Tobacco and Vapes Bill

Baroness McIntosh of Pickering Excerpts

Committee stage
Monday 3rd November 2025 Grand Committee

Moved by

[Baroness McIntosh of Pickering]

30: Clause 16, page 9, line 20, at end insert—
“(4A) The Secretary of State must by regulations make provision for and in connection with a streamlined process for granting personal and premises licences to businesses that—(a) both have an alcohol premises licence and are a personal licence holder, and(b) have not been subject to enforcement action in the last 12 months for actions that a licensing authority would judge as inconsistent with conditions set out in regulations.”Member's explanatory statement
The purpose of this amendment is to acknowledge that the majority of retailers selling tobacco products and vape products do so responsibly and have robust policies in place to prevent sales to children and to prevent the sale of illicit or non-duty paid products.

[Baroness McIntosh of Pickering (Con)]

My Lords, I am delighted to speak on the Bill for the first time—not because of a lack of interest, but because it clashed with other Bills going on at the same time. I declare my interest as chair of the Proof of Age Standards Scheme, known as PASS, which looks to provide age verification in the form of a PASS card—currently it is a physical card, but I hope it will be digital—for those wishing to access shopping, nightlife and alcoholic drinks to prove their age.

I will say at the outset what the purpose is and why there is a need for Amendment 30. I am grateful to the Association of Convenience Stores for helping me prepare and draft the amendment. The ACS has 50,000 local shops and its membership would be greatly affected by the Bill, if this amendment is not carried. The explanatory note helpfully sets out the purpose of the amendment, which is to acknowledge that the majority of retailers selling tobacco and vape products do so responsibly and have robust policies in place to prevent sales to children and to prevent the sale of illicit or non-duty-paid products.

The Bill proposes the creation of a new licensing system for the sale of tobacco and vaping products, which will require thousands of existing retailers to transition to new administrative processes. Local authorities will also have to handle a significant volume of licensing applications. I omitted to say that I also chaired the ad hoc committee of your Lordships’ House that looked at the review of the Licensing Act 2003 and which reported in 2016-17.

Without a proportionate transition system, the Bill may create unnecessary burdens for both businesses and enforcement bodies. There is an established precedent for a proportionate approach. I referred to the introduction of the Licensing Act 2003, dealing with alcohol, which allowed grandfather rights that gave responsible existing licence holders permission to transit to the new framework in a streamlined way. With Amendment 30, I propose the creation of a fast-track application route for retailers that can demonstrate existing robust controls and compliance. The process would not remove scrutiny or licensing requirements but recognise that many retailers already operate under strong regulatory expectations. Eligible businesses would be those that hold an alcohol premises licence, are a personal licence holder and have not been subject to enforcement action in the last 12 months inconsistent with the conditions set out in the regulations.

Why does this matter? The majority of retailers act responsibly, uphold age-verification policies and do not deal in illicit products; for compliant retailers, we should freeze enforcement capacity to target bad actors and high-risk sellers. Also, a proportionate transition would reduce significant administrative strain on local authorities and businesses.

I look forward to hearing from my noble friends Lord Kamall and Lord Howe on their Amendments 35 and 42 in this group, but I end with a request for information on how retailers such as convenience stores and others are expected to have enough time to train and prepare their staff for the provisions of the Bill and particularly for a transition phase. That is key. With those few remarks, I beg to move.

[Lord Bourne of Aberystwyth (Con)]

I support this group of amendments. It is absolutely right that we have a thoroughgoing licensing scheme. Many people would be very surprised to find that we do not have a licensing scheme for tobacco, as we do for alcohol. It is unregulated, so I welcome the proposals to have a thoroughgoing licensing scheme. It should be streamlined; we need to recognise that the vast majority, as has been said by my noble friend, comply with the law and are fully responsible.

In developing a licensing scheme, we need to look at the experience of other, diverse countries that have a licensing scheme—Finland, Hungary, France, Italy, Spain, Australia, Canada and Singapore, to name some—because there is a lot to be learned from them. I urge the Minister to have a good look at what is happening elsewhere.

A vaping licensing scheme is particularly welcome. Currently, vapes are prolific on our high streets, in markets and at counters in nail salons, and so on. They are unregulated, and that must change to protect people and hold those that are responsible to account. I very much welcome the move to have a licensing scheme here, and I associate myself with what my noble friend Lady McIntosh of Pickering has just said.

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[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I am most grateful to noble Lords for their contributions to this debate. This group of amendments deals with the details of the forthcoming retail licensing scheme.

