Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

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

My Lords, I start by thanking all noble Lords for an extensive, passionate and insightful debate. As noble Lords have observed throughout this debate, its quality and its conduct have been exemplary, and I believe that that has allowed the expression of differing and deeply held views. I thank my noble and learned friend Lord Falconer for his work in introducing this Bill to the House, and I know that many noble Lords are waiting to hear from him as the sponsor.

We have all heard the debates across the country, in which campaigners on both sides have made their case with conviction and care. We have also heard the debates in the other place, and we know the previous consideration that this House has given to the topic of assisted dying. Now it is our turn to scrutinise this legislation.

I turn first to the important issue of the role of the Government, which relates in some part to the Motion in the name of the noble Lord, Lord Forsyth, and the amendment to it from the noble Lord, Lord Carlile. The Government are neutral on the principle of assisted dying. It is a matter of conscience. Whether the Bill becomes law is a decision for Parliament, and my role, alongside that of my noble friend Lady Levitt, is to help ensure that, if this legislation is passed, it is legally and technically effective and workable. So, as with any legislation, if Parliament chooses to pass the Bill, the Government will be responsible for its implementation.

The noble Lord’s Motion refers to time being made available for consideration of amending stages. Scheduling is of course a matter for my noble friend the Government Chief Whip, who will indeed keep this under review. The Government have a duty of care to the statute book and, as such, my officials and those in the Ministry of Justice have worked with my noble and learned friend Lord Falconer and the Commons sponsor Kim Leadbeater MP to offer drafting support and workability advice. This will continue throughout the passage of the Bill and is and has been usual practice.

Turning to the Motions in the name of my noble friend Lady Berger—

[Lord Forsyth of Drumlean (Con)]

Can the Minister explain why, despite requests from the sponsors of the Bill, and despite the precedent which has been taken with other Bills which were Private Members’ Bills but matters of conscience, such as capital punishment and abortion, the Government are not prepared to provide time so that this House can ensure that it is properly scrutinised and considered?

[Baroness Merron (Lab)]

I can only repeat the point I made that the Government Chief Whip will listen to the will of Parliament and will review as necessary.

The Motion and the amendment in the name of my noble friend Lady Berger refer to a Select Committee reporting to the House ahead of Committee of the Whole House commencing. The Select Committee should report by Friday 7 November. The outcome of these Motions and any others are indeed a matter for this House to decide on.

To the points that noble Lords have raised over whether this matter should have been for a Private Member’s Bill or a government Bill, I remind us all that, on matters of societal change, the Private Member’s Bill, with government neutrality, has long been used as the right vehicle to handle matters of sensitivity and importance such as this one. On this point of neutrality, I hope that noble Lords will understand my role and why it is not appropriate or possible for me as the Government Minister responding to respond to every point raised during the debate.

I thank the Delegated Powers and Regulatory Reform Committee and the Constitution Committee for their scrutiny of the Bill. As many noble Lords have highlighted, their recommendations will be important in the consideration. The content of this Bill and any delegated powers are a matter for the sponsor and Parliament. I am grateful to both committees because their recommendations will inform the scrutiny of your Lordships’ House. Noble Lords heard my noble and learned friend Lord Falconer’s opening remarks. He has already considered those reports and will continue to do so.

Many noble Lords have spoken about the importance of high-quality palliative care for all those who need it. I want to be clear that irrespective of any legislation on assisted dying, everyone must be provided with high-quality compassionate care through to the end of their life. While the majority of palliative and end-of-life care is provided by the NHS, we recognise the vital role played by the voluntary sector in supporting people at the end of their life. That is why we are providing the hospice sector with £100 million of capital funding for eligible adult and children’s hospices, to ensure that the best physical environment for care is available.

We recognise that more could be done to support people who need palliative and end-of-life care, as a number of noble Lords said. We are looking at how to improve the access, quality and sustainability of all-age palliative and end-of-life care, in line with the recently published 10-year health plan, and to make the shift from hospital to community, including making that care part of the work of neighbourhood health teams.

I thank noble Lords once again for their engagement, care and thoughtfulness during this debate. As I have said, the Government remain neutral on whether the Bill becomes law. Should Parliament pass this legislation, I can say to your Lordships’ House that it will be our responsibility to ensure that it can be implemented safely and effectively.

Genome Screening: Newborn Infants

Baroness Merron Excerpts

Thursday 18th September 2025 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I beg leave on behalf of my noble friend Lord Winston to ask the Question standing in his name on the Order Paper.

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

My Lords, as set out in the 10-year health plan, this Government have an ambition to offer newborn genomic testing as part of routine NHS care, subject to evidence gathered through the Generation Study, which is using whole-genome sequencing to test 100,000 newborns for over 200 rare conditions. With advice from the UK National Screening Committee and appropriate funding, genomic testing could be available for all newborns in the UK by 2035.

[Baroness Thornton (Lab)]

I thank my noble friend the Minister for that Answer, because this is of course a very serious issue, particularly in the case of babies and minors. There are grave difficulties in obtaining informed consent. Every person may be born with hundreds of genetic mutations potentially associated with fatal diseases, but nearly all are unlikely to cause serious health issues in the vast majority of those carrying such markers. Can my noble friend say what plans the Government have for funding and ensuring properly informed consent in screening programmes? I thank my noble friend Lord Winston for informing my question.

[Baroness Merron (Lab)]

My Lords, the Generation Study is particularly designed to inform policy of the type that my noble friend is rightly concerned with. These are extremely important issues, and I am glad to have spoken to our noble friend Lord Winston about these matters. Perhaps I could give the assurance that the study will test only for treatable conditions, where there is robust evidence that the condition is highly likely to develop within the first five years of life, and suspected positive results are then reviewed and confirmed through further tests. If genomic testing is used within future screening programmes, informed consent will still be required.

[Lord Kakkar (CB)]

My Lords, I draw attention to my interest as chairman of UK Biobank. The value of large-cohort studies is not only in the collection of baseline data, and indeed, in this case, the genome sequences of the 100,000 newborns, but in the opportunity to secure the long-term longitudinal follow-up of participants, so that there is a broader understanding of the change in health and health dynamics.

The Minister mentioned the question of consent with regard to genetic testing, but there is another question of consent, with regard to long-term access to the primary care data of those individuals who have participated in the study. Is the Minister content that there are appropriate arrangements in place with regard to consent to ensure long-term access to primary care data for those individuals?

[Baroness Merron (Lab)]

The noble Lord raises a very good point. Certainly, it is part of how we develop the use of data. I am aware that he did not directly ask me this, but perhaps I might use the opportunity to say that data safety, which I know is a matter of concern to many noble Lords, is absolutely paramount here. We also have absolute regard to conducting studies ethically, but the point about primary care data, its use and its value, as well as its safety, is very well made and one which we are certainly developing still further.

[Lord Jopling (Con)]

My Lords, while the screening of genomes in newborn infants is of course very important, it is even more important to find a cure for some of these dreadful hereditary diseases—I am thinking particularly of Huntington’s chorea. Does the Minister have any information as to what progress is being made, with a prospect some time, before too long, of having a cure for this dreadful disease?

--- Later in debate ---

[Baroness Merron (Lab)]

I am grateful to the noble Lord and will be very pleased to write to him on that specific. Part of this work in the programme we are referring to is on treatable diseases. For example, the Generation Study covers hereditary fructose intolerance, which means that babies would not be able to ingest fructose normally. By identifying it, we can then recommend removing fructose from their daily diet, which is a way of overcoming that condition. So, by spotting the condition early, we can take action. As the noble Lord says, there are indeed a number of areas in which further work needs to be done, but I would be very glad to write to him on the detail.

