That an humble Address be presented to His Majesty as follows:

“Most Gracious Sovereign—We, Your Majesty’s most dutiful and loyal subjects, the Lords Spiritual and Temporal in Parliament assembled, beg leave to thank Your Majesty for the most gracious Speech which Your Majesty addressed to both Houses of Parliament”.

My Lords, it is a real honour to open today’s debate on behalf of His Majesty’s Government. When it was my privilege to close the last debate on the last gracious Speech, I spoke about the Mental Health Bill and the Tobacco and Vapes Bill. I thank noble Lords across the House for their engagement and thoughtful scrutiny of both those pieces of legislation, which have delivered significant Acts of Parliament and what I would describe as significant acts of change for the better. Those two Acts are among the most important steps for improving public health in decades—cornerstones of the Government’s commitment to reduce inequalities in this Parliament.

This gracious Speech sets out how we will go even further to make our country stronger and fairer through a renewal of our public services. I hope noble Lords will welcome the progress that the Government have made since taking office in respect of the health service, including action on waiting lists, now down by half a million, while the number of people waiting less than 18 weeks for planned care now stands at 65.3%, up from 59%. We see ambulances responding to strokes and heart attacks arriving five crucial minutes faster compared to last year. We have met our manifesto commitment to recruit an additional 8,500 mental health staff three years early.

Underpinning everything, we have set out a new direction for the future of healthcare through the 10-year health plan. We are reforming the NHS to make it fit for the future. We are shifting from sickness to prevention, from analogue to digital and from hospital to community. As noble Lords have regularly observed, we face an uphill battle, which is what the noble Lord, Lord Darzi, found in his independent review. One of the noble Lord’s conclusions was that past legislation was too rigid and overly specific, which had the effect of increasing bureaucracy and diluting accountability over time, and of this we have certainly taken heed.

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.

My Lords, I thank the Minister for the clear way in which she introduced the debate. We all know that our country faces profound and growing challenges in health and social care. As the leader of the Opposition made clear in her response to the gracious Speech in the other place, we are entering a period of deep structural pressure that will test the foundations of our system. His Majesty’s loyal Opposition will engage constructively with the Government’s proposed reforms, but it is essential that the Government reassure patients that any changes will improve the quality of care, protect patient safety and their privacy and avoid costly disruption.

Our system of healthcare, especially the NHS, is caring for more people than ever before. Although people may be living longer, too often they spend their later lives and later years in poor health. Increasingly, patients present not with a single condition but with multiple, complex and interlocking needs. Multimorbidity is no longer a challenge for the future, but a challenge for now. It is reshaping demand across primary care, hospitals, community services and social care. That pressure is compounded by the wider state of the nation’s health. Healthy life expectancy has fallen, meaning more years lived in ill health, a sustained greater demand for services and a heavier strain on an already stretched workforce.

In the drive to improve our health by reducing obesity, for example, successive Governments have relied heavily on top-down or trickle-down, state-led interventions, such as sugar taxes. But often this has not led to sufficient changes in behaviour. Often, the poorest families simply end up paying more, or swap their favourite brand of sugary drink or snack for a cheaper brand. What is amazing about this view is that, when I speak to public health academics, they agree with it, but they also agree that community led, bottom-up approaches are far more effective than top-down state interventions.

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.

I too thank the noble Baroness for the very sincere conviction and clarity with which she gave her introduction. From these Benches, I shall speak to the housing issues in the humble Address and will save a lot of the detail for the various Bills—so I hope the Minister does not think that she is going to get let off too lightly—knowing full well that my noble friends will address the issues of health and transport in greater detail.

Listening to the housing measures in the gracious Speech, I was struck by a rather familiar feeling, the sort you get when you get handed a glossy developer’s brochure. Noble Lords know the one—the sunlit streets, the happy families, everything finished and perfect, not a wheelie bin or an old banger in sight. It all looks excellent until you actually visit the site, where the picture is somewhat different. I am afraid that, with much of what we have before us, the gap between the brochure and the build still looms rather large.

Let me be fair: there is much to welcome. There is energy, there are Bills already in motion to support the ones that are coming forward and, for me, there is a real recognition that housing is not just another policy; it is actually the most important issue for millions of citizens and for the economy of the whole country. However, as someone who has spent years trying to get homes built—I was dubbed the pro-development mayor—I have learned that housing policy is judged not on what it says on the paper but on what gets built where. My test is simple: will this deliver more homes, and particularly more social homes, at the pace needed to turn the tide and at an affordable price?

It must be said that, on the whole, the sector has been very pleased. Long-term funding for social housing, at last, is very welcome: we cannot build homes with short-term thinking. A stronger Homes England and sensible powers to provide land for social homes and community facilities are vital. Unlocking land matters. The provisions in the Social Housing Bill supporting those fleeing domestic abuse are close to my heart and genuinely important—housing should always be part of the solution and not a barrier—and there has been progress on the remediation of homes with cladding. “At last”, the campaigners will say, but the date of 2029 will still feel a long way away. But let us close that brochure and look at the reality. There are over 1.3 million households on waiting lists and over 130,000 households in temporary accommodation, including thousands of children. As Shelter has put it,

“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.

My Lords, before we move on, I remind noble Lords on all sides that there is an advisory limit of five minutes for speeches. If we could stay within that, that would be great, because obviously we want to finish at a reasonable time this evening, and we have to show other noble Lords who are speaking a bit of respect.

My Lords, I thank the noble Lord for that notice before I got up. In the brief few minutes I have, I am going to speak mostly about the Health Bill. The Bill is light in legislation, with 72 clauses and 48 pages, but it has 143 pages of schedules. One wonders whether most of the powers might therefore be through SIs and guidance, and that is what we have to explore.

I will concentrate my remarks on the notes produced by the Government following the gracious Speech. It is customary, as has been noticed over the last three days, that most noble Lords offer their alternative legislation to that which the Government are going to bring forward. This is evidenced by the 300-plus noble Lords who will have spoken by the close of business tomorrow. I will refrain from doing that; I will stick to what is in the legislation and follow the notes that have been circulated.

Early this morning, I listened to a podcast about health and social care. It was recorded just a few weeks ago, and the person who was interviewed was Andy Burnham. Some of the things that he reflected on in the podcast are in the legislation, but he focused mostly on social care and prevention in the wider sense. I do not want to predict the future, but I wonder whether we will have another Bill in times to come following that podcast. However, I put that aside.

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 Lords, as the Church of England’s lead bishop for housing, I commend the measures in the gracious Speech that will improve different parts of our housing system.

The housing affordability crisis threatens to unravel the unwritten social contract: that if you get a decent education and then work hard, you should be able to earn enough to save for a deposit, buy a home, get married, start a family and provide stability for your children until they can do likewise. While these proposed Bills are important and worth while, I urge the Government to use this forthcoming legislation to address the most acute part of the housing crisis: the affordability of homes, whether for rent or for purchase.

The social housing renewal Bill represents an opportunity to build more decent, affordable homes. Will the Minister consider allowing councils access to low-interest, long-term development finance on the same favourable terms as those given to housing associations?

It is important to complete the legislation in the leasehold reform Bill and to get it right, so that it delivers a fairer system and justice to those leaseholders who have suffered gravely at the hands of unscrupulous freeholders. At the same time, we need to recognise that legislative nuance may yet be required to preserve the heritage value of certain historical estates.

There is a fundamental moral case for correcting the imbalances, distortions and injustices in our housing system. First, there is the growing inequality between those with housing equity and those without. The former have seen their unearned housing wealth grow inexorably, whereas those whose income is derived solely from their labour watch the bottom rung of the housing ladder slowly receding from their grasp. Secondly, there is the lack of labour mobility. People struggle to relocate to where new jobs are emerging, which puts a drag on economic growth, productivity and incomes. Lastly, long-term damage is even more insidious. Prolonged high housing costs delay family formation and fewer children are born. Would-be parents cannot afford to stop work to raise a family unless one of them is a high earner. The consequences of demographic decline can be severe, including a shrinking workforce, a growing old-age dependency ratio and severe pressures on health and social care provision for an ageing population.

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.

My Lords, in my 29 years in this House I have spoken in many a debate on the health provisions in many a gracious Speech. I have longed for the day when I could rejoice in the plans set out for a new deal on social care. Sadly, I am still waiting. Whatever improvements His Majesty’s Government make in the way healthcare is delivered, it will not be as effective as we hope unless we tackle the elephant in the room—the grave shortcomings in social care and their inevitable juxtaposition with NHS care. However, there are many things to welcome in this modernisation Bill.

In the past I have had cause to complain that the NHS did not pay sufficient attention to the contribution of unpaid carers, nor seek to meet their needs as well as those of the patient. This time I am pleased to say that carers’ rights to involvement are threaded throughout the Bill in relation to services commissioned by the Secretary of State and by integrated care boards. Where ICBs have acquired the involving responsibilities of local Healthwatch organisations, carers have clearly been included and are in the Bill.

The creation of a single patient record across health and social care is also greatly to be welcomed and should reduce the need for carers to repeat information on behalf of the person they care for—as the Minister has reminded us. I have lost count of the number of times I have been told by patients and their carers, “Why is it that every time I meet a new person dealing with my relative’s care I have to start from scratch and give them all the details? Why on earth don’t they pass the details on to each other?”

When I chaired a committee in your Lordships’ House about integration between health and community care services, it was clear that integration was controlled as much by professional attitudes as by patient need and that data sharing was hindered by cultural and perceived—often inaccurately—legal obstacles. Often there was a misguided sense of protecting patients by not sharing data when patients themselves always assumed that the information had been shared. So the move to create a single patient record is welcome. As part of wider plans to digitise the NHS, it will be a game-changer. Patients will receive safer, quicker and more accurate healthcare and clinicians will have accurate data about a patient in one place.

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?

My Lords, it is always a pleasure to follow the noble Baroness, Lady Pitkeathley. On social care, she is absolutely right.

On housing, the Government’s target of 1.5 million homes is not a policy but a dream. By their own calculations, they are already 400,000 adrift. In London we need 88,000 new homes a year. Last year they finished 6,000. While I welcome all the plans to speed up planning, much of which are now in place, that is not the problem. The number of sites with planning permission not yet built on is more than 1.5 million. The problem is not potential supply but demand. Builders will not build if there is not a buyer. If there is no buyer, it is not just the market buyers who are hit but the people wanting social homes. Following what the right reverend Prelate said on affordable homes, half the social homes are built through Section 106. They are built on the back of market homes. If we do not get the market homes, we do not get the social homes. That hits those in real need.

On 17 December 2024 the noble Baroness, Lady Taylor, answered questions on a Statement that stated that there were,

“to our shame as a nation, just shy of 160,000 homeless children living right now in temporary accommodation”.—[Official Report, Commons, 12/12/24; col. 1057.]

A year later it had risen to over 176,000.

We need to kick-start both markets—market homes and social homes—and we urgently need a successor to Help to Buy for first-time buyers. Most renters want to buy. The average rent is higher than the average mortgage payment. But, without wealthy relatives, many renters simply cannot afford the deposit. This is where we need urgent government action in conjunction with the financial institutions and developers to find a successor to Help to Buy. I note in passing that the Government made a profit of £1.3 billion on Help to Buy.

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.

My Lords, my contribution today considers the housing aspects of the King’s Speech, and I will echo some of the points made by the noble Lord, Lord Young of Cookham. I declare my housing interests as listed in the register, including chairing the Northern Housing Consortium’s Renew initiative to boost local economies through housing-led regeneration.

There are three Bills in the King’s Speech that relate to the ongoing acute shortages of decent affordable housing. These Bills complement the Government’s efforts, currently thwarted by adverse market conditions, to secure the building of 1.5 million new homes in this Parliament. Although the Government’s Homes England programme of £39 billion for new social housing over the next decade represents the largest input of funding for the sector since 2010, a lot more still needs to be done. All three new Bills are very welcome. I offer a comment on each.

First, the commonhold and leasehold reform Bill will address key aspects of the current leasehold system, which is in desperate need of radical change. The Bill’s main omission is the absence of sufficient action to improve the performance of managing agents of blocks of leasehold flats and weed out the worst operators. The Housing Minister has promised requirements for mandatory qualifications, but, sadly, the Government have not brought forward measures to create any code of practice to raise standards enforced by a proper regulator of property agents.

Secondly, the remediation Bill—the so-called Grenfell Bill—will tackle the slow speed to date of the removal of unsafe cladding, the cost of which should fall on those manufacturing it and specifying its use. This saga has, to date, taken almost 10 years to find resolution, with work on unsafe cladding in high-rise buildings being completed on only a third of known cases. We must hope, as the noble Lord, Lord Young, mentioned, that the new legislation supported by the noble Lord, Lord Roe, and the building safety regulator, which he chairs, will finally fix the crisis, and that those who have behaved appallingly—and, it seems, criminally—will be brought to justice.

Thirdly, the Social Housing Bill will continue the Government’s attempts to boost the amount of social and affordable housing against the backdrop of 176,000 children in temporary accommodation where their health and well-being are suffering so badly. Among that Bill’s measures are important extra support for domestic abuse survivors to remain in their homes and greater protection of precious existing social housing from further loss through right-to-buy purchases. We would have over 2 million more social homes but for the sales under that giveaway scheme. Some 40% per cent of the homes sold are now in the hands of private landlords charging up to three times the previous council rents, with the cost falling largely on the taxpayer. No wonder few local authorities have been building new homes when they have known that these can be bought cheaply and sold on by their occupiers. That would be like trying to run the bath with the plug out.

However, I see a big omission from the Social Housing Bill in the absence of any reference to the regeneration of existing outdated social housing stock, not least the worst of the 1960s tower blocks and prefabricated buildings. Little Awaab Ishak, who died from the effects of mould growth, lived in substandard 1960s social housing. Tougher regulations now require social housing providers to take more urgent action and a sensible settlement has been agreed for annual rent increases, but rental revenue will not stretch to paying for serious renewal and replacement. This urgent need for regeneration matches the necessity to build new homes and deserves more government attention.

The three Bills take us in exactly the right directions. I commend them, with the proviso that I foresee that there might be some useful, modest amendments for your Lordships to consider in due course.

My Lords, I will speak about an issue that millions of our fellow citizens suffer under a system that exists not by accident but by design. Housing, His Majesty told us, is

“a source of insecurity for many people”.

That is perhaps the most restrained description of the leasehold system one could offer in this House. Some 91% of owner-occupied flats in England are leasehold. In total, one in five properties—nearly 5 million homes—is leasehold. These are not fringe numbers; they represent the daily lived experience of millions who do not truly own their home, and so it is right that it was included in the gracious Speech.

Before I turn to the scandal of what leasehold has become, I want to say something about building homes in the first place. This is a matter of which I have direct experience. As a cabinet member for regeneration for eight years in Brent, I know what it takes to bring homes forward at scale. Building homes is not a technocratic ambition; it is a moral one. The Government’s commitment to build 1.5 million homes in this Parliament is right and necessary. But here is a truth that experience teaches: it is not enough simply to build homes; we must ask what kinds of homes they will be and on what terms people will hold them. We must ensure that the homes we build do not become the instruments of a new injustice. That is precisely where the leasehold system bites hardest.

The majority of new homes delivered at scale will be flats—that is the arithmetic of housebuilding. If they are sold as leasehold, as has been the default for generations, every new home that we build is a potential new entrant to a system of tenure that is unjust. We cannot build our way to a fairer housing market while maintaining an unfair tenure at its heart.

It is young people who bear the sharpest cost of both failures. For a generation of young people, the aspiration of home ownership is not being deferred; it is being extinguished. The Institute for Fiscal Studies found that home ownership among 25 to 34 year-olds stood at 55% in 1997. By 2017, it had collapsed to just 35%. Since 2005, home ownership rates have fallen for every age group except those aged 65 and over, whose rate has risen by 7%. We are building a country in which housing wealth accumulates with age and inheritance, not with work and aspiration. That is an intergenerational injustice.

When these young people finally reach the property ladder, often through a flat, which is often their only realistic option, they find themselves met not with security but with ground rent, service charges and a tenure that gives the cost of ownership without the control. The Government estimate that more than £600 million was paid by leaseholders in ground rents in 2025 alone. For a young person already stretched across a 30-plus year mortgage and a huge deposit, that is not a minor inconvenience; it is further extraction from those who can afford it least. The Government’s manifesto committed to bringing the feudal leasehold system to an end. This is structural reform of a system that has for generations denied working people the full fruits of home ownership. The Bill will cap ground rents, ban leasehold for new flats and make commonhold the default.

On commonhold, the Bill is at its most radical and most just. Flat owners will hold their rents as freeholders, managing their building collectively as equals, with no absentee overlord and no arbitrary charges approved without scrutiny. As the chief executive of the Property Institute has observed, this model already operates in most countries across the world, including Scotland. The Government are proposing not revolution but joining the rest of the civilised property-owning world. Some 5 million leaseholders across England and Wales are waiting for this legislation, and the Government have an electoral mandate to act.

I shall add only one note of caution. The Property Institute is right that empowered commonholders must be supported by qualified professional property managers and that resident empowerment must not outpace protections against an unregulated sector. This House will rightly scrutinise the safeguards with care. Let us be clear what this moment represents. The Government are committed to dismantling this archaic and iniquitous system, not overnight, not recklessly, but decisively and for good. For every young person currently saving for a deposit they fear will never be enough, for every leaseholder paying rent on land that they thought had been bought, and for every family in a new-build flat discovering that the tenure that was sold does not deliver the security they were promised, this Bill will matter. Building more homes is essential, but building them fairly is non-negotiable.

My Lords, I rise to welcome the health Bill part of the King’s Speech and declare an interest as chair of University College London Foundation NHS Trust and of Whittington Health. I express my gratitude to the King’s Fund, the Health Foundation and colleagues at both my trusts, to whom I pay great tribute for all the work they do, and many others for their briefings and conversations.

I want to welcome the Bill, but there are a lot of buts. I completely agree with the noble Baroness, Lady Pitkeathley, about the absence of a mention of social care. Where is social care? We were expecting to see it in this King’s Speech, and there is nothing. Alas, that is the first point where there is a big but.

Secondly, abolishing NHS England and transferring its powers to the Secretary of State in the Department of Health is fine, and in many ways very sensible, but the detail is slim and, let us be clear, we tend to go through phases of restructuring in the NHS. Moving the deckchairs is something that Health Secretaries like to do, despite this Government having said that they were not going to do it. Bringing powers back to the Secretary of State without a clear way of keeping a public eye on what is going on is clearly a cause for concern. We await the detail. I would be very grateful if the Minister could spell out for us where accountability, independence and the public interest will lie in this new system, all the more so when so many powers are transferring from NHS England to the Secretary of State, including the ability to direct local NHS organisations.

These powers risk Ministers being given too much power over the day to day, with too little power lying in the hands of patients and the public. That is all the more important given the decision—or the intention, anyway—to abolish Healthwatch. A stronger replacement than what is currently on offer will be needed. The NHS is a public service, deeply rooted in our communities. Many of us are even more worried about what this means for the patient and public voice, given the lack of clarity at best about governors, with whom we at University College Hospital have worked extremely well, and I pay tribute to them. We are seriously concerned that their role will not be compulsory in this new future, with no adequate patient and public voice replacement.

Thirdly—and this is the compliment—there is the single patient record. I think we are all thrilled about that, but even there the devil is in the detail. We know there is a long history of NHS IT failures that have been quite expensive. Who is going to be in charge? What will be the safeguards? Will the Government recognise deep concern among staff and the public about Palantir, as my noble friend Lord Patel has already said? The Department of Health has brought in Palantir, but disquiet is widespread and is expressed at our public meetings. How will privacy and security be guaranteed with a company that is not UK-based? We need far more detail. Trust from patients, staff and the public will be essential for the plans to succeed.