Let me say in opening, in response to all of these amendments, that our intention in this regard is very much what the noble Earl, Lord Howe, just spoke about: to support legitimate businesses that stick to the rules while deterring and being able to deal with rogue retailers. We want the scheme to minimise the burden on retailers and local authorities as far as is possible—again, a point that was rightly made by a number of noble Lords.

Let me first turn to Amendment 30, moved by the noble Baroness, Lady McIntosh. I hope I can reassure her that the Government are carefully considering the design and implementation of the licensing scheme. In respect of her opening comments, we look forward to continuing to work with the Association of Convenience Stores and other important and relevant groups. Considering the design and implementation of the scheme will include the interaction with alcohol licensing.

I can tell the noble Baroness, Lady Walmsley, that we are working closely with the Department for Business and Trade as well as the Home Office. However, as she recognised, ultimately, our objectives and motivations are different; they may be complementary, but they are different. For example, on alcohol licensing, the focus is on supporting resilience and growth of on-trade venues that provide safe and regulated spaces for people to socialise. With tobacco and vape licensing, as I said, it is about ensuring that we support those who abide by the rules and act as a deterrent to those who do not. Of course, we have a public health objective.

The noble Baroness, Lady McIntosh, asked about pressures on enforcement, which is a very reasonable question. Local authorities will be able to use the licensing fee they collect from retailers to cover the cost of running and enforcing the licensing scheme. That will assist local authorities and will ensure that the scheme is implemented and sustainable. I believe the noble Baroness also asked if there would be enough time for training and development. Again, that will be part of our discussions that will follow from the call for evidence and the consultation after that, which I will come to very soon.

I want to pick up the point the noble Lord, Lord Bourne, made about looking to other nations. We are aware of several international examples where this has been very successful, including some cities in the United States, Finland, Hungary, France, Italy, Spain and Australia. We have much to call on and will absolutely be considering what works best in the development of our own scheme.

Noble Lords will recall from earlier discussions that we have recently launched a call for evidence, which closes on 3 December. That is on a whole range of issues, including questions about the process for granting licences and implementation more generally. That will inform a subsequent consultation on the detail of the scheme. The points being raised today are all important and they will be considered through both those actions.

I turn now to Amendments 35 and 42, tabled by the noble Lord, Lord Kamall. Amendment 35 seeks to prevent the Secretary of State requiring licensing authorities to consider the location and/or density of tobacco and vape retailers when they make decisions on the granting of licences. The call for evidence asks for feedback on how licensing authorities should make decisions and whether and how much factors such as the ones the noble Lord rightly raised, location and density, should have a role. However—I am sure many noble Lords would agree with this—there are certain places where it would obviously be inappropriate for a tobacco or vape shop to be located. For example, I have not heard a call for vape shops to open next door to children’s nurseries, so there are some obvious points. As our aim is to stop children and young people smoking and vaping, it is absolutely right that we consider factors that might have a role, such as the location and density of retailers. I am very much looking forward to the feedback on this through our call for evidence.

Amendment 42 would require the Government to consider the benefits of combining tobacco and alcohol licensing into a joint scheme. I certainly understand the noble Lord’s very good intention to learn from existing licensing schemes and to avoid unnecessary burdens on retailers—something I have already associated myself with. We recognise that alcohol licensing is established and familiar to a lot of businesses, and that we can learn from alcohol licensing when designing the new scheme. That is why the call for evidence includes detailed questions on the design, and why we have to consult. It is the right thing to do, but it will also meet the intentions of the amendments before us. This process will allow us to consider where we can make use of existing systems and practices, as noble Lords have called on us to do. We share the view that the minimisation of additional costs and burdens, as far as possible, is the right thing to do, while ensuring that the new licensing scheme achieves our aims on tobacco and vapes.

I agree with the noble Lord, Lord Bourne, when he said that the current lack of a licensing system for tobacco is a major gap in enforcement. Therefore, I am glad that the introduction of this new retail licensing scheme is strongly supported by retailers and the public alike. I hope I have been able to reassure noble Lords and that they will not press their amendments.

[Baroness McIntosh of Pickering (Con)]

My Lords, I am very grateful for the opportunity to have had a debate on this small group of amendments. I am also grateful for the support from my noble friend Lord Bourne. I took great comfort from the fact that this has been achieved in other countries, so we can perhaps follow their good practice. I also thank my noble friend Lord Howe.