[Lord Kamall (Con)]

My Lords, while genome screening of newborns is welcome and could be an important part of the prevention agenda, it raises a number of ethical issues. I will focus on just one: at what stage do you tell someone who has a high probability of getting a medical condition, say in their 40s or 50s, about the probability or even certainty of developing that condition, without causing undue distress or even premature treatment? Can the Minister briefly tell noble Lords about the conversations that are going on in the department about these ethical issues, perhaps with the medical profession, and perhaps write in more detail later?

[Baroness Merron (Lab)]

As I mentioned to the noble Lord, Lord Kakkar, the matter of ethics is crucial in this development. It might help if I restated— I absolutely understand the noble Lord’s point—that that is why the Generation Study, which is directed at newborns, is for treatable conditions that may develop in the first five years of life, not later on. I understand why that would be of concern, and similarly of concern to my noble friend Lord Winston, so I hope that assurance will be helpful.

[Lord Mohammed of Tinsley (LD)]

My Lords, I just want to return to the issue of data and consent and build on the question from the noble Lord, Lord Winston, that the noble Baroness, Lady Thornton, talked about. Given that a newborn child cannot really provide consent for whole-genome sequencing and that the information collected has lifetime implications, what specific measures will the Government take to ensure that a child’s future rights to privacy and autonomy are protected, particularly concerning the storage and potential reidentification of their genetic data in research libraries?

[Baroness Merron (Lab)]

There were a number of very helpful points in there. To reconfirm and satisfy your Lordships’ House, this is for conditions that may develop up to the age of five. As with all screening, consent is required. As the noble Lord rightly says, a baby of course cannot consent, but the parents can. Around the age of 16, the plan is also to be able to seek that consent again from the young person. On data storage, it is stored securely in a research library run by Genomics England. Access is tightly controlled, overseen by an independent committee and permitted only within a secure environment. If the noble Lord would like more details, I would be very happy to provide them.

[The Lord Bishop of Chelmsford]

When will the House have the opportunity to debate this policy for whole-genome sequencing with all its details, given that it has such weighty and far-reaching implications for healthcare, prevention and a number of ethical issues, as we have already heard?

[Baroness Merron (Lab)]

A debate in this House will be a matter for my noble friend the Chief Whip. Members of your Lordships’ House may seek to encourage such a debate, which I would certainly welcome. I can say to the right reverend Prelate that the sequencing of 100,000 newborns through the Generation Study will be completed by summer 2027. The evaluation part of the study will then be completed and presented to the UK National Screening Committee, which will make a recommendation. Subject to all of this and appropriate funding, genomic testing could be available for all newborns by 2035— so there is a long window of opportunity for the right reverend Prelate.

National Health Service Regulations

Baroness Merron Excerpts

Tuesday 16th September 2025 Lords Chamber

[Lord Pack]

To ask His Majesty’s Government what assessment they have made of the effectiveness of the National Health Service (General Medical Services Contracts) Regulations 2015, as amended by the National Health Service (General Medical Services Contracts and Personal Medical Services Agreements) (Amendment) Regulations 2025.

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

My Lords, implementation of the 2025-26 GP contract changes is still under way. GP practices have recently been issued contract variations, but the changes have not yet taken full effect. The changes, agreed with the British Medical Association for the first time in four years, will improve access for patients and enable local health systems to hire more staff. The Government will closely monitor the impact once the changes are fully implemented in the coming weeks.

[Lord Pack (LD)]

My Lords, my concern is about the degree to which GP contracts are dictated by extremely prescriptive legislation. The recent change to keep GPs’ computers switched on overnight—rightly, to improve data sharing—is a striking example. It did not require just negotiation with GPs or advice from security and privacy experts, as it of course should: it also required Parliament to legislate to change the contract details. Does the Minister not agree that embedding this level of micromanagement in legislation not only is unhelpful but actively stifles innovation in the NHS?

[Baroness Merron (Lab)]

That is an interesting assessment of where we are; it is not one that I was about to speak of, but I hear what the noble Lord says. Let me say that, in implementing contract changes, it is absolutely usual—and, in my opinion, correct—that regulations are important and are consulted on. There is a whole list of things here around transparency. There was consultation with the BMA’s General Practitioners Committee, as well as the laying of the regulations and bringing them into force. This is all quite the usual practice—and actually, I think, good practice. I appreciate that GPs are very much the front door to our NHS and it is absolutely important that we make these changes in order to assist them and their patients.

[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.

[Lord Harris of Haringey (Lab)]

My Lords, my noble friend has described these changes in terms of the benefits for patients. How will the Government know whether they are of benefit to patients, given the decision to wind up HealthWatch, which itself was less than adequate in terms of patient representation compared with Community Health Councils, an organisation I knew well many years ago? Surely, that is a negative step and there should be a mechanism for local consultation and local engagement with patients through an independent body.

[Baroness Merron (Lab)]

I appreciate what my noble friend says about HealthWatch, which has done a sterling job over the years. However, in assessing where we are in ensuring that we have the right framework in place, including on patient safety—Dr Penny Dash recently published her report saying that the landscape was “cluttered” and it was difficult to hear the patient voice—it is right that we make the changes that we do to improve things. The reform to the GP contract very much assists general practice to be at the heart of a neighbourhood health service, and that is where we are going.

[Lord Sahota (Lab)]

My Lords, when the new Government came in, I heard that they were planning walk-in clinics. How is that progressing?

[Baroness Merron (Lab)]

In terms of development, as my noble friend will know, the 10-year health plan speaks very clearly of a “neighbourhood health service”, which people will find it easier to access. It will be up to local areas how they do that. In a number of areas, as my noble friend refers to, that will mean clinics where all services are under one roof. We would certainly encourage that. I can also give an example of a pilot scheme taking place now with mental health crisis centres. They are 24/7, all year round, and are available without referral for people who need mental health support, as well as advice and guidance: they can access those.

[Lord Kamall (Con)]

My Lords, as the Minister will know, the 2025 amendments to the regulations made several key changes, one of which was to keep online consultation talks open during surgery hours. While these Benches welcome the shift from analogue to digital, we understand that the National Pensioners Convention estimates that between 500,000 and 700,000 older people would not be able to access either the online consultation tool or patient records, either because they are not online or because they struggle to navigate apps and websites. Can the Minister update the House about what her department is doing to work with GPs and, in fact, the whole system of health and care, to make sure that that small minority of people who are not digitally literate, including older people, are not locked out of receiving health and social care?

[Baroness Merron (Lab)]

The noble Lord makes an important point. There is absolutely no intention that people will be disadvantaged in any way. This is about equalising access, which means keeping all forms of access open. That may be online, but it will also be possible to deal with things in person and on the phone. Obviously, if we can take pressure off phone access, or personal access, through the use of online, that will assist the group to which the noble Lord referred.

[Lord Hunt of Kings Heath (Lab)]

My Lords, my noble friend referred to Community Health Councils. I was one of the first CHC secretaries to be appointed in 1974.

[Lord Hunt of Kings Heath (Lab)]

Wait for it, my Lords—I was also the Minister who got its abolition through your Lordships’ House. Mea culpa; I was mistaken. We should bring it back.

[Baroness Merron (Lab)]

My noble friend does himself credit with his honesty, which I too will take example from .

[Lord Kirkhope of Harrogate (Con)]

My Lords, there are concerns about the use of physician associates in many general practices. They are not of course doctors but are now on the front line of giving advice and assistance. Is the Minister satisfied about the way in which these people are deployed? Is she happy that the security of patients is completely safe with the use of these people?

[Baroness Merron (Lab)]

Physician associates often work in hospitals and are there to develop the availability of care. The noble Lord is right to say that there are concerns around physician associates. That is why my right honourable friend the Secretary of State for Health and Social Care announced an independent review to work out where there are problems and what we need to do to make sure that there is no confusion among patients about who is treating them, and also that patient safety standards are upheld.

