(1 day, 13 hours ago)
Lords ChamberCausation is denied. My noble and learned friend can read it in Hansard, and I spoke to her outside. It is a testament to her dedication that she has been following this on TV. I do not know whether that shows how poor daytime TV normally is, though those of us who were here on Wednesday will remember that your Lordships’ House is very late night TV as well.
I spoke on the amendments when we first touched on this topic in Committee, right at the beginning. As my noble friend Lady Coffey said, those amendments interrelate with what has been discussed today. The Front Bench is focused on the question of making sure that we do not end up with a situation where different citizens and residents in the United Kingdom have substantially different rights in areas as important as this. I listened carefully to what the noble Baroness, Lady Smith of Llanfaes, said about what actually happened in the Senedd. The phrase “voting in the dark” was a stark one, which I think we ought to remember.
On the question of what the Bill actually does, I am reminded of when I studied private international law, where you have something called the characterisation question—something that lawyers often like. It basically goes like this: in order to get the answer you want, you rephrase the question to focus on the bit of the problem which you want to focus on. In this case, you ask the question, “What does this Bill do?” The noble Lords, Lord Pannick and Lord Carlile of Berriew, rightly say, as a matter of form, that the Bill amends the criminal law and therefore is a competence of Westminster. In reality, assisted dying will not be provided by the criminal justice system. In practice, it will be provided by the health service. That is why I listened carefully to what the noble Lord, Lord Stevens of Birmingham, and the noble and learned Lord, Lord Thomas of Cwmgiedd, said: in practice, this is a Bill which touches on health, which is a devolved competence.
That brings me to the wider and more important point. Earlier this week, the noble and learned Lord, Lord Falconer of Thoroton, raised Jersey, Guernsey and the Isle of Man—the Crown dependencies—in the debate on the Crime and Policing Bill. We also learned this week that the Scottish Parliament has chosen not to proceed with the version—and it was a different version —of this Bill proposed there. If this Bill were to receive Royal Assent, we would therefore end up in a position where substantially different rights would exist for different residents and citizens in the United Kingdom.
That raises an important point of principle, on which I would be interested to hear the noble and learned Lord’s view. Does he see it as a success of devolution that, on an issue as significant as this, people living in different parts of the United Kingdom—and for the purposes of this group of amendments, Wales—might have different rights in law, or does he have a potential solution to create a situation where, as close as possible, people have the same or substantially the same rights?
I respectfully ask the Minister to respond on this point as well. Frequently, we have heard from the Front Bench the phrase, “We are neutral”—that the Government are interested only in workability and will look at these issues as and when they arise. However, this is a deep constitutional issue. The Government cannot be neutral on the point of whether they are content in principle that people in England might have different rights on assisted dying from people in Wales. The Government ought to have a stance on that fundamental constitutional position. The Government also ought to have a position on the point raised by my noble friend Lord Deben as to whether, if this Bill were to go through, with palliative care being such an important part of the overall process, they would equalise funding to make sure that residents of Wales have the same access in practice to palliative care as those of us who live in England do.
For those reasons, I look forward to the responses of both the noble and learned Lord and the Minister.
My Lords, I am grateful for the views that have been expressed today. As usual, I will keep my remarks to those amendments that raise significant legal, technical or operational workability concerns. I very much associate myself from these Benches with the welcome to the noble and learned Baroness, Lady Prentis. We were delighted to see her return to your Lordships’ House and look forward to hearing from her.
I turn first to the amendments tabled by the noble Baroness, Lady Coffey. Taken together, they would restrict eligibility for assisted dying to England only and exclude people resident in Wales, registered with a Welsh GP or who have recently moved across the border. They would remove the powers of Welsh Ministers to issue regulations and guidance and limit the commissioner’s monitoring functions to England. Individually and as a group, the amendments could have complex effects, risk significant unintended consequences and lead to a lack of clarity about eligibility and the effect of the law across the England-Wales border.
Restricting the Bill to England, as we have heard, would also create a divergence in the criminal law of England and Wales. The protections in Clause 32 would not apply in Wales and the Suicide Act 1961 would continue to apply there as it does at present. It would therefore be an offence to take steps in Wales to assist access to an assisted death in England even where lawful under the Bill in England. That would represent a significant divergence in homicide- and suicide-related offences and run counter to the current devolution settlement.
Amendment 887 would remove Clause 57(2) and (3), preventing certain provisions from extending to Scotland and Northern Ireland, including those on approved substances, advertising, and employment protections. This would risk parallel and potentially conflicting regulatory regimes; may allow advertising of services in Scotland and Northern Ireland, contrary to restrictions in England and Wales; and could leave health professionals who, for example, live in Scotland but work in England and Wales without the same employment protections as someone in England.
There are a number of further amendments in this group concerning powers in the Bill relating to the provision of an assisted dying service in Wales; namely, Amendment 765, tabled by the noble Lord, Lord Goodman, Amendment 764, tabled by the noble Baroness, Lady Finlay, and Amendments 742, 743, 844, 903, 905 in the name of the noble Baroness, Lady Smith. I bring to the attention of noble Lords that these amendments may alter or impinge on the devolution settlement. Any such changes would usually be made following consultation across the UK Government and with the Welsh Government to explore the wider implications. Further, the Senedd would be expected to consider material changes that affect devolved competence.
Amendment 762, tabled by the noble Lord, Lord Goodman, would require the Secretary of State to specify which organisations will provide assisted dying services in Wales, within one month of the Act passing. This raises workability concerns as it requires clarity on who provides services before key implementation decisions have been made. This could be an interference with the ability of the Welsh Ministers in the devolution settlement to exercise their powers in a devolved area. As regulations under Clause 42 are made using the affirmative procedure, this amendment would also require parliamentary debates in both Houses within one month of the Bill being enacted.
Amendment 767A, tabled by the noble Baroness, Lady Coffey, appears to seek to limit the power of Welsh Ministers to make regulations related to private services only and would make Welsh Ministers unable to establish a publicly commissioned service. As currently drafted, the Bill leaves this as a decision for Welsh Ministers. This amendment would therefore have devolution impacts and, if passed, the Welsh Government would need to be reconsulted and the consent of the Senedd would need to be sought for this provision.
I make no comments on the other amendments in this group. As noble Lords are aware, those amendments have not had technical drafting support from officials. Therefore, any further revision and corresponding amendments may be provided to provide consistent and coherent terminology throughout the Bill.
My Lords, may I question the Minister? The 49th report of the Delegated Powers and Regulatory Reform Committee drew attention to the very unusual nature of the clause in the Bill that allows the delegated powers to be used to do anything that an Act of Parliament can do and drew attention to the fact that this is extremely rare. Is the Minister saying that that is acceptable in this Private Member’s Bill and therefore potentially sets a major precedent in relation to other legislation? Can she clarify whether the Government, simply in relation to that, not to any other part, dispute the Delegated Powers and Regulatory Reform Committee’s conclusion?
I am sure that all noble Lords welcome that report and its comments but, as the noble Baroness is aware, it is a matter for the sponsor to decide the response to that rather than the Government.
Baroness Smith of Llanfaes (PC)
What is His Majesty’s Government’s approach to the legislative consent Motion process and making sure that the Sewel convention is kept to? What intergovernmental discussions have this Government had with the Welsh Government on the constitutional implications of this Bill in particular?
As noble Lords will be aware, engaging with the devolved Governments is a matter for the sponsor, not the Government.
My Lords, we have heard talk in this debate about respecting the devolution settlement. No, we do not. It is not that long ago, for instance, that the Northern Ireland Assembly voted against abortion but got abortion, and everybody on both Front Benches voted for it. So let us not fool ourselves that we have this great commitment to devolution and respect the views of the relevant assemblies. No, we do not.
I express my personal pleasure at seeing the noble and learned Baroness, Lady Prentis, back in the House. She was an extremely successful Attorney-General because she was wise and knew the law. I am very glad that she is back here to keep us in order.
On issues in relation to Wales, we have understood throughout the importance of complying scrupulously with the devolution settlement. The people of Wales have to be respected and the devolution settlement has to be respected. On two propositions here, there is no doubt.
First, this is about the criminal law. If a Bill were passed in the Senedd that sought to change the Suicide Act under the existing devolution settlement, it would have no effect because it would not be within the Senedd’s power to do it. That has to be dealt with by this Parliament.
Secondly, and separately, as a matter of practicality, how assisted dying is to be introduced in the health service and the provision of health in Wales is, in practice, a matter for Welsh Ministers. The approach that we have taken is that this Parliament must deal with the criminal law and Welsh Ministers must be left to deal with the decisions about how it is introduced. It may be that that requires an Act of the Senedd. Because of that possibility, we have included in the Bill the power for Welsh Ministers to give the National Health Service in Wales the power to take steps. That power would normally be given by the Senedd, but so that there could be no doubt about that, and so that it would not wait upon the Senedd, we have included it in the Bill.
Constitutionally, we are allowed to include it in this Bill. Even if there was no legislative consent Motion agreeing to it, we could go ahead without the consent Motion. I and the sponsor in the other place have made it clear, specifically and in writing, that we respect the devolution settlement and that if there is no legislative consent Motion in Wales that consents to this Parliament legislating in an area normally dealt with by the Welsh Senedd then we would withdraw those provisions, because we would not be respecting the devolution settlement. From our point of view, we have proceeded with these provisions only once the LCM has been given. That is our position in relation to it.
I shall now deal with the amendments in that context.
The Earl of Effingham (Con)
My Lords, before I speak to the substance of the amendments in this group, I pay tribute to the noble Baronesses, Lady Nicholson, Lady Berridge, Lady Fraser of Craigmaddie, Lady Grey-Thompson, Lady Hollins and Lady O’Loan, and the right reverend Prelate the Bishop of Newcastle. They have all stood up for a particularly vulnerable group of people, and they are absolutely right to do so. I am sure that the noble and learned Lord, Lord Falconer, is listening most carefully to their arguments.
Individuals with speech, language and hearing difficulties are particularly vulnerable, and it is imperative that they fully understand the process, their rights and the terms of the Bill before they can access the provisions made within it. My noble friend Lord Blencathra said that we really need to know that an individual understands what they are doing, and the noble Baroness, Lady O’Loan, used the phrase “crystal clear”. They are both absolutely right.
Surely how society cares for the most vulnerable of its citizens is an unmovable benchmark. Society must protect people with communication difficulties. The noble Baroness, Lady Berridge, specifically questioned the Government, and His Majesty’s Loyal Opposition believe that it is fair and reasonable to ask the Minister what specific work officials and Ministers have undertaken to establish the core risks posed by the Bill to those with hearing, speech and language impediments. In the view of His Majesty’s Government, how effective are the safeguards currently in place? Can the Bill be improved from a neutral perspective of workability to ensure that no one who faces the challenges we have discussed in this group ends their life without being given the obvious support that they need to fully understand the life-changing decision on which they are embarking?
As the noble Lord, Lord Winston, referenced in the previous group, during the course of the Bill, noble Lords have debated detailed provisions and addressed complex moral issues with a laser focus. However, the question at hand is not a complex one. Those who are not able to understand the situation without proper support must be provided that support if they are to take the decision to end their life. Surely that is non-negotiable.
The noble Lord, Lord Shinkwin, said that we have to think differently and challenged the noble and learned Lord, Lord Falconer, to lead by example. The right reverend Prelate the Bishop of Southwark took the words out of my mouth when he said that he remains hopeful that the noble and learned Lord will agree with this line of thought and commit to engaging collaboratively with all noble Lords whose amendments in this group aim to implement the right and appropriate protections for this vulnerable body of individuals.
My Lords, I am most grateful for the debate that we have had today. In keeping my comments limited to amendments on which the Government have major legal, technical or operational workability concerns, I turn first to Amendments 171A and 174A, tabled by the noble Baroness, Lady Nicholson. The duty outlined within these amendments may prove difficult for doctors to discharge as they are ambiguously drafted and use undefined terms such as “religious, cultural or sex-based” barriers. It is also a mandatory duty that does not afford discretion to the doctor to refuse unreasonable requests.
The duty to appoint an advocate conflicts with Clause 22. It is unclear how these proposed advocates would be appointed or trained, or what their role or responsibilities would be. Furthermore, your Lordships’ Committee may note that where a person has religious, cultural or sex-based barriers, the amendment would also require such a person to be provided with an advocate who has training in and experience of relevant safeguarding issues and must be the same sex as the person seeking assistance. Introducing a more extensive mandatory duty for the provision of adjustments, including an advocate, may give rise to workability issues, as the cohort of advocates meeting these criteria could be very limited and may result in a person being delayed or unable to take part in a preliminary discussion.
We all know what we are talking about here, but yes, absolutely.
This all goes back to the fundamental point of the Bill. I am addressing this point because the hypothesis is that the person has less than six months to live but, notwithstanding that, we are making sure that this particular group of people have an independent advocate. My point is simply that, if we are going to go down this road, there needs to be consistency: if they are not going to have an independent advocate, they really need to confirm it rather than merely indicate it. I apologise for my slightly loose language; the noble Baroness was quite right to pick me up on that. I hope the noble and learned Lord will consider my point as to whether “indicating” is actually the right test in subsection (2)(b)(ii) of his proposed new clause.
I am most grateful to noble Lords for their contributions to this debate on independent advocates. I will limit my comments to those amendments on which the Government have major legal, technical or operational workability concerns.
I turn first to Amendments 168, 300 and 553, tabled by the noble Baroness, Lady Grey-Thompson. Without further consequential changes, Amendment 168 would result in an internal inconsistency with the framework currently set out in the Bill, which provides an independent advocate only for certain qualifying persons.
Similar concerns arise with Amendment 300, which seeks to establish a new system of advocates for disabled people. It is important to note—not just in reference to these amendments, which I heard the noble Baroness acknowledge are not quite as she might wish them to be, but in relation to the debate—that the Equality Act 2010 definition of disability is very broad. For example, it includes those with cancer. As a result, most people who are terminally ill for the purposes of the Bill would fall within that definition. That means that the amendment could apply to the majority of those seeking an assisted death.
