Vaccine Health Technology Assessment

Baroness Goudie Excerpts

Thursday 8th January 2026 Grand Committee

[Baroness Goudie (Lab)]

My Lords, I thank my noble friend Lady Ritchie for arranging for us to have this debate today. It could not be at a more important time for us.

Vaccines are one of the clearest examples that we have of prevention working well. They stop illness before it starts, they reduce pressure on the National Health Service, and they protect the most vulnerable in our society, yet, when we assess their value, we tend to look at them through a very narrow lens. At present, vaccine health technology assessments focus primarily on clinical outcomes and direct health system costs. That matters, of course, but it is not the whole story. When we ignore the wider societal and economic effects of vaccination, we risk undervaluing one of the most effective public health tools we have. This matters particularly for women, children and carers.

I shall start with children. When children are vaccinated, they are less likely to fall ill, less likely to miss school and more likely to stay engaged in learning. School absence is not a trivial issue. We know from the Government and from OECD analysis that sustained absence affects educational attainment and long-term life chances. When illnesses disrupt schooling, that does not affect the child’s health in the short term but it can shape their future for the long term, and that affects the country as a whole, yet the benefits of vaccination in reducing school absence and protecting learning are rarely counted in formal assessments. These costs do not disappear; they simply fall elsewhere, on families, on schools and ultimately on society. Every child’s health should matter.

I turn to carers. When a child is ill, or when an older or disabled family member becomes unwell, someone steps in to care. In the UK, that someone is most often a woman—mothers, grandmothers, daughters, sisters. They take time off work and reduce their hours. Sometimes they have to leave the workforce altogether. That does not make a family happy, it does not help GDP and it does not really help the family. The Library briefing makes it clear that societal perspective on health technology assessment can include informal care and productivity effects. That is not radical—it is already recognised in economic evaluation guidance—but in practice these impacts are often excluded or treated as secondary.

If we do not account for the burden placed on carers, we are in effect saying that their time, labour and lost income do not count. This is not gender neutral; it entrenches inequality by hiding costs that fall disproportionately on women and their pensions. Vaccination reduces that burden. It helps families to function and prevents crises in households that are already under strain. Those are real benefits, even if they do not show up immediately in the national health balance sheet.

There is also an important equality dimension. We know that vaccination uptake is not equal across communities; in some areas and groups in England, childhood vaccination rates have fallen and inequalities have widened. When preventable illness occurs, the social and economic consequences are felt most sharply in the communities that already face disadvantage. We must work hard to encourage families in those communities that vaccinations are safe overall and that it is the right thing to do. At the same time, we must not be too pushy; we have to work out the right way to encourage this across friends and across communities, as we did during the Covid situation. We worked very hard on that in this House. One of the leaders, who was a Muslim, very much helped us to do that and we need to look at that kind of work again.

This is not a fringe argument. The World Health Organization defines health technology assessment as

“covering both … direct and indirect consequences”

of health interventions. Academic work has repeatedly shown that vaccinations generate broader societal value, including educational benefits, productivity gains and protection against inequality. NICE already allows for analysis beyond the standard reference case when appropriate. The tools exist; what is missing is consistency and clarity about how and when wider societal benefits should be included for vaccines.

I want to acknowledge that there are challenges here. Measuring wider impacts is complex. There are legitimate concerns about double-counting and about privileging economic productivity over other values, but complexity is not a reason to ignore large and predictable effects; it is a reason to be transparent, to publish assumptions and to use sensitivity in all analysis. It is precisely because of those concerns that we must ensure equality and caregiver impacts are explicitly considered, not sidelined. If we count only what happens inside the clinic, we miss what happens in homes, in schools and in carers’ lives. Vaccines do not just prevent disease, they prevent disruption, inequality and unnecessary strains on families and workplaces. If we are serious about prevention, fairness and long-term guidance, our assessment frameworks need to reflect the world as it actually is.

Preterm Birth Committee Report

Baroness Goudie Excerpts

Friday 6th June 2025 Lords Chamber

[Baroness Goudie (Lab)]

My Lords, I thank the noble Lord, Lord Patel, and the members of the committee for this really important report, and for the time at which it has come, because the situation in this country for pregnant women, babies and preterm babies is a huge risk. This is the future of our country and the future of the world, and we do not treat the situation in the way it should be treated.