[Baroness Pitkeathley (Lab)]

My Lords, does my noble friend agree that, from the patient’s point of view, the team around the GP is as important as the GP? As yet, we have no way of applying the regulations to teams. Does she think that this ought to be pursued, in the interests of the patient?

[Baroness Merron (Lab)]

I agree with my noble friend. In the contract changes, we have removed caps on the number of staff recruited. Importantly, we also expanded reimbursable roles to include practice nurses, to do the very thing that my noble friend asked about, which is to increase workforce capacity.

Respiratory Syncytial Virus: Vaccination Programme

Baroness Merron Excerpts

Tuesday 9th September 2025 Lords Chamber

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

My Lords, I am sure we are all in agreement in our thanks to my noble friend Lady Ritchie for securing this important debate and for her very thorough and considered introduction. Acknowledgement has also rightly been paid to my noble friend for her campaigning and her raising of awareness of this issue, which has made a real difference, as we have heard. I am grateful to all noble Lords for their helpful contributions and questions, which I will reflect on and share with the responsible Minister: Ashley Dalton MP, the Minister for Public Health.

RSV is a common virus that 90% of children get before the age of two. It is often mild, causing a cough or a cold, but can also be serious—it can sometimes be fatal because it can cause lung infections such as bronchiolitis and pneumonia which make it difficult for babies to breathe and to feed. Watching your baby struggle for breath is alarming for any parent, carer or family member, and far too many know what this feels like as RSV is the biggest cause of winter admissions in children’s hospitals every year.

My noble friend asked about the collection of systematic data. I can confirm that, as with all major infectious diseases, the Government regularly review data collected on the impact of RSV and continuously monitor immunisation programmes, including uptake levels in different groups. I am glad to say all noble Lords have raised this theme, and I will return to it later. Researchers and government epidemiologists provide evidence to the Joint Committee on Vaccination and Immunisation and the JCVI’s advice is of immense and direct importance to any decision.

In June 2023, the JCVI—as noble Lords have said—recommended programmes to protect babies against RSV, and in September 2024 this Government introduced vaccinations for all pregnant women from 28 weeks. But last year the JCVI highlighted how very premature babies may not benefit from this new programme, either because they are born before their mothers are vaccinated or because there is limited time for the protection to be passed down to them during pregnancy after their mothers have been vaccinated.

I am glad to say that this debate gives me an opportunity to update your Lordships’ House on the key changes the Government have made recently to deliver equity in RSV protection, something all noble Lords have emphasised the importance of this evening. Since 2010, the NHS has offered an immunisation called palivizumab to infants at greatest risk of severe RSV illness. This is effective, but it is also expensive, as it requires a monthly injection, which means it has been limited to around 4,000 infants at most risk each winter. I know that the noble Lord, Lord Mott, is very concerned, as am I, about winter pressures, and rightly so.

I am therefore delighted to announce that from the end of this month the NHS will also start offering immunisation to all premature babies born before 32 weeks, as advised by the JCVI. This is the result of the Government working with the NHS and partners to secure a product that is more effective in tackling infant RSV. The new immunisation is called nirsevimab. It provides better protection and requires only a single injection over winter. I am sure that all noble Lords will welcome this development; it shows the improvements and changes we can make by harnessing technology and innovation, and I am glad to be able to share it with noble Lords this evening.

My noble friend Lady Ritchie asked about the steps the Government are taking to ensure protection for all infants going into their first winter, including for babies born prematurely and those whose mothers have chosen not to get vaccinated. Let me say loud and clear that my message is that vaccination during pregnancy is the best way to prevent babies from becoming seriously ill with RSV.

The vaccination programme is expected to have a major impact on RSV this winter, including for the most premature babies. The vaccine is offered from week 28 of pregnancy, and most are given it by week 31. As my noble friend observed, a study led by NHS paediatricians found that the vaccine was 72% effective in preventing hospitalisations in the first six months of life for infants whose mothers were vaccinated more than 14 days before delivery. Every noble Lord who has spoken this evening has rightly counselled against listening to misinformation, which is dangerous and damaging, and I certainly share that view.

The JCVI also noted that clinical trial data shows high levels of immunity in babies born 14 days after the mother is vaccinated. Compared with babies whose mothers are not vaccinated, immunity was also relatively high in babies born less than 14 days after the vaccination. This has informed the JCVI’s advice that babies born before 32 weeks are the group that requires an additional immunisation to protect them during the winter. Again, as with all new programmes, the Government will be closely monitoring the impact of the programme in different population groups.

As we have heard, the maternal RSV programme is only a year old, and already vaccine uptake in pregnant women has increased since the programme began. We want to see many more pregnant women getting vaccinated. Every noble Lord who has spoken this evening rightly asked what is being done to reduce the current variation in uptake of the maternal RSV programme across regions and ethnic groups—and the noble Lord, Lord Kamall, made a helpful comment about his recent meeting with affected groups.

We very much recognise how much more needs to be done, particularly in areas and communities where uptake is lower. That is why we are continuing to implement the NHS vaccination strategy to make vaccinations more accessible, locally tailored and inclusive. To do this, we are transferring the commissioning of vaccination services to ICBs. That will support NHS regions with delivering vaccination services that are properly tailored to the local needs of local populations.

We are also providing better access to vaccinations. For example, we are updating information resources in 30 languages, encouraging maternity services to have early discussions with pregnant women about vaccinations, and ensuring that training is in place so that staff can have the knowledge to address concerns and confidence in the programme. From this month, we are running broadcast and digital media communications to encourage pregnant women to get their RSV, whooping cough and flu vaccines, with greater efforts being made in the communities and geographical areas that have lower uptake.

The noble Lord, Lord Rennard, asked where the update on the UKHSA immunisation equity strategy is. I am glad to be able to tell him that the update was published in July, and it sets out to ensure a whole range of things, which I think will be of interest to noble Lords: there will be more accountable system leadership on immunisation inequities; there will be better access to timely, high-quality data; practitioners and policymakers will be better able to share, generate and use evidence; and there will be better people- and place-based approaches to communications and engagement around immunisation. It is certainly intended that these actions will raise awareness in communities across the country, as we have discussed.

The noble Lord, Lord Mott, rightly referred to winter pressures. I hope that in the way I have described, the reduction of the incidence of RSV will take pressure off the NHS in the winter. We know that flu is very much a recurring pressure. I emphasise to noble Lords that this year’s flu vaccination programme is under way. It began on 1 September for children and pregnant women; and adults aged over 65—which I know not everyone in the Chamber is, but a number of us are —those with long-term health conditions, and front-line health and social care workers can get their flu vaccine from 1 October. Again, I encourage everybody to do so.

The noble Lord, Lord Rennard, asked when the JCVI will consider the immune-suppressed. It has advised that the expansion of the older adult immunisation programme will be guided, as ever, by emerging evidence of disease incidence in different groups, and we will certainly be considering any future advice.

The noble Lord, Lord Kamall, asked about good news stories, so to finish: the reported increase in the uptake of whooping cough vaccines given to pregnant women reached 72.6% because of the communication and the attention given to that. The Government will continue to monitor the impact and the Government are pleased to have made a real and positive impact for babies, parents and others affected by RSV.

Suicide Reduction

Baroness Merron Excerpts

Monday 8th September 2025 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what steps they are taking to reduce the rate of suicide.