Then there are the changes to the local management of the NHS with the revision of integrated care boards’ membership. It might well help simplify the system, but the changes also risk undermining partnership working, which is needed to improve health and care. Removing, for instance, mandatory local authority representatives from ICBs could make things worse, and bringing in mayors is really not enough.

Lastly, there are the things that we were expecting to see. I had expected to see something on the role of the new advanced foundation trusts. We need to understand something about the proposals to cap some trusts’ spending, including that of foundation trusts and maybe even advanced foundation trusts, in order to use the cash to support other cash-deprived trusts. Will the Minister clarify? Will she also tell us what really lies within this new Bill about neighbourhoods and integration?

To sum up, I and many others were delighted to see much of what is in this Bill, but we are puzzled by some of the changes, by more power going to the Secretary of State and by the lack of a patient voice. I hope the Minister can provide some clarity and, indeed, some comfort.

My Lords, I have had a long career in transport, particularly in the railways. I can remember the day they were first nationalised. I worked in the industry in good times and bad times. In the good times, for example when I was chief operating manager at Crewe, more than 90% of the trains on the west coast main line ran on time, day after day. Money was tight, but we managed.

The newly publicly owned railway faces radical change, which I welcome. Running railways is a job for railway professionals, not civil servants, regulators, armies of lawyers, financial manipulators and consultants, often paid a lot of money, producing poor standards of punctuality and poor financial management, as we see in the case of HS2, which was not designed or built by railway professionals. This is about to change radically, and I hope the Minister will endorse these thoughts and say that the integrated railway that he envisages will result in consistently better performance for users and taxpayers.

Can he confirm a changing role for the rail regulator and that Great British Railways will strategically plan network access to make best use of the network and the limited capacity we have available and hope in time to improve? Does he believe that freight deserves a better deal, particularly as train loads and speeds increase? Does he believe that the curse of bus substitution is something we can look forward to seeing the end of, because people always prefer to stay in a train as long as they have reasonable notice of what is happening? Will the Minister turn his back on the blame game and concentrate all efforts by operators and engineers on putting right yesterday’s failings the next day or as soon as possible thereafter? I believe the recently appointed managing directors are doing this already and will be keen, as will their staff, to run the best operated of the franchises, or divisions, or whatever they will be called.

What is the future for open access operators? What changes does the Minister think need to be made to safety regulation and for the needs of the mobility-impaired?

Railways are a long-term industry, and planning timescales are necessarily long. We need a financial framework that supports this, not year-to-year planning. Does the Minister share my view of the railway that we need to set our sights on for 2040, when Scotland and London will be half an hour closer together and one mainline route will always be open between important centres?

I want to finish with something that I heard last night. When the Chelsea Flower Show came to its conclusion with the awards, the best show was exhibited by a lady who has won 19 gold medals. She said that creating something like this was like creating a decent railway; it was all down to team effort. I hope that the Minister will endorse that view when he comes to speak.

My Lords, it is a pleasure to follow the noble Lord, Lord Bradshaw, and to acknowledge his expertise and his dedication to the rail industry. When I saw that I had been drawn to speak after him, I knew that, by the time we came to that part of the debate, we would be on the transport section. I am grateful to the noble Lord for being the first speaker to take us into transport as far as the Loyal Address is concerned.

The Government put GBR in their manifesto, so it was obviously going to happen. It is interesting to note that, since privatisation and franchising of the railways, there was a Labour Government for 14 years, who decided to stick with the system that they had inherited. I think they decided to stick with that because they knew that it was working. Prior to privatisation, there were 700 million passenger journeys a year on our railways. During the period of privatisation, that figure went up to 1.7 billion. That was pre the pandemic. We saw private investment taking in the railways. I remember when I first got elected that the last place anybody would want to spend any time was St Pancras station. It was a dump. It was awful. It lacked investment. It lacked investment because nobody was investing in the railways. If you are competing against the health service and education for public sector money, and you want to put money in the railways, guess which comes last? It is the railways. I raise my concern about that and what may well happen. I am sure that, in the new utopia that we will get as far as GBR is concerned, we will see no delays and everything will be fine in the future—well, in your dreams, and in the Government’s dreams. It is a great pity that they will not be using the expertise of getting private investment in.

As a Secretary of State for Transport, I saw the detail that was gone into when a new franchise was coming up for renegotiation, the extra services that were lobbied for by local Members of Parliament and the like. That was encouraging, and more services were provided. I worry about the conglomeration of it all as to whether we will get that sort of dedication into those individual services; I am sure it will happen.

I want also to make a reference to HS2. It disappoints me immensely that we have got ourselves into such a mess on that project. Yesterday, the Secretary of State said that she was angry. She singled out four Prime Ministers. Not surprisingly, no Prime Ministers of the Labour Party were singled out, just Conservative Prime Ministers. So I had a look at the original Command Paper that was given to Parliament in 2010. Who was it signed by? The answer is Gordon Brown and Andrew Adonis—the noble Lord, Lord Adonis, as he is now. Who started this project? The Labour Party started it.

How did we get it so wrong? How has it been possible for such an important national scheme to have gone so wrong, and been deliberate? It is not the first time railway projects have gone wrong. The Command Paper is still a relevant document, and a very good one. On page 12, it says:

“The West Coast Route Modernisation Project cost £8.9 billion”

—let us not forget that this was 2010—

“and took almost a decade. It delivered fewer benefits than originally envisaged and caused serious disruption to travellers and to business, at a significant economic and social price in addition to the cost of the project itself”.

Getting rail infrastructure right, as the Minister knows probably better than most, is not something that happens overnight. It takes time, and a commitment over a longer period.

There are other Bills in the gracious Speech. I want to give the Minister one possible quick win: when it comes to the highways finance Bill, how about a clause saying that any utility company that has traffic lights on roads over the weekend, particularly A roads, has to pay £50,000 a day to leave those traffic lights in position over that weekend? I am pretty sure that, if there was such a charge on them, they would get them down fairly quickly over those weekends and that motorists would be very pleased indeed. They are growing like mushrooms, like we have never seen before.

My Lords, it is a pleasure to speak after the noble Lord, Lord McLoughlin.

I welcome the proposed legislation regarding social housing and health outlined in the King’s gracious Speech, as I believe that they are inextricably linked. I declare my interest as chair of the Look Ahead housing association, which delivers not only housing but social care for people with mental health and learning disabilities.

The Government have committed to several housing plan reforms in future parliamentary Sessions and have done so in the past, as has been referred to earlier, but particular changes are now proposed in relation to making commonhold a default tenure for new flats. This is excellent news but leaves many tenants in leasehold flats in very difficult situations regarding increasing costs, as other noble Lords have said.

The proposed remediation Bill is intended to accelerate the removal of unsafe cladding and strengthen protections for residents. This will be essential to ensure that works are completed swiftly. However, the proposals are unclear about protecting current tenant-owners encouraged to buy shared ownership with housing associations prior to the recent changes in legislation. Those individuals remain accountable for significant costs, as was illustrated only yesterday in the news about tenants of properties in the former Olympic village. It illustrated the significant stress and challenges facing many people in regard to these issues. Can the Minister explain how this issue will be resolved under the new legislation?

Any new social housing to be built must be designed so that families can live safely and healthily in their homes. As others have said, it remains a scandal that we still have children living in hotel rooms with parents, with the uncertainty that temporary accommodation creates and its associated mental and physical health problems. What is the Government’s timescale for ensuring that no child remains in temporary accommodation for more than a month, thus enabling them to stay in the same school for significant periods?

I welcome the announcement that legislation is to be introduced to abolish NHS England and believe that significant cost savings that can be redirected into patient care. However, the Bill appears to omit reference to parts of the healthcare system—most notably the need to provide NHS dentistry more equitably across England—and does not make significant reference to the fact that the new Mental Health Act will need to be implemented, and that this will be costly. Can the Minister explain where responsibilities for such services, particularly specialist services, will be held in the new system? Will they be at the department or with ICBs? What information will be provided on the role of regional teams?

Like others, I warmly welcome the single patient record. The introduction of new digital platforms is to be commended and will make access to information much swifter for every health and care provider with regard to individual patients. However, much of the NHS is commissioned from providers who are not part of the main NHS. For example, acute mental health services, radiology reviews and cataract surgery are provided in independent services commissioned by the NHS. What is the intention of the Government in terms of independent providers having access to, and the ability to add information to, the single patient record? I suggest that this is an issue that will need careful exploration and possible amendments to the Bill, both for the protection of the information in patients’ records and to ensure that information on assessment and treatment from all services paid for by the NHS can be used and incorporated into the single patient record.

Finally, as the Minister said earlier, the last Session passed vital legislation on public health measures for future generations on tobacco and vapes. I am concerned that this Session makes no reference to the important issue of alcohol harms and what might be done to improve this scenario. It would be helpful if the Minister could comment on whether a minimum unit price for retail sales, not those in hospitality, might be considered to reduce the health damage caused by alcohol abuse and addiction and the associated costs of treatment in our health service.

My Lords, I declare my interest as the vice-president of the Local Government Association and vice-president of the National Association of Local Councils.

Housing appears to have taken a back seat in the Government’s agenda. For all the talk of 1.5 million new homes, we heard no mention of that target in the King’s Speech. When we asked for a progress update last month, we were instead referred to a Written Answer from February. Can we have those updated figures now, please? How many dwellings will be completed this coming year? According to the department’s official statistics, an estimated 342,100 net additional homes were delivered in England between the start of this Parliament and March this year. At this rate, it will take over five and a half more years to meet the target of 1.5 million homes. The Government must not shy away from these facts. When will we see an improvement in the figures?

We Conservatives delivered 1 million new homes over the last Parliament and had a plan to build 1.6 million homes in the next. Despite 14 years in opposition, Labour did not and do not have a plan to meet their less ambitious target. We knew this, and my right honourable friend the Leader of the Opposition in the other place, when she was the shadow Housing Secretary, told the then Secretary of State that she had been stitched up by her colleagues. We support the delivery of more housing and my right honourable friend in the other place offered our help, which throughout these recent Bills has not been taken up. Instead, this Government’s choices, on top of global pressures, have left us with high energy, labour and regulatory costs, pushing up the overall cost of housebuilding and leaving many consented sites unviable.

Time and time again on the doorstep, we heard of young people’s desire to own their own home. Too many are trapped in the rental sector, and even there the Government are not helping the supply of rental properties. Smaller landlords in particular are exiting the market. What is the Government’s assessment of this trend and the impact on the supply of rental properties? The Renters’ Rights Act is now in force, and we are already seeing the consequences of this. Build-to-rent developers are affected, too, with the Act expected to increase the number of rent appeals even further. Is the data on the average time for property chambers to process rent appeal cases now being collected, and what does it show so far? The Government are also committed to capping ground rents through the Commonhold and Leasehold Reform Bill, and we look forward to this Bill and to looking at these ideas in detail. In the meantime, what action is planned in relation to service charges, which are getting higher and higher every single year?

We are also seeing long waiting lists in social housing. Thanks to this Government’s choices to increase employer national insurance and taxes on business, unemployment has now risen to 5%. Even worse, youth unemployment especially is increasing, with one in six young people unable to find a job. Young people have no hope of getting on the housing ladder under this Government. Where do they go? This Government risk creating a vicious circle, where more and more people are forced to look to social housing. Yet, shockingly, around 33,000 new social tenancies each year are going to households where the lead tenant is not a UK national. The Government are spending around £4 billion a year to deliver about 30,000 new social homes annually, meaning that spending on the affordable homes programme is going entirely on housing non-nationals. How is this sustainable?

Housing is a major policy area which is fundamental to solving the cost of living crisis. However, we are not seeing it prioritised in this debate. We need a constructive policy environment to tackle these issues, not just policy tweaks or arbitrary state interventions that do not fix problems at source. This House deserves to see proposals for genuine solutions, as well as clear figures, to ensure we see actual delivery. I look forward to the Minister’s response.

My Lords, as life president of RoSPA, I welcome the opportunity today to speak on an issue that crucially affects us all: the growing crisis of preventable accidents. It is not receiving the attention or urgency it deserves, and people are dying because of that. Accidents are not rare or isolated incidents. They are the leading cause of avoidable deaths and injuries in the United Kingdom. They happen in places where people should feel and be safest: in their homes, their communities and doing the ordinary things in life. Research from the Royal Society for the Prevention of Accidents shows that around 23,000 people die each year because of accidents, while close to 1 million—yes, 1 million—are admitted to hospital. More worrying is that the accidental death rates have risen by more than 40% over the last 10 years. This is not a temporary spike; it is a sustained increase that highlights that there is a major flaw in how the country approaches accident prevention.

That flaw is a lack of a coherent national strategy for reducing accidental harm. At the heart of the problem is that responsibility for preventing accidents is fragmented across government departments, agencies and systems. Valuable work takes place, but it is leaderless and disconnected. This point was clearly reflected in the recent Westminster Hall debate on accident prevention. The Minister for Local Transport highlighted a range of welcome initiatives already under way. We heard of the good work on safety in transport, housing and the workplace, in products and fire prevention—all important in their own right. But what came across clearly was that responsibility for accident prevention exists in separate departments but lacks an overarching framework to bring it together.

Let us look at falls, the leading cause of accidental death and serious injury, particularly for the elderly. Everyone in this Chamber will know the devastating impact that a fall can have on older people, leading to prolonged hospital stays, a loss of mobility, isolation, and an end to their independence and well-being, costing the NHS and the social care system £6 billion every year. We have seen the cost that this inflicts on families emotionally, practically and financially, yet this harm and these costs are preventable—and the place to focus on is in the home, where most of these accidents occur. The Minister said that everyone has the right to live in a safe home. Creating safe homes means homes designed and maintained with safety and accessibility in mind. It means co-ordination with health and care services, identifying risks early. It means GPs, community nurses and local services being able to intervene before serious injury occurs.

Preventing accidents cannot be the responsibility of central government alone. It requires central and local government departments, employers and charities to work together. Governments can make that happen. A national accident prevention strategy would give the co-ordination and leadership needed to connect existing safety efforts, identify gaps, improve accountability and reduce unnecessary duplication of work across different departments, all ensuring that precious time and resources are used as effectively as possible.

The Labour Government have a proud history of leadership in health and safety. The Health and Safety at Work etc. Act 1974 put an end to the devastating toll of injuries and death that for 150 years had plagued the world of manufacturing. I know that a national accident prevention strategy could and would have the same impact in reducing the unacceptable and unnecessary number of accidental deaths and injuries that plague us now. Let us have a national prevention strategy now.

My Lords, I am pleased to speak in this debate on the gracious Speech and to welcome the focus on public sector reform and delivery. This is my first intervention since I was appointed the chair of the Advisory, Conciliation and Arbitration Service. As noble Lords know, ACAS is independent of government and provides impartial advice and support to both employers and workers. I am acutely conscious in my new role of the need for me to maintain and protect ACAS’s independence and impartiality. With that in mind, I will not be voting on any measures relating to employment law, labour regulation or any areas in which my doing so might be misconstrued as impacting on ACAS’s impartiality. I refer the House to my declaration in the register of interests.

The gracious Speech sets out the Government’s plans for further reform of critical public services. The public sector improvements proposed are far-reaching and impactful, but I argue that they are deliverable only with a strong industrial relations framework that rejects the outdated models of perpetual conflict and finds a new consensus. In 2025, the UK lost 740,000 days to industrial action. While that is significantly lower than the post-Covid bump of over 2.5 million per year, it is much higher than 10 years ago—and, as we know, that conflict cost GB employers at least £28 billion a year. All the evidence shows that the most sustainable business improvements are made where workers and their bosses make changes together. That has been the experience of a huge number of employers and unions, who have built robust modern systems of dialogue and partnership. Our challenge now is to bring everyone else up to those standards.

For example, the creation of Great British Railways is a real opportunity to reset industrial relations in the transport sector. Good workforce relations are going to be key to its success. I welcome the announcement of a long-term rail network strategy, but I hope my noble friend the Minister recognises that the workforce needs to be part of that strategy from the start, underpinned by a framework of strong collective industrial relations.

This is not just a problem in collective disputes. Research commissioned by ACAS tells us that about 44% of people who work in the transport and storage sectors experienced individual workplace conflicts in the past year. That carries a real cost to business through absenteeism, presenteeism, low retention and disengagement of staff. Does the Minister recognise that there are huge financial and operational advantages in creating a modern industrial relations framework in the transport sector that can prevent conflicts developing in the first place?

Good workplace relations are equally critical to the success of the health and social care sector. In fact, in this sector, employers’ research shows that there is a clear link between positive workplace relations and patient outcomes. There is more that we can do to improve industrial relations across the NHS, and the new adult social care negotiating body is a positive first step. It brings employers and unions together to tackle pay conditions and retention, and I am pleased to report that ACAS is supporting this work and the wider reforms. However, the fact remains that there is a higher incidence of conflict in the health and social care sector—47%, compared to 44% overall—and a higher prevalence of discrimination claims, and individual disputes are even more likely to end up being decided in employment tribunals.

The lesson from these examples is that our nation depends on workplaces in both the public and private sectors being efficient, responsive and innovative, with positive relationships between workers, leaders and their unions. However, we have seen a marked decline in the skills, knowledge and confidence needed to underpin relationships at work and manage conflicts early. I propose a simple reframe of good industrial relations, based on three principles. The first is collaboration and partnership, treating each other with mutual respect as negotiating partners rather than adversaries. The second is balancing interests to deliver the prize of economic growth, improving productivity and better working lives. The third is proportionality, where formal action is used only as a last resort to mitigate the harm that it aims to rectify.

I hope my noble friend the Minister recognises the prize that can come from reshaping industrial relations for the new challenges we face in both the public and private sectors, which can ultimately build an economy that is stronger because it works for all.

My Lords, I declare my interest as a councillor in Central Bedfordshire Council.

As my noble friend Lady Scott of Bybrook said, we have a housing crisis, and nowhere is that clearer than in London. The noble Lord, Lord Livermore, often speaks of 14 years of a Conservative Government. Well, after 10 years of a Labour mayor in London, do this Government really believe the situation in the capital is improving? There are 13,000 rough sleepers in London, up 10% this year. That represents around one-quarter of the English total. More than 75,000 London households are in temporary accommodation, over half the English total, and there are 341,000 households on London waiting lists. Many private renters in London are paying over 50% of their income on rent.

Despite all that, housebuilding in London continues to fall. Latest figures show that in quarter 1 of this year only 937 new homes were registered. That is a drop of 84% in the last decade and well below the target of 88,000 homes a year. Affordable housing starts in London have fallen by almost 80%, to around 4,500 last year. We on this side of the House have consistently argued for prioritising and facilitating building on brownfield land in London, yet the Government have failed to deliver. Of course we need safe buildings and quality homes, but how many more costs and delays can developers absorb before they stop being viable?

Recent analysis from Ackroyd Lowrie shows build costs have increased 80% in the last decade, whereas house prices are up only around 14%, and in some cases the average London build costs now exceed average selling prices. Adding layers of bureaucracy and costs in the pursuit of the ideal home is resulting in no homes at all. London Councils spends more than £4 million daily on temporary accommodation. What are the justifications of the Government and the mayor for managing this crisis rather than solving it? London does not lack demand, sites or potential funding. We need to remove the blockers. We need a system that delivers homes quickly, at lower cost and at scale.

