Health Bill

Baroness Bennett of Manor Castle Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

Everyone deserves relationships, choice and opportunities to contribute. I would like our ambition to be that every young person, including those facing mental illness or disability, can say, “I have somewhere to go, someone who welcomes me and something worth while to give”. That is an ambition for good work, better mental health and a society in which we all belong. I hope the Government will support this amendment.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I will speak very briefly to these two amendments. It is a great pleasure to follow the noble Baroness, Lady Hollins, who made some of the points that I intended to make. We really need to give people the chance to meaningfully participate and to be part of society. Good work may be one route to that, but it may not be suitable or available to everybody.

The noble Baroness said that there is a great deal of not-good work out there, and I will point to some figures that recently came out on the loss of autonomy across the entire workplace. In 1992, 62% of people said that they had a great deal of discretion over the task they conducted and how they organised their working day. In 2024, that figure was 34%—it very nearly halved. People are not getting a sense of agency and autonomy in their workplace. That is without me getting into, as the noble Baroness did, the issues of zero-hours contracts, inadequate wages, unpaid overtime, et cetera.

Having said that, Amendment 279QF has some very good elements. I particularly applaud proposed new subsection (3)(a), which states that

“the Secretary of State must consult … young people with lived experience of mental health conditions and of being out of education, employment or training, and their families and carers”—

nothing about us without us. It is crucial that it is there, but I respectfully suggest to the noble Lord, Lord Singh, that perhaps this would be better as a “good work and meaningful participation in society” amendment or something along those lines.

I am afraid that I respectfully disagree with Amendment 48 from the noble Baroness, Lady Coffey. I will be interested to hear what the Minister says about it. A basic principle of the NHS from the very start has been that healthcare is provided on the basis of need. Giving the Secretary of State a special duty to help get people back into work would take away from that basic fundamental principle. Not making it on the basis of need and seeking to use the NHS to serve the economy would be a disturbing change in principle that needs to be highlighted and questioned.

In introducing the amendment, the noble Baroness talked about prescribing a job. That terminology would be really frightening to many people. I have met people with serious mental health conditions—we know there are significant numbers of them, including people in the NEET category—who are not applying for benefits, stepping away from the system and not getting help because it is really frightening to them. We absolutely do not want them doing that with the health service. If the health service were seen as a place of fear or compulsion then that would be dangerous to their future health and well-being and, indeed, the future health and well-being of society.

[Lord Mawson (CB)]

My Lords, I welcome these two amendments because they encourage us to debate a very important matter—employment. I have said before that the GPs I work with would remind us that, in the very challenging communities in which they work, getting a job does more for people’s health than anything they can do as doctors. We have done lots of work in this space over the years in east London and we are now replicating that practice around the country. It is why people like me are encouraging the health service and the public sector to learn from science and business that you innovate and learn only by doing things, not by writing clever reports or academic documents at 60,000 feet. You actually have to engage.

For example, to pick up the point from the noble Baroness, Lady Bennett, we have been running for over 15 years, with Investec, a jobs and small business programme in east London. It has been enormously successful. We have built 97 businesses, or local people have, many of them with health, mental health and other complicated conditions. When you get into the granularity of all that and you watch people’s lives, you watch what happens to their children and their family when they get a job and how things actually change, it is an extraordinary thing, that journey. It is a journey, I feel, and that is why I have been challenging the direction of travel of this legislation and this Government, because I fear we are missing a serious opportunity. If it is true what Michael Marmot and some of us saying—we come to very similar numbers that 70% to 80% of the determinants of health are social and nothing to do with doctors—then we enter this space, which is really important.

I declare my interest: I am working on a 30-acre site in Surrey at the moment, with a school that has been in very difficult circumstances. In the middle of that, there is an old primary healthcare building stuck there, disconnected from the school. There is a college behind a fence over there, which is doing what the head teacher would describe as babysitting children. Is this really about employment or is it ticking boxes? You have a large piece of land where you could bring health, education and housing together in a very interesting environment. We are looking at that opportunity. There is a real opportunity there to build what this Government call a neighbourhood health centre.

I am into all that, but neighbourhood health centres in the modern world cannot be just about bringing biomedical people together in a building—a biomedical box. That is not taking seriously what this conversation is about. We need to build multidisciplinary teams. We got into employment, health and wealth seriously over the years. We have even done projects with eight year-olds on developing their business plan. It is really interesting what happens when you do that with children. It would be interesting to have the Minister’s response on this. There is an opportunity, with neighbourhood health centres, to innovate, do something seriously and pick up the strands of this discussion.

I suggest that the way we get beyond the concerns from the noble Baroness, Lady Bennett, is to create practical learning by doing cultures on the ground, because all that theoretical stuff then falls away as irrelevant. You get into people with names and addresses, you watch what happens as you bring business, entrepreneurs, health practitioners and teachers together on the ground, and you start to build multidisciplinary teams. Innovation and something rather different happens. It absolutely relates to what the noble Lord, Lord Singh, said. I have been involved, as has he, in mental health, because mental health is a really big issue in these communities. You begin to get into the detail of that and beyond the theory into practice. When you watch a young person or an adult move away from many years of dependency and drug use—much of that drug use, by the way, at great expense from the NHS—you watch them take on life and see what happens to their children and family, my goodness it is a great inspiration. My view is that that is what these neighbourhood health centres should be about is multidisciplinary teams, learning by doing and getting into the granularity of what this discussion is about.

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[Baroness Finlay of Llandaff (CB)]

My Lords, the noble Lord, Lord Young, has highlighted the problem specifically for children. I shall expand on that slightly, because this is a major public health problem. Prevention is essential. Children who have had their teeth extracted may do fine if they are fit and well, but there is another group of children who are already ill, who may have a malignancy or may be on chemotherapy, or who have learning difficulties. There is a need for even more prevention measures for those children because, at every stage where they get tooth decay, their risks of things such as septicaemia and so on go up.

It is also a public health issue. In schools, children are now being taught to brush their teeth, which is excellent. The fluoridation programme is to be commended, and some of us would like to see it rolled out even faster. However, the other area is fizzy drinks, sweets, babies being given sugary dummy things to suck, and so on. Children are being brought up to have tooth decay, sometimes from the age when they are weaned.

These are all big public health initiatives, but the health service is being left to pick up the tab. I found it rather worrying that the cost of these decay-linked dental extractions in young people is over £50 million a year. This is not insignificant, and it really needs to be tackled.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I will speak very briefly. I begin with an apology to the British Dental Association, because I told it I had signed Amendments 213 and 216 but then found the email stuck in my outbox this morning.

I shall make just two points. First, the arguments for action, at least in those two amendments, have already been powerfully made, even though we have not yet heard from the noble Baroness, Lady Pidgeon. I had a meeting with my honourable friend Adrian Ramsay in the other place with a great organisation, the beautifully named Toothless in Suffolk, which is now Toothless in England. It is great to see people getting out, campaigning and doing politics, but they should not have to campaign to get basic dental services. To pick up on the figure mentioned by the noble Lord, Lord Hunt, six in 10 adults have not seen an NHS dentist in the last 10 years.

Secondly, following on from the point that has just been made about children’s health, we also need to consider dentistry at the other, older end of life. There is increasing evidence of the effects of a systemic inflammatory burden on heart disease and diabetes, and there is very good evidence that it makes managing blood sugar more difficult. There are increasing links to pneumonia, exacerbation of COPD, and, potentially, joint inflammation and Alzheimer’s. We tend to think of dentistry as being one thing and health another, but actually we need to join all this up and see dentistry as requiring the same focus and attention—as part of the whole general health of our society, rather than as a separate thing.

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[Lord Crisp (CB)]

My Lords, I am delighted to have put my name to both amendments, and to have heard them argued for so powerfully and cogently by my noble friends Lady Hayman and Lady Boycott. I want to emphasise one or two points, and add one slightly new point, because so much has been covered very quickly.

It seem odd that, in this year of all years, we decide to get rid of a power that used to be there, to reduce the emphasis on climate change and not to make it clear that the duties of NHS England need to be transferred in their detail. This was the point that my noble friend Lady Hayman was making. It is not just the general point that the Secretary of State has a responsibility as part of government policy to ensure that climate change is tackled; the detail of it needs to be there. Requiring NHS institutions to create and publish detailed resilience plans—the sort of plans that you can recognise in practical detail—would not only be useful for them but, frankly, give the public confidence, because there is a public confidence issue here.

I will not emphasise the Wellcome report on climate change. I hope that noble Lords and the Minister have had a chance to look at a report that is specifically focused on climate change and health. As I recall—sorry, this sounds like an advert—it has nine chapters that detail the impact from the latest research that is available globally. It is a powerful report; I declare an interest.

The NHS is interesting in this regard, because the NHS is both affected by climate change and a cause of it, and between them these two amendments deal with that. When I was chief executive of the NHS, there was some extraordinary figure that something like 3% or 5% of traffic in London was caused by the NHS and by people going back and forth to appointments. There is a lot on that side in terms of the impact on the climate from what the NHS does. A lot has been done in the last 20 years, but there is more to do.

The second amendment, proposed by my noble friend Lady Boycott, is about helping the NHS to be resilient. This is the big point that I want to emphasise. It was in my noble friend’s speech, but I would like to make it even clearer: many people in your Lordships’ Chamber have been involved with the NHS, and I guess we all know that everything in the NHS is a priority to someone. That is why it is so difficult to deal with, and one has to think of it in that way—but there are some overarching priorities. Frankly, this is an overarching priority. It is not about a discrete issue; it is about something that is going to affect all the services we have talked about earlier today, and other services as well. I hope that the Government are going to give this a high priority in their future thinking. I suspect that the public expect them to do so, and one can only imagine the consequences if the NHS does not get this right. I hope the Minister will accept these amendments. As my noble friend Lady Boycott said, the case is compelling and we are looking for an affirmative.

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to take part on this group and to utterly applaud the three speeches we have already heard. I have not signed any of these amendments, because I wanted to leave space for others. Speaking as an old newspaper editor, “Green signs amendment about climate and environment” is a bit like “Dog bites man”, so I wanted to ensure that we had the maximum impact from other signatures. We have already heard the case made powerfully for this, but I want to make a couple of additional points and to follow on from what the noble Lord, Lord Crisp, said about priorities.