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

My Lords, our Plan for Change clearly commits to a renewed focus on preventing suicides. We know that one-third of all suicides are committed by people who are in contact with mental health services, and our new 10-year health plan sets out how we will strengthen and improve those services. We are committed to delivering an ambitious cross-government suicide prevention strategy to extend our reach, and recently published the new Staying Safe from Suicide guidance.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank my noble friend the Minister for her Answer. Wednesday 10 September is World Suicide Prevention Day; can my noble friend give the House further assurances that the Government are intent on delivering the suicide prevention strategy for England and the implementation of the ambitions contained therein? Will the Government work with civil society, including charities such as the Samaritans—which is currently subject to some restructuring—to ensure that suicide prevention is an integral part of the delivery of the NHS 10-year plan, to which the Minister has already referred?

[Baroness Merron (Lab)]

I am very pleased to be able to provide the assurances that my noble friend seeks. I reiterate our commitment to implementing the strategy. My colleagues and I continue to work closely with our trusted partners in civil and voluntary society and elsewhere. The Secretary of State will be joining the Samaritans this week at their World Suicide Prevention Day event. I am also pleased that the e-learning module from NHS England’s Staying Safe from Suicide guidance, which I mentioned earlier, will be launched later this week.

[Baroness Browning (Con)]

I know that the Minister has an interest in this. Would she please find time to read the report, published last week jointly by Cambridge and Bournemouth universities, on suicide and autism? Among all the neurodivergent conditions, autism has by far the highest suicide rate. It is not rocket science why; it is preventable and I know the Minister will do all she can to help get that figure down.

[Baroness Merron (Lab)]

The noble Baroness is quite right to speak as she has done. The suicide prevention strategy and the seven priority groups it identifies does include autistic people. As the noble Baroness will know, I think that is particularly key and I will certainly be pleased to look out for the report to which she refers.

[Lord Scriven (LD)]

My Lords, first, I welcome the Minister back to her place and wish her rudimentary health in the future.

Internationally, a co-ordinated government approach, as the noble Baroness said, is a proven factor in reducing suicide. She said moments ago that two-thirds of people who commit suicide are not actually involved in mental health services. In light of international practice, where the best success rates are when co-ordination is dealt with not by one department but across government, would the Government look at potentially moving this to the Cabinet Office, rather than it being led purely by the Department of Health?

[Baroness Merron (Lab)]

I thank the noble Lord for his warm welcome back to the Dispatch Box in full health. The noble Lord makes an interesting suggestion. I will be co-ordinating a cross-government suicide prevention approach. It is the case, as the noble Lord alludes to, that this cannot be solved by DHSC alone. However, it is where it is placed presently and I assure him of the cross-government commitment we are making, and also how that will be developed so that it is much more meaningful than it is at present.

[Baroness Watkins of Tavistock (CB)]

My Lords, I too welcome back the Minister. With her leadership in this area, how will she ensure that the e-learning programme, which I am delighted is now ready, will be extended way beyond mental health practitioners? For example, school nurses, health visitors and many community nurses would benefit from undertaking that module. To do so, they would need additional time as part of their continuing professional development. Can the Minister confirm that that will be considered?

[Baroness Merron (Lab)]

I thank the noble Baroness as well for her kind comments. I assure her that the whole point about the e-learning module is that it can extend to people beyond those in mental health services. As I mentioned, only one-third of those who die by suicide are in contact with mental health services. Of the other two-thirds, a number are in contact with other health services, or other services, while some are in contact with none. There is a lot of work to do in this area and I am looking forward to developing it in the way that the noble Baroness referred.

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Ritchie, for raising this important issue today. The Minister will be aware that the data on suicides shows some disparities: for example, men make up three-quarters of reported suicides and the north-east of England has a suicide rate nearly twice as high as that of London. What research are the Government aware of that explains such disparities? What is being done in local communities, especially by civil society organisations, to try to reduce the rates of suicide in those communities?

[Baroness Merron (Lab)]

The noble Lord is right that there is disparity, which is often linked to priority risk factors, including, for example, financial difficulty, physical health, alcohol and drug abuse, harmful gambling, domestic abuse, social isolation and loneliness. Those priority risk factors are, sadly, more at play in the more disadvantaged areas to which the noble Lord referred. As we seek to develop further the effectiveness of the strategy—we have made great progress so far, but it is not enough—we need to ensure that the whole country is attended to and that we address the risk factors for suicide for everybody.

[Baroness Berger (Lab)]

My Lords, I too extend my warm welcome to my colleague; it is fantastic to see my noble friend back on the Front Bench. In our country, the greatest killer of women in the year after birth is suicide. What are my noble friend and her department specifically doing, within the suicide prevention strategy, to look at this very serious issue? What can we do to stop these tragedies, which affect not only the mothers but their children?

[Baroness Merron (Lab)]

I thank my noble friend for her comments and kindness. She is quite right that maternal health is absolutely key and to speak about the impact not only on mothers but on their children. We have developed a considerable programme for mental health well-being. We are also recruiting 8,500 mental health workers to reduce delays and provide fast treatment, because we need to ease pressure on what are incredibly busy mental health services. The area to which my noble friend referred is key and will be part of our development on maternity provision.

[Lord Stirrup (CB)]

My Lords, suicide rates among veterans as a whole are broadly in line with those of the population at large, but they are much higher among younger veterans, both men and women. There is evidence that, in the past, the NHS has struggled to understand the mental needs of such veterans. What is being done to improve the situation?

[Baroness Merron (Lab)]

The noble and gallant Lord raises an important point. I have been in discussion about a whole range of matters around veterans’ health with the Veterans Minister, and I would be very pleased to discuss this further with him in the way that the noble and gallant Lord described.

[Lord Oates (LD)]

My Lords, the Minister will be aware of the excellent work done by Samaritans’ volunteer listening service. Is she aware of its grave concern over plans to close over half of local Samaritans branches? Can she tell us what assessment the Government have made of the impact of those changes? Will she meet with representatives of those volunteers to discuss their concerns?

[Baroness Merron (Lab)]

I regularly meet with the Samaritans and doubtless will be doing so again soon. I know it is a matter for the Samaritans to decide how best to use its resources, but I will gladly speak with them.

Prostate Cancer

Baroness Merron Excerpts

Wednesday 3rd September 2025 Lords Chamber

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

My Lords, this has been an extremely valuable debate on what is a very important matter. I find much to commend in the points noble Lords have made. I am very grateful to the noble Lord, Lord Mott, for bringing this debate forward, for his work in raising awareness of prostate cancer and for his continuing campaign. Let me say at the outset that we are committed to finding a solution and working at pace on research, testing and treatment.

I thank the noble Lord, Lord Kamall, for welcoming me back to the Dispatch Box. I have missed his questions and all the questions in your Lordships’ House, so it is genuinely a pleasure to be back. This is a very important debate for my return.

I thank noble Lords for sharing their experiences, whether personal experiences such as those shared by the noble Lord, Lord Dobbs, my noble friend Lord Watson and others, or the experiences of those close to those directly affected, such as my noble friend Lady Royall. I thank her for raising that issue.

Too many men are dying of prostate cancer. Indeed, as many have said, any death from cancer is a tragedy. So, let me speak first to our Government publishing a national cancer plan later this year that will have patients at its heart, and our goal to reduce the number of lives lost to cancer. I assure my noble friend Lord Beamish that it will provide a specific focus on prevention and early diagnosis, very much in line with the Government’s health mission to shift from sickness to prevention.

We have been listening to and codesigning the plan with members of the public, the health workforce, charities, academics and other partners. I express my thanks to the cancer community for working tirelessly to advocate change. I say to my noble friend Lady Royall that we work very closely with charities, including on research, which I will come to shortly.

I thank everybody who contributed to our call for evidence on the national cancer plan. It received over 11,000 responses, which are now being analysed.