Moving on, we have previously debated right to buy. Reinvesting proceeds from right to buy into a new home provides two homes in the place of one. It can be done. Many councils, including my own, Central Bedfordshire, have successfully used right-to-buy proceeds to build more homes than were sold; not only that but it has enabled a focus on more specialist accommodation for the elderly and those with disabilities, and on temporary accommodation—which someone mentioned earlier—all of which were in short supply. This is a pragmatic solution: reinvesting to build more homes.

Getting on the housing ladder is increasingly difficult and out of reach for many. It is not only the deposit; it is higher mortgage rates, driven by the economic policy of this Government. Help to Buy has gone and stamp duty relief for first-time buyers has been reduced. When I bought my first home, you bought what you could afford—usually something small and somewhere less fashionable—and then, over time, you moved on. That was how people got started and how communities regenerated. That is how staircasing works. Today, much of that progress is wiped out by stamp duty and fees. For many families, moving home now comes with a tax bill the size of a deposit. This is not how we support the economy or aspiration.

If we are to address the housing crisis this country faces, we must solve the London housebuilding crisis. We need a practical system that builds more homes and helps people on to the housing ladder.

My Lords, why do we have five days of debate on the King’s Speech but no mention of the environment—it is not included in the issues to cover? I point out that the Conservative Government always put the environment down as an issue that should be debated, but here, Labour has failed, as it always does on the environment. In his speech, the King actually said:

“My Government will remain a leading advocate for tackling climate change”.

That is absolute nonsense. There are no plans in any of the Bills mentioned that will help the environment, help nature or help people to enjoy the environment.

According to the Natural History Museum’s Biodiversity Intactness Index, the UK ranks 189th out of 240 countries and territories for how intact its nature and biodiversity remain. Can a country truly claim to be a global climate leader while its own nature crumbles? Paul de Zylva, Friends of the Earth’s senior nature analyst, explained the gap between the UK’s green rhetoric and the grim reality of its biodiversity collapse. Just 53% of the UK’s original nature is left intact, which is far below the index’s safe limit of 90% and the global average of 79%. The United Kingdom has always prided itself on being a green and pleasant land, and a nation synonymous with rolling countryside, abundant wildlife and environmental stewardship, yet beneath this postcard-perfect image lies a startling reality: the UK is now one of the world’s most nature-depleted countries. As the 2030 deadline approaches, Britain’s natural wealth lies in ruins.

The UK Government track approximately 50 different biodiversity indicators, and the 2025 results paint a troubling picture. Indicators still heading in the wrong direction include the size of fish in the North Sea, the status of pollinating insects—that is bees, hoverflies and moths—and bird numbers on farmland and in woodlands. Perhaps the Minister can tell me the plans to move these figures in the right direction. I accept that we do not have an Environment Minister on the Front Bench, but perhaps I can have a letter explaining that.

Then there is the global threat. We have recently had a Ministry of Defence committee report headed by Lieutenant General Richard Nugee, a former senior British Army officer and a leading voice on climate and national security. He told us that the report clearly states that climate change is now a core national security threat. We have ice melting at a frantic rate in Greenland, an incoming record-breaking El Niño event and species going extinct faster than Labour voters. This all affects our safety.

It is obvious this Government do not really care about rural areas, the countryside, nature, our waterways and “all that green stuff”. They just see newts, hedgehogs and bats as annoying things that get in the way of their bulldozers. I wish this had been a King’s Speech designed to revive the country and help people, especially those living in poverty, but instead it is a set of policies they hope will stop Keir Starmer being evicted from No. 10.

Will any of these government policies deal with the endemic problem of corporate greed that forces up the cost of living and our tax bill, especially the fossil fuel companies that are greedily helping to destroy our planet? Will any of this legislation make fares cheaper by ensuring that the rolling stock of our railways is owned by us rather than rented? Will it become easier for people to leave their cars behind by opting for a superb public transport system—and please do not give me that guff about electric vehicles, because there is a cost to them as well?

Will the water industry be taken into public ownership or will bill payers continue to pay billions of pounds to support a business model that relies on pumping raw sewage into our rivers and on to our seashore? Will taxpayers continue to pay the bulk of the housing benefit budget to private landlords or will we start a mass building programme for council houses, so that the public’s money goes directly into providing well-built homes at reasonable rents, with green spaces that the residents can enjoy? I cannot see any of this happening.

If Labour is looking for a reset under a new leader then we really ought to start with rent controls. Our new Green Party mayors and council leaders want the power to set rents that work for people in their areas. Greens understand that the poorest in society need clean air and green space as much as the richest do.

In short—I am cutting my speech extremely short— this Government urgently need some tuition from climatologists and green economists. I would be very happy to put them in touch with the best.

My Lords, it gives me great pleasure to speak in this debate on the gracious Speech delivered last week by His Majesty the King, although I profess I have first-time speaker nerves. My remarks concern the overlap between children in school and wider societal health. I suggest to the Government a simple, cost-effective solution that I believe would reduce the spread of sickness and improve health and save money.

My subject, clean air for schools, could have been discussed in the debates on education and the economy. Good government is joined up; it does not exist in individual Whitehall departments. The health improvements that come from providing clean air in public spaces have wider benefits. Breathing poor-quality air is a risk to children’s immediate and long-term health.

It is now accepted that outdoor air pollution is a problem. Less appreciated is that indoor air can be up to five times more polluted than outdoor air. The pollutants that can be present in our indoor air include particulate matter, as well as biological aerosol such as airborne viruses, mould, fungal spores, pollen, bacteria et cetera.

Quite apart from increasing sickness, elevated levels of pollutants have been shown to affect a child’s ability to focus, now linked to diminished performance in exams. Children spend most of their time in schools, but with densely packed, poorly ventilated classrooms, it is where they are most likely to pick up sickness. A recent study tracked 816 students and staff across a school year and found that at least 85% had a virus detected and 80% had an illness episode. The study states that:

“Schools are an important setting for infectious disease transmission”,

but they do not have to be.

A brilliant campaign called Clean Air for Kids has started in my home city of Bristol. It was started by a Bishopston resident, Ruth Brooker, when her son was going through cancer treatment and she wanted to get him back to school—or, as many parents would say, back to the “germ factory”. Ruth’s campaign is now going nationwide, beyond just Bristol—another good thing originating from my great city. Her campaign is simple: it is to add an air filter to each school classroom and to regularly open windows to reduce the number of coughs, colds and Covid-19 infections that kids and their teachers catch at school which then spread into the community. It is a cost-effective solution.

The Liberal Democrat spokesperson in the other place recently estimated that installing air filters in schools in England would have a one-off cost of around £140 million, while Sky News reported that supply teaching costs in state schools and academies in England last year were £1.4 billion. The running costs are low too. The Clean Air for Kids campaign has calculated that over the 20-year lifetime of an air filter that runs all day in schools during term times, including installation and running expenses, it would cost less than a tenner per child per year to provide pupils and staff with clean air—about the same cost as a coffee and a cake.

This simple solution would quickly pay for itself many times over in the savings from supply teacher budgets. The problem is that very few schools, local education authorities and academy trusts can afford the upfront cost of installation, but the Government easily could. With political leadership, we could transform the lives of schoolchildren, their teachers and their families by improving the quality of indoor air. Additionally, a programme of installing air filters to reduce the spread of sickness in schools will stop others becoming sick too. It will improve productivity, help the economy and drive growth, while protecting the NHS and taking the pressure off benefits budgets. It would have huge well-being outcomes, which in themselves would improve society.

We drink two litres of water and breathe in 11,000 litres of air every day. We would not want our children to drink dirty water, so why would we let them breathe dirty air indoors? Will the Minister share this with the relevant Minister and write to me or, even better, meet me and Ruth Brooker to discuss this further?

My Lords, my remarks today focus mainly on health and its poor relation, social care, which had no mention in the gracious Speech. I will also comment briefly on some defence and national security issues, which will be centre stage tomorrow.

As we have heard, the modernisation Bill will abolish NHS England, make changes to the duties of integrated care boards and create the framework for a single patient record. In essence, it will pull many of the functions back into Whitehall, including transferring some powers directly to the Secretary of State. While recognising the improvements that the Minister set out when opening the debate, I have to admit to some disappointment at what feels like a largely technocratic Bill, focusing on structural and digital reform and accountability arrangements rather than on improving patient care and outcomes.

With the exception of data integration, there is very little focus on improving social care or mental health provision, which are both badly needed. As we said throughout debate on the Mental Health Bill, we need to see major investment in preventive and community services if the three big shifts in the 10-year plan are to be realised. The absence of social care from the legislative programme, referred to by so many speakers, reinforces my view that the Government give this low priority and fail to recognise the need for a fully joined-up health and social care reform programme. We cannot just wait for the Casey commission’s final recommendations; we need action now.

We also urgently need a new mental health strategy with a strong focus on community services and early intervention. The Government have recently issued a call for evidence, which I welcome; indeed, they are more than welcome to borrow from the wealth of ideas and evidence in the Liberal Democrats’ recent policy paper, Whole-Person Mental Health. This includes a new offer for young people, protecting by law the share of the NHS budget spent on mental health and the introduction of mental health check-ups for adults going through major life events.

While I welcome in principle, as so many others have today, the move to join up health and social care records to avoid the frustration of patients in having to keep repeating their medical history, many questions remain about how this is to be done and how privacy concerns will be addressed and trust built with patients. The proposed abolition of Healthwatch is a matter of huge concern to me and one that I shall be following very closely. In short, any successor arrangements must have a strong independent element to ensure that an authentic patient voice is heard.

Where Healthwatch worked well, it also provided unsolicited feedback on matters of real concern to patients and helped bridge the gap where trust between local communities and the healthcare system is fractured. The current proposals for ICBs and local authorities to take over the local responsibilities of Healthwatch feel unworkable to me. Can the Minister please explain how that will deal with the much-needed co-ordination between health and social care? In my book, it will simply exacerbate the divide. I am also concerned that the very large footprint of ICBs will make them disconnected from local communities.

As I said, at the heart of the Bill lies the abolition of NHS England. But I sense a real disconnect between a narrative saying, “You can’t run the NHS from Whitehall and need to devolve decision-making”, which I agree with, and simultaneously bringing more powers back to the centre and the Secretary of State. Two quick examples of this are the proposed new cap on NHS foundation trust spending limits and the need for appointments of all chairs and non-executive directors of these trusts to have Secretary of State approval. The rhetoric and the reality of this Bill do not add up.

On health inequalities, I am sure we are all deeply concerned by the widening and deepening inequalities in healthy life expectancy between the most affluent and deprived areas. It is scandalous that there are now, broadly, 20 years separating these two extremes. Yes, the Bill contains a duty on the Secretary of State to reduce disparities in health, but where is the programme of action to tackle the wider social determinants of health inequality and improve the nation’s health? The Bill should be seen as an opportunity to do just that and improve support for unpaid carers.

Finally, a healthy population is essential if we are to protect our shores effectively, strengthen our national security against the growing number and severity of threats that we face and increase our national resilience. This was all set out very cogently in the recent report by the Joint Committee on the National Security Strategy, on which I serve. Given the rising global tensions and rapidly changing geopolitics, we urgently need to see the Government’s long-overdue defence investment plan and far more detail on the target to spend 1.5% of GDP on security and resilience. I hope that relevant Ministers will respond to both these points in tomorrow’s debate.

My Lords, modern transport infrastructure is not simply about moving people from A to B. It is about economic growth, productivity, housing delivery, social mobility and national competitiveness. Too often, transport is viewed as a cost. In reality, it is one of the greatest investments that a nation can make.

From my time in local government and as chair of London Councils transport and environment committee, I have seen the transformative impact that investment in transport infrastructure can have on communities, businesses and local economies. Reliable and integrated rail infrastructure does more than just improve journeys; it increases labour market access, boosts productivity and creates the confidence needed for investment.

The creation of Great British Railways provides an opportunity to deliver a more integrated, reliable and passenger-focused railway network that supports growth and connectivity across the country. Business invests where connectivity is strong; people seek work where transport is reliable; developers build homes where infrastructure exists; and local economies thrive where communities are connected.

Investment in transport infrastructure also generates benefits far beyond the immediate area in which the project is delivered. One example of this is the Bakerloo line upgrade and extension. I have consistently argued that this is not simply a London transport project but a national growth project. For too long, parts of south-east London have experienced lower levels of transport investment, despite their enormous economic and housing potential. The benefits and return on investment are clear. This transformative and shovel-ready infrastructure project will unlock 107,000 new homes and 150,000 new jobs, while adding £1.5 billion in GVA to the national economy. Those are not simply transport statistics but indicators of economic growth.

Transport infrastructure changes the geography of opportunity. It determines whether someone can realistically access work, education, training or culture within a reasonable journey time. For many communities, better transport is not simply a convenient thing, it is a game-changer. Transport infrastructure helps to ensure that people from all communities can access jobs, education, training and opportunity and share in the benefit of economic growth. The economic benefit would not stop at London’s borders; the project would support engineering and manufacturing supply chains across the United Kingdom, including rail manufacturing jobs in Goole in Yorkshire and beyond.

Modern public transport infrastructure is also essential to reducing congestion, improving air quality and supporting sustainable economic growth. Infrastructure requires long-term thinking and partnership between national government, local government, businesses and regional leaders. Does my noble friend the Minister agree that long-term certainty around infrastructure investment is essential to giving businesses, developers and local authorities the confidence to invest, plan and deliver growth? Transport infrastructure is ultimately an investment in people, opportunity and national renewal. If we get this right, we will not simply be modernising transport networks, we will be unlocking growth, expanding opportunity and helping to build a fairer and more prosperous country.

My Lords, it is a pleasure to follow the noble Baroness, Lady Dacres, in this debate. I declare my interest as a vice-president of the Local Government Association and also the part owner of rented property in West Yorkshire.

It is a disappointment that the Social Housing Bill will see the further curtailment of right to buy, something I firmly oppose. Getting people on to the housing ladder should not be perceived negatively, and I pay tribute to private sector organisations, such as Rentplus UK, that are building affordable housing and getting young home owners on to the property ladder. You cannot make a modern-day case for capitalism if people do not own capital. It is why socialism always seems to have state-funded housing as the option, because it gives the state more control. As a former leader of Bradford Council, I recall inheriting from a socialist administration a housing revenue account which was millions in deficit with housing repairs and was out of control. My point is that legislation is all well and good, but poor management and governance on the ground will always be the barrier to the delivery of decent social housing standards.

While there is a case for the construction of more social homes—namely, that the state can reduce its housing benefit bill, which is potentially rising to £71 billion by 2050, with the increase in social housing stock—I hope that the Bill will go some way to addressing the key challenges occurring in social housing. I also hope that it will pave the way for local authorities that retain housing revenue accounts to have equal access to the £2.5 billion of low-interest loans announced in the 2025 spending review, currently accessible only to social housing providers.

Because of the Renters’ Rights Act, there needs to be a general acceptance that more renters in the private sector will be pushed into social housing, given the lack of private rental supply, as the Act will push more landlords out of the market. Consequently, councils may need to recruit additional staff and upskill the existing workforce. Future new burdens of funding must be up front, realistic and multi-year. Landlord penalties are unlikely to cover costs. Councils must have the right powers, skills, capacity and funding to enforce the new laws effectively and provide much-needed security for private renters.

Separately, and while I appreciate this may not fall within the Bill, I was pleased to hear that the Law Commission is soon to initiate a new project on the disposal of escheat land to the Crown Estate and whether other bodies will be able to take on this land. If the Law Commission finalises its work before the Bill passes through this House, I very much hope that the Government might consider the ability for escheat land to be handed over to local authority housing revenue accounts as opposed to the Crown Estate. The Crown Estate is sitting on many brownfield sites, which could easily be unlocked to local authorities for the purpose of building social housing. I hope that the Minister will be closely following the work of the Law Commission and make representations on behalf of local government.

My Lords, it is always a pleasure to follow the noble Baroness, Lady Eaton. I welcome the reference in the gracious Speech to the continuing modernisation of the NHS. I will speak today about the Government’s commitment to the 2.5 million women in England living with osteoporosis and ask where that commitment now stands. Fracture liaison services are the gold standard for stopping osteoporosis in its tracks before it becomes catastrophic. Where they exist, patients who suffer a first fracture are caught, assessed, placed on medication and supported through a structured programme, interrupting the cycle that would otherwise lead to further breaks, lost independence and, in too many cases, premature death.

The Government committed to making these services universal across England by 2030, and it was a commitment that was warmly received. Since that day, women living with osteoporosis have heard that commitment 63 times in Parliament, in the media and in government documents, including, most recently, the Renewed Women’s Health Strategy for England. Yet no implementation plan has been published and there is no timetable, milestones or dedicated funding. The result is institutional paralysis. Some 60 new services are needed, but none has opened and, in that time, there have been 4,000 deaths that fracture liaison services could have helped to prevent.

That is why more than 60 organisations are calling for this rollout to happen. This coalition spans women’s health groups, royal colleges, trade unions and the world of business. However, this coalition is growing increasingly concerned, and the Government simply repeating the pledge is no longer sufficient to allay those concerns. The Society of Radiographers has warned that rollout must begin this summer for the 2030 target to remain achievable. These services cannot be created overnight; they require recruitment, staffing and commissioning. In some areas, local plans have been put on hold, waiting for national direction.

I make a straightforward plea for transparency. If there is a reason why the Government cannot move forward right now, please can they tell us when the plan will be published? Do Ministers still believe that the plan is deliverable by 2030? The 2.5 million women and 700,000 men living with osteoporosis and the sector that supports them look forward to an answer from the Minister.

My Lords, as we enjoy day 4 of the debate on the King’s Speech, I will concentrate my remarks on health, although inevitably that is inextricably linked with housing. I am happy to endorse the remarks of the noble Baroness, Lady Donaghy, because what she says about osteoporosis is absolutely right; it needs tackling.

Looking for something positive to say as an opening, I welcome the commitment to a single patient record. Any objections on the grounds of data privacy must be overcome by the sheer common sense of the proposal. Qualms over data ownership are genuine. Palantir is a business with tentacles in strange places, and it is right that those should be explored and that we should find means of keeping them at bay. But my GP is in Westminster and has easy access to tests that are done in Chelsea and Westminster Hospital, but the same cannot be said about tests done at Tommy’s—St Thomas’ Hospital—which is actually closer to the surgery, or indeed Guy’s. In an age of data being easily transported, the river really should not be an obstacle to efficient communications in the NHS.

The single patient record has huge potential benefits, but it is the major bright spot, as far as I am concerned, in the King’s Speech. The NHS must modernise, but does that really require yet another massive shake-up? In the long term, it may be the right thing to do, but at the moment it is really not what the NHS needs. It was the noble Lord, Lord Darzi, who asked us to

“just imagine if all the effort and resource that had been poured into dissolving and reconstituting management structures had been invested in improving the delivery of services”.

Those words were echoed by the new Health Secretary less than two years ago, but now Wes Streeting has given us one parting gift: another NHS upheaval. I believe it will cause confusion and discontent in an NHS that is already wrought with tension.

However, on the truly vital issue of social care, the King’s Speech was almost silent. As others have remarked, this is a terrible omission. The lack of a proper social care system is a massive problem for the NHS. It was July 2011 when Andrew Dilnot proposed an answer to what was even then seen as a desperately urgent problem. His report was knocked into the long grass and, whenever the issue rolls back, it is knocked back again. This time, the Government opted for the increasingly popular answer to any tricky problem and asked the multitalented noble Baroness, Lady Casey, to lose it in a forest of consultations. So I add my voice to those who are asking: what is the timetable for something to emerge from all these consultations? When will we at last see something positive happening on social care?