I have encountered many individuals in the NHS who are doing spectacular work in reducing the NHS’s carbon emissions. The Minister is not currently in her place, but I will say to another Minister that I encourage her to visit County Durham and Darlington NHS Foundation Trust, where tremendous work is being done, particularly on reducing the impact of acute care. Sometimes with acute care there is a feeling that we have to do the emergency stuff and we cannot do anything here. Actually, what we have seen is that in looking at where the use of intravenous drugs can be reduced and tablets used instead, clinical outcomes are improved and the amount of plastic use is significantly reduced. When you really start to look at what you are doing and how you can do it better, you can improve both clinical and environmental outcomes. That is just one example that I happen to know about.

It is important that the people who are doing this know that they have support from the centre and that this is an NHS priority, because they are putting time, energy and attention into this. Unless we see support from the centre by saying that this is a priority, it is hard for them to get the resources and support they need to make change happen. We know that any large organisation has a large sense of inertia, and delivering change needs support right through the organisation. As the noble Lord, Lord Crisp, said, the climate emergency is a health emergency as well, and there are so many ways in which these two factors interact.

On the amendment from the noble Baroness, Lady Boycott, looking at resilience to climate and environmental degradation risks, I want to cross-reference it to the joint intelligence chiefs’ report on the impact of environmental degradation on our food security. Are we thinking about the food security of the NHS? We have to be able to feed the patients, but there is also a great deal of feeding of staff that has to happen in the NHS. How much have NHS institutions looked at how secure their food supply is? That is something that the joint intelligence chiefs, not known as radical green activists, have said is really an issue. I note in passing that we still have not seen the publication of that full report, which is very disappointing.

There is another issue that I think everyone is very aware of after this summer. I note that my honourable friend in the other place, Hannah Spencer, has a Private Member’s Bill about working conditions and having a maximum working temperature, which, whatever that might be, has been exceeded in many of our NHS institutions over the past summer. We have seen staff collapsing as a result of the heat in their workspace. That has to be considered unacceptable, but what is it doing to patients if staff are collapsing from heat?

[Baroness Coffey (Con)]

My Lords, this is another interesting group. I want to follow on from the initial amendment from the noble Baroness, Lady Hayman. I have more of an interest in thinking of the Environment Act and the targets there and reducing waste. This is a story about how much single-use plastic is used in the NHS.

I spent a month in hospital a few years ago and, for me to have a shower every day, a nurse used to get a bin bag or two and then strap them around my arm, basically because I could not get water on a particular cannula. I was a bit surprised by that, because you could just buy from Amazon a whole bunch of sleeves that can be dried and reused. I am sure there is some clinical reason that they could cite—I was struggling to find out why—just because I was in hospital. I did exactly what I have just mentioned when I went into recuperation at home. Instead of just thinking about straws or plastic cups, the NHS has a real opportunity to do a lot more thinking about what it uses, what needs to be thrown away and what could go back to somewhere else. I am not suggesting that people reuse syringes and the like, but the NHS could think more carefully, instead of this single-use culture.

Building on that, the amendment tabled by the noble Baroness, Lady Boycott, is also highly relevant. I am very conscious that we did not make much progress in getting hospitals built, sadly. Some of this was, frankly, due to an argument going on between local hospitals, the NHS, the Treasury and so on about what was going to be built. The purpose of moving to a modular basis of building is to have something that is scalable and that should be a lot more resilient in the future. The reason I mention that is that we still have the challenge of hospitals that have a RAAC risk and the unfortunate delay in their construction being replaced. I think there are five around the country—it so happens that three of them are in East Anglia—that will not now be happening until, I think, 2033.

One of the simpler things that we can learn from the continent, where we have seen extreme weather—indeed, we have been experiencing it more regularly ourselves—is design, thinking about heat, as has been mentioned. Indeed, that month I spent in hospital happened to be during a particularly hot summer, and I bought my own fan so I could try to keep cool. It was regularly removed because it had not gone through the electricity checking system and therefore obviously had a dodgy plug that was going to blow up the entire hospital. There are areas like that where intelligent design, thinking through not only the use of materials but the design of hospitals in future, is going to be vital.

I appreciate that this is not just about hospitals. Quite rightly, noble Lords have referred to what is happening in terms of quality of housing. This Bill can play a role in trying to get embedded, right across the country in our NHS settings but also at home, that real change and transition. Whether it is about having more shutters, making that much easier to operate and, if you have them at scale, much cheaper to deploy, or whether it is about thinking carefully about design and whether every NHS building has to be BREEAM Excellent —my personal view is the answer to that is no—it would certainly reduce a lot of cost. By and large, BREEAM Excellent tends to prefer air conditioning to aspects of simpler design. I am very pro air conditioning, but that does not mean it is needed quite everywhere.

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[Baroness Hyde of Bemerton (Lab)]

My Lords, I thank all noble Lords who took part in the debate on this important group of amendments. I will address Amendments 52 and 248 together.

I turn first to Amendment 52, tabled by the noble Baroness, Lady Hayman. The Government remain committed to tackling climate change and ensuring that the NHS continues to play its part. I agree with the noble Lord, Lord Crisp, that this is an overarching priority. However, we do not believe that this amendment is necessary. I am indeed going to say that the climate change target and environmental targets referred to in the amendment already apply to the Secretary of State through the Climate Change Act and the Environment Act. The 10-year health plan was clear that we will continue to support the NHS’s climate ambitions. The reforms in this Bill do not remove or weaken that commitment.

The amendment also provides for guidance on the discharge of climate duties. However, the Bill already enables the Secretary of State to issue such guidance to integrated care boards, alongside transferring NHS England’s existing guidance powers for NHS trusts and foundation trusts to the Secretary of State. Importantly, integrated care boards, NHS trusts and foundation trusts will retain their existing statutory climate duties. We will continue to support the aims of the NHS’s climate ambitions in a way that improves delivery of care, returns savings to front-line services and drives wider economic growth. I say to the noble Baronesses, Lady Coffey and Lady Bennett, that I look forward to debating in full the use of single-use plastics in the NHS in the group of amendments on medicines and medical devices beginning with Amendment 111, but I will not pre-empt a fulsome discussion of that by delving into that content here, so we can all look forward to that.

I turn to Amendment 248, in the name of the noble Baroness, Lady Boycott. NHS trusts and foundation trusts have to consider the need to adapt to the current and predicted impacts of climate change. All trusts and foundation trusts are already required to have green plans in place. In reply to the noble Baroness’s point about how we will ensure that this happens, following the abolition of NHS England, the Secretary of State will issue guidance to support the system in discharging their duties, building on the existing Green Plan Guidance published by NHS England. There are statutory guidance-making powers in the NHS Act 2006 for ICBs, trusts and foundation trusts, under which the Secretary of State expects to issue guidance to support that system in discharging its duties.

As many noble Lords raised, including the noble Baroness, Lady Hayman, we know that the impacts of climate change are already being felt across the NHS, including disruption from heat in particular, flooding and other types of extreme weather. That is why the 10-year capital plan committed to renew that focus on climate resilience. We have strengthened adaptation planning with green plans to prepare for severe weather events and improve climate resilience of local sites and services, and plan to conduct an adverse weather emergency response exercise in every NHS region by 2030, so strengthening that whole system preparedness for extreme heat through UKHSA-led planning, co-ordinated alerts and mandatory local response arrangements across the NHS.

All trusts are required to have adverse weather plans to ensure service continuity during major events, such as heatwaves. Beyond planning for acute incidents, trusts also undertake climate change risk assessments to identify and reduce overheating risks and their potential impacts. There is already, therefore, a clear framework for trusts to plan and respond to climate risks. I humbly suggest that the Government do not have their head in the sand but that our focus should be on delivering against these existing duties and plans. The 10-year health plan also committed to supporting the NHS’s existing net-zero targets and climate objectives as set out in Delivering a “Net Zero” National Health Service, published in 2020. I am sure noble Lords are aware that, since the publication of that strategy, NHS carbon footprint emissions have indeed fallen by 17%.

To address the point raised by the noble Lord, Lord Hunt, I have covered some of the local duties points. The CQC guidance will remain, but I will write in full laying that out. On the point from the noble Baroness, Lady Pidgeon, about how this will be reported to Parliament, information on annual NHS emissions will continue to be published in the DHSC’s annual report and accounts, which are also laid before Parliament annually. That will ensure that Parliament continues to receive that regular information on the NHS’s progress towards those environmental objectives. I hope that this reassures noble Lords that the Government recognise the importance and, as many noble Lords have raised, ongoing salience of this issue.

[Baroness Bennett of Manor Castle (GP)]

I think this was probably before the noble Baroness came into the House, so I will not ask her whether she remembers the Financial Services and Markets Bill, on which we had a very similar debate. The Government eventually made a concession that was introduced directly into the Bill and did not say that we had to rely on the overarching Environment Act, et cetera. Will she have a look at the debate on the Financial Services and Market Bill, in particular Third Reading, when the Government explained why they had given way on that Bill?

[Baroness Hyde of Bemerton (Lab)]

I believe I was in the House; it was after the King’s Speech. I will absolutely go away and review that debate and take it back.

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Together, our amendments and the amendments of the noble Lord, Lord Tarassenko, provide a complete, coherent framework. They would secure public ownership, prevent vendor lock-in, protect patient privacy, enforce open standards and guarantee digital sovereignty for our NHS. I urge the Minister to accept this package, and I look forward to her response.

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a great pleasure to follow two of your Lordships’ House’s real experts in this area, and I look forward to hearing from a third shortly. To extend the metaphor of the noble Lord, Lord Clement-Jones, we are singing from the same hymn sheet, but just different parts. That is what this group of amendments is doing.

I will start with my Amendments 168, 169 and 172B, and I will deal with Amendment 268 at the end, which is somewhat different. These three amendments address different parts of the same problem. Who has access to NHS patient data? Who controls the infrastructure holding that data? Should the NHS should continue to rely on Palantir to provide that infrastructure?

I will start with the principle behind all three: NHS patient data belongs to a public health service under public control. It should not be accessible to commercial companies simply because the NHS has entered into a contract with them to provide the technology. The Government will no doubt say that patient data remains under NHS control and that Palantir acts as a data processor and cannot use the information for its own commercial purposes. Those are important contractual assurances, but they do not, as the other amendments in this group highlight, answer the issues that are raised. There is a difference between owning the data and having control over the systems through which that data is accessed, processed and managed. There is also a difference between a contractual promise and having the practical ability to guarantee that sensitive information remains beyond the reach of commercial contractors. In fact, we know that that is exactly what is happening.