We continue to invest in all-important research through the research delivery network of the National Institute for Health and Care Research. The noble Lord, Lord Mott, referred to investment by former Governments as well as this Government. The most recent available data shows that in 2023-24, the Government invested over £133 million in cancer research. Having heard the very real concerns about prostate cancer screening, that is why this Government rode in behind Prostate Cancer UK’s £42 million TRANSFORM trial, which, again, was referred to by the noble Lord and others. This Government have invested £16 million into finding better ways to detect prostate cancer in men without symptoms, which has been the substance of this debate, and I have listened very closely.

I can say to noble Lords, including the noble Lords, Lord Patel and Lord Rennard, that the TRANSFORM trial will compare different screening test options. That will include MRI scanning, genetic testing through the spit—or saliva—test, and PSA testing. They are all part of that trial.

I am grateful to the noble Lord, Lord Bailey, for reminding us of a point that should never be forgotten: that black men have double the risk of being diagnosed with prostate cancer. Therefore, I assure your Lordships’ House that the TRANSFORM trial will ensure that at least one in 10 of those invited to participate in the trial are black men. This will establish an evidence base to reduce the increased and unacceptable risk of black men dying from the disease.

The UK National Screening Committee, about which there has been much discussion today, works closely with TRANSFORM, assessing new evidence as it becomes available. This ensures that prostate cancer policy and action is at the forefront. Prostate Cancer UK anticipates that the initial findings will be available within the next three years, while the trial will run for over a decade.

To respond to some of the points made by the noble Lord, Lord Taylor, I have referred to when TRANSFORM will deliver results. The noble Lord, Lord Patten, asked about the devolved Administrations. Health policy officials keep in extremely close contact on this very important issue. But, as noble Lords will be aware, health policy is a devolved matter and no nation within the United Kingdom currently offers a prostate screening programme. However, it is important to say that NICE and the Scottish equivalent have detailed guidance which is being used across the UK. I say to the noble Lord, Lord Taylor, that the BARCODE test is part of TRANSFORM. It may be a good test indeed, but we have to be sure that it is a good predictor of disease before going forward.

The PSA test absolutely has a place in men’s healthcare. The test works best in men with symptoms of prostate cancer. It also works in men who have had prostate cancer treatment to assess whether the treatment has been effective and in surveillance of men who have been successfully treated for prostate cancer.

The core issue of today’s debate has been GPs, although we have also talked about screening, and I will come on to that. Many GPs want to, and indeed do, inform men, particularly those at the highest risk, about prostate cancer. Health awareness is crucial in making informed decisions about one’s own health and I absolutely hear the point. This will be part of the consideration of the men’s health strategy which we will see in due course, following the consultation call for evidence. I think the reluctance men may have to come forward on health matters is understood and cannot be ignored.

There have been quite a few comments about GPs not being able to raise matters, not being able to offer tests, et cetera. The noble Lord, Lord Mott, raised the prostate cancer risk management programme in respect of allowing GPs to have proactive conversations with high-risk men. A number of noble Lords raised this, including my noble friends Lord Watson and Lord Beamish, and the noble Lords, Lord Dobbs, Lord Patel and Lord Kirkham, among others. This management programme is only guidance; it is aimed at GPs and their dealings with men. GPs—and I emphasise this to all noble Lords—are not prevented from taking relevant clinical actions that are in the best interests of patients or from having proactive conversations with patients. The Government will consider revising the management programme in line with the outcome of the UK National Screening Committee evidence review. The balance of benefit and harm, even in asymptomatic high-risk men, is unknown and under review.

The noble Lord, Lord Bethell, raised risk aversion among medics. In this case it is sensible to be cautious about offering PSA tests to men without symptoms because the current evidence, as we have heard in the debate, suggests that the test is unreliable when men are asymptomatic. I have heard noble Lords speak tonight and previously about their very positive experiences of the PSA test, and I absolutely have regard to that but there are issues to which it is important to refer. Even if there is a cancer present, the diagnostic tests—which include biopsy and MRI following a raised PSA result—cannot reliably differentiate between cancers that grow slowly and aggressive disease that requires treatment. Some slow-growing cancers may never progress to causing any harm in a man’s lifetime and by detecting non-aggressive cancers there is a risk of leading men into treatments they do not need. As the noble Baroness, Lady Murphy, said, this exposes men to significant harmful side-effects, including bowel and bladder incontinence and erectile dysfunction. We expect GPs to use their clinical knowledge expertly in discussing prostate cancer and sharing the pros and cons of a PSA so that men can make an informed choice.

I want briefly to refer to the national screening programme. We know that it would improve equity so that all eligible men would have equal access, regardless of who they are or where they are. With this in mind, we are seeking a solution. We have asked the National Screening Committee to prioritise looking again at the evidence for a population screening programme and one targeted at specific high-risk groups. I assure your Lordships’ House that the work of the committee is on track. Scientific reports were received in August. They are currently receiving expert consideration, following which there will be a public consultation to allow the committee to make a recommendation on prostate cancer screening, focusing on the essential question of whether the balance of good versus harm is met. The noble Lord, Lord Mott, and other noble Lords inquired about timelines. Consultation is expected to start in this calendar year and will last, as usual, for three months.

This has been an extremely important debate. I hope noble Lords get a sense of progress, commitment and delivery and I look forward to returning to this point in order that we can save lives.

Diabetes: 10-Year Health Plan

Baroness Merron Excerpts

Thursday 26th June 2025 Lords Chamber

[Baroness Humphreys]

To ask His Majesty’s Government whether their forthcoming 10 Year Health Plan will reflect the priorities set out in Diabetes UK’s 10 Year Vision for improved prevention, early diagnosis and access to care and technology for people with diabetes.

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

My Lords, the 10-year plan is not focused on specific diseases and conditions but will instead set out the changes that our NHS needs to be fit for the future—from hospital to community, from analogue to digital and from sickness to prevention—all of which closely align with the priorities in Diabetes UK’s 10 Year Vision.

[Baroness Humphreys (LD)]

I thank the Minister for that positive Answer. More than 12 million people in the UK now have diabetes or prediabetes, with research showing a staggering 51% increase in the last eight years in the prevalence of type 2 diabetes among under-40s in England, at an age when the condition is more aggressive and the risk of complications is higher. To help reverse this trend, will the Government embed suggestions from Diabetes UK’s 10 Year Vision into their 10-year plan, including the creation of a healthier food environment, with a ban on TV advertising of unhealthy food and an extension of the soft drinks industry levy?

[Baroness Merron (Lab)]

I can say yes to both of those because we have already committed to do that. The advertising restrictions were a manifesto commitment and will be implemented from 6 January. I can also tell the noble Baroness that from October this year, as the result of a consultation, the industry has already voluntarily agreed to abide by those restrictions. We had to make changes to make it more workable and I am glad we did that to get the right approach. I am also glad that we worked to get the voluntary agreement. I also said yes to the noble Baroness in respect of Diabetes UK’s 10 Year Vision, which we are very grateful for. I am also grateful for Diabetes UK’s interaction, which has been considerable, in the consultation on our 10-year plan. I thank Diabetes UK and I am sure the noble Baroness will join me in that.

[Baroness Williams of Trafford (Con)]

My Lords, following the report from the charity Breakthrough T1D, which found that people in lower socioeconomic groups and those over 65 were least likely to be aware of new technologies such as the hybrid closed loop systems, what plans do HMG and NHSE have to raise awareness of the latest technologies available to type 1 diabetics of all ages and socioeconomic groups?

[Baroness Merron (Lab)]

The matter of health inequalities is, obviously, one we are very concerned about. A national review is currently under way to update on monitoring, including of various groups. NHS England supports ICBs in improving diabetes care, including through the use of the medical technologies that the noble Baroness referred to, and, importantly, in reducing the variation in care that we still see across the country. It does that by using national data and insights, funding local clinical needs and addressing health inequalities through the national diabetes prevention programme. I certainly agree with the noble Baroness about the importance of raising awareness and the incredible contribution that new technology is playing. It has to be available for all and I hope we will establish that in the way I have mentioned.

