Healthcare Services: Acute, Primary and Community
House of Lords · Lords Chamber · 25 Jun 2026 · 17 speeches · Official Report
Motion to Take Note
Moved by
That this House takes note of the relationship between (1) acute, and (2) primary and community, healthcare services.
My Lords, it is a great privilege to open today’s debate on matters that are of such concern to so many people and which lie at the heart of our local communities. As we all know, health services are severely overstretched, whether in a local context or elsewhere. The systems are simply not coping. Anxiety and fear are facts of life for many, particularly the elderly and vulnerable, who fear they will not have proper access to healthcare-so much so that A&E has become the default destination for desperate patients unable to find care or advice through their local doctor. Some 18% of patients attending A&E did so because there was no GP appointment available to them; this amounted to 4.5 million attendances. Nearly half a million people waited 24 hours or more in A&E last year, an increase of 150,000 patients in just three years. Over 1.1 million patients were stuck in A&E, specifically waiting for an in-patient bed to become available. Even more frightening, according to the Royal College of Emergency Medicine report published in June this year, in 2025 around 15,860 patients died in NHS A&E departments in England while waiting for care that could have saved them. That is roughly 1,300 people every month, nearly 10 times the figure recorded in 2015. However, the Government’s 10-year primary healthcare plan promises us community-based health services with a focus on illness prevention and promotion of good health. The vision of a well-resourced community-based health service...
My Lords, I thank the noble Baroness, Lady Janke, for her incredibly powerful opening and the chance to speak in this important debate. I stand here with two hats on: first, as the survivor of a major trauma who has spent a disproportionate amount of time in all parts of the healthcare system, and, secondly, and far more importantly, as patron of Day One Trauma, which I shall describe later. I will make three points. First, we must start with the patient, not with the system. Too often, it seems that, as policymakers, we think about the policy and the organisational structure rather than the experience of the patient in the system. That is particularly true for trauma victims. I start with them because trauma is perhaps the sharpest end of our healthcare services. Trauma patients have to go through so many of the different services that are offered, from intensive care to rehab and community services and then to the long-term support they may need as they live at home. When someone is hit by a car, has a fall or experiences a major trauma, they do not think about the system that they are in-they think about surviving. They do not think, “I’ve now left acute care and I’m in the long-term recovery ward”; they think, “I want to recover”. What matters to them is whether they receive physiotherapy, occupational therapy, psychological support, pain management, speech and language therapy, and practical help to return to work and life. I have met many trauma survivors through Day...
My Lords, I am grateful to my noble friend Lady Janke for securing this important debate. I will focus my remarks on the crisis in medicine supply, the collapse of our community pharmacy network, and the impact that these failures are having on patients, particularly children with ADHD, many of whom have just finished sitting their exams without access to the medication they need. Since September 2023, we have witnessed a sustained and debilitating shortage of ADHD medications across the UK. Medicines on which hundreds of thousands of children and adults depend have been intermittently unavailable for nearly three years. At the height of the crisis, patients were reported to be travelling over 50 miles simply to find a pharmacy with stock. The House of Lords Public Services Committee, in its February report, Medicines Security : A National Priority , made the stark assessment that medicine supply shortages represent a potential national security issue. Some 73% of pharmacy workers stated that ongoing supply issues are putting patients at risk. Consider what it means for a child with ADHD to face their GCSEs or A-levels without their medication. For many young people, that medication is the difference between demonstrating their knowledge, ability and hard work, and sitting in an exam hall unable to engage with the paper before them. Students have reported rationing tablets, taking half doses or going without entirely during the examination period. Parents have spoken of the...
My Lords, I thank my noble friend Lady Janke for calling for this important debate, and it is a pleasure to follow my noble friend Lady Leaman, who spoke movingly of services for children with ADHD. I support everything that the noble Baroness, Lady Lane-Fox, said earlier. The 10-year NHS F it for the F uture plan aspires to change the NHS to make it work better in the mid-21st century. Science, medicine, demography and lifestyles have changed so much since the NHS was founded that radical change must happen. But it must be patient-centred, not organisation-convenient. My chronic illness means that I have more interaction with the NHS than the average patient, and recently that has escalated with new auto-immune problems, so I have seen at first hand what is happening in too many different hospitals in recent months. Good A&Es, including at my local Watford General Hospital, have in place not just an effective triage system but a 72-hour emergency admissions unit to which GPs can refer patients who do not need A&E but need very short-term hospital care-perhaps to get an infection under control. This latter system has worked well for a decade. I have experienced two emergency eye clinics in the last three months. The first, in London, was a complete nightmare to navigate. The staff were wonderful, from the receptionist to the nurses and doctors, but the building was completely inadequate and hampered an effective service for people who may not be able to see where they are...
