lose their home for minor disputes or unexpected costs.

Alongside the ongoing implementation of reforms to the leasehold system which are already in statute, the Bill makes progress towards ending the feudal leasehold system so that future homeowners can buy with greater confidence and fewer hidden costs. It will cap ground rents for leaseholders today and will set a decisive path towards eradicating them, ending this exploitative practice of money for nothing.

Many leaseholders, as we know and have debated many times, are also trapped in unsuitable homes that they are unable to sell. It is a disgrace that nearly nine years on from the appalling tragedy at Grenfell Tower, there are still people in this country who live in buildings with unsafe cladding. The building remediation Bill will deliver on our commitment to fix the cladding crisis and, crucially, make those responsible pay towards fixing the problem that they caused, so that residents can feel safe in their homes and are no longer stuck in property that they cannot sell or move on from. There will be clear legal duties to fix buildings and penalties for those who fail.

Everybody deserves to live in a decent, safe, secure and affordable home, yet too many families in need of a social rented home are languishing on local authority waiting lists, being forced to struggle in the private rented sector or in expensive temporary accommodation. We have committed to invest £39 billion in the social and affordable housing programme over the next decade, with a further £3.6 billion to tackle the root causes of homelessness—and we are going further. The Social Housing Bill will help more families to access a safe and affordable home. It will protect the homes we already have and give tenants greater security, particularly those who need extra support, such as victims of domestic violence. It will also keep homes in the social sector through sensible reforms to the right to buy while ensuring that, where they are sold, the public purse is protected. This Government are putting the social housing sector on to a secure and sure footing.

We will also continue to keep our promise to transfer powers out of Westminster. The overnight visitor levy Bill will grant new revenue-raising powers to local leaders, as a step towards a new era of fiscal devolution in England, so that places can raise funding locally and invest it back into the services and spaces that people use every single day. Mayors will have the power to raise money and invest it into projects that improve their areas, to raise living standards and to support economic growth. They will be able to decide for themselves and not rely on central government to do it for them.

If I had to summarise these reforms, I would say that they are about something in some ways simple but also deeply fundamental. They are about ensuring that more people can live in a safe, secure home. They support better health, stronger communities and a growing economy.

To that last point, this growth also depends on world-class infrastructure, and our economic security depends on a strong transport network, whether of roads, rail or runways, so the Department for Transport is driving economic growth and transforming how people travel. It is making journeys greener, safer and healthier for all, as well as making them more available.

We are delivering a more integrated, reliable and future-focused transport system by improving connectivity, strengthening capacity and making travel more affordable. We are doing this by modernising rail, investing in better roads and empowering local areas to shape the transport services that they need. We are also setting a long-term vision for how people and places connect to drive the transition to net zero.

For too long, passengers have had to put up with unreliable services, confusing fares and no single body accountable for delivering a railway that works. I am glad to say that the Railways Bill puts an end to this by establishing Great British Railways, a new publicly owned company with sole responsibility for delivering for passengers and freight operators. Whether it be through simplifying the complex fares and ticketing system, through developing a timetable that actually works or through ensuring the needs of local communities are no longer ignored, GBR will deliver it. The Bill also establishes a powerful passenger watchdog to ensure that passengers are consistently championed at every turn. In addition, Northern Powerhouse Rail will create more reliable and more frequent services between the north of England’s great cities, so that more housing and better access to jobs, services and culture will have opportunities to grow.

As part of our drive to literally move forward, the Civil Aviation (Consumer Protection and Regulatory Reform) Bill strengthens consumer rights and promotes fair treatment of passengers. We are also making sure those rights are properly enforced by equipping the Civil Aviation Authority with direct powers to take action if airlines or airports fail consumers. The Bill will also promote economic growth through better infrastructure and improve aviation safety.

As set out in the gracious Speech, the highways financing Bill will help to unlock private investment in major road schemes. It gives the Government more ways to fund building and to maintain large-scale road infrastructure projects, while reducing the burden on the taxpayer.

The gracious Speech gives us the tools we need to build a stronger and fairer Britain. I and my Front-Bench colleagues look forward to taking these measures through your Lordships’ House and to working with noble Lords on all sides of the House.

It is only fair for patients to expect world-class healthcare that works around their needs; it is only fair for families to expect safe and affordable housing, and it is only fair that young people should never be cut off from opportunities, no matter where they live.

