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My Lords, access to primary care is improving. The year June 2025 to June 2026 saw nearly 14 million more GP appointments compared with the same period in the previous year, and satisfaction when contacting a GP increased by over 14% compared with July 2024. For the first time, we have introduced a waiting time standard for community health services, and 37.6 million NHS dental treatment courses were delivered in 2025-26, which is 6.2% higher than in 2024-25.
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My Lords, more than 600,000 people are waiting for hospital eye appointments, yet on our high streets there are optometrists who can provide urgent and minor eye care services, ensuring faster, more convenient access for patients. Will the Government require all ICBs to commission these basic community health services?
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The requirement on ICBs now is to focus on the strategic commissioning of health services and to be responsible for all but the most specialised services. Looking particularly at improvement of access to eye care, which is extremely important, the Government recently announced some £20 million to improve digital connectivity between primary care, optometry and secondary eye care. In all these ways, people will be far better served in their eye care.
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My Lords, do we think that the ICBs will have a problem? We know that they have a fragmented IT service as well as terrific work overload, and I believe that they are going to go down from 46 boards to 26. Surely this will cause them a problem in being able to get the access they need. It is a real worry for them and, I would think, even more so for the patients and their families who are trying to access primary and community services.
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I understand why change creates worry, but I reassure the noble Baroness that the 10-year health plan set out the role of ICBs and, as I mentioned, for the strategic commissioning of health services and neighbourhood providers. I believe it will help to move towards fewer integrated care boards; there are currently 36. That will mean a pooling of budgets, greater efficiency, a reduction in running costs and more resources going to the front line. In all those ways, I intend for the change to deliver a better service locally.
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My Lords, what are the criteria that ICBs plan to use to monitor 24/7 access to services in the community? At the moment, the pressures are on emergency departments, where ever more patients arrive, because that is where the lights are on. We have heard about the governance problems of clinical errors occurring where staff are under extreme pressure and patients are in corridors.
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One of the major shifts for the NHS now and in the future is about moving services from hospitals to communities; we had a Question on that just yesterday. It is important to say that the fundamentals of oversight, which we are improving, will be through the NHS oversight framework, which will be clear about delivery and approach. I should add that NHS England will be able to focus on helping the most challenged organisations with their performance and capabilities. If there are problems such as those that the noble Baroness described, they will be identified.
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My Lords, access to women’s health services varies significantly across the country, with women from deprived areas and some ethnic-minority communities facing particular barriers. Therefore, what steps are the Government taking to ensure that ICBs not only commission but deliver equitable women’s health services in all regions, so that a woman’s ability to access timely diagnosis and treatment is not determined by her postcode, ethnicity or social deprivation?
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My noble friend makes an important set of observations. I can reassure your Lordships’ House that reducing inequalities is absolutely hard-wired throughout our renewed women’s health strategy. For example, we are redesigning clinical pathways for the most common women’s health conditions, and that will standardise and improve care across the country.
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My Lords, when I speak to primary and community health providers, they often speak of two hierarchies that they face. At the ICB level, they say that large trusts dominate, whereas at the primary care level, they say that it is GPs who dominate, often at the cost of the voices of pharmacists, dentists and optometrists, who can take on more work, as the noble Baroness, Lady Pidgeon, said. Underneath all these clinical hierarchies sit patients, who in some ICBs struggle to be heard. Given that the Government’s plans to rewire the state include abolishing local Healthwatch organisations, how will they ensure that independent patient voices—and I mean independent, not part of DHSC or from local authorities—are listened to and acted upon at all levels?
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The patient’s voice is absolutely key, and that is why the Health Bill, which is currently in the Commons and will be introduced in your Lordships’ House tomorrow, is very focused on that. There will be much discussion in here. I can assure the noble Lord that patient safety, patient voice and patient experience are absolutely key, and that will be the case as we move forward to develop and further improve the NHS.
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My Lords, there is increasing evidence that access to senior nursing staff in care homes and in the community keeps people out of A&E and therefore reduces many of the problems there. What responsibility will ICBs have to ensure that they purchase district nursing and community mental health training so that we have sufficient district nurses and admiral nurses to support the elderly population?
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Getting the right staffing mix is key, and the noble Lord, Lord Kamall, just spoke about what was described as a hierarchy. I am more interested, as I know noble Lords here are, in the team. The noble Baroness raised a very correct point about the role of nursing staff. These are decisions to be made locally. However, the requirement is on ICBs, and they will be measured—as will be contained in the national guidance—on getting the right staffing mix and the right people in place to meet the move to community health services and reduce unnecessary attendance and bed occupancy within hospitals.
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My Lords, in some places, the relationship between community nurses and acute hospitals is good and patients receive what they think is a care pathway. In other places, the relationship between district nurses and GPs is incredibly problematic, and instead of there being a clear care pathway there is a blockage. What are ICBs going to do to make sure that everybody gets the best distribution of services, not the worst, as happens in some places?
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That is indeed the intention, as the noble Baroness rightly points out. In all this and in the discussion today, which is legitimate, transparency is important. As we committed to in our 10-year health plan, we have already launched a new set of league tables so that every NHS trust is ranked against clear and consistent standards and that we can see what progress is or is not being made. That will raise standards, tackle variations in care and allow a focus, where extra focus needs to be applied, to make changes. Previously, it was far too generic. This will allow us to focus.