NHS England has confirmed that three Palantir engineers have administrative-level access to the national data integration tenant, part of the federated data platform. A further 12 Palantir engineers have had more limited project-specific access for particular data sets and tasks. Now, this is not an allegation that Palantir employees are routinely browsing individual patient records, but administrative-level access to a system holding identifiable patient information is a serious responsibility. It raises huge questions about the boundary between public control and commercial access. I note that the National Data Guardian herself has questioned this. She said that the information about external contractors having access to identifiable patient data appeared to be inconsistent with the data protection impact assessment she had previously reviewed and she sought clarification from NHS England on this.

Amendment 168 addresses this directly. It would stop commercial entities and their employees, officers and subcontractors from accessing identifiable NHS patient data. That includes not just direct access to patient records but administrative and privileged access to databases, as well as access through software, support, maintenance and testing. We need this because we cannot allow the distinction between accessing patient records and administering the systems that contain them to become a loophole in the protection of confidential information. Commercial suppliers can still provide technical services. The amendment does not prevent the NHS from buying software or obtaining technical support, but it requires those services to be delivered using anonymised records. The NHS should be able to benefit from technical expertise without giving commercial companies access to identifiable patient information.

We come to the specific issue of Palantir, which is covered by both amendments. Palantir, as has already been alluded to, is not an ordinary technology supplier with no wider controversies. Its work with the Israeli military has drawn serious criticism from human rights organisations, including Amnesty International, which has documented the company’s links to Israel’s military activities in Gaza. It is also important to look at the ownership and the philosophy of this company. In March, Alex Karp said he believes AI will shift power away from

“highly educated, often female voters who vote mostly Democrat”

and towards working-class men.

I asked the Library to have a look at the ownership and control structures of Palantir. I thank it for its very detailed research, to which I am not going to subject noble Lords in detail. The key point is that Alex Karp, to whom I have just referred, co-founder Stephen Cohen, and chairman Peter Thiel have between them 49.99% of voting power because of the stock structure of the company. I note that the major institutional shareholders are Vanguard Group and BlackRock, Inc. They are not known for being companies that stand up for human rights, the rule of law or the public good. They have very distinct financial interests.

In particular, the company’s chairman, Peter Thiel, is known for his controversial views. At the Oxford Union in 2023, he said that the NHS makes people ill and should be privatised. I note also, in a broader context, that he is on the record as framing politics as an existential struggle against the Antichrist. Mr Thiel has named possible suspects for the Antichrist, including Representative Alexandria Ocasio-Cortez, Greta Thunberg and people who are critics of artificial intelligence. Now, that is quite disturbing. I would also note the fact that he was asked, in a video available online under the headline “Peter Thiel and the Antichrist”, whether he preferred the human race to endure. The interviewer said:

“You’re hesitating”.


Peter Thiel said:

“Well, I don’t know. I would … There are so many questions around this”.


The interviewer repeated:

“Should the human race survive?”


After 18 seconds, Mr Thiel said, “Yes”.

I have some questions to put to the Minister within the framework of the fact that the UN guiding principles on business and human rights make it clear that businesses have a responsibility to respect human rights. Have the Government properly considered those responsibilities when awarding and continuing this contract? Have they assessed Palantir’s links to breaches in international human rights law? Will the Government explain what human rights due diligence was undertaken?

I will jump to Amendment 172B. I stress that it does not say that we have to switch off Palantir immediately. It is a proposal for a transition away from Palantir, with patient care and data security protected throughout. The Government may point to the benefits that they say the federated data platform is already delivering. Of course, better use of data can help hospitals to manage waiting lists and make better use of resources, but none of that requires the NHS to surrender its control.

Health Bill

Baroness Bennett of Manor Castle Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Baroness Merron (Lab)]

I will be pleased to do so and thank the noble Lord.

[Baroness Bennett of Manor Castle (GP)]

The Minister referred to national security grounds being considered in the letting of these contracts. When we talk about national security, traditionally we have thought about hostile states proving a threat, but now we are in the context of the broligarchy—tech oligarchs who wield enormous power and influence, frequently opaquely held, with links to far-right politics and Governments who are funding far-right forces in the UK and around Europe. Is the Minister confident that that kind of national security threat is adequately considered when we look at contracts?

[Baroness Merron (Lab)]

That is not a matter I feel able to reply to in detail right now, although I will gladly write. However, to the best of my knowledge, the interpretation of what represents a threat to national security is set out and is understood.

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[Lord Rennard (LD)]

My Lords, I will speak first to my Amendment 279QA, which would require the Secretary of State to review the funding available for NHS stop-smoking services in England, including options for contributions from the tobacco industry. It is a moderate and, I hope, acceptable amendment in that it asks the Government to think about whether further funding to tackle the harms caused by tobacco should come from the hard-pressed taxpayer or from those companies that are responsible for the huge costs associated with smoking tobacco.

We need more onus on the tobacco industry to pay up from its huge profits to help reduce the huge damage done when it makes its victims addicted to nicotine. It would not in itself increase the financial burden on smokers, as funds would come only from profits, not consumers. I hope that the Minister will accept that my approach in this amendment is not about further taxes on unfortunate consumers. It is about the “polluter pays” principle being applied to tobacco companies.

Action on Smoking and Health estimates that smoking costs £44.8 billion in England alone every year. There is a huge financial burden on our NHS, our social care system and wider society through large-scale losses in productivity that are caused by tobacco smoking. Tobacco addiction places a huge burden on mental health, and it causes great damage through increased levels of ill-health generally, disability, and all the consequences that come from bereavement. My argument is simply that it is right that tobacco manufacturers, whose lethal and addictive products kill two-thirds of long-term users, should pick up more of the tab.

The APPG on Smoking and Health is arguing this at a time when the Government need to raise more funds and when they do not want to increase the burden on ordinary taxpayers. It is no wonder that, in opposition, Labour was emphatically in favour of this principle. On Report of the Health and Care Bill, the noble Baroness, Lady Merron, said that the principle

“strikes me as wholly pragmatic”.—[Official Report, 16/3/22; col. 297.]

Earlier in Committee, she said that such a measure had

“broad cross-party … and public support”.—[Official Report, 4/2/22; col. 1266.]

The noble Baroness, with her eloquence, helped to persuade the House to carry the amendment in support of considering a tobacco levy, by 213 votes to 154. In the Division, 86 out of 87 Labour Peers voted in favour of the principle of a tobacco levy. They included the noble Baroness, Lady Merron; the present Leader of the House, the noble Baroness, Lady Smith; the Deputy Leader of the House, the noble Lord, Lord Collins; and the Government Chief Whip, the noble Lord, Lord Kennedy. They cannot all have been wrong on this occasion.

The Treasury is reluctant to have such a hypothecated tax, however popular it might be, but the Treasury should consider how Prime Minister Andy Burnham has expressed his desire to extract revenue from businesses that do not make a positive contribution to communities. I simply ask: could there be any businesses in this country that are more negative in their impact on communities than the tobacco industry?

The Prime Minister and the Chancellor are desperately seeking ways of raising cash. Depending on the levy agreed, a levy could be applied to the profits of tobacco companies, raising perhaps £5 billion over five years. A very poor argument comes back from the Treasury to try to suggest that it might not raise very much because the actual level of the money raised would depend on the level of the levy, which it does not know and has not set. But there is great scope for taking taxes from tobacco companies’ enormous profits, and the revenue could be quite considerable.

I make a request to the Minister. Can she press His Majesty’s Treasury to meet the APPG on Smoking and Health, which strongly advocates the tobacco levy, to discuss this issue? The levy has been shown to be a revenue raiser, supported by 76% of adults in England. To fulfil the aims of the Government and all of us seeking to reduce further the prevalence of tobacco by helping smokers to quit, we need to do more and to find the money to pay for the action required.

In some respects we are going in the wrong direction, and we have to address that. We want to help the Government with their manifesto commitment to deliver opt-out smoking cessation support within routine care. Amendment 53A in my name would provide for a specific duty concerning a smoke-free England to be included in the Secretary of State’s health service duties and would require a road map for making further progress with annual reports to Parliament.

The world-leading Tobacco and Vapes Act will introduce a smoke-free generation from next year and marks the beginning of the end of the tobacco epidemic in this country. However, it is not job done. There are still 4.9 million smokers across the UK. We need a new target for ending smoking in this country. The previous Government had a target of Smokefree 2030, with less than 5% prevalence of smoking tobacco by that year; sadly, that target is now unlikely to be met.

I applaud the ambition of the Government with the “stopping the start” programme to try to prevent the tobacco habit being taken up in the first place, but we need a similar ambition for current smokers. Less than 5% prevalence would still leave millions of people smoking, and the Government should set a bold new target for when smoking rates will be less than 1%. We need a plan for how that will be achieved, a road map. This would set out which populations have the highest rates of smoking, where we are going to target our efforts and how we will do that. We are making progress. We know it can be achieved when we have clear, funded policies such as financial incentives, a bold target and system-wide change to support quit journeys. I beg to move.

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Lord, Lord Rennard, and to agree with every word he said. I would have signed the amendment had I caught up with it.

I will speak to my Amendments 267 and 274 in this group. These line up very well with Amendment 224 in the name of the noble Baroness, Lady Walmsley, about a duty to promote public health. I do not think they are contradictory; they could both be included and would work together quite well. My Amendment 267 would add a new clause to establish a public health committee and health creation unit to promote public health and cross-government policy-making. At Second Reading there was a lot of discussion that this Bill is about institutional arrangements and has very little in it about actually delivering health; a number of amendments in this group, including mine, seek to address that.

This amendment builds on a proposal put forward by MPs at the Commons Committee stage. I am bringing it forward again because I do not think we can keep treating public health as the responsibility of one government department. We are in a terrible condition. Life expectancy gains have stalled and healthy life expectancy is falling. The latest ONS figures show that healthy life expectancy has dropped to its lowest level since records began in 2011 to 2013. Men in the UK can now expect just 60.7 years in good health and women 60.9 years. Those statistics represent millions of people spending more of their lives in poor health and reflect deep inequalities in our society.

Health Bill

Baroness Bennett of Manor Castle Excerpts

Committee stage
Monday 9th November 2026 Lords Chamber

Could the Minister give the Committee examples of this? Will she also publish illustrative directions before Report? Could the Government not achieve a framework through national outcomes, Clause 16 regulations and NICE guidance, rather than a general power of direction? Why are directions published, rather than laid? Why is there no procedure at all, when the department itself calls such instruments “subordinate legislation”? The really important question she needs to answer is this: how does any of this square with the promise of devolution and earned autonomy, when the centre ends up with more power over ICBs than NHS England ever had? I beg to move.