Amendment 300 would require the independent advocate to confirm that the person has been offered
“all practicable social, medical, and palliative supports which are financially supported”.
However, there is no provision to ensure that the independent advocate would have access to the information needed to confirm this, which could make the amendment unworkable.
Amendment 553 relates to young adults aged 18 to 25. People in this cohort are legally adults, so the requirement for parental or guardian consent and to have an independent advocate may raise Article 8 ECHR issues relating to private and family life. To be lawful, these requirements would need to be objectively and reasonably justified and proportionate.
My noble and learned friend Lord Falconer, the sponsor, tabled Amendments 548A, 549A and 862A to address workability issues with the current drafting of the Bill by clarifying the regulation-making powers and parliamentary procedures in Clause 22. The amendments set out when a qualifying person must be informed about independent advocate support and the circumstances in which that support must be provided.
Amendment 544A, tabled by the noble Lord, Lord McCrea, would create a conflict with Clause 22(3), which sets out the role of the independent advocate in providing support and advocacy to a qualifying person. The amendment would remove the definition of “qualifying person”, which would result in confusion about who is a qualifying person and the role of an independent advocate appointed to assist a person who is not a qualifying person.
Amendment 553B, tabled by the noble Lord, Lord Weir, would place a duty on the commissioner to offer the support of an “independent disability advocate” to a disabled person as defined under Section 6 of the Equality Act 2010. As mentioned previously, given the breadth of the Equality Act definition, this duty would apply to most people seeking an assisted death. The amendment is unclear about the duties, training and qualifications that would be required of them.
Amendments 191 and 195 to 199, tabled by the noble Lord, Lord Frost, and spoken to by the noble Lord, Lord Gove, and the noble Baroness, Lady Lawlor, would require the Secretary of State to establish a scheme of neutral advisers to whom a person must be directed in the situation where a registered medical practitioner is unwilling or unable to conduct a preliminary discussion. The amendments are broad, ambiguously drafted and could give rise to significant workability issues.
Amendment 196 in particular would require neutral adviser organisations to make a number of very broad declarations. For example, under the amendment, a neutral adviser must declare that they do not and will not employ
“any person who has taken part in the provision of assistance for assisted dying”.
This could result in a potentially unworkable duty, as it would require the adviser to make a declaration about current and future conduct. These broad declarations could therefore be practically unworkable and create resourcing challenges by excluding significant parts of the workforce, if interpreted broadly.
My Lords, I have noticed that the time now is 5.18 pm. We have no intention of moving on to another group. When this group is finished, I will seek to adjourn the House. I say to any colleagues waiting for another debate that it will not be happening this week.
My Lords, The Government do not have major workability concerns with Amendments 175 and 384, tabled by the noble Lord, Lord Moylan, whom we are very pleased to see in his place; long may he continue to be there.
I will say a few words about clinical practice, which may be helpful in addressing some of the points raised, including those just now by the noble Earl, Lord Effingham. Most of the questions were really about the Bill and are therefore matters for the sponsor, but I will make a couple of points about clinical practice. It is rare for a clinician to base prognosis on a median life expectancy. In addition, explaining the data used is not common clinical practice. I hope that is helpful to noble Lords.
The issues raised are rightly for noble Lords to consider and decide. Of course, that means that the way the amendments are currently drafted may require further consideration to be fully workable, effective or enforceable.
My Lords, can I share everybody’s genuine pleasure that the noble Lord, Lord Moylan, is here? Can I not congratulate him on telling us about it? I would have done, but he told me he did not want it, so I respect his wishes. I thank my noble friend Lord Rooker for being willing to share his experience of the death of his first wife. I also associate myself with my noble friend Lady Royall; from personal experience, one should not feel that one has got some obligation or is in some way defective if one dies quickly of cancer or takes a particular attitude. We should not be censorious one way or the other as to what attitude people take when confronted with a terminal illness. How would we all react when confronted with it? We probably do not know.
First, we have had a debate about the six months, and I am incredibly unkeen to revisit the six months because I do not think that that was the frame within which the noble Lord, Lord Moylan, tabled his amendment. His amendment is about what is to be told to the patient rather than whether six months is right—I am gratified that the noble Lord, Lord Moylan, is nodding. I will focus on the issue: how should the patient be told? His amendment is in Clause 5, which is about the preliminary discussion. It requires the doctor conducting the preliminary discussion to discuss the person’s diagnosis and prognosis. It requires the doctor to refer to any treatment available to the patient, and the likely effect of the treatment, and it requires them to go through
“all appropriate palliative, hospice or other care”—
it is not just palliative and hospice care; it is other care as well—
“including symptom management and psychological support, and offer to refer them to a registered medical practitioner who specialises in such care for the purpose of further discussion”.
It is a detailed discussion about the prognosis, diagnosis and likely effect of treatment.
I was struck by the speech made by the noble Baroness, Lady Watkins. The idea that you are told you have six months to live, and that is it, is extraordinarily unusual. The idea that this happens is very unlikely; that it could happen in this context seems to me to be extraordinarily unlikely. Noble Lords will be aware that, in Clause 7, there must be a record kept of this conversation. The iniquity that one is trying to deal with seems to me to be unlikely to arise.
Should we be putting into the Bill the specific statistical material that has to be given? If you are relying on a median or an average, do you have to say that you are doing that and what the variations are? No, I am not in favour of that. There is a power for the Secretary of State, by codes of practice or guidance, to give indications as to how it should be dealt with. I trust doctors more than many people in this debate. It would be unhelpful to put in words such as those in the amendment into the Bill, so I am against the amendment.
On a completely separate issue, we have debated the question of the prognosis and the reason for the six months. I strongly adopt the words of the noble Baroness, Lady Noakes, that this is not the view of one person; this is the view of two doctors and a panel of three. This is not just a question of one prognosis and it is over. That is an issue that we dealt with previously. I am delighted that the noble Lord, Lord Moylan, was in a position to move the amendment. I am sorry to say that I do not agree with it.
(2 days, 13 hours ago)
Lords ChamberTo ask His Majesty’s Government what assessment they have made of the extent to which unpaid carers are consulted before a patient is discharged from hospital, and what plans they have to monitor this.
My Lords, the Health and Care Act 2022 requires NHS trusts to involve patients and unpaid carers in discharge planning, reinforced by 2024 discharge guidance. However, this is not always done consistently and carer involvement is not monitored nationally. We will support better implementation by commissioning work from the LGA’s better care fund support programme this year. Care transfer hub guidance also promotes best practice by encouraging early identification and involvement of carers in planning.
I thank my noble friend for her Answer. It was important, though not easy, to win for carers the right to be consulted at the point of discharge. I am sorry that better statistics are not being kept, but I am glad to hear the plans for improvement. The survey from Carers UK shows that the number of carers being consulted is decreasing rapidly. Although I fully understand the pressure on the NHS at the point of discharge and the difficulties of securing proper social care support, does my noble friend agree that it is very short-sighted not to consult carers at this point? If they break down from lack of support, the patient is readmitted and there is further pressure on the NHS.
I completely agree with my noble friend that the involvement of and support to unpaid carers is crucial when a patient is discharged because, as she says, it is vital not just for patient recovery but for the whole healthcare system. I welcome the recent Carers UK report that was published last year, which focused on how government legislation and guidance is or is not being implemented and monitored in practice. That has been and will be very useful work for us to continue with.
My Lords, further to the question from the noble Baroness, Lady Pitkeathley, there are 120,000 young carers aged between seven and 18, many of whom are the principal carer for a parent or sibling, accompanying them when they go into hospital. Although many hospitals are good about identifying the young carers, not all of them are. What more can be done to make sure that these young carers are identified right at the beginning of the process and fully consulted about arrangements for discharge?
The noble Lord is right to emphasise the role that many children and young people have as young carers. The Children’s Social Care National Framework is statutory guidance for local authorities, which have duties to identify young carers who may need support and to assess their needs. I am well aware that young carers may not be aware of this, but there is a right to request assessments. Improving joint working between adult and children’s social care services, as well as health services, is key. Lastly, I hope that the electronic patient record would identify where there was a carer, including a young carer.
My Lords, I declare my interest as a vice-president of the LGA. The model of unplanned discharge places an immediate burden on unpaid carers. What assessment have the Government made of the financial impact on unpaid carers during this period? Specifically, will they consider a discharge support grant to provide immediate short-term funding for carers for the first four weeks following an unplanned or non-thought-through discharge?
I know the noble Lord will be aware of the better care fund, to which there is a commitment of some £9 billion. It can be used in various ways, including in the way that he described. I look forward to the work of the LGA’s better care fund support programme that we will commission this year so that we can work with NHS and social care partners, because we need to strengthen the approach of not just involving but supporting unpaid carers. Discharge should not take place if carers are not able to fulfil the duties that it is assumed they can fulfil.
My Lords, it is good to hear that there is real awareness of the issues caused by this. It is one of the most acute problems in the whole provision of social care, and it falls hard on unpaid carers when they do not even know how or who to ask for help. It has been diagnosed many times as a big issue. There used to be co-ordinator discharge people in hospitals who would help with this process. Are there still such posts? The news about the LGA work is welcome in relation to co-ordination when it counts and support for unpaid carers, who are the experts here. They are not passive arbitrators; they need to have their own knowledge and expertise recognised in this process. Is there provision at the hospital level for this?
My noble friend makes exactly the right points. We certainly recognise the vital role that unpaid carers play in supporting those who are to be discharged. Decisions about staffing and the approach—I emphasise that a multidisciplinary approach is clearly needed here—are a matter for local areas, but I can say in addition that there is a regular cross-government meeting, which is really important when it comes to joining up the approach, that looks at providing unpaid carers with the recognition and support that they need, as my noble friend said. We are also working towards publishing a cross-government action plan later this year. So in this area, including the LGA work, the kind of approach that my noble friend talks about will certainly be considered.
My Lords, I thank the noble Baroness, Lady Pitkeathley, for being a tireless champion of unpaid carers over many years and successive Governments. She quite rightly pointed out that Carers UK found that only 14% of unpaid carers were asked about their ability and willingness to provide care before hospital discharge. I want to follow up on the previous question from the noble Baroness, Lady Andrews. One of the problems faced by successive Governments is that trusts and what were previously CCGs and are now ICBs are very bad at learning from other parts of the system that do things well. For example, Northumbria has been known to have a really good discharge system: it embeds co-ordinators and works out how to get that discharge going. How can the Minister’s department improve learning across the system where there is good practice, take that best practice and appropriately transplant it into other areas so that we can really tackle this problem once and for all?
The whole system needs to do better, as the noble Lord outlines. It will be helpful that we are also looking at commissioning research in this area to look at best practice, as well as barriers and solutions, regarding the involvement of unpaid carers—I think that has been somewhat overlooked, if I am to be honest with your Lordships’ House. We have regional teams that have issued very practical toolkits to help hospitals implement their legal duties; we should remember that there are legal duties in this response. In addition, that is why we are involving the LGA’s better care fund support programme, as I said, as well as seeking to publish a cross-government action plan. These will be steps in the right direction, but I very much acknowledge that we do not start in a good place.
My Lords, although the better care fund is a help, its success depends on how hospitals and the LGA work together. Would the Minister agree that the fund is still used to fund short-term gaps, particularly winter pressures, and that the yearly funding cycle does not help for longer-term planning? Could that be improved?
I can see the pressure and difficulties that can bring. There is a range of reasons why discharges do not take place in a timely fashion—not just processes but the interface between health and social care, and capacity. As we look at how we involve carers and improve discharge rates, matters of funding will be key.
My Lords, we live in a world where we have constant criticism, both of government—rightly, quite often—and of many individuals for their behaviour. But here we have a situation where the health service and, indeed, society are being saved many billions of pounds as a result of the work of people who volunteer to care for their relatives and others—those in the voluntary sector, in our hospice movement and all over the health service. Without these people, we would be in real trouble. Is it not marvellous, and can we perhaps commend them and approve of what they are doing both to save us resources and to show that people are basically good?
I am very grateful to the noble Lord. I and the Government are certainly cognisant of the role that unpaid carers play. That is why, last year, we increased the carer’s allowance weekly earnings limit. This was the largest cash increase ever and means that 60,000 additional carers will qualify. That is part of our recognition, but I share the views the noble Lord has given and the comments about my noble friend Lady Pitkeathley and Carers UK—I am grateful to all.
(4 days, 13 hours ago)
Lords ChamberMy Lords, I am grateful to the Government for this repeat. The Minister in the other place pointed to 1.3 million referrals being diverted through something called “advice and guidance”. This means that GPs must seek input from a specialist before making a referral, but some professional bodies have warned that this mandatory approach will risk creating barriers to patients accessing specialist care and may compromise patients’ safety if they are not referred in a timely manner. To address these concerns, can the Minister set out what clinical safeguards are in place where a GP believes a patient needs to be referred directly to a specialist but is instead referred to go through this advice and guidance process? If a patient comes to harm as a result of any delay due to not being referred directly to a specialist, who will bear responsibility for that decision and how will accountability be determined?
As the noble Lord said, we have seen 1.3 million people diverted since April 2025. Otherwise, they would have been added to the electives waiting list, in clinical terms, unnecessarily. The main thing I can say to the noble Lord on advice and guidance is that I think the figures speak for themselves. That is why we are embedding it into the core contract. We are recognising it as routine practice. It provides more predictable funding and removes annual sign-ups. More generally, I must emphasise to the noble Lord that it does not take away a GP’s right to refer. That remains a matter of clinical judgment and, as in all things, clinical judgment will rule the day.
My Lords, the Government have now mandated a cast-iron guarantee that GP practices’ online portals must remain open in core hours, but a portal is merely a digital letterbox, it is not a clinician. Has the department conducted a full clinical risk assessment of the danger of red-flag symptoms being buried in high volumes of routine digital traffic? If so, will the Minister publish those findings today? If not, how can the Minister guarantee that this always-on requirement is clinically safe for patients?