While the talking continues, NHS beds are being blocked by elderly people who do not need acute medical care but do need social care. Maybe they live in unsuitable accommodation or have no access to the continuing care they need. Some lack family able or willing to take on some caring responsibility, and some are petrified at the prospect of being consigned to what is known as a care home, not least because of the massive bills this can entail. Dilnot proposed a type of insurance scheme that would cap the amount that any individual would have to contribute. Today, with most care homes run by the private sector and the for-profit element dominating, when will people really decide that private equity, with its high leverage and desperate need for income, is not the place for care homes to be entrusted?

So people remain in their hospital beds while others queue up behind them. A year ago, a report of the House of Commons Health and Social Care Committee highlighted the problem. It was costing at least £1.89 billion a year then, and the figure has gone up. We need something to happen now.

It is a pleasure to follow the noble Baroness, Lady Wheatcroft, and I entirely agree with what she said about social care and the need for a timetable—that is a glaring omission from the Government’s programme.

I will speak mainly about health. The NHS modernisation Bill in the gracious Speech promises to reduce inefficiency and place power and resources in the hands of front-line NHS organisations. The review of the noble Lord, Lord Darzi, which has just been mentioned, describes the system as too rigid and complex, overcentralised, and having unclear lines of accountability.

The Government’s intention is to transfer NHS England’s functions into the Department of Health and Social Care and the wider system to reduce bureaucracy and free up resources to be reinvested in the front line. Here I compare what has happened in the devolved arrangements in Northern Ireland, just by way of illustration. Many of the same criticisms led the then DUP Health Minister in Northern Ireland, Simon Hamilton, to announce in 2015 the abolition of the Health and Social Care Board, which was responsible for regional commissioning of services, managing resources and performance management. Responsibility for the Stormont health portfolio has now passed on to other parties, and the board eventually closed in March 2022.

There has been reference to a 50% target for reduction in staff from merging when NHS England closes, but, unfortunately, that has been far from the outcome we have seen in Northern Ireland. Inexplicably, the health department in Northern Ireland now has more than 1,200 staff at Stormont, exceeding the combined number across both the Department of Health and the Health and Social Care Board prior to the board’s dissolution. The department’s new strategic planning and performance group alone comprises an extraordinary 500 people, administrative costs of £305 million and management costs of £264 million—both from two years ago. Each exceeds the respective totals for the HSC board and the department jointly in 2021-22 and previous years prior to the closure of the board.

Much of the rationale for removing the Health and Social Care Board was to reduce and streamline bureaucracy, which we heard the Government talk about in relation to their plans for NHS England. Yet the process in Northern Ireland and the same kind of approach have somehow ended up in a situation where the number of staff and the costs have grown. It is worth people keeping an eye on this and seeing what lessons can be learned from that devolved experience. Certainly, if lessons can be learned, they should be communicated back to the Northern Ireland Executive.

The Government are proposing, as we have heard, that the NHS harnesses digital technology and unlocks the value of health data with a new single patient record, bringing individuals’ information together into one place to improve patient safety and experience. In Northern Ireland, we have a single digital care record for every citizen, created via the encompass programme, which went live in the final two trusts, the southern trust and the western trust, 12 months ago. This provides patients and service users the ability to view and update their health information online wherever and whenever they like, via My Care, the patient portal. This makes it much easier for health and social care staff to view key information about their patients, both in a clinical setting and while out working in the community.

Bringing together health and social care records has maybe proven somewhat simpler in Northern Ireland, given our integrated trusts, compared with the local government responsibility for social care here in Great Britain. Unfortunately, however, the Northern Ireland electronic record does not incorporate GP and primary care data, so we will watch with interest the progress that His Majesty’s Government make on this front. Clearly, integrating primary care data would present a significant further step forward.

I want to see the Government, in this parliamentary Session, do more on fixing end-of-life and palliative care. All older people should be able to die with dignity, comfort and choice. We are now at a crucial point, given where we are with attempts to introduce the assisted dying Bill. We must see a government commitment to really change the provision for palliative and end-of-life care.

My Lords, I would like to take the debate back to transport: I suppose that is no great surprise. I certainly welcome the introductory speech from my noble friend the Minister, who listed all the different Bills that we are going to be discussing in this current Session. Northern Powerhouse Rail is a great idea; civil aviation, great. GB Railways: well, we started that. But, of course, the Minister did not mention HS2, because there is no legislation required at the moment. Yesterday, the Secretary of State announced that the costs would exceed £100 billion. That was the figure I gave to the Department for Transport for several years, along with Michael Byng. The department strongly denied it and stated that they did not recognise my figure. Well, now they do.

In his speech half an hour ago, the noble Lord, Lord McLoughlin, mentioned that this project was started by the Labour Party under my noble friend Lord Adonis. I remember having strong arguments with Andrew at the time. He said, “We’ve got to have the best in the world. We’ve got to go fastest, it’s got to be the most comfortable, all on a straight line linking Glasgow and Edinburgh and many cities in between with London. And by the way, we’re going to start in London”. I asked why, because the existing railways outside the London area were a hell of a lot worse than they were around London. He said, “Yeah, well, the business case is better if you start in London”—and of course that is probably true, but it was not the right reason.

Anyway, it trundled on through however many years of Tory Government, and the Secretary of State finally got angry in her press release yesterday: regretting that taxpayers, communities, contractors and workers have been swindled by the failure of government. She is right. The whistleblowers, other professionals and landowners have all been silenced by some pretty horrendous NDAs. One wonders what the Cabinet Office, the Department for Transport and the Treasury have been doing, because they are all implicated in what may turn out to be a massive cover-up on costs, or even fraud.

The one thing I find particularly surprising is that Ministers are normally required to give permission for projects to exceed budgets: I think it is called a “ministerial direction”. This project is costing roughly six times its original budget, but I can find no record of any ministerial direction—so somebody has been asleep at the wheel, I think, probably intentionally.

We must not blame only the civil servants, however, because Parliament has failed too. MPs and Peers love going to London faster, regardless of cost: we are all guilty of it sometimes. Local services are used by many more people to attend school, college, shopping, visiting friends or whatever—“Yeah, but it’s important to get to London”. You have only to look at the service provided by CrossCountry trains, which must be one of the worst, to see that it does not go to London, which is a big mistake. My noble friend Lady Dacres outlined the need for better local rail infrastructure, and she is absolutely right.

There are lessons here that must be learned. Yesterday, the Secretary of State said they were going on to Euston, but I have not seen any plans. The boring machines are going, but normally when you build a tunnel you know where it is going to end up, and it is a bit unclear here.

We have had a big debate about the type of trains to be used, and there is a fellow called Chris Gibb who is highly experienced in west coast main line traffic. He suggested a much better solution, for which he has been sacked: again, that is no great surprise.

So there are lessons to be learned and I hope the new Government, when they start building the northern powerhouse and everything else, will learn those lessons, keep it small and keep everything within budget.

It is a pleasure and an honour to take part in this interesting, if wide-ranging, debate. I will focus my remarks on the issue that was raised by my noble friend the Minister in opening: namely, the single patient record proposal, which will be part of the NHS modernisation Bill. I have the NHS app on my phone, as well as the patient access app from my local practice, and I have my chart from Guy’s and St Thomas’. I wish they would talk to each other. I am also a participant in UK Biobank, so that has my data as well.

While I welcome the proposal for the single patient record, I do not believe that Palantir is a suitable place to secure our health information and data. In truth, I am probably a bit late, because Palantir is already involved through the NHS federated data platform. However, its involvement is tightly constrained. What is being proposed here—if the data were handed over to Palantir—would be a very different situation, which raises not just technical issues but constitutional, ethical and democratic matters.

First, we need to understand the nature of the organisation. It was founded on the single premise that vast quantities of data, properly analysed, confer decisive commercial advantages. Historically, its customers have been the CIA, the NSA in the States and the US Department of Defense. Its software has been used in ways which, in my view, fall outside UK norms. This is not incidental to the company: it is at the heart of what that company does.

The second issue of concern is that the commercial incentives are deeply troubling. It is important to understand that it is not just the data that they benefit from: it is the links, the structure and the way in which the system works. That is where the real money is to be made. The data is just a means of moving towards a knowledge of the system on which we are based.

The third problem, which is well known, is the issue of dependency. We have seen this all too often. Once you adopt a particular software approach, you are very heavily locked in. If Palantir were to be involved, we would be locked in. It is not simple to walk away. To me, this makes it clear that we need an in-house solution. It is not beyond the capacity of an organisation the size of the NHS to develop its own software, in-house, protecting national interests.

Fourthly, there are questions about the governance framework. A particular concern is whether US surveillance law compels Palantir, as a foreign organisation, to disclose NHS data to American intelligence agencies. I think we need a clear and unambiguous position on that.

Finally, there is an argument of principle. Health data is not a resource to be managed by whoever submits the most competitive tender. It is generated in moments of profound vulnerability: illness, birth, death and mental crisis. The relationship between the patient and the health system rests on a compact of trust; the involvement of Palantir risks severely breaking that trust.

My Lords, while of course I welcome the King’s gracious Speech, the lack of some attention to the needs of this country is staggering. I could speak about HS2, which the noble Lord, Lord Adonis, allegedly has marked on his heart. I do not think that is true, but there we go.

I will speak on welfare, which was not in the Speech. Welfare should be top of the list of this Government’s concerns but appears to have been ignored. Welfare has been treated in this way because of opposition from Back-Benchers who may be pursuing voters in their own constituencies. This is deeply regrettable. The Back-Benchers concerned should be invited to explain themselves to their constituents. The problem is that very important issues are being sacrificed because of some constituents complaining. For instance, getting rid of the two-child benefit cap is frankly embarrassing when we acutely need the money to be spent on defence.

Another issue that was not raised in the Speech is defence. Yes, there was talk of defence, but no real mention of it in the Speech. I raised this issue endlessly with the last Government, and I have to say that things have got appreciably worse since the general election two years ago. It is all very well talking about an Armed Forces Bill, but this does nothing to protect the state. We need a defence investment programme, which we were promised in the excellent paper from the noble Lord, Lord Robertson. I hear that Wes Streeting was calling for it today in the Commons.

I could raise much more that should have been in the Speech. For instance, there was no mention of the antisemitism that is very frightening to Jewish people. These things may be embedded somewhere in other legislation, but frankly they needed to be expressed in the Speech. His Majesty raised his supportive position very well by visiting Golders Green. We need to express more clearly the British people’s resistance to antisemitism in the country.

I grew up on the edge of north-west London, where probably one in six of the boys at school were Jewish. I can honestly say that there was no genuine antisemitism in my school, although we did resent the way they got extra holidays for their Jewish faith. To digress slightly, once they were sitting around discussing what their fathers had done in the war. One young man said, “My grandmother won an Iron Cross”. His name was Soloman, and he was Jewish. I think that is quite interesting. Nobody held it against him.

Similarly, it is obvious that there is a lot of talk of more regulation, whereas we need less regulation in general. Masses of regulation does nothing for this country, and we could be better served with less regulation and a greater respect for law and order. There are 37 Bills in the Speech. I understand that some of the Bills will only increase bureaucratic time-wasting structures on people’s lives. We all talk of reducing the burden on civil servants, but a few of the Bills here may further the bureaucratic nightmare. A European partnership Bill, a regulating for growth Bill and a highways financing Bill are examples of yet more bureaucratic stuff to keep civil servants and the public busy.

The education for all Bill is not going to improve the output of our schools. Most people would say that the educational reforms by the noble Lord, Lord Gove, are working, and now they are being destroyed by the Government. There will be more legislation and no actual improvement. I could wax lyrical about giving 16 and 17 year-olds the right to vote, as I recall my daughter, aged 16, saying that she knew insufficient about government programmes, as did her school friends.

The Northern Ireland Troubles Bill needs to be looked at very closely. I see that some unionists have been opposed to any form of immunity. I understand that, but the truth is that only the nationalists and the IRA benefit from ongoing repercussions that were discussed 28 years ago. Having served in Northern Ireland, I can say that the British Army and the RUC behaved generally quite well. The Government must see that some current attitudes found in the Government are likely to lead to the IRA winning the war, which I do not believe the Government wish to see.

On that note, I will cease speaking. This is a missed opportunity, with far too much detailed legislation that will just add to the burden of this Government and not improve the lives of the people we serve.

My Lords, health is wealth. The last parliamentary Session saw laws enacted that protect some of the most vulnerable in society and give them more opportunities to do well in life: removing the two-child limit, abolishing no-fault evictions and raising pay for the nearly 3 million workers on minimum wage. These may not seem like health measures, but at their heart they are. There is so much to commend in the Government’s agenda set out in the gracious Speech. Improving special educational needs provision, protecting and helping grow our social housing stock and taking the necessary steps to improve our NHS stand out for me as areas that, done right, can make our country healthier and help our economy to grow faster.

I will spend my limited time on what it feels is just beyond, yet within the reach of, the Government’s agenda as currently set out. I will focus on prioritising prevention. As mentioned by the noble Baroness, Lady Tyler of Enfield, helping people stay in good health, instead of treating them once they are out of it, has to be the way forward, and prevention is rightly at the heart of the Government’s 10-year health plan. But we have known for generations that prevention beats treatment, yet we still have an NHS that is geared and tooled up to be a sickness service.

NHS modernisation is, by all accounts, hard to do well. As others have noted, it often does not change what it is intended to. But one of the greatest opportunities we have with the Government’s proposed changes is to make much more prevention possible. Organisations such as Demos and the Health Foundation have made compelling cases for ring-fencing more preventive spending and adapting relevant accounting standards so that it can be properly appraised and reported against.

While changes at the top of the health service are lamentable for several reasons, a great advantage of having a former Chief Secretary to the Treasury serving as the Secretary of State for Health and Social Care is that we can finally crack what is needed for the Treasury to enable preventive spending in departmental budgets in a similar way to how capital expenditure is ring-fenced. By prevention, I do not mean sending more screening letters to people at greater risk of certain conditions, important though that is. I mean tackling our damaging food environments, poor air and often poor housing stock. I mean supporting people to stay in work instead of allowing them to fall out of it due to preventable ill health.

It may sound obvious once I say it, but where and how you live shapes your health. Too much of our population live in places bombarded with junk food advertising, on incomes that make healthier food unaffordable, breathing air that routinely breaches WHO air quality limits, and in cramped, damp and mouldy homes that exacerbate various health conditions.

Crudely speaking—but not too crudely—the poorer you are and the darker your skin, the more likely you are to be at the sharp end of most of these inequalities. I will not run through all the numbers, but the Government’s own estimates are that food-related illness caused by diet costs the UK £74 billion annually, including £11 billion to the NHS. The Royal College of Physicians estimates that poor air quality in the UK is killing 30,000 people a year and costing the UK £50 billion a year. These are outrageous harms at outrageous costs, and they are happening on our watch. If we can deliver on the 10-year health plan, we can roll back some of these harms. This is a packed legislative agenda. We will have to use our next parliamentary Session to bring a clean air Bill, a race and disabilities Bill and, assuming it is needed, legislation to enforce mandatory reporting on the healthiness of food sales, but if we can use this Session to crack the prevention puzzle, we will be well on our way.

Before I close, I would like to speak briefly about putting people’s voices at the heart of issues affecting them. The Health Bill proposes major changes to how we ensure that patients have a say in their health. I know from my experience in south London that many local Healthwatch organisations have been doing important work. In the proposed changes, we have a great opportunity to consolidate a fragmented system and strengthen accountability to patients. But I counsel the Government to ensure that patients’ views are at the heart of shaping the changes, not just heard once patients start experiencing changes that may not work for them.

My Lords, I am delighted to follow the speech of the noble Lord, Lord Babudu, and I apologise in advance for reiterating some of his excellent points.

We spend over £2 billion a year on the NHS, 40% of our day-to-day spending, yet it never seems to be enough. As our population ages, as chronic illness increases, as ever more adults leave the workforce, or never even enter it, as a result of long-term sickness, spending pressure will rise further and our capacity for funding that pressure will fall, so the first point I wish to make to your Lordships is that improving the NHS, while necessary, is not sufficient. Even a superbly efficient health care service could be overwhelmed by an ever-sicker society, so I was delighted to hear the Minister emphasise the importance of prevention when she opened this debate and I urge the Government to be bold. I agree that we need improvements in air quality, inside and out, as the noble Baroness, Lady Linforth, reminded us, to tackle respiratory and cardiovascular disease; we need restrictions on social media to protect young people’s mental health; and we need a serious strategy to tackle alcohol harms, as the noble Baroness, Lady Watkins, set out. In short, we need a healthier population, not just a better NHS.

The second point I wish to make is that, unfortunately, redrawing the boundaries of NHS bodies will not automatically give us a better NHS. I understand why the Government want to abolish NHS England and I accept the valid arguments for doing so, but as the King’s Fund has observed, and those of us in government for the 2012 restructure can attest, reorganisations take far longer than we think, end up costing far more than we anticipate and leave us with a distracted and demoralised workforce. Change does not materialise because legislation transfers duties from one set of public servants in the NHS to another set of civil servants in the Department of Health and Social Care. Change does not materialise because we replace joint local health and well-being strategies with new neighbourhood health plans. Change materialises when Ministers and officials collaborate with clinicians and managers to deliver a coherent plan over a number of years.

I welcome the increase in patient satisfaction with GP access that we have seen under this Government and I commend Ministers and officials for all the work they have done to deliver this. I also point out that some of these improvements began with the primary care recovery plan published in 2023. I say that not to claim credit for the previous Administration but to point out that meaningful change really does require sustained focus over time. I hope that the Minister will ensure that she does not get lost in the legislation and instead is able to keep sight of the operational improvements that the public really care about, including the very urgent tasks of making maternity services safe and fixing social care.

There are two further elements we need to see if the Government are to meet their objective of NHS renewal. First, we need a longer-term capital strategy. The NHS has a capital budget of around £13 billion, yet we do not have a sufficient objective assessment of need, there is no reliable mechanism for efficient allocation, and there are too few incentives to ensure that assets are used productively. That needs to be fixed. Secondly, we need a credible long-term workforce plan. I was disappointed to see the 2023 workforce plan abandoned, but I look forward to seeing its successor. Like the Government, I hope that AI will improve productivity, but I do not recommend hope as the basis for a workforce strategy. I encourage the Government to listen to the Health Foundation’s advice and avoid both overstating the time technology will save and underestimating the staff and management capacity needed to implement it.

Turning to the details of the Health Bill, there will be plenty of opportunities to debate this at length, but I want to mention my concerns that despite the rhetoric of devolution, the Bill in fact represents a significant centralisation of power within the department and a reduced role for local authorities. I am also concerned about the impact of the abolition of HSSIB on patient safety and I look forward to discussing all these issues in more detail. However, there is a major opportunity here, as many other noble Lords have mentioned, and I share the Minister’s hope that the proposed single patient record, combined with wider technology reforms, will be truly transformative for this country. For years, we have aspired to achieve a digital NHS and now the Government have an opportunity to truly create one, but success will depend on public trust and clinical buy-in.

I hope that the Government will learn from the failures of the last 14 years, and in particular GDPR and care.data, as well as the recent cyber attacks that deliberately targeted very sensitive healthcare data. Privacy and security must be built into this project from the start.

There is much more to do to improve both public health and the NHS itself, but I hope that we can make meaningful progress this Session and I look forward to working across the House, with other noble Lords and the Minister, to do so.