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Lord, Lord Scriven, who finished where I am going to start, with the huge powers of direction that the Bill provides to the Secretary of State. His amendments are directed primarily towards parliamentary accountability; my Amendment 39 is about keeping decision-making power local.

This amendment would

“prevent the Secretary of State from using the general power of direction to determine individual local commissioning decisions, while limiting directions on specialised services to defined national purposes”.

The noble Lord, Lord Scriven, said that his amendments are probing. I am afraid that mine aims to suggest a way forward for the Government, because I suspect that we will find in many amendments in this area that the House wants to see something happen with the overweening power that the Bill currently provides. As the noble Lord said, this appears to be going in the opposite direction of what the Government say their intentions are for the devolving of power and resources down to local areas.

What we have here is a fundamental question about where decisions on the NHS should be made and who should make them. Of course there should be national standards and accountability, but that is very different from giving the Secretary of State the power to intervene in the day-to-day commissioning decisions of local health bodies. My amendment talks about things such as

“the opening, closure or relocation of a particular NHS service or facility … the location at which a … service is provided”

and who should provide services.

As the Nuffield Trust has pointed out, the English NHS is already unusually centralised, compared to other similarly sized health systems. The Bill takes us even further in that direction by giving the Secretary of State powers to intervene in integrated care boards well beyond those currently available to NHS England. The powers over NHS foundation trusts exceed the powers that the department held even before NHS England was created. The concern is that these powers might be used not simply when an ICB is failing but when it is not following the political interests, personal prejudices or even whims of the Secretary of State.

Integrated care boards exist to make commissioning decisions that reflect the needs of their local populations. Those needs vary across the country and Westminster does not necessarily—or even very often—understand such individual regional differences. The health challenges facing a rural community are not necessarily the same as those of an inner-city population, but a large inner-city population may have more political clout than a dispersed rural one. The availability of services, transport links and local demographics all matter. Decisions about where a service is provided, whether a facility should open or close or which provider should deliver care require an understanding of those local circumstances. They should not be a matter of political direction from Whitehall.

I think we can all imagine the real risk that these powers will encourage Ministers to announce some great input into an individual hospital facility or services without properly understanding the consequences for the community concerned, or indeed from political motivations. We are talking about the potential for political favouritism, with decisions influenced by that rather than the needs of patients.

The amendment would prevent the Secretary of State using the general direction power to make individual local decisions, but the separate intervention powers under Section 14Z62A remain available. It recognises that specialised services are different; they are often complex, expensive and relatively rare and there is a strong case for national consistency and collaboration between integrated care boards there. In relation to specialised services for clearly defined national purposes, the amendment therefore allows directions for

“determining which services should be commissioned as specialised services”,

ensuring compliance with national standards and commissioning policies, and requiring collaboration between ICBs. We would be allowing national co-ordination where it is needed without providing an open-ended power to micromanage local healthcare.

It is difficult to see how meaningful devolution can take place if local health bodies know that the decisions they make can be overridden by the Secretary of State. Local bodies must have the freedom to make decisions and the accountability that goes with that freedom. We should be building an NHS where local leaders are supported to make decisions based on evidence, professional expertise and the needs of their population, not a system where they are looking over their shoulders and anticipating the next political intervention from Westminster.

We know that that kind of central control can encourage defensive decision-making, discourage openness and make it much harder to have honest conversations about the challenges facing local services. This amendment seriously aims to offer a practical way forward: it would preserve the Secretary of State’s ability to intervene when an ICB is genuinely failing and ensure national co-ordination of specialised services, while protecting the integrity of local commissioning decisions.

[Baroness Manzoor (Con)]

My Lords, the noble Lord, Lord Scriven, has tabled the probing Amendment 40, which includes the proposed new Section 14Z61A. It is important because it seeks to improve health outcomes, rather than simply restructuring the NHS, which appears to be the central purpose of the Health Bill. As the noble Lord stated, it would require the Secretary of State to publish clear national health outcomes covering patient safety, quality of care, waiting times, health inequalities and the effective use of resources. Progress would be reported to Parliament, strengthening transparency and democratic accountability.

Crucially, proposed new Section 14Z61 would require the Secretary of State to set specific outcomes for each integrated care board, reflecting local health needs and involving consultation with local authorities and mayors. This would give ICBs clear responsibilities while preserving flexibility over how they deliver improvements, which would be key. Together, such provisions would strengthen the Bill by creating measurable accountability, protecting local decision-making and ensuring that NHS reform delivers tangible improvements in patient care, illness prevention and public health.

I strongly support this important amendment from the noble Lord, Lord Scriven, and I urge the Minister to adopt it, particularly if the Government’s 10-year health plan strategy is to succeed in the long term.

--- Later in debate ---

[Baroness Bennett of Manor Castle (GP)]

The Minister said that the public expect Ministers to use this power sparingly. That reflects what the noble Lord, Lord Hunt, said about the power being used sparingly in the past. However, to pick up something that the noble Lord, Lord Stevens, said about what has happened across the Atlantic, health is a great deal more political in its provision than perhaps it has been in the past, and these have become controversial, much played out issues. We also have a much more febrile political situation. As a direct example for the Minister, drawing on experience, if we have two hospitals that have children’s emergency services and the suggestion is that only one of them can continue and there is a political contest in this area, is the decision going to be left locally or is the Secretary of State going to intervene?

--- Later in debate ---

Moved by

[Baroness Bennett of Manor Castle]

33: Clause 10, page 6, leave out lines 14 to 21 and insert—
“12E Presumption in favour of public provision of health services(1) In exercising functions in relation to the health service, the Secretary of State must secure, so far as reasonably practicable, that health services are provided by public bodies.(2) A health service may be provided by a private-sector body only where the Secretary of State or other relevant public authority is satisfied that—(a) no reasonable alternative is available for the provision of that service by a public body within a clinically appropriate timeframe, and(b) the use of a private-sector body is necessary to ensure the provision of the service or to meet the healthcare needs of patients.(3) A decision to arrange for a health service to be provided by a private-sector body under subsection (2) must— (a) be supported by a published assessment of the available alternatives,(b) explain why provision by a public body is not reasonably practicable, and(c) be limited to the extent and duration necessary to meet the need identified.”Member's explanatory statement
This amendment establishes a presumption that NHS services should be provided by public bodies and restricts private-sector provision to cases where no reasonable public-sector alternative is available within a clinically appropriate timeframe and private provision is necessary to meet patients’ needs.

[Baroness Bennett of Manor Castle (GP)]

My Lords, we come now to Clause 10 and what will be a discussion of great interest for many people who have an interest in the Bill, but who are not following the fine detail of organisational structures. It is worth starting by noting, particularly as we have a clause stand part notice, what Clause 10 actually does. It appears to say that the Secretary of State may not vary the proportion of health services provided by the public or private sectors, or by different sorts of legal entity, unless the Secretary of State considers it in the interests of the health service. We will hear later about an amendment from the noble Lord, Lord Kamall, and the noble Earl, Lord Howe, which seeks to change that to the interests of patients.

My starting point to the Minister is that this clause appears to aim to fix in place the current arrangements, with their mix of public and private. I think that will surprise many people, given that the mix we have now is in many cases essentially a result of accidents and the outcomes of tenders, not of any sort of plan or systematic thinking. It is also, of course, the result of failures. I am thinking here of an example many noble Lords will remember: the rather infamous Hinchingbrooke hospital case. The private company Circle was running that hospital, but it was such a disaster that it simply handed it back to the state. That kind of historical accident reflects what has happened in our mix of private and public services. I also point the Minister to the article in the Lancet from 2024, entitled The Effect of Health-Care Privatisation on the Quality of Care by Goodair and Reeves. It found

“that aggregate increases in privatisation frequently”

are accompanied by

“worse health outcomes for patients”

—indeed, all too often, deadly outcomes—so it is curious that the Government seem to be seeking to fix it at what we have now. That is where we are at and where this discussion is starting.

I have three amendments in this group. I am moving Amendment 33 and speaking to Amendments 36 and 51. I will go through them in order, but all three address the same fundamental concern: that we have seen this growing role of private companies in the delivery of our NHS. The Green Party and many members of the public see the need to restore public provision as the organising principle of our health service.

Taken together, these three amendments seek to establish a presumption—different to the Government’s current position—in favour of public provision, which I argue is based on the evidence we have before us. They would require a proper review of the existing private sector arrangements and set a clear statutory duty on the Secretary of State to ensure that NHS services are publicly provided. The NHS was founded on a radical idea that healthcare should be available to everyone according to need, not to the ability to pay. But successive Governments have apparently been increasingly comfortable with the idea that it makes little difference who provides a service, as long as the patient does not receive a bill. I would argue that it makes a great deal of difference.

Amendment 33 seeks to introduce a presumption in favour of public provision. We have seen a growth in private sector involvement in the provision of NHS services. The House of Commons Library reports:

“In 2024/25 the NHS in England spent around £20.4 billion on non-NHS providers. This amounted to 10.3% of its resource budget for that year”.


Public money is increasingly being used to purchase healthcare from commercial organisations, rather than building and maintaining the NHS’s own capacity to deliver. The result has been a gradual erosion in the distinction between a publicly provided health service and a publicly funded market in healthcare.

--- Later in debate ---

[Baroness Merron (Lab)]

I will be pleased to write further on the comments that I made.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank all noble Lords who have taken part in this fascinating and important debate, and I thank the Minister for her response.

The noble Baroness, Lady Coffey, said she thought I would be alone in my views, but we have heard from different quarters around your Lordships’ House expressions of concern about the destructive impact of markets and tendering on the NHS; the noble Lord, Lord Hunt, said so in his speech, and indeed he is nodding now. There is good evidence that the views of your Lordships’ House do not reflect the views of the public. I point noble Lords particularly to a study in Social Theory & Health in 2022, which I believe is the only time there has been an open-ended, representative survey of UK citizens about their view of privatisation. Lots of basic questions have been asked, such as “Do you think privatisation is a bad thing?”, but I think that is the only time the question has been asked: why do people think that? The largest single reason was the extraction of profits from NHS services. There is strong public resistance to that, and noble Lords should bear that in mind. The public see clearly that money that should be going to services is going to profits instead, and that is what my group of amendments seeks to address.

We have Committee stage for a reason, to probe amendments, and many noble Lords have probed at mine. To reassure the noble Baroness, Lady Thornton, and others, I certainly need to look at the wording of this. When I was talking about public and private, by “private” I was referring to for-profit providers. I reassure the noble Lord, Lord Scriven, and others that there is no intention here to do away with hospice provision, charity provision and not-for-profit provision. These amendments are all aimed at the for-profit sector.

