The Health and Care Bill, which is about to reach its end after the Easter break, has been a good example of a Bill which had not been thought through by the Government but massively improved in the Lords.

It is also a good example of what can be achieved by cross party working and a Minister who has been willing to listen, except when the Treasury has stuck its oar in and prevented compromise.

The Bill replaces the current Care Commissioning Groups in England with 42 Integrated Care Systems, each headed by an Integrated Care Board responsible for commissioning health and care services across its very large area. In principle the move towards integration of care is very welcome but the detail is crucial.

The ICS may include more than one Local Authority. The appropriate representation on these very powerful boards of Local Authorities and others with the right skills, knowledge and experience has been a big issue which we were determined to get right. I think we got a good result.

The Bill also introduces an advertising ban for foods high in sugar, salt and fat on TV before 9 pm and online. It also sets up a new system for investigating cases where things go wrong and where lessons can be learned by the whole service.

Crucially here we have been able to alter the Bill to ensure that people can give candid evidence in a ‘safe space’ without danger to their own future career. This is fundamental to the success of the system. Too often in the past, potential whistle-blowers have been deterred from saying what happened for fear of bullying and damage to their careers and potential learning has been lost.

Numerous meetings with Ministers, and considerable determination, have resulted in improvements to the wording of the Bill, sometimes by agreement and sometimes by winning a vote and the Government giving way in the Commons.

Agreements were obtained on mental health, health inequalities, children’s services, the rights of carers and safe discharge of vulnerable patients from hospital, palliative care, research, preventing private interests having a hand in commissioning decisions, regulating cosmetic procedures, procurement, Parliamentary oversight of international healthcare agreements, ensuring the NHS plays its part in achieving net zero, protecting patient data safely, criminalising organ trafficking.

The Liberal Democrat vote has been crucial in many of the divisions, in particular, without us the vote to allow continuation of telemedicine for abortion for women who want it, which was introduced with great success during the pandemic, would not have been achieved.

There are still matters to be fought for and we are determined not to give up.

These are

• the need for a proper system of workforce planning for health and care to combat the crisis in staff shortages,
• the highly unfair cap on care costs introduced after the Bill had passed through the House of Commons,
• proposed new powers for the Secretary of State to meddle in local decisions on reconfiguration of health and care services which should be made by professionals and Local Authorities,
• a clear duty on the NHS to ensure, as far as possible, that it does not procure goods made through slave labour or connected to genocide.

Let battle recommence after Easter!

* Joan Walmsley is a Liberal Democrat member of the House of Lords