Funeral Directors: Regulatory Regime

Baroness Merron Excerpts

Wednesday 9th September 2026 Lords Chamber

[The Archbishop of York]

To ask His Majesty’s Government what plans they have to establish a regulatory regime for funeral directors.

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

My Lords, the Government laid a Written Ministerial Statement on 1 September confirming that detailed proposals for formal regulation of the funeral sector are being developed. The Department of Health and Social Care is leading this work with the Ministry of Justice and other departments, working closely with bereaved families, funeral providers, faith groups, local authorities and others.

[The Archbishop of York]

In thanking the Minister for her response, I pay tribute to those affected by the terrible failures in Hull, where I serve, and to the clergy and local community services that have supported the bereaved. I welcome proposals for regulation; what happened in Hull must never happen again. I therefore ask the Minister: when will the department set out further details on the timeline for these proposals and their implementation? Mindful that many of those who suffered in Hull were those least able to afford a funeral for their loved ones, I ask also whether questions of cost and its links to bereavement also be considered.

[Baroness Merron (Lab)]

I also want to express my sorrow and support for those who are so deeply affected. Those who have died cannot speak, so it is left to the rest of us to speak for them. In this case, terrible tragedies were put in the path of proper grieving and understanding about loss. I very much want to associate myself with that and to say that all the matters that the most reverend Primate refers to will be considered. We have already accepted the majority of the 75 recommendations from the Fuller inquiry, but obviously the Written Ministerial Statement says how much further we are going to go. When I am able to update on timelines, I will be glad to do so.

[Baroness Barker (LD)]

My Lords, I too want to register our condolences to the people in Hull who were affected so badly. Scotland, as of 2025, has a fully searchable database of registered funeral directors. One can work out who the owners are, read reports and have details of any complaints which have been made. How long is it going to take us to get to where Scotland already is?

[Baroness Merron (Lab)]

We look forward to working with other jurisdictions to see how their best practice works, and that will, of course, include Scotland. I am very keen that we continue to work closely, for example, with the funeral provider cohort, most of whom, let us acknowledge this, do a first-rate job with immense dignity and professionalism and have been let down also. Safeguards have to be effective without imposing disproportionate burdens and, while it is a bit premature for me to prescribe how the regulatory framework will work, I can assure the noble Baroness that we are looking very closely at what she raises.

[Baroness Browning (Con)]

My Lords, I support the Government in regulation, because what has happened in Hull has been tragic for the people concerned. We have noticed increasing television advertising for funerals without any form of ceremony or service. Of course, that is personal preference, but it looks as though the public are increasingly putting their faith in funeral directors to have sole charge of the deceased from the time they die to the time they are cremated, without necessarily having any input from people around them—of course, some people have no surviving relatives or friends—and I think that trust needs to be regulated.

[Baroness Merron (Lab)]

That, my Lords, is exactly why we are taking the action that we are.

[Lord Sahota (Lab)]

My Lords, some communities prefer to have open-air funeral pyres. What is the Government’s policy on that?

[Baroness Merron (Lab)]

I cannot give a detailed reply to my noble friend, much as I would love to, but I will be glad to look into that and write to him. The main thing to say is that, in all this work, our focus is on the security and dignity of people after death across a wide range of settings. That is what will guide us.

[Lord Brennan of Canton (Lab)]

My Lords, it is quite shocking that, in this third decade of the 21st century, there are currently no minimum standards of care for the deceased, and there is no system of statutory professional regulation or duty of care to a person after they have died. Is it the Government’s intention that those matters should be covered in the regulations they intend to bring forward?

[Baroness Merron (Lab)]

I can assure my noble friend that that is indeed what will guide us.

[Viscount Stansgate (Lab)]

My Lords, I warmly welcome the most reverend Primate’s Question and the Government’s response to it. The terrible events in Hull remind us that there are occasions when terrible events lead to worthwhile reform. In the 1820s, the discovery that Burke and Hare were murdering people in Edinburgh led this House to pass the Anatomy Act 1832, which was a step forward in this area. Can my noble friend outline what range of consultations will be held? There are many reputable funeral director chains, but there are also individuals; it is a wide field. Can my noble friend outline the extent of the consultation that will precede what I hope will be government action?