[Lord Scriven (LD)]

So if the partners at a GP practice made a surplus or a profit at the end of the year, would they fall under the definition that the noble Baroness has just given?

[Baroness Bennett of Manor Castle (GP)]

There is a particular issue with GP practices. My position is that I do not think there should be for-profit in healthcare. That is my long-term position.

[Lord Stevens of Birmingham (CB)]

Nuffield Health, which provides private hospital services to NHS patients, is a registered charity. To clarify, according to what the noble Baroness has just said, she would accept that it would continue to be able to be funded by the NHS but, let us say, HCA hospitals would not.

[Baroness Bennett of Manor Castle (GP)]

I am aware that there are charities and there are charities, but yes, as long as something is operating for a genuinely charitable purpose, I would exclude that from a for-profit definition.

[Lord Kamall (Con)]

I am sorry to intervene, but we are probing the noble Baroness’s amendments. I made a point about some for-profit providers, such as Specsavers, which are often able to provide services much more cost-efficiently, particularly audiology and optometry services, in local communities, often closer to the patient than some distant hospital, which frees up money to be spent on other services in the NHS. Would the noble Baroness oppose that sort of for-profit service, which is clearly in the interest of patients?

[Baroness Bennett of Manor Castle (GP)]

Here, I would cross-reference the noble Lord to what the noble Baroness, Lady Nargund, raised in her intervention on the Minister, which was really important. I should perhaps declare an interest: I confess that my glasses are from Specsavers, where I went for practicality. However, in that kind of context, we also see significant upselling and pressure on patients that would not apply in an NHS not-for-profit context. That is something that we need to think about carefully. Is there alternative provision where that pressure is not applied?

I am at risk of turning into a Minister here, so I am going to try not to do that; I will later on, but not right at this moment. I want to pick up a point made by the noble Lord, Lord Kamall. I think it is fair to say that the noble Lord embraces the fact that more people are taking out private health insurance and paying for private provision. For me, it is a cause for concern if people are forced into that situation because they feel there is not the NHS provision there. If there is no provision of, say, a hip replacement within a reasonable time, so people put possibly a large chunk of their savings into that, that is a cause for concern, not celebration. From my native Australia, I know what happens when you have, in essence, a two-tier health system where many people feel the need to have private insurance. Then it is the leftovers, and the quality of public provision falls away significantly.

The noble Baroness, Lady Nargund, spoke about the importance of provision in disadvantaged areas. One problem that we have with private sector providers is they may see less opportunity to make profits from more disadvantaged areas and be interested in operating in areas that are more for profit.

I am not going to run through every contribution, because that would take too long, but one thing that has come out of this debate in a broad sense is that the Government—any Government—have to make a decision. I come to the challenge to me from the noble Lord, Lord Hunt, about the balance between local and national decision-making. Are the Government going to solve short-term problems by destroying a structure so that it is not there for the future? I would argue that they have a responsibility not just to the patients of today but to maintain an entire functioning health system that will be there with appropriately trained people, appropriate resources and the ability to deal with acute circumstances.

Health Bill

Baroness Bennett of Manor Castle Excerpts

Committee stage
Tuesday 3rd November 2026 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I thank my noble friend Lady Finlay for making the strong economic case for specialist palliative care and for these thoughtful amendments. I have added my name to several of them.

On Amendment 78, ICBs already have responsibility for commissioning palliative care. That came about following amendments to the 2022 health Act, which my noble friend Lady Finlay introduced, but there is insufficient accountability for whether and how they are meeting the needs of their local populations. The House of Commons Health and Social Care Committee’s recent inquiry found no clear standards or reporting requirements for ICBs for the provision of palliative and end-of-life care.

Geographic inequality is striking. In 2023, the proportion of people dying in hospital varied from 36% to 52% between ICB areas, and the proportion dying at home varied from 26% to 33%. Why are there so many differences between different areas? We cannot improve what we do not properly measure, and palliative care at the end of life is an essential component of healthcare, not an optional extra. This amendment would require annual performance assessments regarding the standard of palliative and end-of-life care provided.

Amendment 26 would require urgent investment in palliative care through a transformational fund. The Health and Social Care Committee considered the specialist palliative care workforce to be in a critical situation. It described 78 consultant vacancies and around 40% of hospitals not providing a seven-day face-to-face specialist palliative care service. More funding would support the Government’s intended move towards more care in the community and help to avoid needless prolonged hospital admissions.

Amendment 242 would ensure that NHS and hospice services can work together effectively, with timely information sharing and the access to beds, medicines, equipment and appropriately trained staff that patients need and deserve. At the moment, it is so fragmented; it is very hard for people trying to co-ordinate and manage their own end-of-life care at home, as I know only too well after my husband died last year.

The scale of the voluntary sector’s contribution is considerable. In 2024-25, hospices across the UK provided palliative and end-of-life care to 310,000 people, alongside direct support to 89,000 family members, friends and carers. But the financial pressures they face are significant, and of course they rely heavily on charitable donations and fundraising. However, voluntary sector providers are not peripheral to our health and care system; they are essential partners.

The Public Accounts Committee in the House of Commons has estimated that 300 hospice in-patient beds have been lost due to lack of funding. It would be very timely to agree all these amendments and I give my wholehearted support to them.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I commend all the amendments in this group. As the noble Baroness, Lady Finlay, said when introducing it so powerfully, I attach my name to the noble Baroness’s Amendment 26, which would provide for a transformational fund for improvements in access to support service redesign by scaling proven models of care, supporting also the planned shift from hospital care to community care.

As the noble Baroness, Lady Coffey, alluded to, we have to consider this group of amendments in the context of the Terminally Ill Adults (End of Life) Bill, generally known as the assisted dying Bill. I spoke at its Second Reading in your Lordships’ House and my noble friend Lady Jones covered Committee. It is worth noting that, the second time the Bill was presented in the other place, Andy Burnham said, in a very influential intervention, that before assisted dying is considered in England and Wales, the funding of palliative care should be fixed. That is what the amendments in this group, in their various ways, seek to achieve. The Government often say they will do this when legislative time allows. We have the opportunity before us at this moment.

We have covered many of the points already, but it is worth noting that, by 20 October, more than 100,000 people had signed a petition, which was delivered to No. 10, calling for sustainable hospice funding to be made a national priority. At that event, the Shakespeare Hospice chief executive said:

“Our ask is simple: a fair and sustainable long-term funding model that ensures everyone can access high-quality hospice care, regardless of where they live”.


The fact is, of course, that, in many ways, hospice care and provision is not only a postcode lottery but is going backwards in many parts of the country. On average, about 270,000 people each year receive hospice care, but only 40% of the funding comes from government sources: 60% of the funding comes from people—very often pensioners—standing at train stations rattling buckets. We have a reliance on charity shops, but that funding model is in significant difficulty, in part because of fast fashion and other changes. We have a cost of living crisis that means many people who may have made contributions before are simply not in a position to make contributions now.

I have spoken in your Lordships’ House previously about the very sad closure of the Richard House hospice in east London in 2025. I note as one further example the Queenscourt Hospice in Southport, which has been going for 35 years. In the middle of this year, it cut its in-patient provision by 50%, decreasing bed capacity from 10 to five. It also reduced out-patient services, therapies and hospice-at-home clinical provision. Associated with that was the loss of 20 full-time equivalent medical posts.

I note also that the Royal College of Nursing, at its congress in May, supported overwhelmingly a resolution that the RCN advocates for decent coverage of hospice care. That should not be necessary. We have before us a Bill that gives the possibility for the Government to put this into a legislative statutory framework to support proper palliative care, which the Prime Minister has said that he wants to do.

Patient Data: Research

Baroness Bennett of Manor Castle Excerpts

Thursday 10th September 2026 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank the noble Lord, Lord Patel, for securing this debate. I declare something of an interest, in that I am just back from the ninth World One Health Congress in Lisbon, partially supported by DSAC.

I go to the UKRI to start with the basic fact that the social determinants of health determine up to 80% of health outcomes, with clinical care accounting for only 20%. We must not lose sight of this reality, particularly given that healthy life expectancy is down two years in the past decade. We do not need data to know that poverty, inequality and austerity have enormous health costs. Data collection does not really add to our understanding of a reality that includes the impacts of financial insecurity, poor housing, filthy air and discrimination. The noble Lord, Lord Patel, spoke about economic growth having an impact on health. I would argue that we need a major redistribution of the resources in our society to tackle those things. Waving the magic wand of AI and saying we will fix it with that just does not satisfy.

However, when we come to health data, and there is no doubt it is extremely important and useful, we have a huge problem of trust: patients trusting the system and trusting the Government to govern if their data is handed over. If there are no transparent controls, patients are not going to allow it. I note that the Government themselves, in a letter to the chair of the Commons health committee, acknowledged that, in recent times, tens of thousands of patients have withdrawn their data from use in research projects, with very many of them expressing concern about the involvement of the US defence and health tech company Palantir.

There really is no wonder about that. We need to think about this. Peter Thiel and Alex Karp have said some very disturbing things, but I also go to Palantir’s UK head of operations, Louis Mosley, at last year’s Alliance for Responsible Citizenship. He said Western civilisation was in an existential battle against the “armies of fact-checkers and experts”, lawyers, academics and journalists. Palantir is supposed to be supplying unbiased, fact-based data analysis for the NHS: this is the company that we are talking about.

We know that it had very little track record in health data before it enlisted the aid of the company of the former Member of this House, Lord Mandelson—Global Counsel—and secured this contract. The Government have a really important decision to make on health data and whether they continue with this contract. We must not allow ourselves to be trapped into using these companies. Also, as the noble Lord, Lord Bridges of Headley, referred to in the last debate, we have to ask questions about their financial stability; if we rely on them and they are not financially stable, that is another issue as well.

Women’s Health Strategy

Baroness Bennett of Manor Castle Excerpts

Thursday 23rd April 2026 Lords Chamber

[Baroness Merron (Lab)]

The whole point about the strategy is to ensure that the last point about a postcode lottery does not apply. Access to NHS Online will help hugely with that because it will not matter where you are. If you are referred to the NHS online hospital, you will be able to access the best without initial travel. That will help hugely.