I will remind Members of a few points. The report is titled Reducing Risks and Improving Lives; to do that, we have to work much harder than we are working at the moment. Women’s health is at the worst position that it has ever been. I helped launch a report recently in the House of Lords—some Members were there—where we set out a manifesto for women’s health. The Minister was extremely helpful at that meeting and has helped us since.

As for the current landscape for preterm births in England, in 2022 some 7.9% of births in England were pre term, with 45% of babies born before 37 weeks. Those babies will need a lot of help and support not just in the very beginning but for the whole of their lives, certainly until they are through the whole of secondary school and into university. They also need to have proper checks as adults as well. When you are born and not fully developed, it affects the lungs, the brain—it affects everything. So, it is really important that we have a way in which people are checked regularly.

A number of preterm babies are born to mothers who have pre-eclampsia. Pre-eclampsia has a huge effect on the mother not only while she is pregnant but in the long-term, including heart conditions and other conditions. All mothers who have had pre-eclampsia should be seen by their doctors every 12 months, having heart checks as well. They are the future too—they are looking after children and keeping homes—so it is really important that we look at the state of mothers.

Preterm birth is the leading cause of neonatal morbidity in the UK. Outcomes for preterm infants remain uneven across the country. In most places, it is not registered when a child starts nursery or school; it should be, so that teachers have an understanding of what the issue may be if a child is not doing well, and how that can be helped.

There are disparities in the rates of preterm births. Preterm births disproportionately affect marginalised groups. Among black women, the rate is 8.5%; among Asian women, it is 8.3%; and among white women, it is 7.7%. These disparities are rooted in structural inequalities such as poverty and unequal access to proper healthcare for pregnant women. Women should be being seen regularly. They should know that they must keep these appointments, and if they do not, this must be followed through.

Further, we should have much more advertising and education for women and young girls about becoming pregnant, how you must be looked after and how you have to look after yourself. If something is not right when you are pregnant, you know yourself that it is not right. It should not be for the nurses to say, “Oh, go away and come back next week—it’s nothing”. They should let you come in and be checked. I know some people will be more nervous than others, but that would also save lives and prevent other awful things from happening.

There are poorer maternal health outcomes due to unconscious bias in healthcare settings. Addressing preterm birth requires confronting the underlying social determinants of health. We need much more understanding by social workers and counsellors. We also need more understanding of what is needed and for people not to be isolated. Sometimes, if someone has a problem—if they lose a baby or take a baby home that needs help—they are isolated and left on their own, sometimes in pretty terrible accommodation, and they do not see anybody. Again, we should be giving support. The Government should do that, because of the impact it has on families and the other children in the family.

Parents of preterm babies experience high levels of trauma, anxiety and uncertainty, and an increased risk of postnatal depression. That has a terrible effect on the marriage, on the other children and on how the baby is being looked after. Nearly 40% of mothers with preterm infants report clinical symptoms. There are challenges due to separation, impacting emotional and developmental outcomes. People leave them alone. The husband or partner does not always come home because they cannot always understand what is wrong. It is really important that we try and get these clear messages out that everybody needs to support each other.

There is also the financial strain of travelling, as the noble Lord, Lord Patel, mentioned, when babies are miles away from where their parents live. They are kept separately, and their parents are expected to come back and forth, where there is no accommodation for them in the hospital. They should be able to stay at the hospital, even if it is nearby. This is really bad. One has known what this is like—we have all had people we have had to support.

There is the loss of income, and parents get exhausted. They have to apply for extra entitlements, which take a long time to come and with which nobody is very helpful. They have to do it online, but they are not always capable or up to it because, emotionally, they are worried about what is happening to the baby and to themselves. This places additional emotional and administrative pressure on families.

As I said earlier, social isolation is a real problem. We really have to look at pregnancy in a completely different way than it has been looked at in the past. It is not just the case that you have a baby and then you will be fine. Today, we have to give much better care both to the baby and to the mother and father.