I should declare my interest as a professor of politics and international relations at St Mary’s University, where I teach an MBA module in healthcare policy and am helping with a new medical school, which will accept its first trainees this year. I also run seminars and supervise students at the Vinson Centre for the Public Understanding of Economics and Entrepreneurship at the University of Buckingham, which also has a medical school, but I have no relationship with that.

Unfortunately, successive Governments have failed to pay enough attention to the successes of community-led projects. An example is BRITE Box, which gives families ingredients and a recipe card with instructions to help them to cook healthy meals together. The recipe cards have been designed to be child-friendly, with more pictures and simpler wording. Often, it is the children who encourage their parents to join in preparing the meals as a family. BRITE Box aims for the box of healthy ingredients to cost around £5 to feed a family of four. This helps not only with budgeting but with changing eating habits and tackling obesity. So, while the Government repeat their mantra “From Hospital to Community”, on which there is obviously widespread agreement, can the Minister answering tell noble Lords what plans there are for the department to work more closely with existing projects that are already tackling many of these problems in their own communities? How can we expand the role of these projects in those communities?

At precisely the moment that the NHS needs resilience, it is constrained by workforce shortages, delayed discharge driven by fragility in adult social care and urgent and emergency care performance that reflects a system operating too close to the edge. The continual risk of industrial action, which the recently departed Secretary of State promised to end, only adds further to uncertainty for patients and staff alike.

The news last week that waiting lists had fallen is welcome in principle, and the Minister referred to this. However, I subsequently read in the Health Service Journal that the “majority of the improvement” in March was driven not by genuine progress but by a “record” spike in “unreported removals”. When I asked a Written Question on the reasons for patients being removed from the waiting lists, the Government replied:

“The Department does not hold the data”

showing the reasons why patients were removed from the waiting lists. Really? So how did the Government decide which patients to remove from the waiting lists if they did not have the data on why they were removed? There has to be a reason for these patients to have been removed. I urge the Minister to go back to the department and give a more credible response, so we can understand the reasons for the removals.

I turn to the King’s Speech and, in particular, the NHS modernisation Bill. On the face of it, some proposals are welcome: a single patient record, clear accountability in local systems and a simplified approach to patient safety. Any reform that reduces duplication, improves efficiency and, above all, improves patient care and outcomes deserves support. However, as successive Governments of all colours have found, good intentions do not by themselves guarantee better outcomes. The Government’s approach is not without risk. The history of NHS reform shows that structural change can impose substantial costs and disruption if not designed carefully and implemented safely. We have seen major programmes such as Epic create unforeseen problems in interoperability and access to information, and we have seen how cyber incidents can rapidly undermine clinical and operational capacity, as happened with the Synnovis cyber attack recently.

The healthcare landscape is now an extraordinarily complex network of providers, partnerships and systems with interdependent responsibilities, so reform driven from the centre must reflect that reality and diversity. A single patient record may have real potential, but it will succeed only if it is delivered with clear standards, accountability for implementation and robust cyber resilience. It must also earn the trust of patients, especially in how their data is protected. Failing to do so would incur the wrath of civil liberties organisations and reduce patient trust. In my time in the department, I supported the initiative of officials to consult organisations such as medConfidential. Although I expected the officials to be sceptical, they said, “We actually agree with many of medConfidential’s asks. They are reasonable and deliverable”. Let us make sure that we have that same relationship of trust between the civil liberties organisations and the department.

While many noble Lords will support the reduction of duplication between the Department of Health and Social Care and NHS England, abolishing an institution is often more difficult than creating one—especially since NHS England currently co-ordinates a vast range of activity that underpins clinical practice and the patient experience and outcomes. When the NHS modernisation Bill reaches this House, we will look to the Government to provide clarity on three points: the timetable and cost of transition; the continuity of national functions, including planning, performance of oversight, specialised services, digital delivery and how they will be maintained without interruption; and how the stated ambition of decentralisation and devolution is reconciled with the transfer of substantial powers to a central department.

I will set out a few areas where we will seek greater engagement from the Government between now and the introduction of that Bill. First, on the shift from treatment to prevention—which noble Lords also agree with—we support the idea that the most effective way to reduce pressure on the health system is to tackle problems at source, to prevent ill health where we can, intervene earlier where we must, and reduce demand on GPs, hospitals and emergency care providers where it is appropriate and safe to do so. While public health has a role to play, it will be important for the Minister’s department and local authorities to work with many of the local community organisations that I referred to. When it comes to healthier diets, I have already mentioned BRITE Box, but many noble Lords will be aware of local community projects, wherever they live, that work in social prescribing, including on music and well-being.