On women’s health hubs, we are building on the pilots that were established. We are now asking integrated care boards to integrate women’s healthcare properly into neighbourhood health centres. It is a big push in the 10-year health plan and, obviously, because this is aligned with it in the women’s health strategy, it is about neighbourhood health, which I know the noble Baroness is a strong voice for. We will also develop more guidance for integrated care boards about how they provide quality and the right amount of speedy and appropriate healthcare for women in neighbourhood settings, which may well be through women’s health hubs. They have taught us a lot. I think we can probably move even further than women’s health hubs, so in that respect the pilot has been extremely helpful.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in responding to the Front-Bench questions, the Minister referred to holding providers’ feet to the financial fire. I believe that she was referring to the part of the strategy that says it will empower women to have a stronger say by asking them to say whether, based on their experience, money should be withheld from providers or where it should be invested. This is returning to the idea of competition, which has done such damage to our health and education systems. Surely if a service is struggling, it needs support; taking money away from it is going to be a real problem. We know that services very often struggle in the most economically deprived areas. Does the Minister agree that reducing funding has never improved a medical system or made it safer, more accessible or better?

[Baroness Merron (Lab)]

That is an interesting invitation to consider. It would probably be helpful if I reiterate or explain better the points about the patient power payments. As I said in response to the Front Benches, its strength—by the way, I emphasise that it is a pilot—is that women’s voices are the voices that are least heard, and we know that creates the biggest problem in women’s healthcare. We know that just asking women what they think—we will be doing that, and we will be transparent in publishing the results, which will drive improvement—will not be enough. The reason for the financial point is that if the provider—it could be a private or a public provider—is not providing the right service then why can women not be heard on that? What will happen is not a cut in funding but the direction of an amount to go into the improvement of the service. In other words, at present there are no consequences for giving poor service. I do not see why women should have to put up with that.

NHS: In-house Software Capabilities

Baroness Bennett of Manor Castle Excerpts

Monday 16th March 2026 Lords Chamber

[Baroness Merron (Lab)]

That seamless movement is an important point generally, but the federated data platform does not centralise or sell patient data. Data remains firmly under NHS control, and access is strictly governed. It is fully auditable and used only for approved patient benefit and NHS benefit. Palantir operates strictly under the instruction of NHS England and it does not, as I said, own or control NHS data. That access is tightly governed. In response to the earlier question, I note that the federated data platform to which the noble Lord refers is cyber resilient and subject to rigorous contractual, legal and information governance controls.

[Baroness Bennett of Manor Castle (GP)]

My Lords, my question also relates to the federated data platform. I am sure the noble Baroness is aware that more than 50,000 patients have written to their local trust boards asking not to have their data placed on it. The Greater Manchester ICB, serving 2.8 million patients, has said that this does not present value for money and is a big public trust issue. Palantir is of course owned by Peter Thiel and Alex Karp, who are closely associated with the Trump regime and have very right-wing and anti-democratic views. Does the Minister acknowledge that this association with Palantir is damaging our NHS?

[Baroness Merron (Lab)]

I would first look at delivery: the federated data platform has enabled nearly 100,000 extra operations, removed over 600,000 patients from waiting lists and reduced unnecessary bed days by 15%, as well as driving a 10% improvement in cancer diagnosis—so people are being diagnosed sooner because the system is working more efficiently, and that is important. This is a three-year contract given in 2023. I refer the noble Baroness to the comments I made to the noble Lord, Lord Kamall, about the rigorous contract due diligence for all commercial agreements, including with Palantir.

Human Medicines (Amendment) Regulations 2026

Baroness Bennett of Manor Castle Excerpts

Monday 9th March 2026 Grand Committee

To conclude, this instrument makes amendments to support permanently the safe supply, distribution and administration of a wider range of vaccines. Most importantly, it will ensure that we have a vaccination system that is fit for the future. I beg to move.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank the Minister for her clear and comprehensive introduction to this statutory instrument, and I express Green Party support for it. I echo the comments of the Minister in the House of Commons, who said that,

“after clean water, vaccination is the most effective public health intervention for saving lives and promoting good health”.—[Official Report, Commons, Second Delegated Legislation Committee, 3/3/26; col. 8.]

We need to say that and keep saying it, particularly in the current era. I am glad that, through this SI, the Government are making sure that we prepare ourselves for the next pandemic, because we know there will be one. I shall speak briefly about the vaccination situation and some of the changes relating to vaccination that occurred in our health system during the Covid pandemic. I have a question for the Minister; if she cannot answer it now, I will entirely understand and appreciate a reply in writing.

In her introduction, the Minister said that we are no longer in a Covid pandemic, but we are still seeing the extensive spread of the Covid disease. I declare an interest as someone who has the financial wherewithal and ability to have had—and will continue to have—regular vaccinations against Covid, although I am not in one of the Government’s target groups. I want to address this because we saw the development of a great deal more private medicine during the pandemic. Private clinics were set up, running Covid tests and offering vaccinations. We have seen a profound change in the ecology of the vaccination system.

In the context of this SI, I have looked at NHS travel vaccines. Typically, the NHS offers vaccination against hepatitis A, typhoid fever, diphtheria, tetanus and polio, if not previously received, and cholera. These are available for certain destinations, but a number of travel vaccines are not covered by the NHS, including for yellow fever, hepatitis B, Japanese encephalitis, rabies and meningitis ACWY. Many noble Lords will have seen the recent tragic case of travel-acquired rabies—the most hideous disease—acquired from the lick of a puppy on a beach, I believe.

My question is about vaccination as we move increasingly into an ecology where some people are able to afford to protect themselves against a wide range of risks, for travelling but also even if they are not travelling. I randomly selected a provider and saw that there is a huge range in prices. Vaccination against dengue fever and Japanese encephalitis costs £125 for each, and for typhoid it costs £40. I wonder whether the Government are taking into consideration the availability of these crucial health measures. Some people are able to afford a broad range of protection but some may not be able to afford or have access to protections that could keep them healthy and, eventually, save the NHS a great deal of money.

Through this SI, we are making sure that we are able to react quickly in crisis situations, but it would be interesting and important to hear from the Minister about whether we are looking at the broader ecology of all this. What are we are doing for public health in the new, increasingly privatised medical arrangements that we are seeing?

[The Earl of Effingham (Con)]

My Lords, I thank the Minister for introducing these regulations. Vaccination remains one of the most effective public health interventions available to us all. The flexibilities introduced during the pandemic enabled the rapid deployment of both Covid-19 and influenza vaccines at scale. It is understandable that the Government now seek to make certain arrangements permanent and extend them to other infectious diseases.

His Majesty’s loyal Opposition support a vaccination system that is resilient, agile and capable of responding to future public health requirements. Expanding the role of community pharmacies and broadening the vaccinator workforce may well assist in that aim, provided that safeguards are robust. However, it would be wrong to wave this past without scrutiny, as temporary powers become permanent.

The introduction of a permanent vaccine group direction mechanism is a significant change. Flexibility must be matched by clarity. If a patient experiences a serious adverse reaction following vaccination under a vaccine group direction, where does the ultimate legal and clinical responsibility lie? Is it with the authorising body, the supervising clinician, the employer or the individual vaccinator? It would be helpful to have that clearly set out by the Government.

On workforce scope, the regulations expand the occupational health vaccinator provisions and align them with professions able to operate under a patient group direction. Can the Minister clarify the criteria used to determine inclusion? Were decisions based on professional registration, competence in administrating injectable medicines, workforce capacity or other considerations? I am sure all noble Lords agree that consistency and safety are paramount.

On public confidence and uptake, greater flexibility does not automatically mean higher vaccination rates, so how will the Government ensure that these changes actually translate into improved uptake among eligible and vulnerable groups? What benchmark will the Government use to evaluate the success of the measures?

A full impact assessment has not been produced. Although the stated impact may be minimal, these are system-wide changes. Reporting under the Medicines and Medical Devices Act occurs on a two-year cycle. Does the Minister consider that sufficient, or will interim data on safety, workforce, deployment and uptake be made available?

These are important questions to answer, and His Majesty’s loyal Opposition do indeed support a framework that is safe, proportionate and future-proofed, but one which has been properly stress-tested.

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[Baroness Bennett of Manor Castle (GP)]

One of the vaccines on the list of those that are only available privately is against typhoid. There was a publication last week, I believe, looking at the spread of antimicrobial resistance to typhoid and the fact that antibiotics that we have been using against typhoid for decades are now increasingly not working. Can the noble Baroness assure me—again, I will understand if she wants to write—that the Government keep this constantly under review? Drug-resistant typhoid would be very serious; 10 or 20 years ago we might have thought that we could just treat people, but that may no longer be the case.

[Baroness Merron (Lab)]

I can certainly assure the noble Baroness that effectiveness is kept under review. I know that she was not questioning this, but I also re-emphasise that typhoid vaccinations are available free on the NHS from GP surgeries. It is important to give that reassurance.

The noble Earl, Lord Effingham, asked where ultimate legal and clinical responsibility lies. An appropriate person has to be responsible for ensuring that only fully competent qualified and trained health professionals are individually authorised to use the most recently approved version of the VGD. That authoriser is usually a clinical manager or service lead. Authorised health professionals working under VGDs must understand their legal and professional responsibilities before they use VGDs. This follows the same principles set out in the NICE guidance. In that respect, I say to the noble Earl that this is not a new situation, but I accept it is quite right to ask about that.

The noble Earl also asked how we will ensure that changes translate into improved uptake. He will know our commitment to stabilising and improving uptake across the vaccination system, including, importantly, among those in underserved communities and groups that have historically lower vaccination rates. We have set out actions to improve uptake in our 10-year plan, as well as in our strategy Giving Every Child the Best Start in Life. We are also taking a multipronged approach, if I can put it that way, to improving vaccination uptake. That includes exploring whether there are other settings, such as community pharmacies and health visitors, who can assist in this. We also seek to continue to deliver clear messaging on the risks of disease and the benefits of vaccination. Importantly, we are investing in better digital services and data so that we know where we can target our efforts.

With regard to the question about community pharmacies having the necessary training and equipment if there are, unfortunately, adverse reactions, all providers and trainers have to ensure that those who are involved in vaccination have the right, high-quality training that enables them to deal with such reactions. I should say—I hope that this is a reassurance—that the amendment does not change the training expectations of those staff. Also, they are consistent: it does not matter where the service is being delivered.

A full impact assessment covering these amendments was carried out in 2023. It considered that making the relevant parts of the regulations permanent and expanding them is unlikely to create any significant additional impact. The amendments delivered by this SI are not controversial and do not reach the cost to business threshold; as such, a de minimis assessment was carried out and published on GOV.UK.