My Lords, I declare an interest as a veteran of many health service reorganisations, through which I have consistently advocated for children and young people not to be forgotten, so it will not be a surprise that I am doing the same today. I have also spent many years making the case for better integration across primary, community and acute services, particularly increasing delivery of paediatric care in primary and community settings. The Government’s commitment to shift care from hospital to community settings is welcome, but we have heard similar aspirations before. How do we ensure that this time it becomes a reality? I have four asks of the Government. First, I echo the comments of the noble Baroness, Lady Lane-Fox, about thinking about the patient journey. Please map child and family journeys clearly, so that people can understand where and how they access support. The 10-year health plan mentions children frequently, but, after reading it and its supporting documents, I was still unclear how neighbourhood health services will fit alongside family hubs, Young Futures hubs, community paediatric services and other existing models. Neighbourhood health services could provide the glue that joins these services together, but there is a risk of duplication and confusion. My second ask is: build on existing good practice, rather than embarking on another cycle of pilots that are never adopted at scale. For example, the Well Centre in Lambeth-well known to my noble friend...
My Lords, community and primary care services are at the heart of the Government’s objective in the 10-year plan to shift from sickness to prevention and from hospital to community. But the funding does not always support that. Over the past nine years, the average increase in spend across health services has been 31% but primary care had only 24%. The patient population has grown by over 7 million since 2015, yet the number of GP practices has fallen by about 20%, leaving some rural areas without accessible cover. I heard a case only this morning of a rural GP who retired from a single-doctor practice; patients had to travel 12 miles to get to the nearest GP and there were no buses. The average list size is now 40% higher than a decade ago. Primary care, including dentists, optometrists and community pharmacists, is part of the prevention agenda yet there are major funding gaps and important aspects of the service suffer. GPs control the patient’s health records, and their patients have in the past benefited from continuity of care, but this no longer always happens and the benefits have been lost despite evidence that continuity is beneficial and can save money. GPs are the first port of call for patients, the point of first triage or suspected diagnosis and the gateway to more specialised services. If people cannot get to see their GP, as my noble friend Lady Janke said, they eventually turn up at A&E, usually with a much more serious condition and at greater cost to the...
My Lords, it is always a pleasure to follow my noble friend Lady Walmsley; I will pick up on her final theme. I thank my noble friend Lady Janke for initiating this important debate. As the vice-chair of the APPG on Pharmacy, I think the case for extra investment has been made by both her and my noble friend Lady Leaman. When the Government took office nearly two years ago, they came with a narrative of transformation. They promised people a fundamental shift away from the expensive, reactive walls of acute hospitals and toward a proactive, preventative “neighbourhood health service”. But looking at the NHS ledger of the 2026-27 financial year, they are forced to confront a recurring theme: the Government’s policy is built on hope while the NHS is living a different reality. The Government stated their hope that primary and community care would finally receive the financial engine required to keep people well for as long as possible at home. The reality under their watch is that the gravitational pull of the acute sector is still as strong as ever, accounting for between 75% to 80% of total NHS spend. The data from integrated care boards for the year ahead show this. Out of a combined £139 billion allocation, the total identified for neighbourhood health transformation activity is a measly 0.25%-and this is to fund the flagship policy of the Government’s health strategy. The reality is that local efforts to invest in community, primary and preventive services have been...
My Lords, I am grateful to the noble Baroness, Lady Janke, for securing this debate and to the noble Baroness, Lady Walmsley, for saying many of the things around primary care and general practice that I want to say. I always feel that I am here defending my own profession. The NHS was founded on a vision of care delivered close to home-in communities, general practices and by district nurses. Yet, over recent decades, a profound imbalance has appeared in resource allocation. Hospital-based care has grown in workforce, infrastructure and funding, while services that form most of the patient’s first point of contact have been left to wither, as we have heard. When I started general practice, on 17 February 1991, I had time with my patients and time to do what my patients-many noble Lords in this room-wanted. The mantra of moving care into the community has not been associated with a simultaneous move of resources, people, infrastructure support or estate. I now do more than any other GP in any other comparable health services. General practice in this country does more and to a greater degree of complexity than in any other. I do everything except open heart surgery in my consulting room-I confirm, for Hansard , that I do not do that. The consequences of this non-shift are evidenced across the full breadth of primary care. Millions of patients cannot register with an NHS dentist. Many resort to emergency departments for toothache-or, worse, leave decay untreated until it...
My Lords, I am delighted to follow the noble Baroness, Lady Gerada, with her first-hand expertise and experience as a GP, and her description of the service that we all would like to see. I am grateful to my noble friend Lady Janke for introducing this vital debate. The relationship between acute services and primary care goes to the heart of how the health service that we value can survive and function. The noble Baroness, Lady Lane-Fox, rightly highlighted the need for the patient to be the focus, not the organisation, and she described the needs of serious trauma patients and the opportunities for technology. My noble friend Lady Brinton highlighted the need for patient-centred services and the whole person being at the heart of this. The consequences of the deep imbalance between acute, primary and community health services are starkly visible in the data. NHS England discharge data from 2025 shows that patients who were medically fit to leave hospital spent the equivalent of 4.34 million days stuck in beds. They were there not because they needed acute care but because the community and social care that was needed to support them simply did not exist. My noble friend Lord Scriven provided the clear financial reality of acute services being prioritised, community services being reduced and the hollowing out of services for people with learning disabilities. Let us look at dentistry. NHS England statistics published in 2025 show that four in 10 children-over 5 million in...