When we develop digital approaches, I have to say again that the figures speak for themselves on, for example, patient satisfaction with general practice: people believe it is finally moving in the right direction. According to the Office for National Statistics, some 77% of people described contacting their GP as easy. That was in January this year, and it was up from just 60% in 2024. I think the public are giving their own view. On development of online access, we always ensure that patient safety is at its heart. I cannot give the commitment to publish that the noble Lord seeks, but I will be very happy to write to him and place a copy of the letter in the Library of the House, giving all the detail about how patient safety is assured. That is core to all our work and developments.
My Lords, it is evident all over the country that there is an epidemic of sick notes. Is there anything that the Government are doing to strengthen the arm of GPs who try to resist giving a sick note on simple request?
If I have understood the noble Baroness correctly—forgive me if I have not—the GP contract does not address that directly. That is obviously a more general but important point about GPs’ practices and how they deal with matters. GPs are given advice in their updated training on how to manage those situations, and I expect them to follow it.
Baroness Gerada (CB)
My Lords, the new GP contract appears to be baking in access over continuity: my GP, when I want to see him. How will the Government protect continuity of care, which is after all what keeps the NHS safe and provides value for money, and which patients welcome?
We have already said that through our 10-year plan, and this contract very much ties into the main pillars of the plan. We found GP services in a very difficult and challenging state, as I know the noble Baroness will be more than aware. We regard GP services as the front door. We want to see that continuity of care and we expect GPs to organise it accordingly. We all understand that it is not always possible, but clearly the best form of care, whether in the community or in hospital, is on a continuous basis and wrapped around the patient’s needs, not the other way around.
My Lords, the Statement made in the other place refers explicitly to coastal areas and deprived places, and I welcome that. Will the Minister say something about how we can ensure that there is good access to GP services in rural areas?
The right reverend Prelate is right to raise this. We have been very concerned for some time about the inequalities in coastal areas and areas of greatest need, where healthy life expectancy is the lowest. That includes communities with higher deprivation levels. That is why we began our reforms last year with an independent review of the outdated Carr-Hill formula. That is about the distribution of GP funding, which is fundamental to the point the right reverend Prelate makes. It is based on data that is around 25 years old in some cases, and clearly our population has changed. I look forward to updating the House when that review is concluded.
I welcome some of the criteria that are going to be used, particularly for deprived communities, in relation to access, but there remains a postcode lottery in terms of access to GPs, particularly in deprived communities. My concern is that, with some of the algorithms and IT being used as a postbox, patients are being referred directly to A&E departments. Will the Government assess in A&E departments which people are being referred that way so, that we can ensure that that loophole is addressed?
It is important to say that online access does not sit alone. There is also in-person access, including telephone access if people prefer that. The intention is not—and it is not the practice—that they are just postboxes. They are dealt with. We constantly keep those approaches under review. Our expansion is about access to GPs. That includes, for example, in answer to some of the points that have been raised today, including by the noble Baroness, repurposing £292 million from primary care network incentive scheme moneys to fund additional GP sessions to create more capacity, because that is necessary whatever way people make contact. That was based on feedback from the BMA, which said this would be a more effective use of funding.
Is there any monitoring of when GPs insist on a telephone call rather than a face-to-face meeting, or when things are sent by email to the surgery and they are then triaged by others rather than their normal GP? Is there any identifying of just how many cases they miss of those very serious conditions that subsequently end in serious illness or even death? I am particularly thinking of such things as sepsis, where the symptoms are not always so overt to begin with as they are as the disease progresses. Is there any monitoring of how successful these new systems are in picking up those types of diseases?
All the systems are under constant review. It might be helpful if I point out to the noble Baroness that one of the key things in the GP contract for 2026-27 is the requirement for all clinically urgent patients to be dealt with on the same day. That is not required currently; I think that will make a huge difference. Again, I emphasise that we will not be defining “clinically urgent”: it will be down to practices to use their clinical judgment, and that is the right place.
(5 days, 13 hours ago)
Lords ChamberTo ask His Majesty’s Government what plans they have for sustaining and enhancing the in-house software capabilities of the NHS.
My Lords, NHS Digital services are built and run to rigorous Government Digital Service standards. They are secure, user-centred, interoperable and continually improving. National Health Service England has significantly expanded its in-house engineering and data capability, and it is reducing its reliance on outsourced systems and strengthening operational resilience. These measures ensure that health and care data is available in all clinical settings to improve outcomes for patients, while delivering value for money to the taxpayer.
I thank the Minister for that reassuring Answer. The NHS has had a disastrous history of outsourcing its IT technology, which has wasted millions of pounds. A requirement of outsourcing is that there must be sufficient in-house expertise to properly assess the need for outside assistance and the quality of whatever assistance is on offer. In the absence of such expertise, outsourcing can be perilous. Moreover, given the requisite in-house expertise, outsourcing may become unnecessary. At a time when a host of novel IT solutions are becoming available, the IT staff of NHS England are seeing their numbers radically reduced. At the same time, the NHS is becoming increasingly dependent on the services of large American IT corporations. Can we be assured—genuinely assured—that history will not be repeating itself?
My noble friend is right to point out the history. The NHS previously relied very heavily on large, outsourced IT systems that, in some cases, led to inflexibility, high long-term costs and limited NHS control over core platforms and data. I was glad to arrange for my noble friend to meet the chief data and analytics officer at NHS England last Wednesday. I hope that, like me, he was reassured that NHS England has very much shifted its model towards building and operating critical digital services in-house, in line with the standards that I referred to in my initial Answer.
My Lords, cyber security is an essential element in any system, but nowhere more so than when people’s health records are being maintained. Many security breaches are attributed, at least in part, to human error. What investment are His Majesty’s Government making to train front-line staff in the new systems and provide continuous professional development to achieve the 10-year digital healthcare plan?
The straightforward answer is that we are doing exactly that. It is important to say that our front-line digitisation—our move from analogue to digital—is not something for the sake of it; we are doing it because it is improving efficiency and outcomes. For example, a 94% coverage of electronic patient records is expected by the end of this month, and the digitally mature trusts show a 13% lower cost per admission. That is a prize worth having, but we can do it only through the systems and training that the noble Baroness seeks.
My Lords, I support what the noble Viscount said. The history of software in the National Health Service is nothing less than a disaster. Coupled with that is a very unfortunate situation where some of the companies that have been responsible for these messes in the NHS are still on the Government’s procurement lists and are still getting contracts from the Government. Surely more attention should be paid to that, and we should curb that as soon as possible.
If the noble Lord has particular companies in mind, he is most welcome to raise them with me. It is important that we look at what NHS teams have done: they have designed, built and maintained national platforms. The NHS app is an example; I am sure that many noble Lords will be familiar with it. That is going to be our digital front door to the NHS. In addition, there is the NHS login and core national infrastructure. All these mean full NHS ownership, governance and control. Supported by £2.5 billion of investment in 2025-26, we are, as the noble Lord seeks, expanding NHS in-house digital capability to reduce the reliance on large suppliers.
My Lords, last week’s catastrophic attack on Stryker by Iranian-linked actors paralysed supply of some critical surgical equipment across the NHS. Does the Minister agree that our total reliance on vulnerable third-party global medtech platforms is a serious security risk? How will the Government ensure in-house expertise and procurement software so that the NHS can bypass compromised commercial networks during such crises?
Cyber attacks across our whole government are extremely concerning, and that is why we have built resilience. On health and social care specifically, I can assure the noble Lord that, in 2025-26, we invested £75 million across health and social care; that built on the £375 million invested since 2017. When I had responsibility for the blood transfusion service, my own experience was that, where there was a cyber attack, we had the systems in place.
My Lords, there is always a very difficult balance between keeping something in-house or outsourcing it, and we should not forget the national programme for IT in the NHS in the early 2000s, which ended up costing between £10 billion and £20 billion. My question is on the company Palantir. The Minister will be aware that there are a range of views on Palantir. Some say that it is the best software available and that no one can match it; others say that they are worried that it will lock the NHS in long-term and scrape data for other uses. What specific measures have NHS England and the department put in place so that, in the event that the Palantir contract is not renewed, the healthcare system will be able to move seamlessly to another supplier?
That seamless movement is an important point generally, but the federated data platform does not centralise or sell patient data. Data remains firmly under NHS control, and access is strictly governed. It is fully auditable and used only for approved patient benefit and NHS benefit. Palantir operates strictly under the instruction of NHS England and it does not, as I said, own or control NHS data. That access is tightly governed. In response to the earlier question, I note that the federated data platform to which the noble Lord refers is cyber resilient and subject to rigorous contractual, legal and information governance controls.
My Lords, my question also relates to the federated data platform. I am sure the noble Baroness is aware that more than 50,000 patients have written to their local trust boards asking not to have their data placed on it. The Greater Manchester ICB, serving 2.8 million patients, has said that this does not present value for money and is a big public trust issue. Palantir is of course owned by Peter Thiel and Alex Karp, who are closely associated with the Trump regime and have very right-wing and anti-democratic views. Does the Minister acknowledge that this association with Palantir is damaging our NHS?
I would first look at delivery: the federated data platform has enabled nearly 100,000 extra operations, removed over 600,000 patients from waiting lists and reduced unnecessary bed days by 15%, as well as driving a 10% improvement in cancer diagnosis—so people are being diagnosed sooner because the system is working more efficiently, and that is important. This is a three-year contract given in 2023. I refer the noble Baroness to the comments I made to the noble Lord, Lord Kamall, about the rigorous contract due diligence for all commercial agreements, including with Palantir.
My Lords, it is historically true that the NHS wasted a lot of money, but this was partly because the development of digital services was in-house. Currently, things are looking much better, and the classic example is the development of the NHS app. However, I will ask the Minister about the health research data service that will be established. Patients should have confidence in data that is used and collected for research, partly because of the recent report on UK Biobank, where the researchers published the codes they were using to access data for research. It has to be made absolutely certain that the public have the confidence in the data that is used.
Absolutely—public confidence is really important, and the debate around this today perhaps emphasises the need to communicate the realities of what is going on. But giving the NHS greater control and long-term value for money, as well as protecting privacy and improving public trust while improving outcomes, is the way forward. But the noble Lord is quite right, and we will ensure that we seek to build that confidence still further.
(1 week, 2 days ago)
Lords ChamberTo ask His Majesty’s Government what assessment they have made of whether NHS services for heart valve disease support healthy ageing and ensure older adults receive equitable access to timely treatment.
My Lords, to accelerate the 10-year health plan ambition to reduce premature mortality from heart disease and stroke by 25% and to tackle unwarranted variation across the country, this year we will publish a new cardiovascular disease modern service framework. It will support consistent, high-quality and equitable care while fostering innovation across the cardiovascular disease pathway.
I thank my noble friend the Minister for her response. The guidelines of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery suggest that the UK is falling behind in terms of diagnosis and treatment for heart valve disease. Can she give an assurance that the new framework will take full account of these guidelines and pay particular attention to the diagnosis and treatment of older people?
I am most grateful to my noble friend for his work in promoting the improvement of services for those with heart valve disease. I can say—it might be helpful—that we are driving down cardiology waiting lists. The number of people waiting over 52 weeks from referral to treatment was down 9% between the end of December 2025 and the end of January 2026. Yes, the modern service framework will accelerate this progress to reduce premature mortality and will set standards for the best evidence-based interventions.
My Lords, management of people with heart valve disease is truly a low-hanging fruit in reducing deaths due to cardiovascular disease. Some 400 people a year die on waiting lists for transcatheter aortic valve implantation. It is simple for people who have breathlessness or suffer from decreased exercise tolerance or chest pain. Even I, within five minutes, could diagnose whether they were at risk of heart valve disease or not—line them up and I will tell you.
I am reassured that the noble Lord can assist within five minutes—we might consider engaging him. The serious point is that early diagnosis is important, and the modern service framework will build on the work that has already been done. I know that the noble Lord is aware of this, but just the use of a stethoscope is the way to make an early and initial diagnosis. We are upping our game here by bringing in AI-assisted stethoscopes, which will be a massive assistance for diagnosis.
My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite her to ask her supplementary question.
My Lords, the Resuscitation Council UK, the British Cardiovascular Society and the National Council for Palliative Care have excellent and sensitive joint guidance on the use of cardiovascular implants towards the end of life. My family’s experience in different parts of the country shows that not all cardiac surgeons take account of end-of-life care in patients. In one case, a patient was told that she would not be allowed to leave the hospital until she had a pacemaker, despite the fact that, at 88 years old, she did not want one and, two years on, bitterly regrets finally agreeing. Can the Minister say whether the review that she just mentioned will ensure that surgeons follow the guidance and work not only with patients but with their other clinicians?
I am sorry to hear the experience that the noble Baroness describes. We are indeed seeking to have a whole-team approach to the whole patient. I absolutely agree with her that it should indeed consider where somebody is in their life stage.
The noble Lord, Lord McCabe, referenced older people in particular in his Question—he did not say where he drew the line at old, but perhaps I will declare an interest. What happens, for example, when really older people need heart surgery but are considered to be an anaesthetic risk? With new developments in heart surgery, I wonder whether the Minister can tell us what progress there has been in carrying out procedures without necessarily needing to have invasive surgery.
I can privately share with the noble Baroness that I suspect that “older people” covers both of us: it is over 65. The point that she makes is important. The option of what is called a TAVI intervention is far less invasive than a surgical intervention, as she referred to. That activity has grown significantly year on year, with something like a 16% increase on 2024-25. That is a very welcome step forward as we move towards minimally invasive procedures.
My Lords, it is obvious that early testing for heart valve disease is an exemplary form of preventive medicine, which is where we all need to get to. The House owes my noble friend gratitude for organising heart valve testing through the Heart Valve Voice, which was extremely successful. Does my noble friend agree with me that, because of the absence of routine testing, we should look for opportunities to link heart valve testing with the other sorts of routine testing where there is a captive audience? These could include, for example, occasions when people go for cholesterol testing or possibly even flu vaccination, which are becoming more routine? If we could get that in operation at an early stage, it could make a significant difference.