I hope that noble Lords will accept that, in amending these regulations, the Government are seeking to maintain important safety measures while increasing the effectiveness of the system’s supply chain and workforce. With that, I thank noble Lords for their contributions and questions.

Tobacco and Vapes Bill

Baroness Bennett of Manor Castle Excerpts

Report stage
Tuesday 24th February 2026 Lords Chamber

This is my attempt to find way forward on these issues. I hope the Government are listening. They may not like my way forward and they may have another suggestion, but this is an area where further work is needed. I beg to move.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise to welcome government Amendments 14 and 15, and I look forward to hearing from the Minister. I will not go through them in detail, as I am sure she will, but I note that this is a lovely practical example, and all credit to the Government that their campaigning has worked. We heard in Committee from both Action on Smoking and Health and the Mental Health and Smoking Partnership about the need for an exemption in in-patient mental health settings for vaping vending machines. The Government have clearly listened, and this is an example of how this all should work, so let us applaud and highlight that.

I support Amendment 16, which the noble Earl, Lord Russell, has just introduced. The ban on disposable vapes is clearly being widely, almost universally, got around. The noble Earl spoke about producer responsibility. Well, we have a profoundly irresponsible industry that is behaving in ways that have serious health and environmental impacts. I spent most of this afternoon hosting an event for the National Association of Local Councils. As soon as I said I was leaving to do the Tobacco and Vapes Bill, the reaction was, “Waste!” That is understandable. Let us look at some figures from Biffa on three recycling facilities, in Suffolk, Teesside and London. Before the ban on single-use vapes came in, they saw an average of 200,000 vapes mixed in with general waste; after the ban came in, that went up by about 3%. There was perhaps a rush of material being sold in that immediate period, but from everything we are hearing, the waste problem is still enormous, and the risk of these lithium batteries exploding and catching fire in waste lorries and recycling centres is absolutely enormous.

We need more action on public health, too. I spoke to a young person today who said, “Well, I’m a bit confused about how vaping relates to health and cigarettes”. Young people are not getting a clear message, and they are being sold these things everywhere. This amendment is saying we need to keep a watch on this and be ready to catch whatever the industry does next, because we know big tobacco is profoundly irresponsible. As the noble Earl said, this is perhaps not the exact way to do it, but we need to make sure we hear from the Government that they are prepared to take action against big tobacco at any time.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I, too, warmly welcome government Amendments 14 and 15, which create an exemption for vape vending machines in mental health hospitals. This was really good to see: it is a humane step and will be very beneficial to patients. It proves that the Government can listen and amend, and I hope there might be more listening and amending, and exemptions, even at this late Report stage. It makes our debates feel as though they can get somewhere. This was an important concession for the Government to make, so I am really pleased to see that.

I have grave concerns about Amendment 7 in the names of the noble Earl, Lord Russell, and the noble Baroness, Lady Walmsley. There is a real danger here that we end up seeing this Bill as a vehicle for a relentless attack on anything to do with nicotine. Unless I am much mistaken, the Bill does not intend—even though this is its effect—to treat all nicotine products in an undifferentiated way. It is aware of Cancer Research’s statement that vaping is “far less harmful” than tobacco and is the most popular tool to help people quit smoking.

But, following on from the remarks of the noble Earl, Lord Russell, I do not want to say simply that vaping can be considered positive only if it is used as a smoking cessation tool, because people will then undoubtedly—and they do undoubtedly—vape as a recreational habit. Is the Government’s aim, or this amendment’s aim, to tackle dependence on any substance whatever? Nicotine is the one that is named, but will caffeine be next? Where do we draw the line? As far as I am concerned, that should not be what this Bill tries to do.

I worry that this will lead to mission creep in the Bill, which will create a kind of pre-crime. I listened to the noble Baroness and I do not think that we should have a moral panic about vaping: that is the main thing. It is not appropriate for this Bill to start doing a pre-crime anticipation of all the things that might or might not go wrong in relation to vaping. That would be a disastrous outcome of this Bill. So I urge the noble Baroness to avoid the siren voices of those urging her to take it even further down the line of prohibition. I urge her to hold firm to the notion that, although there will be some suggested regulation of vaping, we should not and must not make vaping indistinguishable from tobacco in the public’s eye by treating them as equally problematic through the course of the Bill.

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[Baroness Grey-Thompson (CB)]

My Lords, I covered Amendment 17A, in my name, in Committee, so I will be brief.

Currently, the vast majority of cigarette butts are made of cellulose acetate, and each cigarette butt contains around two straws-worth of plastic. Globally, around 6 trillion cigarettes are smoked each year, with 4.5 trillion butts being littered. In the UK, around 3.9 million cigarette butts are littered daily. That is equivalent to 6,000 cigarette butts being dropped in every parliamentary constituency every day. Each plastic butt can take up to 10 years to break down into tiny fragments or microplastics, and they have polluted the entire planet, from the summit of Mount Everest to the deepest oceans. Worryingly, according to recent scientific research, the level of microplastics being found in human brain tissue samples has increased by 50% since 2016 and is increasing in other organs. Local authorities in the UK spend around £40 million a year fighting a losing battle—money that many would argue could be better spent on vital front-line services. The industry could have made a change, but so far has not gone far enough.

Banning plastic cigarette filters is supported by the public, including smokers. In polling commissioned earlier this year by the Parliament News website from Whitestone Insight, a member of the British Polling Council, 2,000 people were asked for their views on this issue. When asked:

“Would you agree or disagree with these statements? Cigarette manufacturers should be required by law to switch from using plastics in cigarette butts to a fully biodegradable alternative”,


almost nine in 10, or 86%, agreed, while just one in 20, or 6%, disagreed. Interestingly, even among current smokers, the vast majority—77%—supported the change. Support was high across every age group, social group and region. In contrast, asked if cigarette manufacturers should be able to continue to use plastic filters, just 13% agreed. The survey also found that eight in 10 people support the government levy and additional taxes on cigarette brands that refuse to switch from traditional plastic butts, including 51% of smokers. Some 84% of UK adults would support cigarette manufacturers being fined for not switching to biodegradable butts, with the revenues going towards paying for cleaning up the environment.

I do not think that this is a party-political issue. It was discussed by MPs, who voted on an amendment that was supported cross-party, including by Conservatives, Labour, Lib Dems, Reform, independents and unionists. Unfortunately, the Government did not accept the change that was being put forward. If we are going to be serious about how we consider the environment, this could be an important change.

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Grey-Thompson, with whom I nearly always agree, but not on this occasion. The noble Baroness and your Lordships’ House will know that concern about plastics, microplastics, nanoplastics and public health, including the way in which they are penetrating every corner of this planet and every piece of our body, is something I am gravely concerned about. As I will come to later, my amendment calls for banning filters altogether.

Very often in your Lordships’ House, I find myself acknowledging that something that is being proposed is not exactly what I want but would be an improvement. I am afraid that I am not convinced that the ban on plastic filters that the noble Baroness proposes would be an improvement. We had an extensive debate in Committee, which I am not going to reprise, but, basically, we have a problem, in that the term “biodegradable”, which is what is being proposed, is exceedingly unclear and is not defined. There is very clear evidence that these so-called biodegradable filters can take nearly as long to degrade as the plastic ones, leach harmful chemicals and remain in the environment for a long time. Studies have also shown that people who believe that cigarette butts are biodegradable are more likely to litter them. Although this might look like a small step in the right direction, I do not believe there is the evidence to actually take us in that direction.

Amendment 77, in my name, as was extensively canvassed in Committee, proposes to end the environmental and health harms of so-called cigarette filters, compelling the Government to act now and ban all cigarette filters, which have no health benefits, reasonable evidence of health harms and, of course, huge environmental harms, whether they are plastic filters or the so-called biodegradable ones.

I thank the noble Earl, Lord Howe, and the Liberal Democrats for Amendment 76, which explores a consultation on this subject. I am absolutely delighted, for the second group in a row, to say to the Minister that the series of amendments that she has tabled, which mean that the Government are preparing the way for banning filters in the future, is a significant step forward.

However, I want to keep my amendment on the paper to make the case for why this action must be taken now. The problem of so-called guilt-free littering makes the littering problem even worse. Companies that manufacture so-called biodegradable filters continue to make profits only if people continue to consume tobacco; the biodegradable filters proposal is essentially coming from the tobacco industry.

This country has never been afraid of leading the world when it comes to tobacco control. We could be—we hear the phrase world-leading so often in your Lordships’ House—the first country in the world to ban so-called cigarette filters. We could use this as an opportunity to reverse the damage done by decades of industry marketing, raise awareness of the harms of smoking and incentivise smokers to quit.

The World Health Organization has said that it believes a ban on filters would have a significant impact on discouraging consumption. A 2023 randomised controlled trial found that those smoking filterless cigarettes consumed less, and filtered cigarettes were perceived to be better tasting, more satisfying, more enjoyable, less aversive, less harsh, less potent and less negatively reinforcing than unfiltered cigarettes.

I recognise that in Committee the Minister said that she would like more evidence and modelling on this behavioural point. There are now academics working on that very point. I am sure they will be reaching out, and I will make sure that the noble Baroness hears about that as well.

While I agree with the Minister that the long-term solution here is to eliminate tobacco use—that is obviously the ambition that pretty much everyone can sign up to—with 5.3 million smokers still in the UK, 75% of whom admit to littering their butts, there is a strong case for action. I am glad to see that the Government’s position has again shifted on this since Committee. I thank Action on Smoking and Health and my colleagues in the All-Party Parliamentary Group on Smoking and Health, as well as the academics who have been highlighting this issue and moving this forward.

Finally, and briefly, I express Green support for Amendments 10, 204 and 133, and particularly for the suggestion in Amendment 133, which I spoke on extensively in Committee, for warnings on individual cigarettes and cigarette papers. Again, this is a place where we would not quite be first in the world, but we would certainly be in the leading pack of doing something that has been shown to have positive impacts in reducing smoking, which is what we are all after.

[Earl Russell (LD)]

My Lords, I will speak to Amendment 204 in my name and those of the noble Lords, Lord Young of Cookham and Lord Crisp, and the noble Baroness, Lady Walmsley. I thank them for their support for this important amendment. This amendment proposes a “polluter pays” levy on tobacco manufacturers, ensuring that those who profit from one of the most harmful products in human history contribute to repairing some of the immense damage they have caused. The principle is simple and widely accepted: when an industry causes profound harm and reaps extraordinary profits, it should help to meet the costs of addressing that harm.