I think the noble Baroness, Lady Walmsley, misunderstood what I am trying to achieve here. I am trying to set out similar grandfather rights to those awarded in the implementation of the original alcohol licensing Act, as applied in 2005. These rights would allow those businesses already selling the products to continue selling them, but under a process I have set out. I hope that is something she might support going forward.

This is intended as a probing amendment, and my noble friend Lord Howe made the point that we are looking for fairness, proportionality and practicality. I hope that will be a red line running through this process. I hope we can return to this at a later stage, but for the moment I beg leave to withdraw my amendment.

Amendment 30 withdrawn.

Healthcare Provision: Inequalities

Baroness McIntosh of Pickering Excerpts

Monday 20th October 2025 Lords Chamber

[Baroness Merron (Lab)]

The 10-year health plan has tackling inequalities at its very heart, and that is the big driver throughout. Health inequalities are strongly associated with deprivation, and it cannot be right that healthy life expectancy at birth for a girl born in Wokingham is 70.8 years, but 52.6 years for a girl born in Barnsley. I think we get a real sense of the challenge.

However, I would not expect every local area to approach this in exactly the same way, not least because the challenges are different. That is why the whole structure of the NHS, including funding, will allow local areas to meet the needs and the challenges, which are considerable in certain areas, in the way that will deliver the best outcome.

[Baroness McIntosh of Pickering (Con)]

My Lords, will the Minister look closely at the inequalities between rural and urban areas in delivering healthcare? The Minister is aware of the work I do with dispensing doctors. Is she aware that community pharmacies and dispensing doctors in rural areas are struggling, as they are not being reimbursed for the national insurance contributions increase announced at the last election? I understand that hospitals are having these reimbursed. Will the Government look at this to ensure that rural pharmacies and GP practices have a level playing field with those in urban areas?

[Baroness Merron (Lab)]

We have discussed national insurance contributions a number of times in your Lordships’ House, and I can only repeat the previous assurance, given not just by me but by other Ministers: that in making the decision, the Chancellor took into account not just the funding available—for example, in the Department of Health and Social Care, which was notable and welcome—but the impact.

In respect of rural areas, the national approach to inform action to improve equality in healthcare does define groups, including those in rural and coastal communities, so I can assure the noble Baroness that this issue does get the attention she seeks.

National Health Service Regulations

Baroness McIntosh of Pickering Excerpts

Tuesday 16th September 2025 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I remind the House of my interest with the Dispensing Doctors’ Association. What assessment have the Government, in particular the Minister, made of the way in which the GP contract will impact on rural doctors—not least the Dispensing Doctors’ Association, which cannot even access the EPS system at the moment, which is obviously disadvantaging its patients?

[Baroness Merron (Lab)]

The expectation is that all GPs, including those in rural areas, will benefit greatly. The premise of the 10-year plan, which was announced recently, is to improve patient access. That is a particular issue in rural areas and is absolutely key, no matter where you are—whether you are appearing in person, are seeking to get online access to your GP or are on the phone. Remember, this is all about, for example, ending the 8 am scramble. Noble Lords have been very critical and I share in their criticism. I think that, particularly in rural areas, where people face various challenges in getting around, these changes will improve things massively for both GPs and patients.

Primary Healthcare Facilities

Baroness McIntosh of Pickering Excerpts

Monday 17th March 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord is right to highlight regulation. Of course, there are many other aspects beyond physical infrastructure: for example, the use of technology, which also supports the subject on which we are speaking. All these matters are being considered as part of the 10-year plan and I am sure we all look forward to that reporting.

[Baroness McIntosh of Pickering (Con)]

My Lords, is the Minister aware that there is a network of community hospitals which survives? Will she therefore use some of the funds to ensure that these community hospitals remain in place, so that, after a stroke or treatment, patients will be made fit to enable them to return home?

Food and Feed (Regulated Products) (Amendment, Revocation, Consequential and Transitional Provision) Regulations 2025

Baroness McIntosh of Pickering Excerpts

Monday 10th March 2025 Grand Committee

[Baroness Coffey (Con)]

My Lords, I welcome these regulations, on several grounds. First, as the Minister mentioned, this is a deregulatory approach. There cannot be many regulations deemed to be deregulatory that have 104 pages, but 70 of those pages deal with revocations of existing legislation. That is to be welcomed.

I completely support that this will be a risk-based approach. I am conscious that consultations are ongoing on products being considered by the FSA under this approach. I am conscious that some may be concerned about removing the need for separate secondary legislation, which is a hangover from our days in the European Union, but this is perfectly routine.