My Lords, it is a pleasure to follow the noble Baroness, Lady Shawcross-Wolfson. I welcome the gracious Speech and a number of the important measures contained therein. In particular, I support the NHS modernisation Bill, the Northern Ireland Troubles Bill, which rightly seeks to place victims and survivors at the centre of this difficult, vexatious legacy, and the European partnership Bill, which offers the prospect of renewed economic co-operation and prosperity. Indeed, I continue to believe that closer alignment with the European Union is essential for our long-term future. I also welcome the social housing renewal Bill. Access to secure, affordable housing is not simply an economic issue; it is fundamental to personal health, family stability and overall well-being.

I want to concentrate, like many noble Lords right across the Chamber, on health. I welcome the Government’s commitment to rebuilding public services after years of strain and fragmentation, as was evidenced by the previous Government. The NHS modernisation Bill presents a real opportunity to restore coherence to the system. As the noble Lord, Lord Dodds, has already said, we already have that single chart in Northern Ireland for each of our patients, but the sad reality is that it does not reflect GP services or one’s contact with the GP or primary care. At the heart of this NHS modernisation Bill, the issue is simple: people want timely access to care and treatment. They want shorter waiting lists, faster diagnoses and services that work seamlessly together.

Previous reforms back in 2011-12 created unnecessary fragmentation, something we have seen clearly in areas such as childhood vaccination programmes, which we are currently examining in the specialist Childhood Vaccinations Committee. There, complexity has undermined delivery, and that must be addressed. I have been contacted, like many noble Lords, by a range of organisations, including Parkinson’s UK, the Royal Osteoporosis Society and groups representing those with chronic skin conditions, all highlighting the same issues—long waiting times, gaps in care and inconsistent access to treatment. I hope that the structural issues highlighted in the NHS modernisation Bill can help to address those matters.

Parkinson’s UK, for example, has emphasised the importance of a fully integrated system. The move towards a single patient record could transform care by ensuring that those with complex long-term conditions receive co-ordinated treatment across multiple services. However, it rightly stresses that essential NHS England functions must not be lost in transition. It also highlights the critical importance of clinical expertise, particularly in neurology, given that one in six people in the UK lives with a neurological condition. Expertise must remain at the heart of decision-making, so I ask the Minister how the Government will ensure that key clinical advisory roles are retained within the new system, and what assurances can be given that the time-critical medicines programme will be delivered in full.

For patients with Parkinson’s, delays in medication are not just inconvenient; they can be life-threatening, but also, prevention must remain a priority. Fracture liaison services are a clear example of where early intervention can prevent further harm. These services identify patients after a first fracture, begin treatment and reduce the risk of reoccurrence. When will the Government publish a clear rollout plan to ensure universal access by 2030, an issue that was raised in previous debates? I am confident that this Government are committed to rebuilding and strengthening our NHS. The direction is right, but obviously delivery will be the key. We must ensure that reform leads not only to structural change but to real, tangible improvements in patients’ lives.

My Lords, there is much that is good in the measures in the King’s Speech and certainly much that is well intentioned. However, I am left with the uncomfortable feeling that, overall, the contents of the speech do not, in a phrase often used by the noble Lord, Lord Hennessy, rise to the level of events. I have some sympathy with the situation in which the Prime Minister and the Government find themselves. Paradoxically, they are shackled by their overwhelming victory in the last general election. The result is that the huge majority in the House of Commons contains a large number of Back-Benchers who have no prospect of ministerial office and who are alarmed by the prospect of tough measures which will harm their popularity in their constituencies and damage their prospects of re-election. In effect, the Government’s Back Benches become part of the opposition to the hard decisions which the Government need to take to achieve their objectives.

A section of the gracious Speech which I warmly welcome is the passage heralding proposals to

“strengthen the delivery, accountability, innovation and productivity of the Civil Service”

and

“to safeguard its impartiality and core values”.

I have never concealed my view that measures are always needed to bring the Civil Service up to the mark. Civil servants operate with other people’s money and lack the profit incentive which exists in the private sector. On the other hand, I believe that we are fortunate in having in this country a deep-rooted tradition of public service and that our civil servants do their best to achieve the Government’s objectives, if they are effectively led. In the recently appointed head of the Civil Service, Dame Antonia Romeo, I believe that we have someone who is capable of giving that leadership.

I particularly welcome the inclusion of the word “impartiality”. It is sometimes forgotten that, like the judiciary and the Armed Forces, the Civil Service is an independent service of the Crown and not the possession of any single set of politicians. If a Minister loses confidence in a civil servant, he or she is entitled to take action, but it should be dealt with by the head of the Civil Service and not through summary dismissal by a politician without due process.

I expressed at the outset of my speech my regret that the contents of the gracious Speech do not, in my view, rise to the level of events. I fear that the same can be said of our political discourse generally. The Government’s present disarray is easy meat for opposition parties and the media, but this is not a game. The dangers which the country faces, both nationally and internationally, seem to me very serious.

This year, we are 50 years on from the 1976 IMF crisis. The circumstances then were in some ways similar. Then, as now, we had suffered an oil price shock, although with different origins. In some respects, the circumstances in 1976 were worse, with inflation and unemployment rising simultaneously, a balance of payments in deficit and our reserves perilously low. Today, our level of national debt is unprecedentedly high and the cost of government borrowing is at an uncomfortable level. The experience of the Truss Government shows what happens if the markets lose confidence.

We should remember Prime Minister Callaghan’s speech to the 1976 Labour Party Conference, when he said:

“I tell you in all candour that the option”

of spending our way out of a recession “no longer exists”. Today is a moment for the same realism and courage. Our country urgently needs political leaders, both government and opposition, similarly to get serious and rise to the level of events.

My Lords, it is a great privilege to follow the speech that we have just heard and I hope we will all ponder it. I am going to be a bit more frivolous in my contribution. When I saw the notice of the King’s Speech debate arrangements, I felt a bit like Cinderella, with everybody going to the ball except me. It was not only me who noticed that there was no slot for Defra or the environment in the debate in response to the King’s Speech; external commentators also remarked upon it, as well as several people within the House. Although there were opportunities to talk about energy, there was no opportunity to talk about Defra issues, including the clean water Bill and the important environmental issues arising from the regulating for growth Bill, as well as other general environmental implications of the overall programme of legislation. Above all, there was no chance to ask Defra Ministers questions.

I asked the Library and it said that I was correct in my recollection. I have been in this House for 29 years and it confirmed that, in the last 30 years—I did not ask the Library to go back any further—there had been the allocation of a day to Defra or its previous incarnations in every Queen’s or King’s Speech debate. I am concerned. Perhaps the Minister can account for the decision to drop Defra and the environment, though he may quite rightly say that it is outside his departmental responsibilities—which is precisely the point I am making.

I am concerned in case the omission signals a diminution of the importance of the environment in the Government’s mind, especially as recent National Trust polling has shown that nature is a major source of pride for the public, second only to the NHS. Despite the pressures of life, 83% of the public say that restoring nature is an important or top priority for them personally. When polled, the public said that weakening nature protections is as unpopular as cuts to the winter fuel allowance. I look forward to the Minister’s explanation as to why there was no Defra day.

However, Cinderella will go the ball. I can talk about housing, and I want to make two pleas. First, along with the commitment for more social homes, can we make sure that we enable smaller-sized renewable energy generators, especially community ones embedded in their communities and developments, to sell their power to local homes and businesses? It has been encouraging that DESNZ Ministers have expressed positive intentions on this. Investors and community organisations on the ground are eagerly waiting to see new rules put in place. Can the Minister say whether we will see this as part of the energy independence Bill?

My second plea—here I declare an interest as chair of the Forestry Commission—is this. I welcome the social housing renewal Bill, and particularly the commitment to build more social homes, but that is not only an opportunity to ensure that more people can live in decent, safe, secure and affordable homes. Along with the overall target of building 1.5 million homes, it offers further opportunities for public benefit, if we look at how these houses will be built.

Let us look at some statistics. The construction sector is currently responsible for 39% of global emissions. Houses built using timber reduce reliance on high-carbon concrete and steel. Wood absorbs CO₂ as it grows and then locks it up for the duration, if used in buildings. We have a magnificent example on the premises, in the vaulted hammer-beam timber roof of Westminster Hall. Its 660 tonnes of wood have sequestered for 625 years CO₂ equivalent to the average annual emissions of 300 internal combustion engine cars. That is just one example of the great amount of wood in the Palace of Westminster.

Wood is also a natural insulator, reducing energy needs. Over the border in Scotland, 92% of all houses are timber framed. In England, that is only 9%—so we need to copy the success of the Scots, which is not a sentiment I often prescribe.

In addition, 40% of UK woodlands are currently undermanaged. Increasing properly certified timber and construction creates a direct economic incentive to bring more woodland into active sustainable management, with benefits to biodiversity, productivity, employment and long-term carbon sequestration.

In conclusion, I ask the Minister what plans there are to use the push for increased social housing to also drive implementation of the Government’s Timber in Construction Roadmap 2025. Will he join with me in commending the Department for Education, which is actively pursuing engineered timber modular solutions for the next generation of schools? I ask the NHS to also follow suit.

My Lords, I welcome the emphasis in the gracious Speech on renewing public services, modernising the NHS and supporting long-term economic security. They are the right ambitions, but they will matter to patients only if they translate into practical reforms that prevent ill health, reduce pressure on hospitals and help people stay independent.

The Minister will not be surprised that I will concentrate today on one such issue, fracture liaison services, as did the noble Baroness, Lady Donaghy, with whose excellent speech I completely agree. These bone clinics identify people with osteoporosis after a first fracture, ensure they are assessed and treated, and help prevent the subsequent devastating fractures that would otherwise follow. That matters because osteoporosis is one of the most urgent threats to our ageing population, causing half of women and one fifth of men over 50 to suffer fractures.

The end result of untreated osteoporosis is a broken hip, which kills a quarter of sufferers within a year, and is a huge burden on the NHS, with around 7% of NHS beds occupied by people with fragility fractures. There is also a stark inequality dimension: people from deprived areas have a 25% higher risk of fractures. Safe, effective medication—costing around £1 per week—exists to stop this and save lives. But today, FLS are missing in half of NHS trusts, and that position has not shifted since the general election.

In 2024, the new Government pledged to roll out FLS to every area of England by 2030, and I applauded them for that. The then Secretary of State, Wes Streeting, said the rollout plan would be one of his “first acts in government”—but we are still waiting. As a result, over those two years, 4,000 people have died needlessly following hip fractures that a prompt rollout of FLS would have prevented.

Ministers, including the noble Baroness, Lady Merron, who is hugely supportive of this cause—and I am very grateful for that—have reiterated their FLS pledge no fewer than 63 times in Parliament and the media, as the noble Baroness, Lady Donaghy, said. Yet still, there has been no progress. The Government’s recent investment in replacing 14 bone density scanners is welcome—bravo—but a scan is just a scan. It does not start patients on medication or help patients adhere to their treatment through regular review, the vital elements of the FLS model that reduce refracture rates by 40%.

This is not a partisan issue; every political party backs the rollout. But, as we have heard, there are no implementation plans, dedicated resources or milestones. Many organisations that advocate for FLS fear the commitment exists on paper but will not be delivered in practice. If that is accurate, the costs are grave. Over 2,000 people die each year following hip fractures that FLS prevent. Since the election, the NHS has already spent an estimated £150 million treating fractures that FLS could have prevented—double the cost of FLS rollout. On any credible path to implementation, we would have expected 24 of the 60 NHS trusts missing FLS to be covered by now. Today, that number stands at zero. Worse, the lack of a national plan is impeding local areas from pushing on with their own FLS while awaiting central direction.

We are now at a moment of truth. The Society of Radiographers warns rollout must begin by summer 2026 if the Government are to have any chance of meeting the goal. It is now an urgent implementation challenge, not a distant timeline. A commitment without a delivery plan is not good enough. If Ministers truly intend a nationwide rollout for these services by 2030, surely there can be no objection to publishing a timetable for delivery. Could the Minister be frank with the House? Does the Department of Health, in view of all the evidence it has before it, believe the 2030 deadline remains deliverable and feasible without dedicated funding?

Ministers have rightly championed a shift from sickness to prevention; osteoporosis is a clear test of whether that ambition translates into practice. If we cannot act here, it is difficult to see where we will. The new Secretary of State, the noble Baroness’s colleague, has the rarest of opportunities: an easy win in a very difficult brief that will save lives and money and tackle stark health inequalities. What is not to like? The policy is agreed, the model is proven and the sector is ready and raring to go. What we need now is not another promise but action, a timetable, resources and the start of delivery. I hope we might get that commitment this evening.

My Lords, I very much welcome the reference to housing in the gracious Speech, particularly the commitment to long-term investment in social housing and to reform the leasehold system, including the capping of ground rents. I declare an interest as a landlord, leaseholder, former renter and co-chair of the All-Party Group on Leasehold and Commonhold Reform.

Labour’s manifesto pledged to end the “injustice of fleecehold”, and in the 2024 King’s Speech, His Majesty’s Government said they would

“take steps to bring the feudal leasehold system to an end”.—[Official Report, 18/7/24; col. 129.].

HMG have my full support in that.

The noble Lord, Lord Gove, guided through the seminal Leasehold and Freehold Reform Act in the dying days of the last Government. He is to be commended for his tenacity. HMG’s commonhold and leasehold Bill aims to make commonhold the default tenure, a long-overdue reform. It will improve the current system for the 5 million existing leasehold properties, bolstering fundamental rights, including enfranchisement and the right to manage, capping ground rents at £250 and other measures.

Alongside that, the Social Housing Bill, aiming to boost the supply of social housing, protect existing stock, strengthen protections for tenants and reduce bureaucracy so providers can build more homes, is also extremely welcome. The last 47 years have been a disaster for social and particularly council housing, stimulated by the right-to-buy scheme, which, while hugely popular, sowed the seeds of today’s housing crisis.

The housing market for potential home owners and renters has never been worse in my lifetime. The calculation is a simple one: there is not enough affordable housing to buy or rent. Thus, while HMG’s housing efforts are to be applauded, it is necessary to have a reality check. Almost two years into this Government, very important aspects of the Leasehold and Reform Act 2024 have still not been implemented. The Act was meant to make it cheaper and easier for existing leaseholders in houses and flats to extend their lease or buy their freehold.

There has been a commitment to abolish marriage value, but to date we have witnessed interminable consultations and legal challenges. To an extent, I have sympathy with the Government. The modern way of governing seems designed to foster delay and challenge, to the point that it is very difficult to get anything much done. Consultations on every conceivable subject and the fear of judicial review stymie the will of Parliament at every turn—just ask the Tories over their ill-fated Rwanda policy. This must change if the Government are to make progress with their programme. I think back to the Labour Government of 1945-51. Those reforms, at that pace, would be impossible today.

There is much to do in the housing field alone. We still await a register for short lets to cover the hollowing-out of long-term rental properties in our towns and cities by platforms like Airbnb—although a register is not a substitute for proper regulation. As we heard from the noble Lord, Lord Best, earlier, we need proper regulation of property management companies, which are currently unregulated despite often managing millions of pounds. Some of these companies are appallingly managed, totally unqualified and rip off their clients.

HMG’s plan to build 1.5 million more homes and invest £39 billion over 10 years in social housing is to be admired, but there are serious doubts if it can be done as things stand. The 1.5 million target is already slipping and housing delivery is stalling. Our population has increased by 12 million people since the mid-1990s; housing supply is not keeping pace with demand. This is the real problem, not avaricious landlords facing escalating costs. The private rented sector has shrunk by 250,000 in 12 months. Where are the additional 1 million private rental homes which, according to Savills, are required by 2030, going to come from?

HMG need to incentivise councils, housing associations and developers to build private and social housing on brownfield sites, and encourage the PRS to grow, not shrink. For that to happen, the economy needs to flourish. The Bank of England and HMG should listen to what the IMF said this week. Instead of pandering to the banks to increase their profit margins, the BoE does not need to hike interest rates and may even need to cut them.

Finally, yes, the country wants change, but it wants good change, not bad change. What everyone really wants to see is improvement in their lives. That is the job of this Government.

My Lords, I am grateful for the gracious Speech and for the opportunity to reflect on its implications for transport across our United Kingdom. I also pay tribute to the House of Lords Library for its excellent preparatory work.

Transport is not just about infrastructure; it is about opportunity, connectivity and fairness. It determines whether people can access work, education, healthcare and community life—and nowhere is that more important than in my homeland of Wales.

The King’s Speech sets out an ambitious programme of change. The task is now for this ambition to translate into communities across the United Kingdom. For the public, what matters is simple: not what is promised, but what actually improves their daily journey.

Let me begin with the Railways Bill and the creation of Great British Railways. The intention to simplify a fragmented system is welcome, and the case for change is clear. But success will not be judged by structure but by outcomes. Passengers in my native south Wales will rightly ask: will services be more reliable? Will journeys be quicker? Will connections improve? Change must be measured in punctual trains, better connections and shorter journey times—not in organisational charts.

It is vital that these changes work for every part of the United Kingdom. That means genuine partnership with the nations and regions and ensuring that investment is fairly balanced—which has not always happened in the past. If this is truly a national railway, it must deliver for every nation—not just some parts.

On road safety, the Government’s proposals have the potential to make a real difference, and measures that save lives must always be supported, as we have seen in the 20mph rollout in Wales. However, we must recognise the realities faced in many communities. In rural Wales, driving is not optional—it is essential. Change must therefore be proportionate, protecting safety while maintaining independence, particularly for older people in our communities.

I welcome the Government’s intention to address micromobility. In cities such as Newport and Cardiff, e-scooters and similar devices are already well in use, so clear, balanced regulation is needed to support sustainable transport while maintaining public safety. Similarly, modernising the law on powered mobility devices is both necessary and timely. For many people, these are important and vital to maintaining independence.

What links all these issues is the need for integration. Transport policy must work as a system and not in silos. In Wales, that means better co-ordination between rail and bus services so that there are seamless journeys. It means recognising the importance of cross-border travel, particularly between south Wales and the west of England. More people move between Cardiff, Newport and Bristol every day than between Liverpool and Manchester. Connectivity therefore does not stop at borders—and nor should transport policy.

The real test is not whether we change the system but whether we improve the services. This House has an important role in ensuring that ambition is matched by accountability. Through careful scrutiny, we can help ensure that these proposals achieve their full potential. Above all, we must keep our focus on the people who rely on these systems every day—the commuter, the business owner, the rural resident. For them, transport is not abstract; it is essential.

I look forward to working constructively with colleagues to support our Government’s reforms and to ensure that they deliver real and lasting improvements across Wales and across the United Kingdom.

My Lords, recently my work has focused on two aspects of prevention of ill health and health inequalities. In 2024, I chaired a one-year special inquiry into food, diet and obesity, and this year I am chairing one into childhood vaccination rates in England. Apart from clean water, these are two of the most effective measures for preventing ill health. Both are in line with the Government’s 10-year plan and determination to raise the healthiest generation of children ever, but there was little in the gracious Speech about implementing these commitments. However, many of the things we need to do will require secondary legislation rather than primary legislation, so I am looking forward to scrutinising a lot of regulations in the coming year.

On food policy, things are moving too slowly. Mandatory reporting of healthy food standards, promised last year, is still awaiting publication of consultation. The ban on less healthy food being advertised before the 9 pm TV watershed and online is having limited effect because of the watering down of the rules to allow brand advertising. This loophole is currently being imaginatively explored by the food industry. The new nutrient profiling model will require secondary legislation to detail how it will be applied. Consultation is under way on this too. We still await the technical consultation on strengthening the soft drinks industry levy—the sugar tax. The 10-year plan promised a ban on the sale of high-caffeine energy drinks to under 16 year-olds. However, progress on this has stalled, although it was announced in the previous King’s Speech and consultation was published in 2025.