My noble friend is right and, certainly, as we move through our 10-year health plan, the opportunity to make every contact count is very important. I refer my noble friend to the advances that we have made in services available in community pharmacies, because measuring blood pressure is hugely important. Our pharmacies, I am glad to say, have delivered nearly 4.2 million blood pressure monitoring checks since October 2021. We have more than 7,500 pharmacies now available in our high streets delivering this service. That is the kind of thing that my noble friend is looking for.
My Lords, I declare my interest as chairman of King’s Health Partners. The Minister made reference to AI stethoscopes aiding in the diagnosis of patients with heart conditions. The evidence for this was established in a very large trial—the TRICORDER trial—involving some 1.5 million patients and more than 200 general practices in our country. What it demonstrated was, compared to the use of the ordinary standard of care, a doubling of the rate of diagnosis for heart failure and a tripling of the rate of diagnosis for heart arrhythmias. The problem was that, subsequent to the trial, the diagnostic rate did not increase, suggesting that it is necessary to invest in training and the establishment of new working pathways to ensure that innovation can be properly established in routine clinical practice. Is His Majesty’s Government funding such activity?
The noble Lord is right to make the point that innovation research is one part of it, but it is actually its implementation that matters. However, the faster and more frequent detection of cardiovascular conditions is the key thing and training is certainly a part of that.
My Lords, I am grateful to the Minister for giving me time for this question. She will be aware that studies analysed in around 155,000 diagnoses of aortic stenosis in England have found that women were significantly less likely to be referred to specialists and far less likely to receive valve replacement. This also applies to patients from deprived areas and in some ethnic minority groups. What assessment have the Government made of these disparities and what action are the noble Baroness’s department and NHS England taking to ensure that patients have access to heart valve treatment regardless of their gender, ethnicity or where they live?
The noble Lord is quite right: women are underdiagnosed, they are undertreated and some ethnic minority groups face poorer access. That is why I very much welcome the fact that, in the framework to which I referred, dealing with inequalities will be absolutely key. Research, in which we are partnering with the British Heart Foundation, will focus on tackling inequalities in higher-risk groups as well as unequal cardiovascular disease outcomes. Inequalities and tackling them will be at the heart of all our acceleration of progress as well as our research.
(1 week, 3 days ago)
Lords ChamberThat the draft Regulations laid before the House on 29 January be approved.
Relevant document: 51st Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 9 March.
(1 week, 5 days ago)
Lords ChamberMy Lords, I will make a short statement on the position regarding legislative consent on this Bill. The Bill is UK-wide, and it has been developed in partnership with the Scottish Government, the Welsh Government and the Northern Ireland Executive. A legislative consent Motion was received from the Northern Ireland Assembly on 10 February 2025, from the Scottish Parliament on 29 May 2025 and the Senedd on 9 December 2025.
Following further amendments to the Bill on Report, supplementary legislative consent Motions have been sought from the Scottish Parliament and the Senedd. It has not been possible to complete this process before Third Reading. However, noting the strong support of the Scottish and Welsh Governments, we are hopeful that this process will conclude shortly. The Northern Ireland Executive has confirmed that their current legislative consent Motion is sufficient. I beg to move.
Schedule 16: Advertising etc: audiovisual and radio broadcasting
Amendment 1
My Lords, Amendments 1 to 5 are minor and technical, and stem from the amendments that the Government made on Report on advertising. The amendments ensure consistency across the advertising-related restrictions in the Communications Act 2003. In particular, they will ensure that a business which manufactures or sells more than one type of product, such as vaping products and nicotine products, is in scope of the restrictions on sponsorship of prohibited products. It was always the Government’s intention to capture any business which manufactures or sells prohibited products, no matter how many different types of product they sold or manufactured. The amendments therefore provide consistency across the advertising-related restrictions and prevent the creation of a potential loophole. I beg to move.
My Lords, it has been a privilege to take this landmark Bill through your Lordships’ House. Smoking is the number one preventable cause of death, disability and ill health and tobacco claims around 80,000 lives every year. While tobacco remains the greatest threat, this legislation is about protecting future generations from the harms of not only tobacco but nicotine addiction.
I extend my thanks to noble Lords who have contributed from right across the House: in particular, on the Front Benches, the noble Lord, Lord Kamall, the noble Earls, Lord Howe and Lord Russell, and the noble Baroness, Lady Walmsley. My thanks go also to the Secretary of State for his leadership and support and to former Minister Ashley Dalton MP, who advanced this Bill to your Lordships’ House.
I also want to pay tribute, as many of us do, to former Prime Minister the right honourable Rishi Sunak for his ambition for a smoke-free generation. I also thank the Chief Medical Officer, Sir Chris Whitty, for his expertise and unwavering focus, and all the officials who have played a crucial role, including the Bill team, policy teams, analysts, the Bill’s senior responsible owners, my private office and the Government Legal Department and the Office of the Parliamentary Counsel for their invaluable contributions.
Finally, I pay tribute to Ministers and officials from the devolved Governments for their collaborative approach. This is genuinely a four-nations Bill which will ensure that we create a smoke-free generation and tackle youth vaping in every corner of our country. I beg to move.
My Lords, we have now reached the conclusion of what many will see as a landmark Bill. I thank all noble Lords who have contributed throughout the various stages of its journey through your Lordships’ House, which began with its introduction as long ago as March last year. From these and other Benches, we heard a range of views on its various proposals and on the Bill itself. For some, it goes too far. For others, it does not go far enough. However, among all the disagreements, there were three points that I think noble Lords can agree on. First, smoking is bad for your health. Secondly, current evidence shows that vaping is less harmful than smoking tobacco. Thirdly, not vaping is healthier than vaping.
Beyond that, our debates covered a number of issues, from the evidence base to how to make vapes an attractive alternative to adults who wish to quit smoking while not appealing to children, as well as matters of individual liberty. We also debated the illicit sale of tobacco, the treatment of specialist retailers, cigarette filters, the compatibility of the Bill with the Windsor Framework and the enforcement of a regulatory regime of considerable complexity. We also probed the Government on the evidence behind some of the proposals, for example on the relative harm of heated tobacco compared with combustible tobacco for smokers who have tried vapes but did not like them, so reverted to cigarettes.
While we did not always agree, I thank the Minister and her officials for meeting my noble friend Lord Howe and me throughout the passage of the Bill. I particularly thank her for the concessions made: we particularly welcome the amendment permitting vape vending machines in secure mental health settings. These are vulnerable people in restricted environments for whom access to cessation aids is not a luxury but a genuine health need and it was right that the Bill was amended accordingly.
(1 week, 5 days ago)
Grand CommitteeThat the Grand Committee do consider the Human Medicines (Amendment) Regulations 2026.
Relevant document: 51st Report from the Secondary Legislation Scrutiny Committee
My Lords, I am glad to introduce these regulations, which will take effect from 31 March 2026. This statutory instrument is technical, relating to the preparation and administration of vaccines.
In autumn 2020, in response to the Covid-19 pandemic, multiple temporary amendments were made to the Human Medicines Regulations 2012 to support the rollout of the Covid-19 and influenza vaccination programmes. Three of these amendments were extended in 2022 and 2024 following public consultation, and are due to lapse on 1 April 2026.
These regulations look to retain several provisions within those amendments—which have been utilised in the Covid-19 and influenza programmes for five years—as permanent legislation and expand them to other vaccines. They are designed to build on the benefits that the amendments have provided to date, as well as on the wider lessons learned during the pandemic and in recent polio and MMR vaccine catch-up programmes. I will briefly set out what each of these regulations does, and what amendments this instrument will make to them.
Regulation 3A(1) and (2) of the 2012 regulations enable trained healthcare professionals, or staff under the supervision of trained healthcare professionals, to conduct the final stage of assembly and preparation of Covid-19 vaccines without additional marketing authorisations or a manufacturer’s licence being required. This enabled bulk assembly of Covid-19 vaccines during the pandemic. Given that we are no longer in a pandemic and have taken a more targeted approach to recent Covid-19 vaccination campaigns, this instrument allows these provisions to lapse from 1 April 2026.
Regulation 3A(3) and (4) permit holders of a wholesale dealer’s licence who do not hold a manufacturer’s licence to relabel Covid-19 vaccines to reflect changes in shelf life resulting from product thawing. This instrument retains these provisions as permanent legislation and expands them to include any vaccine against an infectious disease, which will helpfully support flexibilities in the supply chain now and in the future.
Regulation 19 allows Covid-19 and influenza vaccines to be moved between different NHS service providers at the end of the supply chain, without the need for a wholesale dealer’s licence. This instrument retains these provisions as permanent legislation and expands them to include any vaccine against an infectious disease, with relevant safeguards in place to regulate its use.
The Earl of Effingham (Con)
My Lords, I thank the Minister for introducing these regulations. Vaccination remains one of the most effective public health interventions available to us all. The flexibilities introduced during the pandemic enabled the rapid deployment of both Covid-19 and influenza vaccines at scale. It is understandable that the Government now seek to make certain arrangements permanent and extend them to other infectious diseases.
His Majesty’s loyal Opposition support a vaccination system that is resilient, agile and capable of responding to future public health requirements. Expanding the role of community pharmacies and broadening the vaccinator workforce may well assist in that aim, provided that safeguards are robust. However, it would be wrong to wave this past without scrutiny, as temporary powers become permanent.
The introduction of a permanent vaccine group direction mechanism is a significant change. Flexibility must be matched by clarity. If a patient experiences a serious adverse reaction following vaccination under a vaccine group direction, where does the ultimate legal and clinical responsibility lie? Is it with the authorising body, the supervising clinician, the employer or the individual vaccinator? It would be helpful to have that clearly set out by the Government.
On workforce scope, the regulations expand the occupational health vaccinator provisions and align them with professions able to operate under a patient group direction. Can the Minister clarify the criteria used to determine inclusion? Were decisions based on professional registration, competence in administrating injectable medicines, workforce capacity or other considerations? I am sure all noble Lords agree that consistency and safety are paramount.
On public confidence and uptake, greater flexibility does not automatically mean higher vaccination rates, so how will the Government ensure that these changes actually translate into improved uptake among eligible and vulnerable groups? What benchmark will the Government use to evaluate the success of the measures?
A full impact assessment has not been produced. Although the stated impact may be minimal, these are system-wide changes. Reporting under the Medicines and Medical Devices Act occurs on a two-year cycle. Does the Minister consider that sufficient, or will interim data on safety, workforce, deployment and uptake be made available?
These are important questions to answer, and His Majesty’s loyal Opposition do indeed support a framework that is safe, proportionate and future-proofed, but one which has been properly stress-tested.
My Lords, I am most grateful to noble Lords for participating in this debate. I appreciate the welcome for these measures and the acknowledgement of their importance from the Opposition Front Bench and the noble Baroness, Lady Bennett. I will turn to some of the questions. I will, of course, be very pleased to write to noble Lords on anything I am unable to answer.
The noble Baroness, Lady Bennett, raised the issue of provision of Covid-19 vaccinations and remarked that Covid is still very much with us; I am not quoting her directly but that is what I took from what she said. In answer to that, this is a big change, but it is now a relatively mild disease—I stress relatively—for, I stress again, most people. It can still be unpleasant, but I am glad to say that the rates of hospitalisation and death have reduced significantly since the pandemic. These proposals, as I mentioned in my opening remarks, are very much about building on the successes that we saw in the Covid-19 and the flu vaccination programmes. As I mentioned, they are about taking that best practice and ensuring that we have a vaccination system in the future.
The noble Baroness also asked about private vaccination services. It is still the case, of course, that the NHS offer of vaccination is there for all those who are at higher risk of serious outcomes; there are a number of such people and we want to ensure they are properly looked after. Private provision is also available, as the noble Baroness said, as with some other vaccines. The availability and price of any vaccines provided through the private market is a matter for the private sector and not something that we seek to regulate.
On travel vaccines, as I am sure the noble Baroness is aware, a number of such vaccines are available free on the NHS through GP surgeries. These are against polio, typhoid, hepatitis A and cholera. These vaccines are free because they protect the public against those diseases that are thought to carry the greatest risk if they were to be brought into this country.
One of the vaccines on the list of those that are only available privately is against typhoid. There was a publication last week, I believe, looking at the spread of antimicrobial resistance to typhoid and the fact that antibiotics that we have been using against typhoid for decades are now increasingly not working. Can the noble Baroness assure me—again, I will understand if she wants to write—that the Government keep this constantly under review? Drug-resistant typhoid would be very serious; 10 or 20 years ago we might have thought that we could just treat people, but that may no longer be the case.
I can certainly assure the noble Baroness that effectiveness is kept under review. I know that she was not questioning this, but I also re-emphasise that typhoid vaccinations are available free on the NHS from GP surgeries. It is important to give that reassurance.
The noble Earl, Lord Effingham, asked where ultimate legal and clinical responsibility lies. An appropriate person has to be responsible for ensuring that only fully competent qualified and trained health professionals are individually authorised to use the most recently approved version of the VGD. That authoriser is usually a clinical manager or service lead. Authorised health professionals working under VGDs must understand their legal and professional responsibilities before they use VGDs. This follows the same principles set out in the NICE guidance. In that respect, I say to the noble Earl that this is not a new situation, but I accept it is quite right to ask about that.
The noble Earl also asked how we will ensure that changes translate into improved uptake. He will know our commitment to stabilising and improving uptake across the vaccination system, including, importantly, among those in underserved communities and groups that have historically lower vaccination rates. We have set out actions to improve uptake in our 10-year plan, as well as in our strategy Giving Every Child the Best Start in Life. We are also taking a multipronged approach, if I can put it that way, to improving vaccination uptake. That includes exploring whether there are other settings, such as community pharmacies and health visitors, who can assist in this. We also seek to continue to deliver clear messaging on the risks of disease and the benefits of vaccination. Importantly, we are investing in better digital services and data so that we know where we can target our efforts.