I have a couple of questions for the Minister. First, I am conscious that the Food Standards Agency is a non-ministerial department, with the DHSC leading on this in government and in Parliament. Can she confirm whether DHSC Ministers will be making these decisions or whether it will be open to Defra Ministers?

Secondly, an issue that arose during the passage of what is now the precision breeding Act was concern that the devolved Administrations would be reluctant to have any GMO in products sold in their countries. The purpose of the United Kingdom Internal Market Act and the non-discrimination principle was to make sure that, where something had been given the go-ahead in England, say, it could be sold anywhere across the United Kingdom, respectful of the devolved Administrations but nevertheless giving consumers that choice. Will the UK Government fully assert the non-discrimination principle in the sale of future products? As I said, I support these regulations.

[Baroness McIntosh of Pickering (Con)]

My Lords, I support the comments made by my noble friend and concur entirely. I congratulate the Minister on bringing forward this streamlining and deregulatory process. However, I share some of the concerns put forward by the Secondary Legislation Scrutiny Committee.

My noble friend talked about GMO. I am personally very wary of GMO products: I would like to know if I were eating such a product or if such feedstuff was being fed to an animal that I may go on to eat. Can the Minister assure me that the removal of the renewals process will not lead to any information affecting the suitability of validation methods for GMOs being overlooked? Put simply, can the public and consumers rest assured that the processes that have been followed hitherto will be followed? How can the public be made aware of those processes and know that that is the case?

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[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their valuable and considered contributions to the debate today. I re-emphasise the main point I made in my opening comments: removing automatic renewal processes and statutory instrument requirements will not lower food safety or standards. I am grateful for the support from the noble Baroness, Lady Coffey, and for her bringing to bear her experience across relevant departments, as well as from the noble Baroness, Lady McIntosh, and the noble Lord, Lord Kamall.

I have heard a number of concerns, including from the noble Baronesses, Lady Bennett and Lady Walmsley. I understand the points made, and I hope that I can reassure them further from my opening comments. I am very happy to follow up where I have not got the ability, time or wherewithal to answer the questions.

The noble Baroness, Lady Coffey, asked about ministerial decision-making and the assertion of the non-discrimination principle. These reforms do not change what is in place to maintain the functioning of the internal market Act. Differences in approach will continue to be managed through the relevant common frameworks. I reassure not only the noble Baroness but other noble Lords that the FSA and the FSS are strongly committed to achieving a four-nation consensus, in line with our commitment to the food and feed safety and hygiene common framework. Decisions by Ministers in England—which will be from the Department of Health and Social Care, to the point brought up by the noble Baroness—as well as Scotland and Wales, will still be required for authorisations in their respective nations.

The noble Baroness, Lady McIntosh, asked about processes that will be followed with the removal of the renewals process. This SI does not change current GMO labelling requirements, which I know was another matter of concern to other noble Lords. Products that contain or consist of GMOs must be clearly labelled as defined in current legislation. Nothing will change in that regard. Following the reforms, businesses will continue to be required to notify the FSA and the FSS, if they have any new information which might affect the suitability of a validated laboratory-based method for the identification, detection and qualification of GMOs, something that the noble Baroness, Lady Bennett, was also concerned with.

To the point about the SLSC, it is suggested that the House may wish to consider the steps proposed to maintain parliamentary oversight. However, proportionate processes are in place for sufficient scrutiny of authorisation decisions, such as public consultation and the publication of safety assessments and authorisations. It is an important point that the authorisation process remains open and transparent. The SLSC recognised that this aligned with the processes used by other UK regulators.

[Baroness McIntosh of Pickering (Con)]

I do not wish to labour the point too much, but when a statutory instrument is presented to this Committee, we have the opportunity as parliamentarians to look at it. How will we be informed of the renewals if they are on a register? Do we have to ask someone to notify us? How do we know? At the moment, it is automatic; in future, it will not be.

[Baroness Merron (Lab)]

I understand the point the noble Baroness is making. I will turn to the point about the availability of information, which was also the point that the noble Baroness, Lady Walmsley, made. However, details of applications and authorisations will actually be more publicly available than they are currently. I hope that will be helpful. Of course, as we know, Ministers must provide reasoning if they disagree with FSA and FSS advice when they are making their decisions. In order for the public and anybody—including Parliament—to scrutinise regulated product applications and authorisations, all those tools and resources will be available.