Food, Diet and Obesity Committee Report

Baroness Goudie Excerpts

Friday 28th March 2025 Lords Chamber

[Baroness Goudie (Lab)]

My Lords, I congratulate my noble friend Lady Walmsley on the way she chaired the meeting and kept us together, including making us do a lot of extra homework. It was tremendous, and I so enjoyed working with all our colleagues on the committee. I thank the clerks, Stuart and Lucy, and our special adviser. They found fantastic witnesses and ensured that all of them turned up and that, where they could not come, we got great evidence. It made such a difference to the report.

I am pleased to join the debate as a member of the committee and to discuss our report, Recipe for Health: A Plan to Fix Our Broken Food System. I welcome the opportunity to reflect on the urgent need for reform in how we produce, market and consume food in the United Kingdom. We should consider this in terms of how children and children who are not born yet will have to live in this society, with the high number of obese people we have, and remember that, if a mother is obese, the child has a high likelihood of being obese as well. We must look at that and encourage mothers, through maternal health and in every way, to try to change how they eat. However, we must assist them, including by changing something in the planning system that we learned about in the committee, which is that a lot of flats are now being built or converted where there is no kitchen, so the only thing in the let is a microwave. That is something we must try to alter. It is not for this report, and it is not for the Food Minister, but it is something to be passed down with change in planning laws.

Our food system is broken. Over 60% of UK adults are overweight or obese, and diet-related illnesses consume our national health billions each year. However, let us be clear, it is not merely a matter of personal choice; this is a systematic failure driven by a food industry dominated by multinational giants—companies such as Nestlé, PepsiCo and fast-food chains, as we found out in Blackpool, that flood our shelves and high streets with ultra-processed foods. These products, packed with sugar, salt and unhealthy fats, make up over half of the average British diet—one of the highest rates in Europe. Why? It is because they are cheap to produce and have long shelf lives. How long have they been on the shelves or in the warehouses by the time they get to anybody’s home? They are engineered to keep us coming back for more. This is not an accident; it is the business model. Through relentless lobbying, they have stalled or diluted policies meant to protect public health. Let us take the HFSS advertising restrictions—rules designed to limit junk food ads aimed at children. The report highlights how industry pushback delayed those measures, with groups such as the Food and Drink Federation decrying the impact on “innovation” and “jobs”. The result is a generation hooked before it can make informed choices.

Supermarkets are complicit too. A handful of chains control most of our grocery markets, determining what consumers see and buy. The report points out how shelf space is auctioned off to the highest bidders, processed food brands—as we notice when we go to the supermarket—while fresh local produce is sidelined. In low-income areas, cheap own-brand ultra-processed foods dominate, making healthy eating a luxury that many cannot afford. Products labelled “low fat” or “high protein” are still loaded with additives and sugar. This confusion, the committee warns, drowns out clear nutritional advice.

Profit is the driving force behind this crisis. Reformulating products to cut sugar or salt risks losing that addictive edge and, with it, sales. Voluntary pledges such as the failed public health responsibility deal have proven ineffective. Without a legal framework and enforcement, the industry will not change. The report cites a £6 billion annual burden on the National Health Service due to obesity—money that could fund schools and school meals; as we know, school meals are not made in schools any more but in different places and then brought to schools. They are not good food. Further, school budgets are now run by schools and, sometimes, if they need money for other issues in the school, they cut school meals—it is an easy cut, without anybody noticing. We have to be quite tough about school meals and what children are fed at school.

The Recipe for Health report offers a bold plan to fix this mess, and it starts with breaking corporate strangleholds. First, we need tougher regulation. The committee calls for mandatory reformulation targets forcing companies to cut sugar, salt and fat, with penalties for non-compliance. The soft drinks industry levy cut sugar in sodas by 44%; imagine that success applied across the food categories. Secondly, we must ban all junk food marketing everywhere. Our children deserve the chance to grow up free from corporate manipulation. Thirdly, we must level the playing field. The report urges subsidies for healthy foods—making fruit, vegetables and whole grains cheaper than a Happy Meal. We should tax ultra-processed foods harder and use the revenue to fund community kitchens or school meal programmes that teach children to love real food. We also should consider going back to teaching cooking meals in schools.