With regard to the question about community pharmacies having the necessary training and equipment if there are, unfortunately, adverse reactions, all providers and trainers have to ensure that those who are involved in vaccination have the right, high-quality training that enables them to deal with such reactions. I should say—I hope that this is a reassurance—that the amendment does not change the training expectations of those staff. Also, they are consistent: it does not matter where the service is being delivered.
A full impact assessment covering these amendments was carried out in 2023. It considered that making the relevant parts of the regulations permanent and expanding them is unlikely to create any significant additional impact. The amendments delivered by this SI are not controversial and do not reach the cost to business threshold; as such, a de minimis assessment was carried out and published on GOV.UK.
I hope that noble Lords will accept that, in amending these regulations, the Government are seeking to maintain important safety measures while increasing the effectiveness of the system’s supply chain and workforce. With that, I thank noble Lords for their contributions and questions.
(1 week, 5 days ago)
Lords ChamberTo ask His Majesty’s Government what progress has been made by the Independent Commission on Adult Social Care.
My Lords, the independent commission is making strong progress, and its work is on track. Just last week, the noble Baroness, Lady Casey, set out early recommendations for the Government to consider and take forward. This was informed by the commission’s extensive work, which included engaging with people and their families and across political parties. Later this year, the noble Baroness, Lady Casey, will launch the national conversation and publish the phase 1 report.
I am grateful for that. Last week, the noble Baroness, Lady Casey, said that the adult social care system was held together by “sticking plasters and glue” and said on the “Today” programme that the system was “horrendous”. She is due to complete the first part of her review this year—basically, looking at getting better value from the existing system—but the second part, which will look at the long-overdue reform of the adult social care system, will not be completed until 2028. That will be too late for this Government to pass the necessary legislation, making this Parliament the fifth to have ducked this issue. The noble Baroness, Lady Casey, completed her review of grooming gangs in four and a half months. If asked, she could complete the second part of this review by September 2027, which would give us adequate time for this to be done in this Parliament. Will the Minister ask her to do just that?
I understand why the noble Lord pushes this point, and I am sure that we all share his view. It has also been said that there is not a lack of good ideas, but there has been a lack of good politics. That observation has been made. The noble Baroness, Lady Casey, is chairing an independent commission and she has made it clear how complex and deep-seated these challenges are, as the noble Lord described. The 2028 date is a “by” date; the noble Baroness may report sooner, but that is a matter for her.
My Lords, the noble Baroness, Lady Casey, concentrates on workforce issues. I am sure that she and my noble friend agree that patients, families and carers do not care who is employing the social care worker, as long as they are getting support. Should we concentrate on a flexible workforce that works across both agencies without boundaries to meet the changing needs of the population?
That is key in the mind of the noble Baroness, Lady Casey. We need to better join up the NHS and social care workforces. We will have a workforce plan for the NHS in spring this year and we are also investing in developing our social care workforce to professionalise and respect it.
My Lords, last summer, local authorities came under pressure from the Department of Health to make people and their families go through assessments for continuing healthcare. From the speech by the noble Baroness, Lady Casey, on 4 March, we now know that ICBs were at the same time employing private companies to make sure that their CHC payments went down. Will the Minister undertake to review all the applications for continuing healthcare to each ICB throughout this financial year and publish the results, showing how many were accepted, how many were accepted on appeal and how many families were sent on a runaround between the different agencies?
What the noble Baroness describes—people getting the runaround—is, of course, unacceptable, and we have discussed this a number of times. I would be pleased to take back her suggestion to the Minister for Care, Stephen Kinnock.
My Lords, for what it is worth, I congratulate the noble Baroness, Lady Casey, on her initial findings, which illustrate all too well how serious the situation is. The problem will be made worse by things such as, as the Minister just reported, the NHS workforce plan that will be produced in the near future. That is welcome as far as it goes, but it illustrates the separation between NHS services and local authority services. The reality is that there are very few people using adult social care services who are not simultaneously looking to the health service for their continuous needs. Will we continue to do everything possible to bridge the gap between the two services?
Yes, indeed. We have three core foundations in place in our government objectives for adult social care, one of which is—to the point made by the noble Lord—strengthening the join-up between health services and social care services, because people need to experience more integrated, person-centred care. I am glad that the noble Lord welcomes the immediate actions, set out by the noble Baroness, Lady Casey, that the Government must take on adult safeguarding, dementia and motor neurone disease. We are not wasting any time in taking those recommendations forward.
My Lords, picking up on the points made by the noble Baroness, Lady Pitkeathley, and the noble Lords, Lord Young and Lord Laming, when we were in government, we published a White Paper on an integrated national health and care service, to be available for patients from birth to their later years. When the new Government were elected, as was their prerogative, the Secretary of State talked about creating a separate national care service, but we have heard little since. Can the Minister tell your Lordships’ House whether we will have to wait until the next stage of the Casey commission, in 2028, to get any further details at all, especially on how it will work in tandem with our healthcare system, or can we expect any clues or hints before then?
The noble Lord does not have to wait because, in addition to the work by the noble Baroness, Lady Casey, which, as I have said, is independent, she has set out immediate recommendations, which we are working on. We have already made commitments on the disabled facilities grant for housing, so that people can stay in their own homes. We have announced a £500 million investment in the first ever fair pay agreement, and we are uplifting social care allowances to support disabled people more than they ever have been. Those are just some examples, and I would be very happy to direct the noble Lord to other ways in which we are already taking action.
The Lord Bishop of Norwich
My Lords, in 2023, the Archbishops’ Commission on Reimagining Care encouraged a conversation not only between provider and recipient but with all those involved in care and support, to create rounded and fulfilled lives. That includes the voluntary sector, community groups and faith groups, which provide befriending and bereavement support and acts of worship in care homes. What plans does the Casey commission have to ensure that all parties participate in the national conversation mandated in its terms of reference?
As I said earlier, that will be a matter for the noble Baroness, Lady Casey. But I have every confidence that all the groups the right reverend Prelate referred to will be included, not least because the noble Baroness and the secretariat have already met, travelled widely and had many conversations, including with some 400 groups and individuals, focusing particularly on those with lived experience.
My Lords, 83% of adult social care is controlled by private equity. Its business model includes high prices, profiteering, low wages, asset stripping and tax abuse. It has profit margins of between 20% and 40% from adult social care. When are the Government going to end profiteering in this sector and ensure that social care is provided by not-for-profit entities only?
Various sectors have their role to play, and that includes the private sector, the voluntary sector and the public sector. As I have mentioned, we are building a national care service. It will focus on a high quality of care, greater choice and control for individuals and joined-up neighbourhood services, exactly as noble Lords request.
What can the Government do about bed blockers before the final report?
I assume that the noble and learned Baroness is referring to people who are staying in unsuitable settings, such as hospitals, for too long because an alternative is not available. We are looking at reforming the better care fund, which assists a greater joined-up approach, and we are bringing in neighbourhood services so that people can be cared for nearer home. We are also harnessing technology—I have witnessed many good examples of that—whereby people do not have to be in hospital but can be at home, and the money we are investing so that people can improve accessibility within their own homes will also assist people to get back home.
(2 weeks, 4 days ago)
Lords ChamberMy Lords, I will respond to this group of amendments concerning the proposed retail licence scheme for tobacco and nicotine products. We welcome the inclusion of a retail licensing scheme in this Bill. This is a significant and constructive addition to earlier versions. The proposal represents a major step forward in strengthening the regulation of tobacco and nicotine sales in the UK. It brings the sale of tobacco into line with established practice for alcohol. Tobacco, of course, remains the single most harmful product that is still readily available. It is the single biggest cause of preventable illness and early death in the United Kingdom. It therefore follows that the sale of these products should be subject to comparable regulatory oversight. Extending the oversight to vapes and other nicotine products will further assist trading standards in addressing non-compliant, unregistered and under-age sales. This combination of proportionate regulation and clear enforcement powers will help to protect both the public and responsible retailers from unscrupulous and illegal competition.
The principle underpinning this reform is simple: the right to sell products that carry health risks must come with clear responsibilities. We want a system that supports compliance, deters abuse and places public health at its heart. Amendment 21A, tabled by the noble Lord, Lord Kamall, and the noble Earl, Lord Howe, would ensure a minimum of a one-year gap between regulations being passed and coming into effect, allowing for a transition period. We entirely understand the wish to allow retailers, local authorities and other enforcement bodies adequate time to prepare for the new framework. Implementation must be orderly and practical. However, setting a fixed one-year time delay in primary legislation risks creating unnecessarily rigid constraints. Some elements of the scheme may be ready to begin earlier, while others might benefit from a longer period. The Government’s approach—to determine the precise timing through secondary legislation, informed by evidence gathered from those affected through consultation and negotiation—will ensure that that transition happens as smoothly and credibly as possible.
Turning to Amendments 23, 30, 43, 45, 114 and 115, I have listened carefully to the points made by the noble Earl, Lord Lindsay, regarding how existing specialist tobacconists should be treated within the new regime, including on transitional protection and possible exemptions. We acknowledge that the Government have already made some considerable steps in these areas, and we fully recognise the intention here: to try to give certainty to small specialist retailers who have operated responsibly and reasonably within the law for many years. However, these amendments would, in effect, enshrine grandfather rights in primary legislation, automatically conferring licences or permanent exemptions from any future limits on the number or distribution of these outlets throughout the United Kingdom and the devolved Administrations. That would effectively pre-empt the consultation process and remove discretion before any evidence has been gathered or assessed in any way.
It is important that all aspects of eligibility, transitional arrangements and the scope of any future caps or location-based controls are properly considered through consultation, considering not only the interests of existing traders but the wider objectives of public health, community protection and fair enforcement. Given that this applies to existing retailers, not new ones, it does seem that these points should be made within the consultation. We hope that the Minister intends to do that and is open and considerate to these small and normally very compliant retailers—a point that has been made several times. We imagine that the retail licensing scheme will differentiate between the different types of retailers; but given that all details have yet to be confirmed, these amendments feel premature to us.
Amendments 24 and 25 relate to national registers and a unified digital portal. Again, to us, it feels like these things will be necessary for any licensing scheme, and we therefore assume that these amendments are not necessary, but it would be helpful if the Minister could confirm that. On Amendments 31 and 44 and alcohol licences, we believe that this is already possible, but it would be useful if the Minister could confirm that.
I would like to pick up on one point that was made in the debate. It would be helpful if the Minister could say a word about how breaches made under one licence would be communicated and passed on to the people who are regulating the other licences, and how she feels these two licensing schemes would interact with each other, specifically where breaches have taken place.
My Lords, I am most grateful to noble Lords for their contributions to this debate, as well as the engagement they have been good enough to give their time to before Report.
Let me start with the amendments from the noble Earl, Lord Lindsay. The UK Government, Welsh Government and Northern Ireland Executive are carefully considering the design of the licensing scheme. A recent joint call for evidence asked detailed questions about implementation. This included specifically inviting feedback on whether applications for existing businesses should be treated differently from those for new businesses, and whether factors such as the location and density of retailers should have a role in granting licensing. I know, particularly from the debate today, that the question about existing businesses is a matter of concern to noble Lords.
We are aware that, under reforms to alcohol licensing through the Licensing Act, existing compliant businesses were indeed brought on to the new system, as noble Lords have referred to before, using grandfathering arrangements. I can assure noble Lords that we are considering this carefully alongside the feedback from our call for evidence, and we will invite further feedback when we consult on our proposals. However, the main point I would like to emphasise—a number of noble Lords have asked about this, and rightly so—is that, as I have said before, the Government do not wish to create a scheme which arbitrarily puts law-abiding retailers out of business. That is absolutely not the intent of this policy.
The noble Lord, Lord Johnson, the noble Earl, Lord Russell, and my noble friend Lord Mendelsohn, along with other noble Lords, raised questions about specialist tobacconists, which we have discussed, and rightly so, on a number of occasions. With regard to various regulations that we have spoken about, and on specialist tobacconists broadly, as the noble lord, Lord Johnson, acknowledged, I gave the assurances on day 1 of Report last week, and I hope they have been heard.
We want a scheme that is proportionate and fair, as I believe noble Lords do, particularly to the many existing businesses that operate responsibly—I emphasise that, because they deserve credit—but we also want to deter those who break the law, which was called for by the noble Lord, Lord Strathcarron. Again, feedback on our proposals will help us strike the right balance. While I cannot accept the noble Earl’s amendment, I hope I have provided some reassurance that we are considering the details of this scheme in a way that is sympathetic to his aims.
I am grateful to the noble Lord, Lord Udny-Lister, for tabling Amendments 24 and 25 and to the noble Lord, Lord Kamall, for tabling Amendment 21A. I am sympathetic to what noble Lords are seeking to achieve with these amendments. We agree with the need to introduce more rigour around who can sell these products and to minimise additional burdens on retailers and local authorities as far as possible. We also share the desire of the noble Lord, Lord Kamall, to ensure that retailers have enough time to prepare for the new licensing scheme. However, I believe these amendments are not needed as they are about how the scheme is implemented effectively. This is something we need to consider properly—the noble Earl, Lord Russell, referred to this—through consultation.
I can confirm to the noble Earl, Lord Howe, as I have before, that we are in regular contact with retail associations on implementation of the Bill, including the design of the future licensing scheme. This work will continue.
I know how strongly the noble Lord, Lord Lansley, feels about the point that he is raising. We have engaged with the UK’s main independent vaping bodies—the UK Vaping Industry Association and the Independent British Vape Trade Association—and that engagement will continue. We will continue to hear their considerations and those of their members, but ultimately our policy decisions on future regulations will be guided, as noble Lords are aware, by evidence to protect and improve public health. I appreciate the view of the noble Lord, Lord Lansley, which is different from the one that I am suggesting, but I hope he can be reassured about our engagement directly with those bodies because we feel that is the right thing to do.