During debate on the Mental Health Bill, we discussed the increasing incidence of mental-health issues across the population. Sometimes medication is appropriate, but not always. Another option could be social intervention, such as music or art therapy. We know that these can help people feel much better, without the need to go to hospital in the first place. There are many such organisations up and down the country. I urge the Government to seek the solution in prevention, by increasing well-being, and not always through treatment.

We also need a credible workforce and staff retention plan: sadly, this is something we realised too late when in government. The continued risk of industrial action—combined with growing concerns that shortages in some clinical roles are putting patient safety at risk—creates a deeply worrying picture. Across the country, patients who choose to use the NHS live with the fear that a long-awaited appointment, operation or procedure may be cancelled at short notice. Against the backdrop of an ageing population leading to increased pressure on the public purse, the UK faces a challenge: while we probably have more doctors and nurses than before, is it realistic and affordable to keep recruiting more staff to try to keep pace with demand?

One way that the former Secretary of State wanted to address this issue was through the increased use of technology. During my time as Minister for Technology, Innovation and Life Sciences, one of my frustrations was that much of the technology to improve prevention and diagnosis was already available. This could be better use of a mobile phone camera to send high-definition photos or scans to be analysed by health professionals, or wearable technology to monitor patient health. But one problem is that there is no front door for start-ups and scale-ups in medical technology with the potential to transform healthcare. We need a front door, a one-stop shop, to distinguish the sales talk from those who claim to have a solution but actually have nothing more than a minimally viable product, from those who have a potentially transformative tech solution that could be adopted and make huge changes across our system of healthcare.

Another problem is that current suppliers of technology are often reluctant to work with start-ups, and quite often erect technical barriers to the adoption of solutions they did not invent. When I was a Minister, I had many emails on this subject; I still do now, as a shadow Minister. People offer real solutions that could potentially transform healthcare, but the existing suppliers find an excuse not to interoperate. We also need the department to be wary of vendor lock-in, especially in the development of a federated data platform.

When it comes to tech, the obvious phrase on everyone’s lips is the potential of AI. It does have huge potential to help analyse datasets and enable clinicians to make more informed decisions. But we must ensure that there is a human backstop immediately available when there are problems. I am sure many noble Lords have been caught up in online or telephone customer service—what people call “doom loops”—where they are unable to reach a human. While some companies may get away with this sort of customer service, or lack of customer service, timely human intervention in healthcare could make the difference between life and death.

During my time in this House, I have heard noble Lords on the Government Benches say that the state cannot do it all. The role of partnerships with non-state providers will be crucial. While our system of healthcare is often used as a political football to score points, I hope that, particularly in your Lordships’ House, we may be able to find some room for consensus.

I think back to when my father was a bus driver and a member of the Transport and General Workers’ Union. My father’s subscription included treatment at the independent Manor House Hospital, so when my mother had to wait to be seen by a specialist on the NHS, she was able to be seen by a specialist there. Today, we know that many trade unions offer private health insurance or health plans as part of their membership package. In seeking to improve the supply of healthcare in a sustainable way, I wonder if we can find some consensus and agree across the political divide on an increased role for non-state providers, including mutuals, such as Benenden Health, and charities, friendly societies, co-operatives and private non-profit providers. I recognise that there will be some political disagreement over private for-profit providers, but I wonder if even there we could find agreement where they have been used to increase capacity and reduce pressure on the National Health Service.

Let me be clear: this is not to diminish the role of the NHS, which is treasured across the country by people of all political persuasions. However, we need to consider how we reduce pressure on the NHS and the public purse, while increasing capacity and patient choice. I have tabled Written Questions on the role of mutuals in healthcare, and hope that I will be able to work with noble Lords on all Benches to encourage more of these organisations to play a greater role in our system of health and care.

We also need to be realistic about labour shortages. We know that, after the war, it was mostly Commonwealth citizens who came to this country to rebuild our public services. However, we live at a time when the Government, the Opposition and a populist party are making sceptical noises over immigration. Given this, we need to have a serious, grown-up conversation about where we find the young people to fill the vacancies in health and social care and pay taxes to fund the public services for an ageing population. Is it realistic to find them from only among the current UK population, or do we need to acknowledge that we need some immigration? How do we do that in a sensitive way, without invoking accusations of domination being made by some national politicians?