[Lord Patel (CB)]

My Lords, I declare an interest as a patron of the South Asian Health Foundation. The south Asian population has a very high incidence of diabetes, particularly type 1, which is probably related to a strong gene marker. Some 50% of people with type 1 diabetes have some kind of gene marker. Those who have a strong gene marker in a particular region, the HLA region of chromosome 6, have a very high incidence. My point is that, if we screen people, particularly those with a family history of diabetes, for genetic markers, we will identify them much earlier, even in childhood. The prevention that is therefore required—changing their environment and diet—becomes more effective. This ought to be one of the preventive strategies for diabetes in high-risk populations.

[Baroness Merron (Lab)]

The noble Lord is quite right in his observations, which play to the point of the NHS that we want to see not just now but in the future. Noble Lords may have heard the announcement earlier this week that the Government are committing the necessary funding to screen babies early in their lives through the use of genomics, in order to, as the noble Lord said, identify underlying conditions that can be dealt with early on. There are some that cannot be prevented, but if they are diagnosed and anticipated, their management will be much better.

[Lord Rennard (LD)]

My Lords, continuous glucose monitoring and Mounjaro have helped me to come off insulin after 20 years of daily injections and have greatly improved my diabetic control. Such innovations are undoubtedly a cost saving to the NHS in the long run. Does the Minister think we are looking far enough into the future when we consider the cost-benefit analysis of their use? How can NHS spending plans take into account their long-term benefits to the economy by keeping people in work and getting many people back to work?

[Baroness Merron (Lab)]

The noble Lord, Lord Rennard, knows that it is always good that we hear about his own experience, because he epitomises the changes that are possible. I believe there is an understanding—not least because, as noble Lords will know, the Chancellor very recently gave the department a settlement that was, in large part, because of not just immediate need but looking to the future and the kind of NHS that is fit for the future we will see identified in the 10-year plan when it is published. Technology is certainly a huge part of that, which is why CGM and the hybrid closed loop system—the latter of which began to be rolled out in April 2024—are so important. There have been huge advances and they will be part of that NHS of the future that we seek to build.

[Baroness Altmann (Non-Afl)]

My Lords, I am delighted that the Government are producing their 10-year plan, and we look forward to seeing it. Following on from the question from the noble Lord, Lord Rennard, about protecting the labour force, can the Minister say something about fracture liaison clinics being rolled out across the country, to follow up on commitments made in the past that these clinics will be available across the country? These clinics can help boost productivity in the workforce; help older people, especially women, stay in the labour force; and prevent the fractures that so often force them out of work or cause accidents for older people.

[Baroness Merron (Lab)]

Fracture liaison services do an incredible job. I refer the noble Baroness to the words of the Secretary of State—I will not quote them because I do not have them to hand and there is nothing worse than misquoting somebody, particularly the Secretary of State—who has made his intentions quite clear on fracture liaison services. We certainly appreciate their value and the need to make that kind of provision available across the country.

[Lord Scriven (LD)]

With regard to what the Minister said about the DNA database of children with diabetes and other conditions, what are the mechanisms in place if a child, at the time they reach Gillick competence, no longer wishes to have their data on that DNA database? Will there be mechanisms so that the child can at that point withdraw their data and prevent it being used?

[Baroness Merron (Lab)]

All the usual provisions will apply, but, as we develop the system, all that detail will be confirmed. I will ensure that the point the noble Lord raises is fed into that consideration.

NHS and Social Care: Joint Working

Baroness Merron Excerpts

Thursday 26th June 2025 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what plans they have to promote joint training programmes and opportunities for joint working for staff who are separately employed by the NHS and social care agencies to encourage integration between the two services.

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

My Lords, the Government are committed to developing an integrated health and care workforce which is skilled and well supported and has opportunities for high-quality learning, to enable staff to develop and progress their careers across an integrated system. We are also implementing joint induction for all health and care staff, a mid-career management programme and, during 2025-26, the introduction of new management standards and unified core leadership and management standards for managers.

[Baroness Pitkeathley (Lab)]

I thank my noble friend for that positive reply. Does she agree that one of the main barriers to integration between health and social care is the lack of knowledge of the skills and experience of other professionals? Should the importance of integration therefore be included in initial clinical training, and should clinicians of all kinds be encouraged to understand the work of others by job rotation, so that they can be helped to appreciate the role of other colleagues and the importance of all professionals to patient care, no matter which agency employs them?

[Baroness Merron (Lab)]

I very much agree with my noble friend about the importance of integration. As she explained, it is not necessarily about training to be joint, but about the approach. I will feed back her particular suggestion about job rotation to Minister Karin Smyth, who is responsible for developing the workforce plan. I will also share her view—again, I am sure she will see this reflected in the workforce plan when it is published following on from the 10-year plan—on the importance of multidisciplinary teams in many areas. The one that we are talking about, health and social care, is a prime example.

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank the Minister for her previous very positive answers, but one of the biggest barriers to working together is different terms and conditions for care and health workers: in particular, the lack of pay for care workers who have to go between different visits in rural areas and have significant dead time. If we are really to move this forward, should we not put pressure on councils to ensure that the contracts they let allow for the time travelling between people who are being cared for?

[Baroness Merron (Lab)]

The noble Baroness raises a practical and realistic point that many care workers speak about. She will know that we are implementing a new fair pay agreement that, for the first time ever, will reflect what people actually do. Also, for the first time, there will be a universal career structure for adult social care that supports care workers. The approach that the Government are now taking shows a line of movement that takes seriously the pay, terms and conditions of care workers. I should also add that the noble Baroness, Lady Casey, will have free range to decide how she wishes to conduct her review of social care. Perhaps the noble Baroness, Lady Watkins, will ensure that she speaks to the noble Baroness, Lady Casey, about that.

[Lord Lansley (Con)]

My Lords, does the Minister agree that sometimes the most effective integration of care is around the decisions and choices of the care recipient themselves? To that purpose, would she agree that the NHS should be pursuing personal health budgets that can be combined with direct payments from social care entitlements, so that recipients of care can design their care, which will sometimes include the appointment of staff who are able to meet both purposes?

[Baroness Merron (Lab)]

I certainly agree with the noble Lord about the importance of the individual needs of the person at the centre. For too long—and part of this is a lack of integration—the needs of the person who receives, wants and needs that care and support have not been at the front. On his suggestion, I would just counsel waiting for the 10-year plan. It may not do exactly what the noble Lord says, but it will set out a way forward on how we will resolve such matters. I am sure that he will participate in further discussions about how we can get to the place that we all want.

[Baroness Burt of Solihull (LD)]

My Lords, I was very pleased to hear the Minister’s words on the progress and planning for this NHS 10-year plan. I was looking through, well, everything that I could find, really, and I could not find that any progress had been made, so I wonder whether the Minister could update the House on what is happening now and when she thinks we might start implementing this programme.

[Baroness Merron (Lab)]

I am not entirely sure, but I think that the noble Baroness is referring to my first Answer.

[Baroness Burt of Solihull (LD)]

Yes, I am.

[Baroness Merron (Lab)]

Good—thank you. This derives from the review by Sir Gordon Messenger. The first review was in 2022 and Sir Gordon came up with seven recommendations to strengthen leadership and management. To build on that, in November, Secretary of State Wes Streeting asked Sir Gordon to deliver further recommendations. That is why we now have a new national entry-level induction for new staff. As of 25 April this year, for example, it is being used by nearly 70% of trusts and ICBs to support staff enrolment. That shows how much it was needed and how much change it will make.