[Baroness Merron (Lab)]

My noble friend endorses the point that I made earlier, which I know the House recognises: that the majority of funeral providers, even within the current set-up, are providing a first-rate service that encourages trust as well as respect and service. However, because of these terrible circumstances, we have to act to protect people. I say to my noble friend that we are working very closely with funeral providers to get it right, so that they can do the work they need to do without undue burden, but with protection for those whom they are working for.

[Lord Kamall (Con)]

My Lords, I associate these Benches with the comments that were made about the poor people and their families who had to suffer in Hull. The most reverend Primate spoke about the impact on local communities and how legislation should consider costs. Given this, do the Government intend to ensure that smaller independent funeral directors—most of which, as the Minister said, do an amazing job in helping families through a very difficult time of bereavement, and which serve many of our communities with great care—are properly involved in shaping these reforms, and that it is not just the bigger companies and organisations that are involved? What steps will be taken to guarantee that any new requirements are proportionate and do not place unsustainable extra burdens on providers, while of course avoiding a repeat of the scandal that we saw in this case?

[Baroness Merron (Lab)]

This is the way that we are conducting ourselves. It would be a bit premature to draw conclusions on any funding requirements—we are, of course, talking about private businesses. However, we are looking—as we always do, but particularly in this area—at the costs, benefits and the impacts of different approaches before decisions are taken. Within that, we are working with the full range of funeral providers and not just the large funeral providers.

[Baroness Finlay of Llandaff (CB)]

My Lords, this is much to be welcomed, because a funeral is a very important part of marking the passing of, and respect for, a person. So, in the consultation, will the Government ask hospice bereavement counsellors—specifically those who see people on the ground face to face—for their comments? Often, managerial people higher up in the bereavement service may not know some of the details that have been extremely important to families and that may have caused great offence or may have been particularly helpful, and they can get lost in the retelling as things are passed up the chain.

[Baroness Merron (Lab)]

The noble Baroness is quite right that funerals are very personal matters—personal to the deceased, who may or may not have left their wishes, and personal and affecting for those left behind. So hospices and other groups will be worked with closely in the way the noble Baroness describes, as they are important stakeholders for us.

[The Lord Bishop of Manchester]

My Lords, I want to pick up a point made from the Opposition Front Bench a few moments ago about family funeral directors. Over the last 20 years or so, we have seen many of those, in effect, bought up by large conglomerates. It is important that any regulation is created in a way that makes it commensurate for those small providers and does not create a further incentive for the large, sometimes multinational, bodies that do not have that degree of personal understanding of a particular local community.

[Baroness Merron (Lab)]

On that point, I was interested to look at the figures, which show that the largest three businesses collectively account for approximately a third. The right reverend Prelate emphasises a point made by other noble Lords about the importance of ensuring that regulation enables all sizes and scales of businesses in this area to do the job we need them to do and has regard to all the points that we have referred to here, while letting them conduct their business.

NHS: Agency Medical Staff

Baroness Merron Excerpts

Wednesday 9th September 2026 Lords Chamber

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

My Lords, in the 10-year health plan we committed to eliminate agency spending by the end of this Parliament. We are making significant progress. Medical agency spending fell by one-third, from £963.5 million in 2024-25 to £642.6 million in 2025-26. Overall NHS agency spending fell from £2.1 billion to £1.2 billion over the same period, a reduction of 43% and the lowest level on record.

[Baroness Davies of Devonport (Con)]

I thank the Minister. It is important to ask what efforts the Government are making to increase the number of permanent staff against bank or agency work. A friend of mine is a senior mental health nurse, and she tells me that agency staff cannot intervene in a severe mental health situation or give immediate medication in A&E. Can I ask specifically what permanent staffing for mental health nursing is going to be happening, and how can the Government try to increase this, bearing in mind we have an epidemic of mental health issues among young people?

[Baroness Merron (Lab)]

In the not-too-distant future, the mental health strategy will pull together all of the strands that the noble Baroness and her colleague are concerned with, and she is right to be concerned about them. In all these areas, patient safety comes first. That is the driver as to why we are reducing the use of agency. I agree that the end game in all of this is to increase the numbers of permanent staff, and the forthcoming workforce plan will support us in that.

[Lord Patel (CB)]

My Lords, can the Minister say in the spring of which year the workforce plan will be published?