I come back to today’s debate, where we are considering housing and transport, as well as health. My noble friends Lady Scott, Lord Jamieson and Lord Moylan will say more on housing and transport, but I hope that the Minister and the Government recognise the connection between health and place. I saw that the noble Lord, Lord Mawson, was in his place earlier; he talks about this a lot. The Government had an opportunity in the King’s Speech to go much further in reflecting that relationship by adopting a genuinely place-based approach that looks at not only healthcare services but the environments in which people live, work, travel and age. The evidence is clear: sustained improvements in health will not be delivered by the Department of Health and Social Care acting in isolation. It requires a rounded approach across housing, transport, planning, education, work, local government, and perhaps other departments too.

Finally, we have heard time and again how the pressures in social care are directly affecting secondary care capacity. I look forward to the contribution of the noble Baroness, Lady Pitkeathley, who talks about this often. Delayed discharges, poor hospital flow and workforce shortages in adult social care all feed back into the NHS, leaving beds occupied by patients who are medically fit to leave but cannot be safely discharged. If the Government’s modernisation agenda is to rely on local integration through ICBs and more joined-up patient records, then that must be matched by a clear and credible plan for social care. If we do not fix social care, we do not fix the wider health system. Without such a plan, social care will remain one of the most limiting factors in the NHS’s ability to recover.

I will end by taking a step back from policy. As ever, the patient has to remain at the centre of our concern. His Majesty’s Opposition will work with the Government when it comes to improving outcomes and the quality of patient care, creating a system of health and care that is responsive, responsible and effective. We need a system that is robust, efficient and accessible—a service in which people feel empowered to seek help, are able to do so when they need it, and feel confident that they will receive their treatment in a timely and effective way. We need to move away from the 1940s model of trying to get hold of your GP so that they can sign a prescription or refer you to a hospital. Technology and a diversity of health and social care organisations can help with this transition. These Benches stand ready to support reforms where they remove needless duplication or bureaucracy, improve outcomes and the experience of patients, and strengthen our system of health and care to meet the demands of the future.

“This is the devastating result of a severe shortage of social rent homes”.

That is the benchmark.

We welcome the Social Housing Bill and its broad policy direction but, sadly, at its heart it is mainly a right to buy reform Bill. Necessary? Absolutely: it reduces discounts, tightens the system and seeks better replacement. Our policy is to allow councils to make their own decisions in that regard as to what would suit them, but this is at least a step in the right direction. But let us be clear: slowing the loss of homes is not the same as building new ones. It plugs the holes in the bucket but, at the moment, the bucket has very little in it. It does not yet deliver the step change in supply that we need.

This brings me to one of the biggest gaps: affordability. There is very little said about affordability. This is not only a housing crisis but an affordability one. For those who need social housing, supply is too low. For renters, rents are too high, and for first-time buyers, ownership is too far away. We must and can build more homes, but if people cannot afford them, the problem simply moves rather than disappears.

In the private rented sector, people are being squeezed from both sides, with high rents but no realistic route into ownership. The local housing allowance no longer matches market rents in many areas. Are the Government considering changes in the welfare system to support housing, or will we continue to expect people to bridge a widening gap that should not exist at all?

Our concern is the lack of a real route to delivery, because this is where ambition—and there is no lack of ambition from this Government—meets reality. Planning departments are overstretched, with around 80% underresourced. Recruitment plans are welcome, but they do not yet match the scale of the gap. Perhaps the Minister has an update on the promised target of 1,400 new planners by the end of the Parliament. But you cannot accelerate delivery if the system that approves development is running short of people.

This takes us to construction. There are currently 140,000 vacancies in construction. There is an ageing workforce, with many due to retire in the next few years and far too few apprentices coming through. There is a cross-party consensus about the need for more homes as we seem to vie with each other to announce higher targets, but targets do not build houses. Builders, plumbers and carpenters build them, and we do not have enough of any of them.

We should not forget SME builders, which are often the backbone of delivering the homes we need. What are the Government doing to support these businesses, which are crucial to delivering their ambition? They are often the ones which deliver smaller sites faster and more flexibly, and very locally. Yet they face tight margins, rising costs, complex regulations—always their moan—and difficulties accessing land and finance. The system as we have it now increasingly works for the bigger players, not the smaller ones. That matters, and I hope it matters to government, because if we squeeze out SMEs, as has been happening year on year, we reduce capacity and slow delivery.