[Lord Rook (Lab)]

My Lords, the Archbishops’ Commission on Reimagining Care identified a number of solutions to tackle the workforce challenges in adult social care. These included better pay, improved career progression and role redesign. Could the Minister outline some of the steps that the Government are taking to address low pay, and to develop better training and development programmes and a more strategic approach to career progression in the sector?

[Baroness Merron (Lab)]

I very much welcome that report and am pleased that the Government have been responsive to identifying what we need to do. I never tire of saying that, to support the workforce in the way that my noble friend said, we are introducing a new fair pay agreement for adult social care and implementing the first universal career structure for adult social care. That will—and I know noble Lords are concerned about this—lift the status and attraction of work in social care. I believe that, alongside, for example, the apprenticeships that we are now making available and many other measures, we will get to a place where those in the workforce are doing the job we would like them to do and are being properly recognised on all counts for it.

[The Lord Bishop of Sheffield]

In the light of the 2023 Hewitt review into integrated care systems, how are the Government building greater awareness of adult social care in the NHS workforce in order to enable greater collaboration?

[Baroness Merron (Lab)]

Well, it is absolutely part of training, and the movement towards that integration of understanding across both sectors has been continuing for some while. The right reverend Prelate gives me the chance to say that we also have a digital platform that allows skills to be recognised across. The more we can do in that way, both technically and with people, the more success we will have in being integrated and building care around the person who requires it.

[Baroness Stedman-Scott (Con)]

My Lords, as I understand it, one of the principal issues about the integration of healthcare and community social care is the lack of data integration. Many hospitals still rely on manual processes to send discharge letters to GPs and social care providers. Would the Minister be good enough to tell us what the Government are doing to drive forward automation of discharge letters and similar clinical information?

[Baroness Merron (Lab)]

The noble Baroness is quite right in her observations on the need to move to much better services here. First, on her point about discharge letters, appointment letters and so on, the Government have already committed funding and direct support to local areas that are not currently providing what we might call 2025-standard communication. Noble Lords will see a considerable change; some trusts are already doing that and doing it excellently, but we want to bring that up. On the noble Baroness’s specific point, I can tell her that we are continuing to encourage the use of digital social care records to make sure that the individual’s medical record is there. Over 85% of people who draw on registered care now have a digital social care record. I hope that I have gone a bit further than the noble Baroness was asking.

Perinatal Mental Health

Baroness Merron Excerpts

Wednesday 25th June 2025 Lords Chamber

[Baroness Berger]

To ask His Majesty’s Government what assessment they have made of the spending on perinatal mental health services in England in the financial year 2024-25.

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

My Lords, this Government recognise the importance of perinatal mental health services. Spending on specialist community perinatal mental health services continued to increase in 2024-25. The latest NHS figures show that integrated care boards spent £212 million that year, which is an increase of £18 million from 2023 to 2024. This does not include spending on mother and baby units. The final spend for those in 2024-25 is not yet available, but £58 million was spent in 2023-24.

[Baroness Berger (Lab)]

I thank my noble friend the Minister for her reply and declare my interest as chair of the Maternal Mental Health Alliance. It is heartening to hear the Government’s assessment that there have not been any real terms cuts to perinatal mental health services this year. That is in spite of evidence from the Royal College of Psychiatrists. I listened very closely to what my noble friend said. She will know that maternal suicide remains the leading cause of maternal death in this country six weeks to a year after birth. Will the Government look to reintroduce the target to increase access to perinatal mental health care, which was dropped from the 2025-26 NHS planning guidance, to ensure that commissioners do not divert funds elsewhere?

[Baroness Merron (Lab)]

I pay tribute to my noble friend for her work as the chair of the Maternal Mental Health Alliance. I share her great concerns about the rate of suicide among new mothers in particular. The NHS planning guidance is not an exhaustive list of everything the NHS does. I am sure my noble friend will remember that the Darzi review highlighted that one of the problems in the NHS was too many targets. We have reduced the number of national priorities by focusing on what matters most to patients but, as my noble friend acknowledged, maternity funding has not been cut. Indeed, healthcare systems leaders now have more autonomy to meet the demands of their local populations.

[Baroness Gohir (CB)]

My Lords, I declare an interest as CEO of Muslim Women’s Network UK. We conducted maternity research in 2022 and found that there is a lack of awareness in some minority ethnic communities that women can suffer from poor mental health during and after pregnancy, which results in the situation that, when women ask for help, they are not believed by their families and are accused of being a bad mother or even possessed by evil spirits. Will the Government look at doing some awareness raising of perinatal mental health in minority ethnic communities and make those services more accessible to those women?

[Baroness Merron (Lab)]

The noble Baroness raises a very important point, particularly on voices not being heard. I am sure she heard the announcement on maternity safety made by the Secretary of State on Monday. He highlighted the issue of women’s voices and that women are so often not listened to. That is particularly the case among the minority ethnic groups the noble Baroness referred to. I assure her that that is taken into account. I am glad to say that there are record numbers of women accessing community perinatal mental health services. On the point raised, that is why it is for local areas to serve their local communities in the way she describes.

[Lord Scriven (LD)]

My Lords, given the £8.1 billion annual cost of untreated perinatal mental illness, will the Government mandate a ring-fenced, inflation-proof budget for perinatal mental health services within ICBs to ensure sustainable long-term investment, rather than relying purely on discretionary funding?

[Baroness Merron (Lab)]

I do not share the view that it is discretionary funding, not least because what matters are the outputs, which are, as I described, that a record nearly 65,000 women accessed a specialist community perinatal mental health service or maternal mental health service in the 12 months to April 2025. That gives some idea of the scale—that is a 95% increase compared with four years earlier. So the output is absolutely there. Was it ever the case that all needs were met? No, it was not, even before the change to the planning guidance and the ring-fencing. I emphasise again that this Government’s whole approach is to ensure that local communities are properly served. That is why ICBs can make decisions about how they provide what I regard as first-rate services.

[Lord Patel (CB)]

My Lords, I support much of what the noble Baroness, Lady Berger, said, particularly about the leading cause of maternal deaths—39% of them—being suicide. Not only that: 37% of those mothers who took their own lives had a known history of mental health issues, yet they were not properly looked after. That is the main problem. Although guidelines exist for screening mothers during pregnancy and after the birth of a baby, they are not universally followed. There is a great variation in the adoption of these guidelines and using the screening tools that are available to identify mothers at risk during pregnancy. We need to put much more effort into that. On the cost, there is only one small model that describes the benefits of identifying mothers at risk during pregnancy and after delivery. We need a detailed study to show the cost-benefit analysis of doing that.

[Baroness Merron (Lab)]

The noble Lord, building on my noble friend’s point, makes a very important point. I will add to what he said. The impact on affected families is absolutely devastating and has very long-lasting effects, particularly on children. As the noble Lord said, the suicide prevention strategy outlines what clinicians should do, which is complete screening of women’s mental health during pregnancy and the first year after pregnancy. I hear the points that the noble Lord made and will put them into my discussions about suicide prevention, because I am also concerned about the number of people who take their own lives who are in no contact with the health services; we have to find a way of making contact with them. This is less the case in this circumstance, but that theme is still there. I thank the noble Lord for that contribution.

[Baroness Williams of Trafford (Con)]

My Lords, following an Answer to a Written Question from my noble friend Lord Kamall, data shows that last year only one post was available in the north-east and one in the south-west for obstetrics and gynaecology specialist training stage 3, and only four posts were available in London. How will the Government rectify the dearth of provision?