Given the unambiguity of that harm, it is only right that those who are responsible contribute to putting it right. The amendment would require the Secretary of State, within two years of Royal Assent, to establish a levy on companies deriving income from the manufacture of tobacco products. Its receipts would form a dedicated fund within the Department of Health and Social Care used solely for smoking cessation, tobacco control and healthcare for those suffering from smoke-related illnesses. Regulations would be made under the affirmative procedure to ensure proper parliamentary oversight.

This is not a new charge on consumers. It draws on the vast profits of an industry that for decades has taken far more from the public purse and the public’s health than it has ever contributed. Four companies control over 95% of UK tobacco sales, enjoying monopoly-like power and profit margins averaging 50%, some five times the UK manufacturing norm. Together they make almost £900 million a year in UK profits, and they often pay little corporation tax here in the UK.

Compare that with the cost. Smoking drains £43.7 billion a year from society in England, including a cost of £1.8 billion to the NHS and far more in lost productivity, social care and human suffering. Tobacco duty and VAT raise barely £6.8 billion—only a fraction of the real cost of these harms. The “polluter pays” principle already underpins environmental law and is embedded in gambling reforms, where a statutory levy funds prevention and treatment. It is only logical to apply the same reasoning to tobacco, a product that kills nearly 74,000 people every year in England.

Tobacco and Vapes Bill

Baroness Bennett of Manor Castle Excerpts

Report stage
Tuesday 24th February 2026 Lords Chamber

[Lord Johnson of Lainston (Con)]

My Lords, first, I thank the Minister for her highly engaged approach to these issues facing small specialist tobacconists in the niche handmade, hand-rolled cigar industry. I also appreciated the assistance of her officials at the Department of Health, who have been sitting through a very long debate and must be wondering when it is going to end; I think this is the last group. They demonstrated a high level of understanding of cigars, their impact on health and the effects this Bill could have on the people involved in the specialist industry. I really do appreciate that. We have had a hugely successful, open dialogue around what is a very important issue.

I believe from my conversations with the Government that they do not want to destroy this important cottage industry of mainly small family-owned firms—which, I might add, attract a huge amount of tourism to this country and are world class in their standards of service and compliance. They sell a product which is not associated with childhood smoking, and they are not at risk of contributing to the remorseless rise of vapes, snuses and other nicotine delivery products. Wonderful shops like Davidoff, Fox, Sautters and Cgars, to name a few, employ hundreds of people and give satisfaction and happiness to thousands more.

It is very important that we accept the amendments proposed by my noble friend Lord Lindsay to protect these stores, especially those in the cluster of St James’s Street. I know we will come on to this later, but I would particularly welcome comments from the Minister on guidance to local authorities in this area, which reflects a number of the points in these amendments, as well.

The issues around packaging are also surprisingly important to the industry. We are not asking for anything other than a commitment to the continuation of existing legislation, which protects how speciality tobacconists display cigar products and can trade new and, importantly, vintage cigars. These products have to be stored and distributed in cedar or cedar-lined wooden boxes, which cannot be changed at source. It is important for noble Lords to understand this; they have to be transported in a certain way, in a certain type of box. It is not simply about moving them into some other type of packaging; and the packaging cannot be changed at source, since they predominantly come from important trading partners such as Cuba or the Dominican Republic, which do not have the capacity to change the packaging to enable us to have plain packaging.

By the way, the boxing and labelling system also helps ensure authenticity. This follows the discussion we had about counterfeiting earlier.

It is also important to recognise that these boxes and how the cigars are packaged are a far cry from packaging that advertises or that is targeted at children. It should be noted that health warnings are already applied to all these boxes. I stress that we are not looking for a carve-out or loophole with these amendments; we are looking simply for the continuation of a sensible policy to allow a niche industry of speciality tobacconists, with important trading partners, to exist and continue its trade as planned. This fits in with the express quotes from the Minister that, in effect, preserving the status quo as it stands today and rolling it forward is part of the Government’s agenda. We respect that and find it enormously helpful.

There is overwhelming evidence that going back on this original legal commitment would mean the end of the specialist cigar industry, so if we introduced plain packaging, it would be devastating for this important area of our economy and would have no benefit to the overall plan of making Britain smoke-free either.

I went to inspect the offices of Hunters & Frankau, which is the main importer of Cuban cigars, to see how a ban on ordinary box packaging could be implemented. If your Lordships saw the hundreds, if not thousands, of product lines in this Indiana Jones-like warehouse—I must say, when I had a chance to tour those storerooms, it was a very happy moment for me—your Lordships would see that it is totally impractical to bring in some type of plain packaging, given the way these authentic handmade products are sourced and distributed.

Canada and Australia have been quoted as having brought these measures into place. They are very different markets, so I do not think they are comparable in reality. In actuality, it has led to the almost total collapse of the handmade cigar industry as a result of the reduction of lines from many hundreds down to a few tens. The effect has not been on large multinationals or big tobacco; it has been the closure of many small businesses. Family-owned tobacconists and specialty suppliers have closed as a result. Needless to say, the consumer also suffers.

Finally, I would be grateful to hear confirmation that the Government have no plans to go back on previous legislation that allowed for a very small number of sampling rooms in this country—I believe the number is fewer than 30. These are not to be confused with so-called cigar lounges, of which there are many, which are predominantly outdoor areas, albeit with some type of heating and sometimes roofing. The investment in these humidors, which is what they are, with sampling rooms attached, has been significant. Several major hotels have integrated them into their business model. They are part of the supply chain of handmade premium cigars and to disestablish them would cause significant unnecessary harm.

I reassure noble Lords that at no point will these actions create a loophole for big tobacco. I am very aware that that has happened in the past, with flavourings, cigarillos and so on. Protecting these characteristics will not see an increase in youth smoking. I think we are all agreed on that. No one I have met, even those who are most fanatical about this Bill—some people are, and I do not disrespect that—wants to see an end to our specialist tobacconist industry today.

These are small, family-owned businesses, which behave impeccably, are drivers of tourism, create income for the Exchequer and behave extremely effectively in providing a niche community with cigars. To have clear commitments about these important matters from the Minister at the Dispatch Box would allow the industry to continue to be a highly responsible part of British retail. It would allow these small, family-owned stores to continue to drive footfall and income for this country. It would be a fair way to treat the adult, free-choosing, occasional cigar smoker into the future too.

[Baroness Bennett of Manor Castle (GP)]

My Lords, as we have already heard, the amendments in this group seek to carve out exemptions for specialist tobacconists, particularly when it comes to cigars. I will focus primarily on Amendments 126, 127, 147 and 192. I begin by focusing on what cigars actually are. They are often described—and we have heard them described—as luxury or artisanal goods, but they are, first of all, carcinogenic tobacco products that are harmful to human health.

I support the Government’s approach, as the Bill stands, to comprehensive tobacco control regulation that ensures that future generations do not become addicted to any form of tobacco. We have heard arguments that their use is infrequent and primarily among those over the age of 25. Indeed, the absolute numbers show that the majority of cigar smokers are over 25, but that reflects population size. In reality, among smokers—this is a really important point—the younger someone is, the more likely they are to be smoking cigars. Toxic influencers such as Andrew Tate actively promote cigar use to a young, predominantly male audience, linking cigars with power, wealth and success. We know how quickly this kind of influence can spread and be taken up if we leave loopholes for it.

As we have already heard, cigars have traditionally benefited from carve-outs of regulation on things such as pack size, flavours and packaging. Were we to change that now it would open the door to future innovations, as some of the proponents of these amendments have already acknowledged, with, for example, cigarillos. Action on Smoking and Health data shows that these are popular among young people who smoke: 35% of 11 to 17 year-olds have tried them in 2024 and 2025. We must not leave space in the Bill for innovation by the merchants of death, which I am afraid these amendments do.

Although I understand the intention behind the amendments that refer to plain packaging, I do not support them. The suggestion is that plain packaging will be fatal to the industry. I note that New Zealand, Australia, Canada, Ireland and Uruguay all apply standardised packaging to all tobacco products, including cigars. Data from Canada shows that, since that has come in, there has been only a very minor drop in the sale of cigars, in line with traditional long-term trends.

It is also important to note that the power to introduce plain packaging for cigars is not new. It already exists under regulations introduced in 2015 by the Conservative-Liberal Democrat coalition and implemented by a subsequent Conservative Government. The Government issued a call for evidence on this in November 2024.

Finally, I will touch very briefly on smoke-free places and cigar lounges. I do not support Amendment 192. Yes, the customers may choose to be in that space, but the staff may not have a realistic practical choice about being there; it may be the only job they can get. We do not want workers exposed to second-hand smoke under those kinds of conditions.

[Baroness Northover (LD)]

My Lords, my noble friend Lady Walmsley signed Amendment 126, to which the noble Earl, Lord Lindsay, referred. It seeks, above all, to ensure that all small retailers are treated fairly. I am sure the Minister will be addressing this.

Moving on to cigars and cigar lounges generally, I do not see why these should be exempt. In Committee, we heard from the noble Baroness, Lady Ramsey, about a new cigar lounge in Sheffield which has opened near a school. A public health team at the council made representations saying that it had serious concerns about the impact of the lounge, particularly in an area where smoking causes great health inequalities, but it was powerless to stop this. As we have just heard, having staff working indoors in these lounges seems to go against the very intention of the original smoke-free legislation, which was to protect staff from the harmful impact of second-hand smoke.

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[The Earl of Lindsay (Con)]

My Lords, I am grateful to the Minister for the thoughtful answers she has given to the various points my amendments have raised. I am also grateful for the time she allowed for discussions between Committee and Report to understand the issues better; my thanks to her. I am grateful to my noble friends Lord Johnson of Lainston and Lord Kamall for the support they have offered for these amendments.

Before coming back to what the Minister said, I say to the noble Baronesses, Lady Bennett and Lady Northover, that there is quite a lot of confusion over the statistics relating to cigars as a generic category. I remind both of them that my amendments deal solely with handmade cigars, not with cigars as a single generic whole.

As I said, handmade cigars are not inhaled. They are relatively expensive compared with other smoking options. A lot of cigars out there on the market are machine made; some of them are small enough to be cigarillos. The statistics about young people indulging in cigar smoking almost wholly relate to people who are smoking not handmade cigars but other types of cigar.

[Baroness Bennett of Manor Castle (GP)]

I am very aware of the hour, but I just had a quick look online and saw “Andrew Tate’s favourite cigars”—exactly the kind of very expensive products that the noble Earl is talking about. That is what is being promoted to young men in particular.