On leasehold reform, we feel the direction is generally right, but we are nowhere near the destination, and there seems no sign of that. Commonhold is not clearly the default. Conversion remains complex, and everyday issues, such as service charges and property management practices, remain only partially addressed. The legislation seems geared towards future development and comes at the expense of existing leaseholders, particularly those in flats, leaving them trapped in a harmful two-tier market, further devaluing their homes and leaving them dependent on predatory freeholders and unregulated management agents whose interests are diametrically opposed to their own. These are the two glaring omissions that we would seek to fill. We have the promise of reform for some, but we agree with the Prime Minister, who, after the election, said, “Incremental change won’t cut it”—but this is incremental.

Then there is the much-welcomed remediation Bill. This is a test of whether subsequent Governments meant what they said after Grenfell. Nearly a decade on, thousands of buildings still require work. Progress has been made, but nowhere near quickly enough. The Public Accounts Committee has called it “far too slow”, and campaigners speak of people trapped, unable to sell, facing rising costs, living with uncertainty, lives on hold. Until the work is completed—not promised or planned but completed—we have not honoured the promise of “Never again”. Promises of everything being done by 2029 still seem a long way off if you are one of those people.

Finally, there is the last missing disappointment. Let us be blunt and realistic: public protest is often the reason for held up delivery, which those of us in local politics will know only too well. People are wary of any changes and unconvinced of the positives about development. This is despite their children not being able to live in the town, village or city in which their parents live. So why is that? Could it be homes built without infrastructure, promises not delivered, fears of overcrowding of major services such as schools and GP surgeries, or even about somewhere to park? These are real fears and concerns, which have built a lack of trust. Unless we rebuild that trust through better design, real engagement and delivering what is actually needed and promised, we will not build at scale and take communities with us.

The Government’s policy direction to solve this problem—despite their rhetoric in the introduction—is to take decision-making away from communities and upwards towards combined authorities’ mayors. When I read my planning email this morning, I saw that there may be further plans to give more decisions to council officers and not to councillors. I can understand why that is, but that is not what we need. As with many of the issues facing society at the moment, we need real leadership at all levels—from not just Ministers, who do say what needs to be said, but local MPs and councillors of all parties, including mine.

We will support the Government where we believe they are going in the right direction. We will do the usual urging faster and further, and in some regards, we will certainly challenge omissions; otherwise, there remains a gap between what is promised and what is delivered. What is missing is not intent or activity, and possibly not even resources—though more are always sought and welcome—but certainty of delivery at the scale and pace required. It is all about whether people have somewhere safe, secure and affordable to live. Right now, it feels like we have got rather good at producing the brochure; we just have not delivered the houses—but I am sure the Minister is as impatient for this as we are.

Sticking to the Bill, I am grateful to the Minister, the noble Baroness, Lady Merron, for introducing its health aspects, and I will pick up some of the points she made. The first is the abolition of NHS England. I accept that there was a disconnect between NHS England and the Department of Health and Social Care that needed to be addressed, and this Bill tries to do that. However, in doing so, it gives wider and deeper powers to the Secretary of State and to Ministers, to the point of the ability to intervene both locally and nationally. That might be a good thing, if the leadership recognises that any intervention has to be for the benefit of the patient, but that will have to be tested in times to come. That is my anxiety about that— I hope that is not my phone I can hear ringing; it is not.

The Bill strengthens local democratic accountability in the health system by means of mayoral nominees on the integrated care boards. In some areas, such as Manchester, these are referred to as health commissioners. If the responsibility of the mayoral representative is to focus on local and regional healthcare and to drive the ICB’s commissioning powers that way, that will be most welcome.

There are other issues, such as the CQC now being responsible for patient safety. The CQC has not improved the quality of healthcare in all its time. There are issues around the recognition of the patient voice, which will be taken away from Healthwatch and put into the Department of Health via a patient experience directorate. I do not know whether that can be regarded as the patient voice.

In my last minute or so, I comment the single patient record—it is universally accepted that we should have a patient record that goes from GPs to hospitals to social care—but there are issues with the curation and use of this data and with who has ownership, which now appears to be in the hands of the department and the Minister, not the patient. We have to explore how this data will be released and to whom, and its relationship with the NHS data platform, which is contracted out just now to organisations such as Palantir. This is an important issue to explore in depth, which I hope we will do in Committee.