The noble Baroness, Lady Walmsley, suggested a reporting mechanism. I am happy to look at that and will take into account what she said. But I say to noble Lords—and I know they know this—that statutory instruments are not the only way in which to hold matters to account, nor are they always the best way to ensure transparency and openness. We are seeking to be more transparent and ensure that we make this an easier place for industry, the public and others to work in—which most noble Lords welcomed.

National Cancer Plan

Baroness McIntosh of Pickering Excerpts

Monday 10th February 2025 Lords Chamber

[Baroness Merron (Lab)]

I am glad that my noble friend is in the health that he is. I am sure that those who have supported him will appreciate his thanks and ours.

The considerations my noble friend raises are very much part of the considerations of the national cancer plan and the 10-year plan. With respect to funding, the allocation to healthcare in the recent Budget has allowed us to take steps to arrest a continuing decline and to fix the foundations. The fact is we are spending more and we are getting less. We have to do things differently. That will mean not just looking at money but reforming care, using solutions such as technology and AI to go further still.

[Baroness McIntosh of Pickering (Con)]

My Lords, I refer to my interests in the register. I warmly welcome the national cancer plan. The Minister will be aware that there still is an unacceptable wait time of 62 days. Will she use her good offices to ensure that there is early referral from GPs and that more funding is made available—for this purpose and longer appointments with GPs—if that is needed to make the case for earlier diagnosis and referral?

[Baroness Merron (Lab)]

I say to the noble Baroness that the overall trend for cancer performance is improving but it still needs to improve further. We will take all the necessary steps. The planning guidance set stretching targets for cancer, which will see around 100,000 more people every year having cancer confirmed—or ruled out—within 28 days, and about 17,000 more people beginning treatment within two months of diagnosis. The key to all of this has to be early diagnosis and treatment and ensuring that people do not get missed out, as we have discussed earlier. The trajectory is in the right direction, but they are small steps and we need to ratchet it up.

National Insurance Contributions: Healthcare

Baroness McIntosh of Pickering Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

As the right reverend Prelate is very aware, most hospices are indeed charitable. They are independent organisations that receive some statutory funding for providing NHS services. As we discussed in a recent debate in your Lordships’ House, the amount of funding that charitable hospices receive varies by integrated care board area, and that will depend in part on population need and the breadth and range of palliative care and end-of-life care provision within the ICB footprint. With NHS funding being provided on a tariff basis, as is usual every year, there is NHS planning guidance, a local government finance settlement and consultations with independent providers. That will happen this year as it has every single year under every previous Government.

[Baroness McIntosh of Pickering (Con)]

My Lords, the Minister is aware of my interest with the Dispensing Doctors’ Association. The idea that allocations will be made in due course simply will not wash. GP practices, care homes and pharmacies will close their doors if the Government do not act urgently.

Pharmacies: Rural Areas

Baroness McIntosh of Pickering Excerpts

Tuesday 10th September 2024 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I refer to my role with the Dispensing Doctors’ Association; I am grateful to the Minister for paying tribute to it. The right reverend Prelate identified the problem of having equal funding in urban and rural areas, where the dispensing doctors she identified fulfil such a crucial role. Can she give the House a commitment that sufficient funds will be made available in the negotiation of the GP contract so that all the services that are available in urban areas will also be available in rural areas?

[Baroness Merron (Lab)]

I know that the noble Baroness understands that there are some services which cannot be provided—for example, online services do an excellent job, as do dispensing doctors, but although I regard the online option as a very creative one that I would like to see expanded further, there are some things that require in-person attention and that will not be possible. We of course take account of situations across the country, in all the discussions, and that includes rural areas.

Inflammatory Bowel Disease

Baroness McIntosh of Pickering Excerpts

Monday 20th May 2024 Lords Chamber

[Lord Markham (Con)]

I think there are two things. One is the CDC programme; the 160 centres and 7 million tests that we have rolled out are now very much helping in that space. However, it is also about making sure that the right people get the tests. On the question of awareness as well, we now have these faecal tests—a bit like bowel cancer screening—which can tell with 90% sensitivity whether you have inflammatory bowel disease or irritable bowel syndrome. With one, you absolutely need to see a specialist for endoscopy, while with the other, you do not. Telling the difference is key.

[Baroness McIntosh of Pickering (Con)]

My Lords, does my noble friend share my concern that a number of people, increasingly women, are being wrongly diagnosed with IBS when in fact they have an underlying cancer condition? How does he imagine that we can rectify this situation?