[Baroness Merron (Lab)]

On the basis we have moved beyond spring of this year, I can say that, to ensure the workforce plan reflects the new Government we have, the Secretary of State and my colleague, Minister Karin Smyth MP, the responsible Minister, are working to ensure the workforce plan properly reflects the priorities —so I hope we will not be keeping your Lordships’ House or the noble Lord waiting for too long.

[Lord McColl of Dulwich (Con)]

My Lords—

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[Baroness Merron (Lab)]

I am not sure about something that specific. Our whole emphasis is to end spending on agency staff, but patient safety has to come first. That is why we still have some use of agency staff, and where we need temporary staff, using the NHS staff bank, we can call on a pool of healthcare workers who are more established to directly fill temporary shifts. I would not say there is an allocation to what is described as corridor care, because we are also driving it down.

[Lord Watts (Lab)]

My Lords—

--- Later in debate ---

[Lord Watts (Lab)]

My Lords, does the Minister agree with me that health trusts could do a lot more than they do at the moment to offer flexible hours for nurses and other medical staff? I have known of many cases where nurses, for example, have tried to get flexible hours and, having been refused, then end up coming back as agency staff.

[Baroness Merron (Lab)]

The key theme my noble friend is raising here is very much about staff retention within the NHS. That is not only the ideal but the practical, best way forward. We are taking action, including, as my noble friend talks about, on flexible working. We are also taking action to make staff feel safer in the workplace, enhancing support for staff health and well-being by, for example, improving access to support for mental health and musculoskeletal conditions. They are the two biggest causes of sickness absence, which also drive demand for temporary cover.

[Lord McColl of Dulwich (Con)]

My Lords, when the permanent staff are asked to do overtime or to fill in, rather than have agency medical staff, they are paid at a lower rate. Why do we not pay them the same rate as the agency medical staff? This would boost morale, lead to more continuity of care and also reduce the hassle of finding agency medical staff.

[Baroness Merron (Lab)]

Agency staff can cost the NHS more, which the noble Lord referred to. That is why we now have the agency price cap, which did not exist when agency spending rose completely out of control—for example, it stood at around £3.7 billion in 2015-16, because there were limited national controls. The agency price cap is the maximum amount that an NHS trust would normally pay for an agency worker. I do not quite recognise the situation that the noble Lord referred to on NHS staff, but I will take it away and check the situation.

[Lord Scriven (LD)]

My Lords, while the Minister talks about reduced agency spending, which is welcome, total temporary workforce costs remain largely unchanged, seemingly displacing into bank premiums, overtime and other insourcing. Will the Minister commit to publishing the total combined costs of flexible staffing, so that Parliament can judge whether taxpayers’ money is actually being saved or merely reshuffled within budget lines?

[Baroness Merron (Lab)]

I will certainly take away the points that the noble Lord raised, but I do not recognise his description of reshuffling, not least because the requirements on local health providers to reduce agency expenditure are quite clear. They have to report against them and drive further reductions. Those moneys are directed into front-line care. After all, that is what we all want to see.

[Lord Kamall (Con)]

My Lords, I thank my noble friend Lady Davies for raising this important point. I will touch on a number of issues that have been drawn together. Within the NHS, there are three very different categories of non-permanent staff—agency, bank and temporary staff—each with different implications for the continuity of care, as my noble friend referred to. Given that agency staff are supplied externally, bank staff are supplied from the trust’s own books and temporary staff are moved between services, can the Minister tell the House whether her department monitors the impact of each of these differences on the continuity of care for patients, including whether patients can see the same doctor, if possible? If so, where is that data available?

[Baroness Merron (Lab)]

The noble Lord has welcomed our emphasis on the continuity of care. It is the best form of healthcare that we can offer. The only way to do that properly is through an established NHS workforce. The reality is, as noble Lords will be very aware, that there are times that we need to use some type of temporary cover in order to secure patient safety. The main thing is that we are committed—and it will be delivered through the workforce plan—to a more settled workforce and a workforce that can properly provide the care that we need. We are not yet in that place, but the steps that we are taking will get us there.

[Baroness Watkins of Tavistock (CB)]

My Lords, the Minister quite rightly said that retention is one of the most important things, both for our own staff and the advantage to patients. Yesterday, the Health APPG heard evidence from senior staff in Georgia, USA, who explained that by starting to pay off student loans between three and five years of continuing service, they had managed to retain and get a much more stable workforce. When will the department look at the cost-benefit analysis of such an approach?