There are issues around ICBs and their role now as a commissioner of services, and the representation on their boards. That requires further exploration, because it appears that the local authority representation might now be removed.

I will engage with this Bill constructively, with a view to be helpful and not in any way to criticise. The 10-year health plan and the 10-year cancer plan are good documents to drive improvement in healthcare.

My second point is that there is a real danger that vital qualitative aspects of the housing that we need will be sacrificed in pursuit of arbitrary numerical targets. I encourage the Government to promote the language of building homes, not units, and creating communities, not developments, and places, not housing estates. We also need to ensure that the foundational infrastructure is delivered in a timely way. Good design also creates the shared green spaces where both nature and residents can thrive. The report of the New Towns Taskforce underscored this priority. Can the Minister provide assurance that the new towns unit is putting as much emphasis on the qualitative aspects of delivering new towns as the quantitative?

The Church of England is ready to support the soft relational side of place-making as we strive to offer a Christian presence in every community. We can provide schools, social housing and management of community centres. Our network of volunteers can offer a welcome and attend to the spiritual and social welfare of the residents. Together with other grass-roots charities and faith organisations, we can help build the relational networks that shape the character of any new community. I hope that we will not allow the pressure for action, acute though it is, to deter us from creating a housing system that our children and grandchildren will thank us for.

On patient information, I put in a plea for sharing information with carers when appropriate. Too many carers who take huge responsibility and often administer NHS procedures to those for whom they care are denied information about the patient condition for reasons of confidentiality. I fully appreciate and understand this, but a carer cannot be expected to take 24/7 responsibility for the care of someone and then be denied access to information that would greatly help them in providing that care. Will the single patient record also allow access for the unpaid carers who provide the bulk of care?

I mentioned Healthwatch. Although I acknowledge the variety of quality in local Healthwatch organisations, they did provide a valuable source of gathering varied and rich data about communities and their needs. Now that these responsibilities are being transferred, as the modernisation Bill goes through Parliament we must ensure that the voices of patients and carers are heard loud and clear in the new system. I would be glad to receive reassurance that the Minister remains committed to this, as the noble Lord, Lord Kamall, reminded us that the Opposition remain committed.

I started with reference to the ongoing elephant in the room, social care. I end by saying that although frustrated by waiting for any definite proposals from the review by the noble Baroness, Lady Casey, I am heartened by the things I have heard the Minister say thus far and look forward very much to the outcomes from the national conversation that she is initiating. I understand that this has been slightly delayed. Can the Minister confirm the timetable for this very important development?

On remediation, I warmly welcome the appointment of the noble Lord, Lord Roe, to chair the building safety regulator. I commend him on the progress he has made in reducing the backlog of approvals for new high-rise homes. But there is a real challenge post Grenfell. Almost nine years later, over half a million people are still living in flats with a fire risk. Less than 20% of buildings over 11 metres high with unsafe cladding have been fixed.

The remediation Bill puts a little meat on the bones of the Government’s remediation acceleration plan, but there are still a range of issues on which leaseholders and I have been campaigning: non-cladding defects are not comprehensively funded; non-qualifying leaseholders continue to face ruinous costs; developers in the developer remediation contract are, in far too many cases, doing the bare minimum and marking their own homework; safety risks are being reassessed as tolerable, with buildings left half safe; building insurance premiums remain eye-watering; leaseholders are still having to pay for waking watches; and shared owners still face problems—they cannot sell because their registered social landlord will not buy, so they are having to sublet.

On funding for buildings under 11 metres with the same sort of cladding as Grenfell, we had an announcement in July 2025, but we still have no details. The BSR’s remediation improvement plan is yet to have an effect on high-rise buildings, with the median approval time now at 46 weeks. Leaseholders and residents are pushed from pillar to post, scrambling for simple answers about their homes.

In opposition, Labour understood that accelerating remediation without fixing the structural problems that I have mentioned would not work and recognised that remediation had to be comprehensive and independently overseen, with leaseholders and residents at the centre. Put simply, some leaseholders in some buildings are protected from the costs to fix some safety defects—that is simply not good enough. I look forward to working with this Government, as I did with the last, to do justice to leaseholders, who are in no way to blame for the misfortune that confronts them.