[Lord Markham (Con)]

For the benefit of the House, I would say they are often confused. Irritable bowel syndrome is suffered by about 10% of the population while inflammatory bowel disease—we are talking about Crohn’s disease and colitis—is suffered by less than 1% of the population. The key thing is trying to understand the difference between the two; as I say, we have this poo test, for want of a better word, which can do that. With people who test positive, you absolutely need to get them into that screening programme and get it right the first time, so you can pick up those problems and things such as cancer.

Integration of Primary and Community Care (Committee Report)

Baroness McIntosh of Pickering Excerpts

Thursday 9th May 2024 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I congratulate the noble Baroness, Lady Pitkeathley, and the committee on their report and on securing this debate. I also welcome my noble friend Lord Jamieson and congratulate him on his excellent contribution today.

I declare my interest as an adviser to the Dispensing Doctors’ Association, and the fact that my late father and brother were both dispensing doctors. Dispensing doctors are general practitioners who provide primary healthcare to around 9.9 million rural patients. Almost 3.5 million of those patients live remotely from a community pharmacy and, at a patient’s request, dispensing doctors are allowed to dispense the medicines they prescribe for them. Only certain patients are eligible to receive dispensing services from a dispensing doctor. In total, around 7% of all prescription items are dispensed by such doctors.

The unique benefit of a dispensing doctor service is that it provides access to medicines and general healthcare under one roof. They provide a total network of 1,107 dispensing practices, spread across England, Scotland and Wales, and are a wonderful example of integration between prescribing and dispensing services that are collocated.

Turning to the conclusions of the report and the Government’s response, I think it is important to note that in Scotland health and social care partnerships have existed for a few years, yet funding arguments continue and, despite integration, there is still inadequate funding for social care, with a lack of care placements, delays in discharge from the acute sector and difficulties admitting patients in A&E, so integration has not yet met the needs of patients in Scotland. I ask my noble friend directly: does he agree that neither GPs nor their contracts currently prevent shared facilities? There used to be physios, district nurses, health visitors and others all collocated at a surgery, but it was these very organisations that removed themselves from the premises, not GPs.

I have some points to put directly to my noble friend the Minister. Remote consultations are simply not the answer. Complex patients and multiple conditions need more face-to-face time with GPs. Social care is means-tested; healthcare is needs-led. The difference between them must be addressed before integration can proceed further. Does he not agree that coterminous health and social care areas do not necessarily work for health, where patients may be given a choice, and it could actually destabilise current general practice if that were to happen? I also ask him to consider that it is not about who owns GP practices, which is perhaps a red herring. The Government must address the rules about occupation, then ownership itself becomes irrelevant. Will my noble friend and his department be mindful of the poor history of contracting, particularly GPs contracting out for out-of-hours service?

I ask my noble friend this directly, because this is something where NHS England, particularly in parts of Suffolk, has got the wrong end of the stick: why has EPS for dispensing doctors, and indeed hospitals, not been commissioned and the infrastructure put in place? The question of who is to pay for that infrastructure remains a vexed issue. I put to my noble friend the words of Dr West, who chairs the Dispensing Doctors’ Association; they strike a chord with those of many others, such as the noble Baroness, Lady Barker, and my noble friends who talked about data sharing, as well as the noble Baroness, Lady Pitkeathley. He asks why there is not one prescribing record per patient. Currently, there are different records for GPs and each hospital where that patient may be treated.

Will my noble friend urgently address the issue of GP training? The government response says:

“We will ensure that all foundation doctors can have at least one 4-month placement in general practice by 2030 to 2031”.


I am staggered, as I am sure others are, that this is not already the case. How can it be that, among doctors who are reaching the end of their training and are looking to have a placement, there are still about 100, as of this week, who do not yet have a placement to go to? That is unacceptable when they have reached the end of what is already a very long period of study and training.

To conclude, if integration is to proceed, which I would welcome, it has to be costed and well thought through. There is no one size fits all. What may well work in an urban area such as Pimlico, which was the example that was chosen, may not work in North Yorkshire or other very rural, sparsely populated areas. It has to be acceptable for the doctors and healthcare workers as well as the patients. Again, I note that integration in Scotland has not yet brought benefits to patients. I urge my noble friend the Minister to put GPs at the centre of patient care and ensure they have access to all patient needs, to ensure better care and fewer emergency admissions to hospital and a joined-up healthcare and social care service.