[Baroness Merron (Lab)]

As the noble Baroness is aware, the long-awaited 10-year plan will be with us shortly. That will set out the parameters for change and the services that we need. Following that, there will a long-term workforce plan, which will deal with the kind of matters the noble Baroness referred to.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I had not intended to ask a question but, following on from the contribution from the noble Lord, Lord Patel, impacts other than the most undesirable one of suicide come from postnatal depression. Among those are an inability of new mothers to cope well with the demands on them and therefore provide the care that very young children need. Is the Minister confident that the way that the NHS now—I am struggling not to say “gets rid of”—moves mothers out of hospital very soon after birth provides the right start to the sort of care that particularly vulnerable women need immediately after giving birth?

[Baroness Merron (Lab)]

My noble friend raises a very useful consideration. Decisions about how long a new mother stays in hospital are a local matter and specific to that woman. The other point I want to raise is that the services we are talking about have actually been expanded to provide care to women for up to two years after birth. That is incredibly important, as is providing a mental health assessment and signposting support for partners, who we should also remember in all of this. The services we are talking about cross the entire span and go on for two years beyond it. That certainly underpins the kind of services we want to see, but I certainly agree with my noble friend that individual cases must be seen as individual cases.

NHS: Private Equity

Baroness Merron Excerpts

Wednesday 25th June 2025 Lords Chamber

[Baroness Altmann]

To ask His Majesty’s Government what assessment they have made of the potential risks to GP services and NHS costs presented by the takeover of Assura’s surgeries by private equity providers; and whether they plan to intervene to retain domestic control of such services.

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

My Lords, Assura’s portfolio of over 500 properties is leased to GPs and other NHS and private healthcare providers. Arrangements for leased properties and their ongoing healthcare are secured through lease arrangements. A change in ownership does not affect their legal status; leases will continue to be set out and protect the terms of occupation for GP surgeries and other NHS service providers. Officials are in dialogue with Assura and prospective purchasers—and will keep monitoring proceedings.

[Baroness Altmann (Non-Afl)]

My Lords, I thank the Minister for her Answer. Following Care REIT falling into foreign hands, the board of Assura was happy to sell out to KKR, risking an uncertain future for GP surgeries serving millions of people, rather than ensuring continued UK ownership to support NHS current and future infrastructure.

The dangers of allowing overseas takeovers and private equity buyouts are written in the wreckage of our care home sector. I have two questions. First, what power do the Government have to prevent further erosion of UK critical infrastructure? Secondly, do His Majesty’s Government recognise the damage caused by the FCA to so many such real estate investment trusts, and other investment trusts, which own and manage critical UK infrastructure? The exaggerated so-called investor costs have led to unwarranted under- valuation. Therefore, foreign bidders come in and take the opportunity to snap up our future infrastructure for short-term gain, denying those opportunities to pension funds, which are the ideal long-term investors for such companies.

[Baroness Merron (Lab)]

I understand the noble Baroness’s concern, but perhaps I could assure her and your Lordships’ House that it was decided this week by the board of Assura to recommend to shareholders an offer from Primary Health Properties, which is another UK real estate investment trust, similar to Assura, which is focused on primary healthcare premises. It is the case—or was the case, depending on how you look at it—that there was another bidder for Assura: KKR. As the noble Baroness said, KKR is an American private equity and investment company, but it seems very unlikely to be successful at this stage. The assurance I can give the noble Baroness is that a change in ownership does not affect the legal status of existing lease arrangements. I would also say that the ownership of the general practice estate is very much a mixed model in which GP practice buildings can be leased from a variety of landlords, including companies such as Assura, which actually constitute quite a small proportion of the overall estate.

[Lord Winston (Lab)]

My Lords, given that there are a vast number of overseas investments in different areas of private medicine in London—for example, in vitro fertilisation, much surgery, and so on—can the Minister tell us whether there is any fundamental difference between this and Assura healthcare? Providing it is under the proper regulation of the NHS—which I believe it is—there is no particular harm that we can identify.

[Baroness Merron (Lab)]

My noble friend is quite right. What matters is the assurances that are in place to enable provision to be made, whether that is on the estate or on services, as my noble friend refers to. I can certainly assure your Lordships’ House that in preparation for this discussion of course I asked the question: are there risks? I am assured there are no risks about which we need to be concerned.

[Lord Hodgson of Astley Abbotts (Con)]

Will the Minister look at the National Security and Investment Act 2021? This gives the Government the power to designate a sector as having particular importance for the future of our country. It might be appropriate, when we are dealing with healthcare, which is obviously a key part of our infrastructure, for this to play a role in the sorts of issues she is tackling when responding to this Question today.

[Baroness Merron (Lab)]

I am grateful to the noble Lord for his suggestion. This was another area I raised with officials who have been in contact with Assura and the proposed new company, Primary Health Properties plc. The implication, I believe—I am sure the noble Lord will happily correct me outside the Chamber if this is not the case—is that somehow the Government should take on this responsibility. This would be a significant cost because the Government would have to offer in excess of the £1.79 billion currently offered by PHP and, in addition, take over £2 billion of debt raised against the properties which is secured against future rental income streams. I hope that gives some idea of the scale. There is also no strategic imperative. I understand the concerns, but the market is currently delivering, and it is expected to continue to do so.

[Lord Scriven (LD)]

My Lords, this raises a wider question regarding the NHS primary care estate. Will the Government look seriously at implementing new controls and transparent pricing benchmarks to prevent overseas investors not just imposing exploitative rents but producing punitive dilapidations, which is where they will make their money when they return the estate to the public sector?

[Baroness Merron (Lab)]

The noble Lord raises an important point. I assure him that rent and service charges continue to be set in line with the original terms if there is a change of owner. Whatever the ownership, properties occupied by GPs are required to be professionally valued by the district valuer. The service advises commissioners on whether levels of rent are value for money and align with market rents in a particular area. The other thing I might add, which I mentioned in answer to an earlier question about the mixed model of the general practice estate, is that nearly half of them are in any case GP-owned and 26% are GP leasehold. We do not currently see a problem in the way the noble Lord describes, but if there are particular examples to follow up, I am very happy to do so.

[The Earl of Effingham (Con)]

My Lords, the private sector has a significant role to play in alleviating the pressures faced by the NHS. Please allow me to quote the Secretary of State for Health. He said the independent sector can “help us out” and:

“We would be mad not to”.


Can the Minister help us understand why a number of experts in your Lordships’ House are saying outside the Chamber that there is currently excess capacity in the private sector at benchmark NHS prices? There would be no extra cost to the taxpayer but huge incremental benefits to people on NHS waiting lists. However, the spare capacity is not being used.

[Baroness Merron (Lab)]

Again, if there is particular information I should have, I would be delighted to receive that. I can only wholeheartedly agree with my right honourable friend the Secretary of State about the need to use capacity in the private sector. It is one of the ways we are driving down waiting lists and offering more appointments. As I am sure the noble Lord knows, we committed to 2 million extra appointments in our first year of government; we have far exceeded that already with 3.6 million.

[Lord Patel (CB)]

My Lords, I accept what the Minister said about how the leasing arrangements will remain the same. But can we be assured that both KKR and PHP—whichever wins the bidding war—will follow the same procedures; that is, they will be responsible for providing the equipment and the rents will not increase based on what equipment they provide, and that, therefore, patient care will remain of the highest quality?

[Baroness Merron (Lab)]

I thank the noble Lord for seeking that reassurance, which I can indeed give.

[Baroness Altmann (Non-Afl)]

I beg noble Lords’ indulgence. Will the Minister answer the second question I asked about how our infrastructure, such as these properties, is selling at hugely undervalued levels on the market because of a technical issue relating to regulations imposed by the Financial Conduct Authority?

[Baroness Merron (Lab)]

I fear I am not able to answer in the detail that the noble Baroness would like, but I would be delighted to write to her.