My Lords, I thank the noble Baroness, Lady Janke, for securing this important debate. There is broad agreement across the House on one central point: if we are to build an NHS that is sustainable for the future, we cannot rely solely on treating people once they arrive at hospital. We need strong primary care and early intervention that prevents illness escalating in the first instance. That principle is not new. Successive Governments, including the Conservatives, have spoken about shifting care closer to home. The current Government have made it one of the central pillars of their health strategy through the proposed neighbourhood health service and the commitment to move from hospital- to community-based care. The question, however, is not whether we support that ambition, but whether the Government are delivering it. The figures set out in the House of Commons Library briefing are striking. Between 2015-16 and 2023-24, spending on acute services increased by £14.3 billion, while primary medical care increased by only £1.7 billion and community services by £3.1 billion. Those figures illustrate the scale of the challenge in rebalancing the system; they also demonstrate why simply announcing a shift is not enough. Resources must genuinely follow patients into community settings if the policy is to succeed. These Benches welcome the Government’s stated commitment to shift care out of hospitals into communities. We also recognise the potential benefits of neighbourhood...
My Lords, I congratulate the noble Baroness, Lady Janke, on securing a very important debate. I am also grateful to all noble Lords for their contributions. I recognise many of the challenges raised, which is exactly why we are taking the action that we are. I am glad that the noble Lord, Lord Evans, in particular welcomed the direction of movement, as have so many noble Lords, including the noble Baroness, Lady Pidgeon. It is important that we look at where we started, because I think it reminds us of the scale of the challenge. It was the noble Lord, Lord Darzi, who made the point that we inherited an NHS facing the worst crisis in its history. We all know of people stuck on waiting lists for many years, staff who have felt let down by bureaucracy and little support, and patients who have had to navigate a system that all too often felt complex, disjointed and fragmented-the noble Baroness, Lady Brinton, spoke about literal navigation, which I thought was a key point. Not only was that the situation but we recognise that, while we are making improvements, there is some way to go, and I want to set that out at the outset. I am grateful to the noble Baroness, Lady Lane-Fox, for talking of her own personal experience, and I can say to her that, yes, the patient is at the centre of all the reforms that we are making. The noble Lord, Lord Darzi, found that society is getting sicker. People are living longer but in poorer health and with more complex needs. I should emphasise...
My point was that flexibility is taken away when national directives come down, forcing ICBs to spend money on acute and emergency care.
I always appreciate the expertise of the noble Lord, but I have set out our approach. We are focusing on outcomes and the best way to achieve them. We keep them constantly under review and discussion, so it is not top-down but how we are going to get to the place that all noble Lords want us to get to. I know that I will be able to refer to only a limited number of questions, and I hope noble Lords will forgive me. The noble Baroness, Lady Walmsley, raised dental deserts. We are offering incentives to attract dentists under the golden hello scheme, which is what it says on the tin. Importantly, we are also increasing the supply of dentists. We have just announced the first sustained expansion of dental school places since 2007. The noble Baroness, Lady Walmsley, also asked about progress being made on publishing health food standards and the consultation. I acknowledge her particular interest and expertise. We will soon be consulting on the proposals for healthier foods targets and reporting. Importantly, we remain on track for delivering on this 10-year health plan commitment in this Parliament. If the noble Baroness would like further information, I would be very happy to obtain it for her. The noble Lord, Lord Evans, asked about milestones that will be used to ensure that the shift from hospital to community is taking place, which is important. That is why we have published the Neighbourhood Health Framework , which will ensure that accountability. I am very alive to the...
I thank the Minister for her remarks and her explanation. She is obviously very committed to her plan. I think it is fair to say from what we heard during the debate, which had strong contributions from both professional and patient experience, that people in this Chamber are not convinced and that there is a lot of work to be done to convince people that the plan is going to succeed-not least the people who are working in it. I draw the attention of the Minister to the morale and the sense of crisis that there is in many communities. On my point about local pharmacies, there is a crisis, and if we are not careful there will be none left to help to deliver the plan, and I am sure the situation is similar in other parts of primary care. So, while I recognise that the Minister has tried to be helpful, I think there is still a lot of work to be done and I-and, I know, others in this Chamber-will be pursuing the plan, in the hope that we will see it succeed in the future. It will need a lot of commitment and, as we have said, a lot of resource focused on primary care in communities and making sure that that focus is kept and that we remain committed to it. Motion agreed.