I welcome the Government’s proposals on the review of the school food standards, and consultation has been launched, but I look forward to seeing the proposed changes to the Requirements for School Food Regulations 2014 as soon as possible this year.

Meanwhile, on our high streets, Action on Salt has found massive unnecessary amounts of salt in popular sandwiches—in one sandwich alone more than an adult’s daily limit. This is only one example of the unhealthy food which dominates our food system.

On all these matters the Government need to be bolder. My committee recognised that the food industry makes a lot of profit, some of which it spends on lobbying government, and we recommended that policy on food should always be made independently in the interests of public health, followed by consultation with industry about how to implement the Government’s policy. This has not been happening. Under the previous Government, good food policies were significantly watered down and delayed by up to four years. I urge the Government not to do a deal with supermarkets by delaying healthy food regulations in exchange for capping food prices, as is rumoured. It would be against public health and damage the NHS, and would be very short-sighted. Can the Minister confirm whether the rumour is true: yes or no?

I turn to the single patient record. Health data is currently a shambles, with numerous different systems that cannot talk to each other. This brings risk to patients and barriers to planning. There are undoubtedly issues about privacy, security and ownership of the data, which will be debated when we discuss the Bill.

My current committee has heard in public oral evidence that there are serious issues about vaccination data. Although most childhood vaccinations are delivered and recorded within GP practices, some take place elsewhere. This information is often not brought together into a single record. Some people may not be registered with a GP, or there can be difficulties transferring information from one GP to another. The information is vital for the care of that child and for national data and commission planning. Responsibility for commissioning vaccination services is now to be given to large-footprint, cash-strapped ICB clusters, but where will responsibility and accountability lie nationally?

The challenge will arise of how outreach to under-vaccinated local communities with different characteristics can be designed and managed far away in the headquarters of a large ICB—and whether it will be funded sustainably. However, there may also be a benefit. The ICBs may be able to smooth the transition of information across the life course, from maternal vaccination through early years and the secondary school-age programme and onwards to the adult offer. We shall see.

It is with great pleasure that I follow the noble Baroness, Lady Walmsley. I want to offer something of importance to all women. A newborn girl has around 1 million eggs at birth in her ovaries. By puberty, most of those microscopic eggs have already disappeared, often leaving some 300,000, according to our laboratory calculations. This loss continues in all women throughout childbearing life. By the age of 45, few viable eggs are left in the ovaries and the chance of women getting pregnant spontaneously is less than 2% per month.

No medical treatment prevents this loss of eggs, so egg freezing is increasingly used to preserve female fertility. Frozen eggs are stored in liquid nitrogen but, unlike freezing embryos, which is highly successful, egg freezing is much more difficult—for technical and scientific reasons that I do not have time to explain. Egg freezing is a massive industry, mostly in private clinics. Many women are being encouraged to freeze their eggs. To have much chance of success, eggs must be collected and frozen early in reproductive life, before a woman is 30 or, at the latest, 35.

Information is available for the last 15 years or so from the Human Fertilisation and Embryology Authority, which reports all this data to Parliament in some form. IVF is needed for frozen eggs to become babies, so this is relevant to the HFEA’s work. About eight years ago, the authority claimed that the chance of a woman getting pregnant with her frozen eggs was around 13%. Sadly, this estimate was grossly inaccurate, because its report counted only the transfer of embryos derived from frozen eggs to the uterus. There are many steps in egg freezing before embryos are created. Freezing itself has a failure rate, as we will see in a second, as do many early stages which are not being recorded. To get enough eggs from the ovary, they must be reasonably mature eggs. They must be produced through fertility drugs given in increasing doses, not without some risks.

However, some eggs do not freeze well and do not mature properly. At least 20% that are frozen do not thaw normally. Already there is an increased risk of damage from the thawing. When they have gone through this process, they are then exposed to sperm if they are normal, but they may not fertilise. Of those that are fertilised, many do not develop into embryos. Others may have chromosomal abnormalities—aneuploidy—and other cellular abnormalities which prevent their chance of being a normal embryo.

The HFEA’s figures from the last 10 years record about a quarter of a million eggs being currently in store—263,692 eggs have been frozen and stored. Some 34,000 eggs have been used for the treatment of women in the last 10 years. From these, 2,949 embryos were formed and transferred. That resulted in 609 women getting pregnant, about a 20% success rate. However, there were at least 93 miscarriages, which is 15% of the pregnancies. Therefore, after thawing 34,000 eggs, the real success rate of egg freezing is a pregnancy rate of around 1.7%.

This is not being told to the women. It is not fully reported in the numbers of live births. We do not know the precise status of these embryos. We do not have follow-up; we do not have information about any serious side-effects of the treatment. The HFEA says that it no longer keeps such statistics and that it could take up to 18 months for the Minister to get information.

Egg freezing means a great profit for private clinics. Patients usually pay £5,000 for each treatment but sometimes more—sometimes over £10,000. Some clinics have boasted to me—I have this on record—that they get a better than 60% pregnancy rate after egg freezing, which is more than what is achieved by sex in a comfortable bed. I hope that my noble friend the Minister will write to me about these deeply distressing statistics. They are largely hidden from women, who are frequently told by clinics that they should take out an effective insurance plan for their future well-being and happiness. This is not good information.

My Lords, it is a pleasure to follow the noble Lord, Lord Winston.

London’s housing crisis is no longer a warning sign; it is a full-blown social failure. The Government and the Mayor of London are failing the people of this city. While politicians issue press releases and make grand announcements, ordinary Londoners have been priced out, pushed out and left behind. One in every 50 Londoners is homeless or living in temporary accommodation. Over 100,000 children are growing up without a stable home. I want your Lordships to think about that for a minute. At least one child in every London classroom is homeless. This is not merely disappointing; it is morally unacceptable. While this crisis deepens, London boroughs are struggling with a £5.5 million bill every single day for temporary accommodation—money that is spent on managing, not solving, a problem.

The single biggest failure in London housing today is simple: not enough homes are being built. The Government say that London should deliver 88,000 homes per annum, but last year London delivered only 32,000 homes—not even close. Even the Mayor of London’s own lower target of 52,000 homes was missed by a wide margin. This is not a small shortfall; this is systematic failure, and Londoners are paying the price.

Rents are exploding, families are overcrowded, young people cannot buy and working people are forced to live and work further and further away from the communities in which they grew up. At the same time, private rental lettings are down nearly 40% over a five-year period. The average rent is now £2,280 per month. The average house price in London is £542,000. The Mayor of London talks endlessly about housing targets, but housing targets do not home families; houses do. Londoners can now clearly see the gap between rhetoric and delivery.

Another glaring omission from the King’s Speech is proper action on short-term lets. Across London, entire neighbourhoods are being hollowed out. Residents are regularly dealing with noise, anti-social behaviour, waste, transient occupancy and, in some cases, criminal activity. Meanwhile, permanent housing stock is disappearing from London’s local communities. Councils need real powers, not token gestures. They need mandatory registration, real-time platform data sharing, punitive fines for rogue operators and proper enforcement funding. That is why I have introduced a Private Member’s Bill that will come before this House on 18 June. Communities deserve protection too and, if this Government will not act decisively, Parliament should push them to do so.

Britain’s housing market is jammed shut and stamp duty is one of the reasons for this. It punishes aspiration, traps older people in homes too large for them, prevents growing families moving and blocks younger people from taking their first step on the housing ladder. That is why the Leader of the Opposition, Kemi Badenoch, was right to propose the abolishment of stamp duty on family homes. Research shows that up to 2 million people would consider downsizing if stamp duty was removed. If only half of them did this, over 1 million additional homes would come back on the market. That is how the Government can get movement again: not through slogans, headlines and fantasy targets but through actual movement, homes and opportunities. The wider economic boost to local economies could be up to £1.2 billion for local tradesmen and professionals.

In conclusion, Londoners are tired of excuses. They are tired of hearing promises without delivery, targets without homes and announcements without action. This crisis is destroying aspiration and social mobility in our capital city. Young people cannot buy, families cannot move and councils are overwhelmed. Children are growing up in homelessness in one of the richest cities in the world. That should be a disgrace to all levels of government. We need radical housebuilding, functional rental markets and policies that reward work and aspiration, because housing is not a luxury; it is the foundation on which stable lives are built.

My Lords, it is a pleasure to follow the noble Lord, Lord Bailey, and I thank my noble friend the Minister for her excellent introductory speech earlier.

I have spent nearly 40 years working in the National Health Service. I have seen it at its best—compassionate, innovative and life-saving—and I have seen it when the system fails and when patients fall through gaps that should never exist. That is why I welcome the NHS modernisation Bill, part of a wider national mission to move healthcare from hospital to community, from analogue to digital and from treatment to prevention. I welcome the provision to give flexibility to integrated care boards for addressing local needs. It has the real potential to address the deep health inequalities that scar our society, but we must ensure that there will be no creation of a postcode lottery. I also welcome the abolition of NHS England and reducing bureaucracies.

At the heart of the Bill is its most transformative proposal: the single patient record. We should remember, first, that care is not simply an outcome on a spreadsheet; it is whether patients feel seen, heard and safe. NHS trusts use multiple electronic record systems that often cannot communicate with one another. Millions of patients are treated every year without clinicians having access to their full medical history. That is not just an outdated infrastructure; it is a risk of harm. As a doctor, I can tell you that this happens too often, and unequally. The most vulnerable in our society—those with mental health conditions or disabilities and those without any family at their bedside—are the most likely to fall through the gaps.

The single patient record offers the opportunity to change that fundamentally. It can fundamentally change patient experience and improve clinical outcomes, operational efficiency and financial performance. It can narrow the gap between those whose histories are known and those whose histories are not known. It is, at its core, a tool for equity. Above all, it means that patients are no longer carrying the burden of stitching together their own care.

I particularly welcome the decision to begin its implementation through maternity care. Too many maternity complaints involve failures in communication between services. The consequences can be and have been fatal. One report described a pregnant woman with bipolar disorder and a history of postpartum psychosis whose psychiatric history was not properly communicated between services. She did not receive the specialist care she needed and died by suicide during pregnancy. That was a preventable systems failure. A single patient record can prevent such tragedies.

We must also ensure that significant treatments, both NHS-funded and non-NHS funded, taking place in the independent sector, such as IVF and assisted conception, should be in the single patient record. It is essential to ensure continuity of care, protect patient safety and build a clearer national understanding of the complications and long-term outcomes of fertility treatments. We must not miss this opportunity. In this context, I declare that I am a board member of the Human Fertilisation and Embryology Authority. I ask the Minister for her support to make this happen.

The single patient record will save lives. In time, it will also save money by reducing complications, complaints and medico-legal costs. Other countries have already shown what is possible. In Denmark, linked health data has strengthened clinical care while driving world-leading research. Used responsibly, with the trust of the public and health professionals, this could position our country as a global leader in life sciences.

If implemented well, this Bill has the potential not simply to modernise our NHS but to humanise it and to create a system in which patients are truly known not as isolated episodes of care but as whole people—a system that reflects the founding principle of our NHS: that every person matters equally and deserves care that is joined up, dignified and humane. I look forward to contributing to the Bill when it arrives in your Lordships’ House.

My Lords, it is a great pleasure to follow the noble Baroness, Lady Nargund, and in so doing echo her remarks about the remarkable and customarily imaginative and enthusiastic way in which the noble Baroness, Lady Merron, introduced this debate. In so doing, I declare my interests as chairman of King’s Health Partners and the King’s Fund. It will be, of course, on the NHS modernisation Bill that I will contribute the majority of my remarks.

Before so doing, I would like to touch on one other Bill that has appeared in the gracious Speech, the peerage removal Bill. Here I declare my interest as chairman of your Lordships’ Conduct Committee and as a former chairman of the House of Lords Appointments Commission. This is an important Bill because it touches upon many important constitutional principles. It is designed to address an issue, as stated in the gracious Speech, with regard to the standing and reputation of your Lordships’ House. In its so doing, there will need to be careful consideration of how any statutory provisions touch upon the procedures and processes agreed by your Lordships’ House with regard to conduct and whether any such provisions will extend your Lordships’ provisions for assessment of conduct beyond conduct related to parliamentary activity to conduct outside your Lordships’ House.

Indeed, your Lordships will need to understand in some detail the mechanisms by which it is proposed that, if enacted, the Bill will function. Will it function as a function of your Lordships’ House—that is, a question of resolution by the House—or will it function through the creation of an additional body outside what would be normally considered the processes of a self-regulating Chamber?

In addition, it is going to be very important to understand what other opportunities might be reflected in the passage of such a measure, in particular, whether the provisions of the advisory House of Lords Appointments Commission are ultimately put on a statutory basis so that all nominations, be they political or to the independent Cross Benches, are subjected to the same evaluation in terms of individual propriety and suitability. These are important questions that, no doubt, your Lordships will be able to consider when the Bill comes for consideration in your Lordships’ House.

I now turn to the NHS modernisation Bill. As the noble Baroness stated, His Majesty’s Government began their term in office by undertaking a detailed and forensic examination of the condition of the NHS, which identified it to be in a state of some crisis. It is therefore important that any measure of such substance as those in this proposed Bill should be judged against the standard of addressing that crisis urgently, as I think all noble Lords would agree that time is now running out. We need to take serious, long-term decisions to achieve what was first described with eloquence and clarity in a report led by my noble friend Lord Patel. This was the 2017 report of a special Select Committee on the long-term sustainability of the health and care system in our country.

That report made a number of recommendations. I shall not rehearse all of them with your Lordships this evening, but two important ones regrettably do not appear to have been addressed in the measures proposed in the NHS modernisation Bill. The first was the need to bring together health and social care into a properly co-ordinated system to ensure the ultimate sustainability of our healthcare system. As we have heard earlier in this debate on the humble Address, it has not so far been easy to identify how the measures in this Bill will achieve that objective. The second recommendation was to secure an appropriate investment, not only in innovation and technology but in the development of the workforce, to ensure that innovation and technology could be adopted at scale and pace across the NHS and to achieve the objectives that we all recognise are vital to secure its sustainability.

I make one last point. The measures in the Bill once again centralise an awful lot of power, on the basis of a need for accountability, in the hands of the Secretary of State for Health and the Department of Health and Social Care. It is proposed thereafter to transfer some of those powers back to ICBs, which will become strategic commissioners of healthcare at a local level. Those important mechanisms, and indeed the willingness and determination of the Department of Health and Social Care to use those powers not to control but rather to facilitate, will need to be understood fully as we consider the Bill during its passage.

My Lords, it is a pleasure to follow the noble Lord, Lord Kakkar. The health measures outlined in the gracious Speech raise profound questions about the future direction of the National Health Service. Much of the focus of the proposed NHS modernisation Bill appears to centre on the abolition of NHS England and the transfer of its powers directly to the Department of Health and Social Care and, ultimately, to the Secretary of State. This is presented as a move to simplify decision-making and improve accountability. Ministers argue that, if the public are dissatisfied with the performance of the NHS, there should be no ambiguity about who is responsible. In theory, a more direct chain of command could reduce duplication and speed up reform.

But there are serious concerns that cannot be ignored. NHS England is not simply another layer of bureaucracy; it was created to provide a degree of operational independence from day-to-day political control and, importantly, to help ensure that the voice of patients remained central to how services were designed and delivered. There is also concern about the future of local Healthwatch organisations, which play an important role in representing patients and communities at a local level. If these bodies are weakened or removed along with NHS England, as is proposed in the Bill, there is a real risk that local accountability and patient representation will be diminished even further. Removing these structures risks concentrating too much power in the hands of Ministers while weakening independent advocacy for patients.

At a time when waiting lists remain long, staff morale is under strain and many patients struggle to access timely care, this reorganisation feels disconnected from the real pressures facing the NHS. Structural reform in itself does not shorten ambulance delays, increase GP appointments, recruit more nurses or improve social care provision. There is a danger that yet another major reorganisation consumes time, money and energy that should instead be directed towards improving front-line services.

The NHS has already undergone repeated restructurings over the past two decades. Each one has promised efficiency and better outcomes, yet the core challenges remain remarkably similar: workforce shortages, uneven access to care, rising demand, and chronic underinvestment in prevention and community services. Many people will therefore ask whether abolishing one organisation and transferring powers elsewhere is truly reform or simply rearrangement.

There is, however, one potentially positive proposal within these plans, which has been mentioned widely this evening: the ambition to create a single patient record across the NHS. If implemented properly, this could make a real difference. Too often, patients must repeat the same information to different parts of the system because records are fragmented and incompatible. A shared patient record could improve communication between hospitals, GPs, mental health services and social care, reducing delays and improving safety.

Equally important, giving patients direct access to their own records could empower people to take a greater role in managing their own health, but even here the detail matters enormously. Public trust will depend on strong safeguards around privacy, data security and consent. Patients must be confident that their information is protected and used appropriately. Technology should support care, not undermine confidence in it.

The key question is this: will these reforms genuinely improve patient outcomes? The NHS does not simply need another structural overhaul; it needs investment in staff, modernisation of services, stronger primary care, better integration with social care, and a relentless focus on performance, productivity and patient experience. Without that, changing organisational charts risks becoming a distraction from the urgent work that patients and healthcare professionals need most. The public judge the NHS not by who holds authority in Whitehall but by whether they can see a GP when they need one, whether ambulances arrive on time, and whether treatment is delivered safely and promptly. That is where the real test of these proposals will lie.

My Lords, I start by declaring my railway interests, as I will be speaking a lot about the Railways Bill in my remarks this evening. All these interests are unpaid. They include presidency of the Heritage Railway Association and of the Cotswold Line Promotion Group. I am a member of the Railway Heritage Designation Advisory Board and the National Railway Museum’s advisory board, and I chair the Great Western Railway’s stakeholder board.

I want to commend all those who are making such a success of Railway 200, the 200th anniversary of the opening of the world’s first passenger railway between Stockton and Darlington in 1825. It is rightly being celebrated throughout Great Britain and Northern Ireland, and allows us all to celebrate just how much railways have contributed to a nation’s happiness, health and prosperity. Railway 200’s exhibition train, which is called “Inspiration”, is conducting its nationwide tour and will be doing so until this summer. If noble Lords have not visited yet, I urge them to do so. It is likely to be at a heritage railway close to where they live. Curated in partnership with the National Railway Museum, the exhibition carriages of “Inspiration” are a great celebration of what the railway has done for everyone.

I congratulate my noble friend Lord Hendy of Richmond Hill on the part he has played in making Railway 200 such a success, his commitment to the heritage sector and, most important of all, his determination to ensure that we as country appreciate and stand behind our railways. My noble friend and I were invited to join the celebrations for the 75th anniversary of the Talyllyn Railway this week, but our duties here made it impossible for us to get away to north Wales. I am sure he will want to join me in sending our congratulations to that wonderful little railway.

I have spoken before in your Lordships’ House about the huge contribution that heritage railways make to the regional economy, to tourism and to the preservation of engineering skills. I again thank noble Lords in all parts of the House and the Government for supporting my efforts and those of the noble Lord, Lord Parkinson of Whitley Bay, to make it legal, through an amendment to the Employment Rights Act, for young people to work and volunteer on heritage railways. I am told that that is already making a great difference. It is a small change but an important one.