I want again to reference our call for evidence, which asked about what support retailers and local authorities may require. It encouraged feedback on what works for existing licensing schemes. It also asked a specific question about how long is required to implement the scheme. These are all things rightly of concern to noble Lords in this group. The noble Earl, Lord Howe, raised a point about timings, how the timetable will go and including a lead-in time. We are considering these issues carefully and will reflect on the feedback that we have received before consulting on our proposals. The noble Earl, Lord Howe, understandably asked for an update on the feedback in the call for evidence. That is important because the feedback will, as the noble Earl knows, inform our proposals for consultation. I am not able today to provide the update that the noble Earl rightly seeks, not least because we are still considering the returns from the call for evidence, which closed at the end of last year. But I can say that in our view there is no need to introduce legislative requirements, as in these amendments, before consultation has taken place. The noble Earl, Lord Russell, made a point about the amendments being somewhat premature, but I know they have the best of intentions. The Government are fully committed to ensuring that there is fair and reasonable time for businesses to adapt to any new regulatory regime.
Turning to Amendments 31 and 44 from the noble Lord, Lord Udny-Lister, I am again sympathetic to what he is seeking to achieve. Where a business is found to have not complied with tobacco and vape legislation, it makes sense to bring into question whether that business is acting responsibly in relation to other products. However, any action that licensing authorities take against businesses should, as we would all expect, be justifiable and proportionate. A decision to suspend or revoke a business’s licence might have a significant impact on its livelihood and should not be taken lightly. Noble Lords have rightly made that point in this Chamber.
We are talking here about different products; it might not always be the case that non-compliance with one licensing scheme means that a business is non-compliant with another. It is important that licensing authorities take decisions with evidence of the business’s capability to sell specific products in line with the objectives of the respective licensing schemes. However, I agree that breaching a tobacco and vape licence may indeed be a useful signal for licensing authorities to more closely investigate a business’s compliance with their alcohol licence or vice versa; this is something that the noble Earl, Lord Russell, also asked about. Licensing authorities can and should use their judgment and knowledge of a business’s track record to inform the level of scrutiny that they apply. This includes, where there are concerns that a business is not complying with one scheme, carrying out additional checks to ensure compliance with other licences that it may hold and taking appropriate action where needed.
I hope that noble Lords have been reassured not only today but in the engagement that we have had prior to today, and that the noble Earl will feel able to withdraw the amendment.
My Lords, the amendments in this group were tabled in my name for Committee but were not moved at the time. Government Amendments 67, 69 and 74 are also needed as part of these changes. However, as these amendments are also required for changes that the Government are introducing to the use of proceeds from fixed penalty notices, they will be debated as part of the next group.
At the moment, the Bill places responsibility on trading standards to enforce the future licensing scheme. However, the licensing authority for the scheme will be set out in regulations. The licensing authority may sit in a different tier of local government from trading standards and therefore, as the Bill is currently drafted, would not be able to enforce the scheme. Feedback from stakeholders has suggested that enforcement of the licensing scheme would be stronger and more seamless if those responsible for administering the scheme could also enforce it. These amendments will therefore ensure that whoever is designated as the licensing authority for the scheme will have the powers to do so. In any scenario, trading standards officers will still be able to enforce the scheme alongside the licensing authority. These amendments will help the licensing scheme achieve its aims of supporting legitimate businesses while tackling those who disregard the law, and, in doing so, will support public health.
I turn to government Amendments 144 and 145. Amendment 145 was tabled in my name in Committee but was not moved. It has now been necessary to also table Amendment 144, which is connected. These amendments seek to resolve an issue which has arisen during the passage of the Bill. The Product Regulation and Metrology Act 2025 repeals certain enforcement procedures and provisions in the Consumer Protection Act 1987. As currently drafted, Clause 103 empowers the Secretary of State to make regulations which rely on these provisions. Therefore, without amendment, there is a risk that we may not be able to confer the necessary powers on enforcement authorities.
Amendment 145 allows for the provision of equivalent powers to fully enforce regulations made under Part 5 without referring to the Consumer Protection Act. In doing so, it ensures that regulations made under Part 5 are fully enforceable. Amendment 144 allows for flexibility in the penalties that can be imposed by regulations under Part 5. This flexibility will enable regulations creating new offences to replace certain offences from the Consumer Protection Act and to provide for the lesser penalties associated with them. The amendment retains the maximum term of imprisonment that the Bill currently provides for as a safeguard.
Government Amendment 49 corrects a minor drafting error in the Bill; it does not reflect a change in policy. Finally, government Amendments 208 to 215 are consequential, as a result of changes made by the Legislation (Procedure, Publication and Repeals) (Wales) Act 2025. I hope that noble Lords will support these amendments.
My Lords, I will respond to this group of minor and technical government amendments, which relate primarily to enforcement and regulation-making powers. I thank the Minister for her clear explanation of these technical and complex but necessary clarifications within the Bill. Briefly, our Benches appreciate the explanation given but we fully support what the Government are doing in these amendments and have no particular concerns with them. In the interest of time, I will avoid going into the detail, but we have no objection to any of these amendments.
I will also be brief. I am grateful for the support of the noble Earl, Lord Russell. As I stated in my opening speech, these amendments serve to strengthen the overall enforcement of the Bill, as well as the processes for future regulation—something that I know is of concern to both Front Benches, as well as all noble Lords. For this reason, I beg to move the amendment.
My Lords, in an earlier group I spoke about the importance of fixed penalty notices in the Bill, as they provide trading standards officers with an additional enforcement tool to bring retailers into compliance without taking up court resource. I have carefully considered the points raised by noble Lords in Committee about the proceeds of fixed penalty notices issued for licensing offences, including those made by the noble Baroness, Lady Walmsley.
I am therefore pleased to have tabled these government amendments because they will allow local authorities in England and Wales to retain all the proceeds from the £2,500 licensing fixed penalty notices for enforcement purposes, rather than having to return proceeds to the Consolidated Fund. That will enable local authorities to reinvest proceeds into strengthening the enforcement of tobacco and vape legislation—something that noble Lords have asked for.
In addition, we are investing up to £10 million of new funding in trading standards annually until 2028-29 to tackle the illicit and underage sale of tobacco and vapes, and to help to enforce the law. This funding is being used to boost the trading standards workforce by hiring 120 apprentices across England, and we will continue to provide funding to support the apprentices over the next three years as they complete their training.
Trading standards plays an essential role in ensuring compliance with tobacco and vape legislation. The enforcement provisions in the Bill, further strengthened by this amendment, will give them the tools they need to carry out that role. Proper enforcement of the law will protect the public from potential health harms and help to realise public health outcomes from policies in the Bill and other tobacco and vape legislation. For these reasons, I hope that noble Lords will feel able to support the government amendments in this group. I beg to move.
My Lords, I will speak to Amendments 66 and 68 in my name. These provide that the money collected by trading standards in small fines imposed by fixed penalty notices for offences other than those related to the licensing regulations should go towards smoking cessation services provided by the relevant local authority. The Liberal Democrats have been calling for this since the Bill was first introduced to Parliament.
My Lords, I was very happy to give way to my noble friend to allow him to heap more praise on to the Minister. Sometimes Government Ministers cannot always be assured of receiving praise from other Benches.
My noble friend Lord Howe and I welcome these government amendments and are grateful to the Minister and Department of Health and Social Care officials for reflecting constructively on our debate in Committee on fixed penalties.
On Amendments 66 and 68 in the name of the noble Baroness, Lady Walmsley, while I do not disagree with the sentiment, which is admirable—since in theory hypothecation of taxes, public fines and penalties would lead to more transparency on how taxpayers’ money is spent—there is also a strong argument in favour of more fiscal devolution to local authorities, and whether we should use legislation to tell local authorities what they should be doing with the funds they are responsible for. Nevertheless, I would be interested to hear the Minister’s reaction to those amendments, and I thank her and the Government once again for their amendments.
My Lords, I am most grateful for the contributions to this debate. I can assure the noble Lord, Lord Kamall, that there are no limits to the amount of praise that can be received by Ministers on this Front Bench, and noble Lords should feel free, at any time, to heap praise. We will always be grateful.
I am grateful for the welcome from the noble Lord, Lord Lansley, the noble Baroness, Lady Walmsley—we are very pleased to see her back in her place in good health—and the noble Lord, Lord Kamall. On the noble Baroness’s Amendments 66 and 68, I have heard the call for, as she described, a broad approach. We recognise the importance of local smoking cessation services, which is the very reason we are investing an additional £260 million pounds over the next three years within the public health grant. This will mean that at least £150 million is ring-fenced for stop smoking services every year. The funding is protected, as the noble Baroness seeks, and cannot be used for other public health initiatives. It provides assurance and stability for these essential services.
In addition, we have extended the national smoke-free pregnancy incentive scheme for a further three years from 2026-27 to 2028-29, with funding worth up to £15 million—£5 million per annum. We are also committed to integrating opt-out smoking cessation services into routine care within all hospitals, as set out in the 10-year health plan.
I hope that this reassures the noble Baroness, Lady Walmsley, about how committed we are to providing support for smokers to quit without the need to fund services using proceeds from fixed penalty notices. Instead, as your Lordships’ House has heard, we believe that proceeds can be better used by local authorities on the enforcement of the Bill and other tobacco and vape legislation. It is important that local authorities are able to retain the proceeds to cover their costs in issuing fixed penalty notices and reinvest any remaining funds in enforcement. Strong enforcement of the measures in the Bill and other tobacco and vape legislation will help ensure that we deliver our ambition to achieve a smoke-free UK and to protect future generations from the risk of nicotine addiction. In other words, on the very important points that the noble Baroness is pursuing through her amendments, that ultimately is the best way of reducing smoking.
Government amendments 64, 65, 67, 69 and 74 will support this by allowing local authorities to retain all the proceeds from the £2,500 licensing offence fixed penalty notices as well as the £200 fixed penalty notices in the Bill, which goes further than noble Lords were originally requesting. With that, I hope that noble Lords will support these important amendments.
My Lords, I am most grateful to noble Lords for their contributions to this debate, which have covered a number of important areas. I will start with Amendment 202, tabled by the noble Lord, Lord Young of Cookham, and Amendment 206, tabled by the noble Lord, Lord Lansley—it was also spoken to by a number of other noble Lords, including the noble Lord, Lord Rennard. As noble Lords are aware, there is already a duty on government to review most secondary legislation and to conduct post-legislative scrutiny of primary legislation, and we take these obligations very seriously. For Amendment 202 specifically, the point must be reiterated that this Government are committed to achieving a smoke-free UK, and we recognise that this work will absolutely not be over when this Bill receives Royal Assent.
However, I have listened carefully to the concerns raised by noble Lords, and it is for that reason that I have tabled Amendment 205, which introduces a requirement for the Secretary of State to review the operation of the Act within four to seven years of Royal Assent and to lay a report before Parliament concluding the findings of that review. I can assure the noble Lords, Lord Rennard and Lord Young, that this includes looking at the impact on communities where smoking rates are currently the highest. I hope that this is a clear demonstration of the Government’s commitment to monitoring progress against our smoke-free ambition.
The noble Lord, Lord Young, and others have said that this Bill is not about assisting people to quit. In the last group, noble Lords will recall, I addressed our determination, and laid out the resource that we have committed, to help people to quit smoking now, and that absolutely is a key aspect.
Amendment 205, which I tabled, will ensure that this Government and—I emphasise this—any future Administrations are held to account for conducting an evidence-based review of the Act. Our intent is to make the report within five years, in line with our existing obligations. However, the amendment is set out as it is—it provides the necessary flexibility on timing—because we want to ensure that evidence is in place before conclusions are drawn. We do not want this to be a tick-box exercise.
I can confirm to the noble Lord, Lord Lansley, and the noble Baroness, Lady Walmsley, that independent evidence will indeed be central. Most notably, it will include the living evidence map commissioned by the National Institute for Health and Care Research, which will collate UK-based and international evidence on vapes and nicotine products for the next five years. This will include things such as any published research evaluating the impact of the Bill, and regular summaries will be publicly available to outline emerging trends and evidence gaps. I am pleased to say that this tool was published on 18 February.
As the Bill’s impact assessment outlines, we would not, in all honesty—I know noble Lords understand this—expect to see the full, transformative impact of the Act for some time. It is for that reason that the impact assessment used a 30-year appraisal period for the smoke-free generation policy. Our modelling found that the Bill will save tens of thousands of lives over the next 50 years. None the less, we expect that this review will capture any early indicators and operational progress.
I say to the noble Baroness, Lady Fox, that there is no limit on consultation just to the devolved Governments because, as I set out on previous groups, we are keen and committed and have already set out how we will consult many. We will continue to commission a substantial package of high-quality independent research on what is world-leading legislation.
On Amendment 207 by the noble Baroness, Lady Fox, I appreciate her intention to ensure that the impact of the Act receives appropriate parliamentary scrutiny, as I hope she has heard me say throughout every stage of the Bill. As she is aware, the Government already published a thorough impact assessment of the measures in the Bill on its introduction. Where possible, this has covered estimated impacts on businesses across the tobacco and vapes supply chain, including impacts for manufacturers, importers, wholesalers, distributors and retailers.
For measures delivered through secondary legislation, in particular product standards, flavours and packaging, further detailed impact assessments will be undertaken. I have also spoken about government Amendment 205, which will include consideration of economic impacts where evidence allows. I must also emphasise that we will not prioritise the profits of businesses over protecting children from the risks of tobacco products, vaping and nicotine.
I say to the noble Lord, Lord Mawson, that there is no evidence to suggest that changing the age of sale of tobacco would have any relation to drug use. Indeed, we can look at our experience that, when the age of sale went from 16 to 18, drug use decreased.