The value of a national rail system cannot be exaggerated. They have long played a vital part in shaping regional economies and communities, bringing a sense of community cohesion as they transport people from A to B. They enable people to get to work, school and university, to see friends and family, to go shopping and to go on holiday. There is so much more that they could be doing, particularly in improving the environment, by attracting much more heavy freight off the roads and on to the railway. I know my noble friend the Minister has already received representations from the rail freight sector and been given practical examples of what could usefully be done. I appreciate that the debate on the gracious Speech is not the right place for discussing detailed amendments to the Railways Bill, but I hope the Minister will be able to give an assurance that he and his officials are studying carefully the freight industry’s representations on matters such as access arrangements for non-Great British Railways operators and the freight growth target set for Great British Railways.

I will finish on a positive note. On Monday, direct services between Bristol and Oxford, calling at Bath, Chippenham and Swindon, were introduced by GWR and launched by the Secretary of State. The service runs every two hours and was made possible only because of the capacity improvements that Network Rail has made at Oxford station. Does my noble friend the Minister agree that this is exactly the type of thing we should be seeing train operating companies and GBR doing in future? They are responding to market demand, looking at new routes and growing revenue to help reduce taxpayer subsidy. It is also important to demonstrate that the rail network is not totally London-centric, and the success of this service will enable new housing opportunities and new job opportunities. It is connecting incredibly popular tourist destinations in Oxford and Bath, and will have superb connections to East West Rail when that opens for passenger service. I am sure that there are many other examples of where we can grow the railway in future, and I look forward to my noble friend’s speech.

My Lords, I want to address the parts of the gracious Speech aimed at improving the NHS. Attempts to reduce bureaucracy and duplication in the NHS with the Health Bill are welcome if they can be successfully delivered. However, we have seen little progress in more than a year since the abolition of NHS England was first announced, with it still recruiting hundreds of roles and its pay bill increasing, and I fear that it may be diverting attention away from front-line services.

In that vein, there are four areas on which I will focus my brief remarks today. First, I turn to cancer, particularly rare cancer. During the last Session we saw significant progress with the Rare Cancers Act. This is not a partisan issue and I was proud to support that legislation, but there is no silver bullet and improvements in treatment options for some rare cancers have not significantly improved for decades, so we cannot let the momentum stall. We need further improvements, including improved pathways for the approval of innovative treatments and faster genomic testing. I urge the Government to ensure that rare cancers do not slide down the priority list simply because recent legislation has been passed, and that we remain focused on getting new treatments to patients in need.

Prostate cancer is another issue on which I have campaigned extensively, and I know it is a cause shared by many noble Lords and Members in the other place. Early diagnosis is the difference between a treatable condition and a terminal one, yet one in five men who receive a diagnosis do so too late to be cured. Despite that, and despite it being the most common cancer in the UK, we continue to see a postcode lottery that determines a man’s survival chances and we still do not have a national screening programme. I urge the Government to commit to a more proactive, modernised screening programme and to consider the evidence gathered by the APPG on Prostate Cancer, of which I am an officer, including in the excellent recent report Diagnosing Prostate Cancer: Insights from Primary Care, potentially saving thousands of men every year.

Thirdly, I turn to the state of maternity care. It is no secret that, sadly, it remains a national disgrace that half of all NHS maternity units in England are currently rated as either “requires improvement” or “inadequate”. After a new assessment framework was introduced in 2024, two-thirds of the services rated since were “inadequate” or “requires improvement”, and not one has been “outstanding”. This is a failure of safety for mothers and newborns, who deserve much better. While it is disappointing that there was no explicit mention of maternity safety in the King’s Speech, the House must ensure that it is not forgotten. We await the independent review by the noble Baroness, Lady Amos, with high expectations, but the Government must be prepared to act on those findings immediately, not simply add them to the list of more than 700 existing recommendations from previous reviews. Whether the answers are legislative or operational, mothers must be able to trust the care they receive.

Fourthly and finally, I turn to the challenge of late diagnosis of and poor support for people with ADHD. At a recent meeting of the APPG on ADHD, the tragic death of Matthew Lock was discussed. He was diagnosed with ADHD far too late. His condition was missed by the system on multiple occasions and this ultimately led to him taking his own life. We need to do much more to help those with ADHD so that Matthew’s experience and those of his parents, Richard and Christine, are not repeated for many more families. Will the Minister commit to look again at the excellent work done by the NHS England ADHD taskforce to see what can be implemented without delay?

These four areas do not get the same attention as headline measures to tackle waiting lists, but each one represents an area where patients deserve better and it will ultimately save lives. I urge the Minister to take this contribution in the constructive manner it is intended so that these areas get the attention they deserve within the health system.

My Lords, I am, as ever, honoured to be speaking in the debate on the gracious Speech today and I want to address two issues which I think are related: social care and the procurement of people-focused services. They are both central to the delivery of the NHS 10-year plan and the future of social care. I need to declare some interests: I am honoured to be the chair elect of SCIE—the Social Care Institute for Excellence; I am a patron of Social Enterprise UK; and a senior associate of E3M, working with the leadership of social businesses currently delivering public services.

I think we must all welcome the commitment of the proposed NHS modernisation Bill to ensure that the voices of people using care and support directly inform the services they receive. We need patients and those who have lived experience to be the voices in the design and delivery of neighbourhood health and the national care service. My first question to my noble friend the Minister is: how will the Government ensure that people’s lived experience shapes service design, improvement and accountability? Importantly, if they do that, how will they do it if Healthwatch is abolished? Although Healthwatch is not the only means of capturing lived experience—SCIE, among others, is expert at this—surely the abolition of an independent, separate body to gather and report patient, carer and care user experience, however uncomfortable that may be from time to time, smacks of the NHS marking its own homework. I think I am reflecting the concerns of many organisations, and we can predict this as a matter for some discussion when we reach that part of the legislation.

My second question concerns the importance of social care as an equal partner in the health and social care infrastructure. Given the moving feast of NHS reorganisation, the Casey review and local government reorganisation, this is important. Can my noble friend the Minister explain—I am happy if this is in a letter—how the Government will ensure that social care is treated equally within NHS reform and, before the Casey commission’s report, how they will ensure action to strengthen social care’s role in prevention, independence and community support? How will it otherwise be possible to deliver neighbourhood health?

The commissioning of community services to support vulnerable people should surely be vastly different from buying marketised goods and commercial services. I thank E3M, Stone King and, particularly, Sandra Hamilton for their research and thinking about this. Today, 80% of social services contracts are delivered by private for-profit actors and 50% of the children’s residential system is dominated by six private equity actors, with profits in excess of £45,000 per child per annum. This cannot be a good use of taxpayers’ money. The key words in people-focused procurement should surely be collaboration, not competition, on an open-book basis with predetermined reasonable profit margins. There is no reason why any purpose-aligned private company cannot do this too, as much as a social enterprise or a charity.

My question to the Government is: while some are working to maximise the significant yet little-used flexibilities available under the light-touch regime, how will the commissioning regime change? There is a need for a new and distinct regulatory regime for people-focused services, since 75% of local authority budgets are spent on those services, using market purchasing processes that are not fit for purpose. Caring for our most vulnerable citizens is not a market opportunity to exploit; it is a statutory public service system desperately in need of some long-term stewardship.

My Lords, in response to the gracious Speech, I want to focus on health. This Government’s policy to move more services out of hospitals and into local communities is the right direction of travel. However, NHS England’s neighbourhood health centre guidance deserves a clear-eyed response. After three decades working across primary care, grass-roots community regeneration and social enterprise, my colleagues and I at the Bromley by Bow Centre find ourselves holding two different views at the same time: real optimism about what this programme could become, and deep frustration about the journey and destination described in the current road map.

The Bromley by Bow Centre has been working in this space for 42 years. We built the first integrated working model of what we think the Government are proposing. We are now responsible for 55,000 patients on four sites in east London, and have grown, with our public and private sector partners, a national social business working on place-making projects across the country. I declare my interest. We have focused on practice in the micro because we know that the clues to the macro lie there.

The neighbourhood health centre programme signals a genuine institutional commitment to moving healthcare closer to communities. The ambition to create 250 centres by 2034, the multi-disciplinary model and the acknowledgement that health cannot be delivered by clinicians alone all point in the right direction. At its best, the NHC framework is an invitation. The problem is that it is written in the language of compliance, rather than liberation, and is simply not radical enough.

There is an implied acknowledgment that good health is driven principally by social factors, but there is an underpinning assumption that a successful NHC will be defined by how it more efficiently organises multidisciplinary teams in a single building, rather than how it might meaningfully pass the ownership of health resources into the hands of local communities. What the guidance gets right is the recognition that health is produced in communities, not just delivered by clinicians. The neighbourhood health centre framework could, if NHS England has the courage to allow it, become the vehicle through which a generation of community entrepreneurs—many of them GPs—finally get the platform, the estate and the institutional backing they have always lacked.

The Bromley by Bow Centre was an early example of what becomes possible when you refuse to draw hard boundaries between health, community, enterprise, the arts, green space and human connection. We were not unusual in our instinct; we were unusual in having the space and partners to act on it. NHCs could give many more organisations this same opportunity.

However, the case for flexibility is not simply ideological. We have known for decades that 80% of health outcomes are driven by social determinants. A programme that creates impressive buildings, staffed by excellent clinicians and allied professionals, but fails to address these upstream factors will make a marginal difference at best. The problem is that the guidance is shaped overwhelmingly by a statutory NHS-centric worldview.

The illustrative design briefs for new neighbourhood health centres capture this problem precisely: rooms with narrow purposes, square boxes, places for professionals who drink coffee, but no art-making spaces, no messy spaces and not a curved wall in sight, in buildings that one health colleague described as “prisons”. The consequence of this type of top-down thinking is a dominant multidisciplinary clinical model, with social factors treated as peripheral rather than foundational. These will be places to go for appointments, not places you belong to.

The omissions in the guidance are as telling. The creative arts are entirely absent, despite a substantial evidence base for their foundational and consistent role in good health outcomes. Social enterprise and business are also missing, despite some of the most innovative health-generating work in the UK being done in this space. On community ownership of assets, the words point to local power, but the structures point to central control. Green space and horticulture are a remarkable omission, given the evidence on their broad therapeutic and transformative value—ask the RHS. On funding for non-clinical services, social prescribing is promoted while its funding base is eroded and the resourcing of the non-statutory services that it refers into are being decimated.

Perhaps it is not too late. NHS England has a choice: it can insist on fidelity to the template and create 250 well-resourced and shiny MDT polyclinics that improve access to statutory services, or it can explicitly invite and resource flexible interpretation.

The modern health world is everybody’s business; it is no longer the private domain of the NHS and its clinicians. Such a model is totally financially unsustainable. The challenge for this Government is whether they will create a health landscape based on last-century thinking or a modern, entrepreneurial culture in which everybody plays their part. This is the big opportunity to truly join up government systems on the ground. Let us hope we do not miss it.

My Lords, this has been a really important debate on three fundamentals to our society: health, housing and transport. My noble friend Lady Thornhill talked in detail about the housing aspects in the gracious Speech and about concerns that the proposed legislation does not go far enough and that there is an absence of a coherent delivery plan. The noble Lords, Lord Young of Cookham and Lord Best, and the noble Baroness, Lady Young of Old Scone, also set out some serious challenges in the area of housing. I will build on the excellent contributions from my noble friends Lord Bradshaw—with his decades of railway experience—Lady Tyler and Lady Walmsley.

On transport, these Benches support high-speed rail to Manchester and other northern cities to increase capacity, unlock local rail improvements and boost the economy. Clearly, getting Northern Powerhouse Rail from simply talk—which we have had since it was launched in 2014—to spades in the ground and passengers on trains on rails is critical. Can the Minister therefore advise which version of Northern Powerhouse Rail the Government are committing to? When will passengers be able to travel on any new lines as part of this project? Further, can we have some assurance that this is the end of U-turns and broken promises for our northern cities, which are desperate for greater connectivity? What learnings have there been from the challenges around delivering High Speed 2, which were highlighted earlier by the noble Lord, Lord McLoughlin?

The Railways Bill establishing Great British Railways as a single accountable body to unite track and train management is a key part of the Minister’s work. On these Benches, we remain concerned that some proposals within the legislation may increase the potential for micromanagement and a power grab by a Secretary of State. But our main focus is on a passenger- centred railway that looks at growing the number of passengers and incentivises increased travel by rail, ensuring an affordable, reliable and accessible railway. I look forward to continuing to work with the Minister on this important Bill and hope we can see some amendments to deliver that ambition for passengers. The noble Baroness, Lady Wilcox of Newport, rightly pointed out that this must deliver for all parts and deliver connectivity.

One concern for many people is the state of our roads and pavements. While the highways financing Bill looks to introduce a way to unlock private capital investment into major road infrastructure, we on these Benches wish to be assured that this delivers genuine value for money for taxpayers. Lessons must be learned from previous experiences, particularly in the case of Thames Water, where the model allowed the prioritisation of investor returns over public benefit. I hope the Minister can assure the House on this matter.

I am really pleased to see in the gracious Speech a draft taxi and private hire vehicle Bill. I worked closely with the Minister on the recent devolution legislation and helped to secure some provision for stronger enforcement across the country, and it became increasingly clear that a fundamental review was needed to bring the legislation into the 21st century. There are many concerns about the fragmented system that operates today, and I look forward to the planned consultation and engagement with drivers, the sector and passengers to increase safety and accessibility in this growing sector. Perhaps the Minister can advise on whether autonomous vehicles will be part of this pre-legislative scrutiny, given their growing presence and the timeline for the consultation.

The civil aviation Bill may be only a short Bill, but modernisation needs to work for all our communities and our environment, recognising that noise and air pollution has a significant impact on people and nature. We will look at this carefully to ensure that guardrails are in place for our communities that are affected by airports as they currently exist, let alone those that will be impacted by proposed expansions, which we clearly oppose, such as those at Heathrow and Gatwick. But lacking from the gracious Speech was detail about legislation to regulate and legalise e-bikes and e-scooters. That seems to us to be a missed opportunity, so I would like to hear more on that.

We have heard some strong contributions across the House on the health Bill—the NHS modernisation Bill—including from the noble Baronesses, Lady Watkins of Tavistock and Lady Neuberger. As we heard, the Bill will abolish NHS England as well as key organisations such as Healthwatch and the Health Services Safety Investigations Body, and it will create the framework for the single patient record. But we believe that the government solution, which is to pass responsibilities from one group of civil servants to another, misses an opportunity to improve services for patients and the health of our country. As the noble Baronesses, Lady Shawcross-Wolfson and Lady Bray, highlighted, patients will feel little difference, and these reorganisations cost a lot of money, take time and lose memory from the workforce, and ultimately they will not change the front-line patient experience. We have seen this time and time again over the last few decades with different restructures. I say this as a former NHS employee who has lived through many of those reorganised bodies.

Health and care services, as we have heard, remain under significant strain. More than 6 million people are still waiting for care, and performance is well below the standard that 92% of patients should start treatment within 18 weeks. As my noble friends Lady Tyler and Lady Walmsley outlined so clearly, a real NHS reform Bill would fundamentally rewire the NHS and would have social care, mental health services, general practice and prevention at its heart. We need to stop so many people having to go to hospital and help them leave more quickly when they do. That means having accessible local services in the community, including social care and a new focus on early intervention, which we have heard much about this afternoon, to stop people getting so sick.

What seems to have united many contributions, including that of the noble Baroness, Lady Nargund, is a single patient record. We will consider carefully the plans for this but, as we have heard, people are tired of having to reconfirm their medical histories over and over to different medical and other professionals. We would welcome different parts of the NHS and social care having access to that same patient information, but this has to come alongside new privacy protections through a new health data charter. The proof is clearly going to be in the detail, and we look forward to working with noble Lords to get that right.

Alongside the noble Lord, Lord Patel, and others, we have deep concerns over the abolition of Healthwatch and the HSSIB. Let us take Healthwatch, for example: the Government are stripping patients of their voice in our NHS. Rather than being able to go to—crucially—an independent body to express how the NHS could work better for them, patients will now have to give feedback, either to their local trust or via ICBs or councils. We do not think a department or a director within the department is good enough or has the independence that is required to ensure that patient voices are genuinely heard. The decision to scrap the Health Services Safety Investigations Body is also a major concern; it is fraught with risk. A trusted and efficient safety investigation process is the best way of restoring trust, learning from system failure and preventing costly public inquiries. We hope that the Government will reconsider those proposals.

As articulated by the noble Baroness, Lady Pitkeathley, and the noble Lord, Lord Kakkar, the elephant in the room—the glaring absence from this legislative programme—is social care. It is clear, not just from these Benches but from others, such as the King’s Fund, that:

“Interim action should not wait for the Casey Commission’s final recommendations”.

The King’s Fund goes further and comments:

“The legislative programme lacks ambitious action to tackle some of the other biggest causes of ill health, including obesity and alcohol harm, or to address deep health inequalities across the country. This raises questions about how the government’s promised shift to prevention will be delivered”.

The noble Lord, Lord Babudu, focused on prevention in his contribution as well. The noble Lord, Lord Mott, highlighted the need for prostate cancer screening as a way of prevention. Perhaps the Minister could comment on that area.

With a focus on reorganisation, there will be limited immediate difference in how patients experience health services, which is a huge concern. How does this Bill address the deep-rooted concerns about capacity and access to front-line health services, including mental health and social care services? That is the area in which we would like to see the focus of legislation, rather than rearranging and rebranding civil servants and NHS organisations.

This legislative programme is very full, and we on these Benches will be scrutinising each Bill in great detail to ensure that the passenger, the resident and the patient are truly at the heart of the Government’s proposed legislation.

My Lords, it has been a truly interesting and wide-ranging debate. I hope that noble Lords will forgive me if I confine my remarks to the transport aspects of the debate. There were a number of interesting speeches in respect of transport. I do not propose to respond to them all, but I would like to single out the remarks made by the noble Lord, Lord Berkeley, who I think deserves a rather doleful prize. For over 15 years now, he has been the Cassandra figure wandering across the stage from left to right periodically, telling everyone that HS2 was going to cost £100 billion. There is a great deal of blame to go around in respect of HS2, but none of it falls at the door of the noble Lord. Cassandra eventually has to be shown to be right; we know now that he has been right all along.

I want to start by referring to the circumstances, rather than the content, of the gracious Speech. I think it is fair to say that it was, frankly, painful to see His Majesty peering over the top of his Speech at a Prime Minister standing below Bar, of whom nobody knew whether he would still be in office 24 hours later. How has it come to this after less than two years? When Disraeli referred to Gladstone’s Front Bench as being like

“a range of exhausted volcanoes”,

he was at least acknowledging that they were volcanoes. We have been inflicted with something more like a row of molehills, from which the moles have departed. The rapidly leaving ranks of Ministers who are flooding out are now saying quite openly that the Labour Party was wholly unprepared for Government. How have we got to this stage?

However, we have a ready-wrapped solution at hand: Mr Burnham, and what is known as “Manchesterism”. I have looked into Manchesterism. It is very relevant to this debate, because it boils down to a transport policy. Manchesterism is, in essence, the fact that Mr Burnham has taken control of the buses and put a £2 fare cap in. It is worth saying that the £2 cap was, of course, a Conservative policy; that it was the Conservative policy to continue it, and that it was the Labour Party that put it up to £3 in every other part of the country.