I turn to Amendments 91, 120, 201 and 216, tabled by the noble Baroness, Lady Hoey, and supported by the noble Lord, Lord Dodds. I hope that these comments, in particular my opening remarks, will be helpful to the noble Earl, Lord Howe, because I will start with an update to your Lordships’ House on the notification of the Bill under the EU’s Technical Regulation Information System, known as TRIS. The UK Government have notified certain provisions in the Bill related to Northern Ireland on TRIS. This is an absolutely standard process; it is not an approval process. The Commission and member states may indeed comment, but they do not play a role in approving the UK’s legislation in respect of Northern Ireland.
It is the case, as noble Lords have said, that certain EU member states issued opinions setting out their concerns about the compatibility of the smoke-free generation policy with EU law. It is not unusual for member states to submit opinions on TRIS notifications. To give just one example, several member states also wrote to France recently when it proposed a ban on nicotine pouches, despite several other member states already having introduced such a ban.
The Government have provided a comprehensive response on the opinions they have received. The response sets out the strong public health justification for the policy and explains why the smoke free generation complies with EU law as it applies under the Windsor Framework. The Commission has also now responded, noting our response, and this concludes the TRIS process.
On the points raised by noble Lords including the noble Baroness, Lady Hoey, the noble Lord, Lord Dodds, and, in a different way, the noble Baroness, Lady Walmsley, about legal opinions, your Lordships are probably far more aware of this, but it is worth restating: legal opinions, to state what is obvious, can and do differ. I emphasise that it is not unusual for the tobacco industry to argue that government measures are incompatible with the law. My noble friend Lord Forbes spoke to this very point. Experience tells us that this has happened many times: to give but two examples, on the introduction of standardised packaging in 2016 and on the regulations made under the Tobacco Advertising and Promotion Act 2002.
Amendments 91, 120 and 216 are not required: the Government have already published their response to the Commission, setting out why measures drafted in the Bill which apply to Northern Ireland are compatible with obligations under the Windsor Framework and EU law. I referred earlier to the Government’s published response on TRIS, following detailed opinions from EU member states. I strongly urge all interested Peers to read this if they have not had the chance to do so already, because it sets out in detail why the Government believe that the smoke-free generation policy and other measures in the Bill are compatible with EU law. It covers the Bill’s compatibility with Articles 34 and 36 of the Treaty on the Functioning of the European Union and the EU tobacco products directive, and the public health justification for measures in the Bill.
Finally, I note that we cannot accept Amendment 201 as it could put us in breach of international law by undermining compliance with our obligations under the Windsor Framework. To this point, I am grateful to my noble friend Lady Ritchie for her observations. With that, I therefore ask the noble Baroness, Lady Hoey, to withdraw her amendment.
My Lords, I thank the Minister. We had this discussion a few times in Committee. I tabled these amendments to make sure that all noble Lords are fully aware that no matter how much time we spend on the Bill, and whatever happens, it could end up in the EU ruling that it cannot apply to Northern Ireland. That is just a fact. There may be different legal opinions; I certainly have not relied on just the legal opinions of the tobacco industry. I am just disappointed as, once again, the noble and learned Lord the Attorney-General seems to be very quiet on this and does not want to engage or produce anything that shows us the legal opinion.
However, as has been said many times before, there is obviously agreement between the two Front Benches. Although I welcome the very sensible probing of this by the noble Earl, Lord Howe, there is clearly a consensus that the Bill is going to go through whatever because other Bills are probably more important. I therefore just warn noble Lords that we have been right before when we warned about legal opinion and what was happening in the Windsor Framework, and I think we will be right again. Having said that, I will withdraw my amendment.
My Lords, I am sorry to disappoint the noble Baroness, Lady Walmsley, but, unless it is designed as a probing amendment, I fear I am not drawn to Amendment 123. In essence, it would tie the Government’s hands on the rules around the packaging and display of vapes. If the amendment were accepted, it would make any prior consultation and legal advice completely pointless. Measures of this depth and scope, mandating plain packaging for all vaping products and prohibiting point-of-sale display in all circumstances, would represent a major intervention in what is currently, and will certainly remain, a lawful market, and not only a lawful market but one that serves a significant therapeutic purpose in a public health context. The extent to which the powers in the Bill relating to the packaging and display of vapes need to be exercised must surely depend on decisions by Ministers following full and proper consultation with the businesses, manufacturers and retailers that would be directly affected.
Some regulation in these areas is almost certainly going to be necessary, particularly if we are to protect young people. However, regulation must be proportionate and evidence based. Vapes are not the same as tobacco, as the noble Baroness, Lady Fox, pointed out. For example, there needs to be scope for product differentiation by consumers. If consumers are denied choice, that will kill off any incentive on the part of manufacturers to pursue beneficial innovation. That consideration is important if we believe that vapes are likely to occupy an important place as a smoking cessation tool for adult smokers over the medium to long term.
On Amendments 125 and 134 from my noble friend Lord Moylan, notwithstanding the remarks of the noble Lord, Lord Darzi, I hope to hear the Minister make some positive comments. As my noble friend has argued, both today and in Committee, it is not just the flavour of a vape that gives it an appeal but the flavour that it purports to have, and we know that the flavour descriptor can affect the purchasing decisions of those inclined to use vapes as a recreational toy.
In relation to Amendment 136A, there are clearly a number of considerations that must be weighed carefully. On the one hand, higher-capacity devices may be important for some adult users who rely on vaping as a smoking cessation tool. For those individuals, practicality and product functionality can make a real difference in supporting a transition away from combustible tobacco. On the other hand, there remains a legitimate concern, which my noble friend rightly voiced, about whether larger-capacity devices could increase appeal to younger people or facilitate greater nicotine consumption, with implications for addiction.
I suggest that those are finely balanced issues. I look forward to hearing the Minister’s response on the evidence base underpinning the proposal and how the Government intend to strike the right balance.
My Lords, I am grateful for the contributions in this debate. Amendment 123 was tabled by the noble Baroness, Lady Northover, and spoken to by the noble Baroness, Lady Walmsley. Clause 89, which I will refer to later as well, already gives the Secretary of State powers to regulate packaging, while Clause 13 already provides powers on display that can set requirements as to where products can be sold.
The noble Baroness, Lady Walmsley, asked about evidence. There is evidence that removing branding and standardising packaging reduces a product’s appeal to young people, as the noble Baroness alluded to, while having little impact on adults. However, I can say that we will consult on proposals before making regulations. The noble Earl, Lord Howe, has referred to this issue a number of times and I agree, because we are conscious of the need to ensure a balance between dissuading young people from taking this up while not dissuading adult smokers from quitting.
On the point about research, through the National Institute for Health and Care Research, we continue to fund high-quality research, including research on the packaging of vapes and nicotine products, and I am glad to say that that is due to conclude later this year. While I understand the intention of the noble Baroness, Lady Walmsley, to reduce the appeal and visibility of these products, and I acknowledge her concerns, her amendment does seek to set the requirements in the Bill. As the noble Earl, Lord Howe, referred to, we have a statutory duty and we would be wise to consult on these issues, because we need to ensure, as the noble Earl said, that any restrictions are proportionate and evidence based. However, I reassure the noble Baroness that these are areas on which we will be acting.
On Amendment 136A, tabled by the noble Lord, Lord Udny-Lister, under the Tobacco and Related Products Regulations 2016, vaping products, as has been referred to in this debate, are already limited to 2 millilitres for tanks and 10 millilitres for refill containers. Over recent years, some manufacturers have developed devices where multiple refill containers can be attached to a single device as a means to circumvent the legislative requirements and restrictions.
I want to assure the noble Lord that Clause 90 provides the powers to amend or place additional requirements and limits on vape tank sizes and the size of refill containers. It is vital that we undertake the necessary consultation, because we wish to make sure that our regulations are based on the best possible evidence related to tank capacity limits and that we do not have unintended consequences for adult smokers who use vapes as a quit aid, something I know is of concern, and rightly so, to noble Lords. It is therefore more appropriate for such detailed technical measures to be introduced through secondary legislation. Our recent call for evidence sought views specifically on tank sizes to better understand current market practices and we are, as I mentioned in an earlier group, currently analysing responses and will consider our proposals for consultation post Royal Assent.
Finally, I turn to Amendments 125 and 134, tabled by the noble Lord, Lord Moylan. I begin by assuring noble Lords—and the noble Lord, Lord Moylan, suggested I would do this—that Clauses 89 and 90 already provide powers for the Government to regulate information on vape devices and packaging, including flavour descriptors. I draw the attention of noble Lords particularly to Clause 89(3), which is a non-exhaustive list of the kind of provision that regulations could make, including in paragraph (b),
“the information provided on packaging or otherwise supplied with a product”.
I have listened carefully to the concerns expressed by noble Lords about potential unintended consequences of implementing flavour restrictions too rapidly or stringently, and I understand the points that noble Lords have made about the role that flavoured vapes can play in helping adult smokers quit, something the noble Baroness, Lady Fox, mentioned. Certainly, the noble Lord, Lord Moylan, did a very fine job of inviting us into the world that he has experienced in this regard. In that spirit, I can confirm the Government’s commitment to consult on regulating flavour descriptors as a first step before considering broader restrictions on flavoured ingredients. This commitment reflects our intention to adopt a proportionate approach, again as the noble Earl, Lord Howe, asked me to do, supporting adult smokers in their efforts to quit while also working to reduce the appeal of vaping products to children.
However, and on the points raised by the noble Lord, Lord Darzi, I have to be clear that it is essential that we retain the ability to go further in line with the evidence, which the noble Baroness referred to. Flavourings are added to vaping products and that can increase their appeal. Hundreds of flavoured ingredients are used in vapes and, although some are considered safe when ingested, we do not, as the noble Lord, Lord Darzi, said, know the long-term health effects when they are inhaled, particularly in respect of children. Some initial data drawn from the limited research available is concerning and indicates that certain chemicals may be harmful if inhaled. For this important reason, we must have the flexibility to restrict flavoured ingredients in the future to protect public health. We have sought further data on flavours as part of the call for evidence conducted at the end of last year and we are reviewing those responses. In addition, we are exploring commissioning further research on the health impacts of vape ingredients when inhaled.
I hope that all this reassures noble Lords that the powers in the Bill already provide a comprehensive framework to act on these issues and that our approach will remain balanced and evidence-based to strike a necessary balance between reducing youth appeal and ensuring that adult smokers continue to have access to products that may help them quit. I hope the noble Baroness, Lady Walmsley, will feel able to withdraw the amendment.
My Lords, before I respond to the specific amendments, I will touch on two things that the noble Earl, Lord Russell, said. First, I was previously in the European Parliament and worked on a number of technology regulations, and we can never be absolutely certain that we have legislated for the future or completely future-proofed anything. The only way to do that is to ban everything, frankly. We therefore often find regulation having to keep up with technology when it is far behind it, but we can put certain provisions in place. We can predict certain things but we cannot predict all innovation completely. Secondly, I hope the noble Earl will not mind me gently reminding him that not all vape companies are connected to big tobacco. A number of vape companies have nothing to do with big tobacco, and it is important that we understand that distinction.
My noble friend Lord Howe and I welcome the amendments from my noble friend Lord Lansley. Before the Minister speaks to them, we also very much welcome the two government amendments in this group, which we think respond very helpfully to the issues raised in Committee by my noble friend Lord Lansley. We believe that adding these provisions is a good way of future-proofing the Bill, as much as any Bill can be future-proofed, without necessarily compromising any decisions that Ministers may wish to make in the short term—but also without committing the Government or a future Government to any specific technology solution or to one company’s specific solution. With that in mind, I look forward to what the Minister has to say.
My Lords, government Amendments 130 and 132 provide a power that would allow the Government to regulate the technological features of vaping products and tobacco-related devices, and the software associated with those features, to address emerging risks and to protect children. While the Bill already provides powers to regulate various device features, such as colour, size and shape, I listened carefully to the points raised in Committee about vape technology and the need to future-proof the Bill in order to respond quickly to new risks. I appreciate the support of both Front Benches on this point, particularly the comments of the noble Lord, Lord Kamall, about how far one can ever go when future-proofing. I can assure him that we are not planning to ban everything, but I thank him for the interesting suggestion.
The noble Earl, Lord Russell, spoke to concerning examples of the emergence of technology being used to make vapes more enticing to young people. As he said, some can now come with gaming functionality and others can be linked to what are called puff leaderboards and reward systems, so the more you inhale, the more credits you build up. Emerging evidence suggests—and it is worrying—that these interactive and gamified vaping features may heighten their appeal to children. This raises serious public health concerns around their potential to escalate dependence on nicotine. Our amendments therefore ensure that such emergent technology features can be appropriately regulated to reduce the appeal to children.
I turn to Amendments 124 and 131 tabled by the noble Lord, Lord Lansley. Let me first reassure him, as well as the noble Earl, Lord Russell, with regard to Amendment 124, that the powers in the Bill already enable us to regulate markings, which could include digital markings such as QR codes, to be used as part of a system to authenticate products. On Amendment 131, with reference to the device itself, I am very grateful for the noble Lord’s suggestions and his contributions on how best to future-proof the Bill, including on age-verification technology.
While it is not the Government’s policy to verify age at the point of use, and we have no intention to do so at this time, we recognise that need, as I have said, to be able to regulate technology to protect public health and respond to evidence, as the noble Lord, Lord Lansley, acknowledged. It is for this reason that we are introducing the new regulation-making power on technology to which I have just spoken. I therefore ask the noble Lord to withdraw his amendment.
The Minister referred to QR codes on packaging, which are obviously covered by the terminology of the Bill as it stands. But the example I used was smart tags, which effectively incorporate an electronic feature into the packaging of a product for monitoring. I would like to be assured that smart tags, too, are covered by the existing powers in the Bill.
I would be happy to write to confirm that point, but we feel that the Bill covers what we need to cover now. Our amendments talk about future-proofing, which is the key thing, but I would be pleased to write further.
I am most grateful to the Minister and for the support from the noble Earl, Lord Russell, and my noble friend Lord Kamall. With those assurances, I beg leave to withdraw Amendment 124.