When we think about the mechanism by which Mr Burnham has taken control of the buses in Manchester, let us remember that it was a Conservative Government that gave him the powers to do so. The mechanism he has used to take control of the buses is, of course, a franchising system in which the buses are still owned and operated by private companies, but he sets the fares, the routes and the timetables. In other words, it is a system wholly copied from what has been operating in London since roughly the 1980s. One could almost call it “Londonism”. Who was it who, in the 1985 Act, created that system in London? It was, of course, Mrs Thatcher. We might even say that it comes down to being called “Thatcherism”.

However, there is another paradox here. That very system of franchising, where contracts are let on a concession basis to private companies to provide the bus services, is exactly the system that the noble Lord the Minister has vehemently rejected in relation to the operation of the trains. In his paradise, the trains have to be owned and run by Great British Railways, and there is to be no room at all for any sort of competition, except where it exists already. Since we know where we are coming from, that makes me wonder whether the noble Lord the Minister has yet made the pilgrimage to Wigan to knock on a few doors and make inquiries of Mr Burnham as to whether he still backs the Great British Railways Bill with this mechanism, which is not part of the Manchesterist approach at all.

There is more to say about this Great British Railways Bill. Another thing that is going on is that, overnight, the Labour Party has become a party that wants to rejoin the European Union. Mr Streeting—I am putting Mr Starmer aside as being what might be described as a short-dated stock—wants to join the European Union, and he says so. Mr Burnham also wants to join the European Union, but he would prefer not to say so. Yet the one thing that is absolutely not compatible with being a member of the European Union is a Great British Railways structure in which there is no competition allowed—except, I grant you, temporarily for existing open-access operators. To exclude competition is completely incompatible with the EU’s railways directive.

Indeed, if we did rejoin the European Union, and Deutsche Bahn, or SNCF, or one of the private Italian railway companies turned up and said that they would like to run a service on Great British Railways’ tracks, and we were to refuse them on the basis of this Bill, we would find that the whole principle of the Bill would collapse immediately and we would lose the case under European Union law.

So there we are: we have the Bills, but we do not really know anything about the direction of travel and what is going to happen under an imminent new Prime Minister. We have a civil aviation Bill that replaces the EU regulation of airlines and airports, including consumer protection. We welcome that, but the way in which regulations are to be made is going to be an entirely private matter for the Civil Aviation Authority. I do not think the Government have got the message. We voted Brexit to get rid of unelected bureaucrats making laws for us—but at least we had parliamentary scrutiny. We had an array of European Union committees here in your Lordships’ House that would look at those laws before they were implemented. We are to have none of that: there will be no parliamentary scrutiny of the new regulations made by the Civil Aviation Authority and to some extent by the Secretary of State. That cannot be an acceptable Bill, and it is one that we are unhappy with as a matter of principle: we can support the substance, but the mechanisms are not appropriate.

My noble friend Lord McLoughlin spoke warmly about the highways finance Bill. We support the idea of finding new mechanisms for financing the building of roads, but I am really puzzled, and I want the noble Lord to address—if not today then later, when we get to the Bill—why the regulated asset base model is an appropriate way of attracting private finance, given that we know from experience elsewhere that it tends to encourage overspecification and gold-plating, and anyway is designed for infrastructure where assets are incrementally added, such as they might be at Heathrow, rather than for building a road or a bridge, which presumably once built is built and one does not periodically add to it over time. That is something else that we are going to want to look at.

Finally, I come to the Northern Powerhouse Rail Bill. Both the noble Lord, Lord Berkeley, and the noble Baroness, Lady Pidgeon, spoke in favour of this. In fact, they spoke as if the Bill were likely to make Northern Powerhouse Rail happen: as if it were pushing it forward. I do not want to raise the anxiety level of the noble Lord, Lord Berkeley, but as is explained in the document produced by the Government, the Northern Powerhouse Rail Bill is actually only a renamed High Speed Rail (Crewe-Manchester) Bill. That was a Bill introduced by the Conservative Government. It was carried over into the last parliamentary Session, nothing was done with it, and it is being carried over into the current parliamentary Session. It does not build Northern Powerhouse Rail; it simply creates certain powers to take land for the purpose of building the parts around Crewe and Manchester that are necessary for Northern Powerhouse Rail. There is no objection to this Bill from our side—as I say, it was our Bill originally—but, if anyone thinks that the Government are building Northern Powerhouse Rail, I point out that there is not a penny available to build Northern Powerhouse Rail, unless the Minister is going to tell us that that is what is coming up.

I have to congratulate the Government on acceding to the Conservative Party campaign not to increase fuel duty. That is a small win and something we can call a win-win for both of us, I think.

I will conclude by referring to something for which no legislation is provided. It is not in the gracious Speech, but it is an important matter: the electric vehicles mandate. The electric vehicles mandate is already destroying our automotive industry and is going to ruin the country in many ways, destroying many jobs in relation to cars. But that is not enough for the Government, who now want to extend it to HGVs. I simply say to the Government that they really must think very carefully about this. Indeed, there is simply not enough electricity in the system to power electric HGVs. The Government must move very cautiously on the electrification of HGVs. I hope that, if not today then soon, there will be an announcement from the Government that they are going to reflect on whether this is something they really want to push forward.

We have had a gracious Speech written for His Majesty the King by the Prime Minister, Sir Keir Starmer. We do not know, as we debate it, who is going to be the Prime Minister a few weeks from now. We do not know, as a consequence, who the Secretary of State for Transport or for Health, or the Chancellor of the Exchequer, is going to be a few weeks from now. There is a degree of unreality about this debate. I am grateful to all noble Lords who have taken part and treated it very seriously, and I look forward to hearing the Minister perhaps try to give some gloss to all this that will make sense of it to the rest of us.

My Lords, it is an honour to be closing today’s debate on behalf of His Majesty’s Government. I extend my thanks to His Majesty for his gracious Speech and to all noble Lords for their thoughtful contributions, except perhaps for the last one, which I shall mostly ignore.

I begin by echoing what my noble friend Lady Merron said in her admirable opening speech. She set out clearly and concisely the scope of the Government’s programme for the second Session in the areas of health, housing and transport. I am grateful to her not only for her clarity but for being a valued friend and colleague, as is the Minister for Housing, Communities and Local Government here on the Front Bench.

As my noble friend Lady Merron was in relation to health, I am immensely proud of the progress this Government have made in laying the foundations for better public services, particularly in transport. Transport and the railway have been my life’s work, so it is a privilege to be part of the biggest transformation of the railway in over 30 years. We have also enabled a quiet revolution in bus service provision through the Bus Services Act and opened real opportunity for British innovation with the Sustainable Aviation Fuel Act. I am grateful to all noble Lords for their contributions on these Acts.

I was wondering yesterday and the day before how my noble friends closing these debates would cope with so many varied contributions, and now I have to do the same. I will do my best, but I am reassured that noble Lords who have spoken with such knowledge and passion will raise all their points in the passage of the Bills that are in the King’s Speech.

Before I talk about the Bills themselves, I will address a variety of other matters raised by noble Lords today. I start with the noble Lord, Lord Butler, who spoke widely and wisely, particularly about the Civil Service. I am delighted that he commended the new Cabinet Secretary and his views on impartiality are, of course, supported. The noble Lord, Lord Kakkar, spoke about the peerage removal Bill. We will take careful note of what he said tonight and when he speaks on the Bill itself.

My noble friend Lord Jordan spoke about accidents and, while I cannot say that we will take up his argument about an approach across government, he can rest assured that individual parts of government take this subject extremely seriously. My noble friend Lady Jones of Whitchurch spoke widely about the huge desirability of industrial harmony through dialogue and partnership. I echo that and, in terms of the progress on the railway towards Great British Railways, we will pursue it, and I am pleased that she welcomed the new arrangements in social care.

The noble Baronesses, Lady Jones of Moulsecoomb and Lady Young of Old Scone, raised the absence of the environment from the subjects for debate. I cannot account for that, but this Government are very serious about this subject. Let me give three examples: the pursuit of net zero, the vigorous action by my noble friend Lady Hayman of Ullock on farming and the environment, and the pursuit of more freight by rail are all individual examples of the Government’s care about the environment in the future. I will ask my noble friend Lady Hayman to write to the noble Baroness, Lady Jones, further on that subject.

My noble friend Lady Linforth raised clean air in public spaces for kids. Again, I defer to my noble friend Lady Hayman of Ullock on that subject.

The noble Lord, Lord Robathan, made a wide-ranging speech on various subjects. He raised antisemitism, and I cannot believe that he cannot see a very strong response from this Government to the recent outrages to the Jewish community.

The noble Baroness, Lady Walmsley, spoke passionately about food standards. The Government thank her for her work in this area. I therefore hope that I have covered most of the subjects raised that do not really appear to be covered by the main subjects of this debate today.

Moving to health, this Government have already taken serious action on waiting lists. They are down by half a million and the number of people waiting less than 18 weeks for planned care is now at 65.3%, up from 59%. Ambulances responding to strokes and heart attacks are arriving 5 minutes faster compared to last year and we are meeting our manifesto commitment to recruit an additional 8,500 mental health staff, three years early. That is a foundation which we are not yet satisfied with, but it is a reasonable start.

The objectives of the NHS Bill have been debated in many contributions today. My noble friends Lady Nargund and Lady Ritchie of Downpatrick both fully supported the Bill. Others took a view that care needed to be taken about how this huge change, the abolition of NHS England, should be done—in particular, the noble Baronesses, Lady Shawcross-Wolfson and Lady Bray. We also note the important points made by the noble Lord, Lord Kakkar, on this subject. It is a large step, and this Government are committed to doing it wisely, carefully and properly.

My noble friend Lord Babudu and the noble Baroness, Lady Shawcross-Wolfson, talked about prevention, which is important and one of the principal features of the Government’s policy. The noble Lord, Lord Kamall, and the noble Baroness, Lady Watkins, talked about the connections between health and place. As it happens, the Secretary of State for Health in the other place is making a major speech on this tomorrow.

There was a lot of discussion about the single patient record, data security, careful use and comprehensiveness. The noble Baronesses, Lady Bray, Lady Tyler and Lady Walmsley, the noble Lord, Lord Patel—who was particularly helpful—and my noble friends Lady Pitkeathley and Lady Nargund all supported it. We listened with interest to the noble Lord, Lord Dodds, on the experience of Northern Ireland. My noble friend Lord Davies talked about the particular circumstances about Palantir. We are reviewing the federated data platform contract in advance of the break point. The single patient record is different: it will be supplied through contracts with multiple suppliers with no single supplier dominating. No decisions have been made about who those will be.

My noble friend Lady Donaghy and the noble Lord, Lord Black of Brentwood, talked about osteoporosis and the fracture liaison services. The Government are committed to rolling out fracture liaison services everywhere by 2030, and my noble friend Lady Merron is well prepared to respond to any new issues in that respect.

My noble friend Lord Winston talked about egg freezing. I am singularly unqualified to deal with this subject in any practical way, but my noble friend Lady Merron has listened very carefully to everything he said and has committed herself to write to him.

Similarly, the noble Lord, Lord Mott, spoke about cancer and maternity services. My noble friend Lady Merron listened to that carefully too and is acting on it already. Lastly, the noble Lord, Lord Mawson, talked about his Bromley-by-Bow experience—as a matter of coincidence, he has shown me around that very thing—and it is an obvious long-term experience for government to take an interest in.

On health and local government, the first thing to say is on the Social Housing Bill. The Government believe that everyone deserves to live in a decent, safe, secure and affordable home. The Bill will provide much- needed social housing stock, give affordable housing providers the clarity and confidence they need to build more social homes, and better protect tenants who are victims of domestic abuse by providing them with greater security and stability. The Bill delivers on the manifesto commitments to prioritise the building of new social rented homes and to better protect our existing stock.

A number of noble Lords supported the concept of the Bill, but, unsurprisingly, there was some criticism of it. I can tell the noble Baroness, Lady Eaton, that the proportion of people in rented accommodation is stable and has been since 2013-14. There has been a 3% increase in available homes in quarter 1 of 2026, and buy-to-let loans have increased by 14% in a year. Therefore it is not evident that there is a reduction. The noble Lord, Lord Bailey of Paddington, talked about stamp duty but did not explain where the £11 billion that it would cost to abolish it would come from. The Government are working with the Mayor of London on an emergency housing package to enable rapid delivery of what London needs.

The noble Lords, Lord Young of Cookham, Lord Best and Lord Truscott, and the noble Baronesses, Lady Shah and Lady Watkins, commented on various aspects of leasehold reform. I am confident that, when the Bill comes forward, they will have much to say during its passage. The Government believe the Bill is moving in the right direction to deal with what a number of noble Lords this evening have described variously, up to scandalous. The right reverend Prelate the Bishop of Chelmsford is right that people are entitled to a home and that young people are entitled to have the certainty of knowing where they are going to live. There are powerful arguments for housing reform and I hope that she is convinced that the Government will move in the right direction.

The noble Baroness, Lady Thornhill, referred to social housing. My noble friend remarked that the £39 billion that the Government have allocated to that subject will certainly help provide it. She also referred to SME builders. The £16 billion National Housing Bank, started on 1 April, includes provision for financial support and loans for SMEs in the housing market.

The noble Lord, Lord Best, spoke powerfully about all aspects of the Bills that are being brought forward. I am sure he will make valuable contributions to the discussion of them when they arrive.

I move on to the four transport Bills. The Railways Bill will deliver on the Government’s manifesto. I was enormously encouraged by hearing from the noble Lord, Lord Bradshaw, who all of us with any connection with the railways admire and respect. As somebody who was there when the railways were nationalised in 1948, he has pretty good experience of what is going on. He is right that running railways is a job for railway people. The intention of this Bill is not, as it is wrongly characterised, to give any more powers to the Secretary of State—both the Secretary of State and I want less power—because the railway deserves to be run by people who understand how to make it work better, which is what passengers want.

I have the greatest respect for the noble Lord, Lord McLoughlin. However, we are not starting from where he would like us to be but from where are at the moment. The railway needs an injection of vigour to get better reliability, drive up patronage and drive down costs. That has been seriously absent in the railway post Covid, even though it is run by allegedly vigorous private sector operators.

My noble friends Lady Dacres and Lady Wilcox talked about the benefits of transport investment. They are right that transport is not an end in itself. Transport is the means by which you create growth, jobs and homes. The noble Baroness, Lady Dacres, talked about the Bakerloo line extension to Lewisham. It is up to the Mayor of London to make the case and I know that he will do so. She talked about long-term finance. This Government have given that mayor the first long-term financial settlement for some considerable time, so that he can both spend the money better and decide where it should go.

My noble friend Lady Wilcox talked about it in terms of Wales. This Government have put over £400 million of railway investment into Wales, creating new stations in south Wales and better services in north Wales. That is an example of working together to create benefits throughout Great Britain. I am very pleased to join my noble friend Lord Faulkner of Worcester in congratulating the Talyllyn Railway on its 75th anniversary in preservation—it was the world’s first preserved railway—which is great. He also talked more substantively about encouraging freight, which the Government are extraordinarily keen to do. Freight will form a part of the Railways Bill and a commitment will be made to freight growth in the railway. He also referred to the new service between Bristol and Oxford. That is an example, post Covid, of getting towards the new era and working collaboratively to produce new services. I am sure that Great British Railways will produce more of them.

The high-speed rail Bill described in the gracious Speech is currently headed the High Speed Rail (Crewe-Manchester) Bill. The noble Lord, Lord Moylan, is right that it was put forward by the previous Government. However, since the previous Government summarily cancelled phase 2a of HS2 between Birmingham and Manchester, the Bill has languished. It is now being reactivated because, contrary to what he said, the Government are funding Northern Powerhouse Rail. In fact, this is the first plan for railways for the north of England that is properly funded. Part of that Bill is necessary to create the new line between Manchester and Liverpool.

In the meantime, the trans-Pennine upgrade, which is funded and in delivery on time and on budget, will improve connectivity across the Pennines. On improvements east of the Pennines, the railways in Yorkshire will come sooner because they do not need new railways. There is a credible plan for the whole of Northern Powerhouse Rail. I am very happy to take the noble Baroness, Lady Pidgeon, through the plans to describe precisely what they are. They are funded and there is a considerable amount of money in this spending review to move forward with them.

My noble friend Lord Berkeley and the noble Lord, Lord Moylan, referred to HS2. The Secretary of State for Transport in the other place made a Statement about HS2 yesterday. It is a scandal. I am sure that my noble friend Lord Berkeley can be satisfied that he did tell us that it would cost a lot of money. But I am not sure he told us that the thing had been hideously mismanaged by a series of Governments and management boards of HS2. That is the lesson to be learned: not to not do these schemes but to do them properly. The trans-Pennine upgrade is one example of a scheme that is being done properly and on time.

It is not true that Britain cannot do these things. What is true, as the review recently set out, is that you should be slow to start these projects, decide what they are and then be quick to build them. This one was the other way around. The specification was obviously done by zealots. Part of it is incapable of being delivered because it is so technically advanced. That was wrong when it started and we are having to put it right now.

The highway financing Bill is not a bureaucratic Bill, contrary to what the noble Lord, Lord Robathan, said. It is a perfectly decent proposition about how to fund the Lower Thames Crossing and other future major road schemes. The noble Baroness, Lady Pidgeon, is right that there has to be genuine value for money for taxpayers. We are not proposing to do anything at all like Thames Water, for very obvious reasons, and there is absolutely no doubt that during the passage of the Bill we will debate why the regulated asset base is right for this class, as the noble Lord, Lord Moylan, pointed out.

The noble Lord, Lord Moylan, is right to say that the civil aviation Bill, which has a number of powers, including much better powers for consumers, replaces EU legislation. He has pointed out to me on numerous occasions recently in dealing with statutory instruments that the powers to do that run out very shortly, and this Bill is necessary to replace them. We will debate to what extent it is desirable or necessary to have the Civil Aviation Authority making some of the rules when we get there. The Government’s view is that it is quite reasonable to delegate some of these powers to a competent authority, leaving some others to the authority of the Secretary of State.

I am very pleased that the noble Baroness, Lady Pidgeon, raised micromobility. This House has debated micromobility, e-scooters and the like a number of times in the last nearly two years now. Although it did not feature in the gracious Speech, it is our intention to consult before the end of this year on what we will do about micromobility. The noble Baroness knows the range of different sorts of regulations there are throughout Europe. We have shared that information with her, and indeed I hope with others in your Lordships’ House. If we have not, I am very happy to share it. There is a huge divergence of views about how to regulate these things, so we need to properly consult on them before we get there.

The noble Baroness, Lady Pidgeon, referred to the draft taxi and private hire Bill, which was in the gracious Speech. I take this opportunity to pay tribute to her for our collaboration to make the relevant part of the English Devolution and Community Empowerment Act serve the immediate purpose of better regulation of taxi and private hire out-of-area working. That really is not enough, so this draft Bill, which will need a lot of discussion because circumstances vary throughout the United Kingdom, is absolutely necessary.

I am tempted to respond to the noble Lord, Lord Moylan, on a couple of his points because, well, why not? He referred to the £2 fare cap, but what he did not say is that the previous Government instituted it but did not fund it much past the election date—

How has Andy Burnham managed to fund it, then, in Manchester alone?

The process by which bus franchising was established in Manchester was absolutely tortuous, although he was enabled to do it. The purpose of the bus services Bill is to make it easier to do, but the results are spectacularly good.

I have not been watching the clock. My time is up. I should say that my noble friends Lady Merron and Lady Taylor have listened carefully to the whole debate, as I have, and they will be as well placed as I am to take forward all the issues raised by noble Lords. The gracious Speech marks the next phase in our plan to deliver national renewal across housing, health and transport. This Government are putting better public services first. We have promised to do what these Bills set out and we will do that.