My Lords, I start by thanking my noble friends Lord Udny-Lister and Lord Sharpe for their amendments in this group. I begin with the amendments proposed by my noble friend Lord Udny-Lister. Many noble Lords have raised concerns about the unintended consequences of this Bill. Just yesterday, HMRC published data showing that legal tobacco sales in the United Kingdom fell by 52% between 2021 and 2025. That statistic will be welcomed by those who want to eradicate smoking, but there is still some way to go in encouraging smoking cessation. My noble friend’s amendments simply ask a question akin to that debated in group 5—namely, how far we should go with regulation of vaping and nicotine products, especially when we are trying to promote them as alternatives to smoking tobacco?
Of course, some regulation is certain to be necessary with products such as vapes, but we have to be careful that we confine them to responsible use. We should also be careful not to use a sledgehammer when a nuanced approach might be a more effective way forward in a particular circumstances and settings. If we overdo the restrictions, we risk driving smokers away from quit aids and alternatives such as vapes towards easily available alternatives—unfortunately, such as illicit tobacco, which we know is still too accessible to some smokers. Many noble Lords have spoken to their own experience in local authorities about trying to tackle illicit tobacco. In the right settings, advertising and displays of vaping products can play a role in encouraging adult smokers to switch from cigarettes to less harmful alternatives, and we know that many are already doing so. It is important for the Government to find the right balance.
I turn to the amendment from my noble friend Lord Sharpe of Epsom. There is really little that I can add to the case that he has made so persuasively. The hospitality sector has faced sustained pressure in recent years, including rising energy costs and an increase in the cost of taking on new employees, staff shortages in some areas and increasing regulatory burdens. It is therefore reasonable that when we introduce further restrictions, we carefully consider their cumulative impact on licensed venues.
My noble friend’s amendment is tightly drawn. It would apply only within the curtilage of premises licensed under the Licensing Act 2003; only where advertisements are not visible from outside; only in age-restricted venues with appropriate safeguards; and it explicitly excludes tobacco products. It also provides for regulations to be subject to the affirmative procedure, and requires consultation and a full impact assessment, something very much in line with better regulation, in which many noble Lords believe. That framework suggests a helpful attempt to strike a balance, maintaining strong protections for children and the wider public while recognising that adult-only controlled environments may justify a different approach. It seems reasonable to at least explore whether limited, carefully regulated flexibility of this kind could be accommodated without undermining public health objectives. I hope that the Minister will look favourably on such flexibility.
My Lords, I am most grateful for the contributions to this debate. I begin with the amendments in the name of the noble Lord, Lord Udny- Lister, Amendments 149, 151, 155, 157, 159, 161, 163 and 169.
Survey data shows that there has been a significant growth in awareness of vaping promotion among young people, with 55% of all children aged 11 to 17 aware of promotion in shops. This figure relates to 2025, and that is up from 37% in 2022. We are therefore delivering on our manifesto commitment to stop vapes from being advertised to children, while still enabling them to be promoted by public health authorities as a means for adult smokers to quit smoking, something that noble Lords have emphasised correctly, once again, in this group.
Tobacco advertising, including for heated tobacco products, is already prohibited under the Tobacco Advertising and Promotion Act 2002, and will remain so under the Bill. On Amendment 168 in the name of the noble Lord, Lord Sharpe, I can clarify that the advertising provisions do not restrict the use of, or sale of, products, and therefore should not overly impact on the hospitality sector. I will come back to reference to the hospitality sector, following the comments of the noble Baroness, Lady Fox, when we get to the final group, which is coming up next.
Evidence for tobacco has found that partial bans, as referred to in this amendment, are not as effective as comprehensive bans in reducing tobacco consumption. I therefore feel that it is extremely reasonable to draw similar conclusions for vape advertising. Under current legislation, there are already strict restrictions for vape advertising. We believe that the promotion of vaping to quit smoking is best led by the appropriate public health authorities, because they can provide tailored advice to the individual with the necessary behavioural support.
In response to the comments of the noble Baroness, Lady Fox, the Bill already includes defences for the limited circumstances in which advertising would be appropriate. As I outlined on the first day of Report, following my prior assurances on public health campaigns, we are introducing a specific defence which will strengthen this capability by allowing businesses, such as pharmacies and GPs—something that noble Lords rightly drew my attention to—to advertise non-branded vapes, if it is part of a campaign agreed with the public authority for public health purposes. We are not considering further exemptions due to the risk of loopholes, the potential for poorly enforced entry rules, and the fact that evidence has shown that comprehensive bans on tobacco advertising have reduced consumption, but partial bans, as I mentioned before, have had no significant effect.
On Amendment 152, in the name of the noble Lord, Lord Udny-Lister, the language of “has reason to suspect” is standard practice and already included in the existing Tobacco Advertising and Promotion Act 2002. This wording is specifically designed to avoid loopholes and to ensure that those involved in the design of advertisements cannot evade responsibility by claiming ignorance where there are clear grounds for suspicion. I say again, this is standard legal practice.
Finally, on Amendment 153, in the name of the noble Lord, Lord Udny-Lister, it is important that we recognise and respect the established criminal law system within each nation of the UK. As noble Lords will know, Scotland has a separate criminal justice system, and 12 months is the maximum penalty on summary conviction for this type of offence and is fixed in line with its criminal justice system. For the reasons that I have set out, I hope that the noble Lord, Lord Udny-Lister, will withdraw his amendment.
My Lords, despite the comments of the previous two speakers, I will speak to Amendment 199, the purpose of which is simple: to make every future and renewed pavement licence issued by local authorities smoke-free.
Your Lordships will recall that pavement licences first appeared during the pandemic, when indoor hospitality was restricted. They gave cafés, pubs and restaurants a lifeline. It seemed obvious that these spaces should follow the same rules as indoors: no smoking. The LGA supported this, saying that
“it sets a level playing field for hospitality venues across the country and has a public health benefit of protecting people from unwanted second-hand smoke”.
It welcomed this national policy because it stopped the stupid situation of allowing people to smoke in a pub pavement area on one side of the road but not on the other if a local authority boundary ran down the middle of the road and they had different policies. Since then, pavement licences have become a permanent fixture. However, after some lobbying from some parts of the hospitality industry, the requirement for smoke-free was removed without proper consultation of health authorities.
In 2021, this House supported an amendment from the noble Lord, Lord Faulkner of Worcester, noting the missed opportunity to make all licences smoke-free. Amendment 199 seeks to honour that vote and ensure that this health-protecting measure is applied consistently.
There is currently a requirement for some seating to be smoke-free, but the distinction means very little when you talk about a very small bit of pavement. More than 10 councils have made smoke-free a condition of obtaining a pavement licence, including Liverpool, Manchester, Newcastle, Northumberland County Council and Durham—not outstandingly liberal authorities, as far as I can tell. Feedback shows that customers and businesses welcome the change. In Liverpool, a survey of premises found that 74% of those asked expressed support for the scheme, including many smokers. Councils also aim to reduce cigarette litter with this initiative, which would make outdoor seating areas cleaner, more welcoming environments.
Second-hand smoke is harmful at any level. It worsens asthma and other respiratory conditions, and contributes to heart disease, stroke and lung cancer. Smoke-free spaces are also popular with the public. Polling from ASH shows that 59% of people support banning smoking in outdoor areas of pubs, cafés and restaurants; indeed, 40% said that they would be more likely to visit these venues if smoking were banned outside. That is more than double the number of people who say that they would go less often, debunking the idea that smoke-free means customer-free. Making outdoor areas smoke-free is not only sensible but what the public want.
I regret that this issue is not covered by the recent consultation on smoke-free places. It is a shame that the Government felt that they were not able to include hospitality in that consultation at all and that they fell into this false narrative that smoke-free is somehow an economic threat to hospitality.
Less than 12% of the population smoke, so the financial viability of the hospitality industry is clearly not dependent on the continued consumption of tobacco, including outdoors. Indoor smoke-free legislation was a far more drastic intervention, and we heard many of these arguments from those opposed then. However, a survey in 2012 of nearly 5,000 pub customers reported that more than one in five visited the pub more often than before smoke-free legislation. I do hope that the Minister will, in future, consider looking at the pilots for smoke-free pavement licences to assess the economic relationship between the hospitality sector and smoking. As prevalence continues to fall, we must be at a tipping point soon, where these spaces will naturally become smoke-free.
This brings me to Amendment 196, tabled by the noble Lord, Lord Sharpe of Epsom. I think we may disagree on the potential impact any restrictions will have on hospitality, but in any case, the Government would consult on any use of smoke-free powers as they are doing currently.
Moving on, I welcome Amendment 194A from the noble Lord, Lord Kamall, and the noble Earl, Lord Howe. There is no doubt that the public are keen to see more places where smoking and vaping are prohibited. However, this policy must be pursued not merely to cater to the things that people dislike, but also to ensure that it is addressing matters that are harmful to the public. Clearly, reducing children’s exposure to second-hand smoke passes that test. While the evidence of exposure to second-hand vapour remains unclear, I think we can agree that reducing any possible risks around children must be prioritised, following careful consultation.
In that respect, I do not support Amendments 194 and 195 from the noble Lord, Lord Udny-Lister, which would remove these powers altogether. However, there is a challenge in all of this. Given the high level of public misunderstanding about the difference in harms between vaping and smoking, as the noble Baroness, Lady Fox of Buckley, has said—and she is quite right —how do we ensure that in creating vape-free places we do not exacerbate those misconceptions? I talked to a young man the other day who asked me, “What are you doing in the House of Lords?” I explained about this Bill, and he said, “Oh, all my friends vape”. He said, “I think it is just as harmful as smoking, isn’t it?” QED. Of course it is not.
I welcome the commitment in the published consultation to treat vaping differently from smoking where it is providing support to smokers to quit. I am on the same side as the noble Baroness, Lady Fox, on that score. Will the Minister say more about how this policy will be communicated to improve public understanding that vaping is less harmful than smoking? How will any exemptions to indoor vaping regulations be used to best effect to encourage more smokers to see vaping as quitting aids?
It is disappointing to see only council-run playgrounds included in the ban on smoking in playgrounds. Why should children playing in settings not run by councils not be similarly protected? There are also other places, such as transport hubs, where the public and workers are regularly exposed to other people’s smoke, so are the Government planning to commit to look at these too?
Amendment 192A from the noble Earl, Lord Howe, is very interesting, but we do not think actors should have to smoke at work. I think it was pointed out in Committee that there are alternative products that can depict smoking for artistic purposes; in particular, I believe that the National Theatre has such a device. If it is good enough for that theatre, it is good enough for me. Moreover, Wales does not have this exemption in place, and it has not harmed Welsh theatres.
We do not think that Amendment 193 is appropriate either: most venues are vape- free anyway, and the law is just really catching up.
On Amendments 197 and 198, I do not think that heated tobacco should have special exemptions at all. Only 1% of the population use it and it is not recommended by NICE for cessation. However, I do have a couple of questions for the Minister about heated tobacco devices, because I have had a letter expressing some concern that the law is not terribly clear. The advertising offence in the Bill applies to any advert,
“whose purpose or effect is to promote … a tobacco product”.
So can the Minister confirm that heated tobacco devices—not just sticks—will be caught under this definition, as advertisement of the device might constitute promotion of the tobacco product?
I see that in Clause 132 the Government explicitly take the power to extend provisions in Part 6 to tobacco- related devices. I understand that this is to future-proof the advertising restrictions against any innovation in this space, as we know the tobacco industry is likely to use any loopholes. I ask the Minister: why are heated tobacco devices explicitly included in Clause 132? Is it because of the difficulties they have had recently with two big supermarkets advertising heated tobacco products? Is it just the devices they are advertising, or are they simply breaking the law about advertising the tobacco sticks themselves? A little clarification would be most welcome if the Minister could provide it, please.
My Lords, I am grateful to noble Lords for their contributions on this last group of amendments. It may be helpful if I remind your Lordships’ House that, on 13 February, the Government published their consultation on free-from places. We are consulting on making outdoor public places, including children’s playgrounds, hospitals and schools, smoke-free and heated tobacco-free. Additionally, we are consulting on making outside playgrounds and schools vape-free.
With regard to indoor spaces that are currently smoke-free, we are consulting on also making these heated tobacco-free and vape-free. I want to emphasise—and I hear different opinions on this within your Lordships’ House—that the consultation does not consider extending these proposals to outdoor hospitality. I hope that this addresses the concerns raised under Amendments 194 and 197, tabled by the noble Lord, Lord Udny-Lister, as well as Amendment 196 from the noble Lord, Lord Sharpe.
With regard to Amendment 193 from the noble Lord, Lord Udny-Lister, the vast majority of people—around 90% of those over 16—do not currently vape. Just because someone is present in an over-18 setting does not mean that they are content to be exposed to second-hand harms. This would be of particular concern to those who are medically vulnerable, whose conditions may not always be visible.
Additionally, under the proposals put forward in the consultation, those who wish to vape would still be able to do so in outdoor hospitality settings. I should say that we have been pleased to meet various stakeholders, including UKHospitality and the British Beer and Pub Association, and we have welcomed their input.
Furthermore, a number of establishments, as I am sure we are all aware, have already introduced their own policies restricting vaping indoors. These proposals provide consistency and clarity for the public and businesses, and that is crucial if we are thinking about legislation.
I turn to the evidence. Amendments 195 and 198 in the name of the noble Lord, Lord Udny-Lister, question the need for the vape-free places and heated tobacco-free places clauses. I also refer to Amendment 194A in the name of the noble Lord, Lord Kamall.
We have already published a draft impact assessment alongside the consultation on free-from places. To the points made by the noble Earl, Lord Howe, this sets out the evidence base for the proposed policies. I encourage noble Lords to review the document, which is thorough, if they have not had the chance to do so already. I can say that we will reassess the evidence after the consultation is closed, and we will consider any additional evidence identified before deciding on final policy positions and publishing a final stage impact assessment alongside regulations.