[Baroness Merron (Lab)]

The noble Baroness has not asked me to make a commitment, and I am glad that she did not, because I could not give that commitment at this stage. However, in addition to the action that we are taking, which I referred to earlier in this Question, we are looking broadly at how we can retain people. The cost to individuals is a key matter. The noble Baroness will be aware of the constraints upon us. It is a matter of seeing what else we can do. We are undertaking targeted retention work, not least to understand why staff have left. There are a variety of reasons: some obvious and some less obvious. They all need to be tackled, and we are taking a multifaceted approach.

Integrated Care Boards: Access to Services

Baroness Merron Excerpts

Tuesday 8th September 2026 Lords Chamber

[Baroness Pidgeon]

To ask His Majesty’s Government what assessment they have made of access to primary and community health services by integrated care boards.

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

My Lords, access to primary care is improving. The year June 2025 to June 2026 saw nearly 14 million more GP appointments compared with the same period in the previous year, and satisfaction when contacting a GP increased by over 14% compared with July 2024. For the first time, we have introduced a waiting time standard for community health services, and 37.6 million NHS dental treatment courses were delivered in 2025-26, which is 6.2% higher than in 2024-25.

[Baroness Pidgeon (LD)]

My Lords, more than 600,000 people are waiting for hospital eye appointments, yet on our high streets there are optometrists who can provide urgent and minor eye care services, ensuring faster, more convenient access for patients. Will the Government require all ICBs to commission these basic community health services?

[Baroness Merron (Lab)]

The requirement on ICBs now is to focus on the strategic commissioning of health services and to be responsible for all but the most specialised services. Looking particularly at improvement of access to eye care, which is extremely important, the Government recently announced some £20 million to improve digital connectivity between primary care, optometry and secondary eye care. In all these ways, people will be far better served in their eye care.

[Baroness Chisholm of Owlpen (Non-Afl)]

My Lords, do we think that the ICBs will have a problem? We know that they have a fragmented IT service as well as terrific work overload, and I believe that they are going to go down from 46 boards to 26. Surely this will cause them a problem in being able to get the access they need. It is a real worry for them and, I would think, even more so for the patients and their families who are trying to access primary and community services.

[Baroness Merron (Lab)]

I understand why change creates worry, but I reassure the noble Baroness that the 10-year health plan set out the role of ICBs and, as I mentioned, for the strategic commissioning of health services and neighbourhood providers. I believe it will help to move towards fewer integrated care boards; there are currently 36. That will mean a pooling of budgets, greater efficiency, a reduction in running costs and more resources going to the front line. In all those ways, I intend for the change to deliver a better service locally.

[Baroness Finlay of Llandaff (CB)]

My Lords, what are the criteria that ICBs plan to use to monitor 24/7 access to services in the community? At the moment, the pressures are on emergency departments, where ever more patients arrive, because that is where the lights are on. We have heard about the governance problems of clinical errors occurring where staff are under extreme pressure and patients are in corridors.

[Baroness Merron (Lab)]

One of the major shifts for the NHS now and in the future is about moving services from hospitals to communities; we had a Question on that just yesterday. It is important to say that the fundamentals of oversight, which we are improving, will be through the NHS oversight framework, which will be clear about delivery and approach. I should add that NHS England will be able to focus on helping the most challenged organisations with their performance and capabilities. If there are problems such as those that the noble Baroness described, they will be identified.

[Baroness Nargund (Lab)]

My Lords, access to women’s health services varies significantly across the country, with women from deprived areas and some ethnic-minority communities facing particular barriers. Therefore, what steps are the Government taking to ensure that ICBs not only commission but deliver equitable women’s health services in all regions, so that a woman’s ability to access timely diagnosis and treatment is not determined by her postcode, ethnicity or social deprivation?

[Baroness Merron (Lab)]

My noble friend makes an important set of observations. I can reassure your Lordships’ House that reducing inequalities is absolutely hard-wired throughout our renewed women’s health strategy. For example, we are redesigning clinical pathways for the most common women’s health conditions, and that will standardise and improve care across the country.

[Lord Kamall (Con)]

My Lords, when I speak to primary and community health providers, they often speak of two hierarchies that they face. At the ICB level, they say that large trusts dominate, whereas at the primary care level, they say that it is GPs who dominate, often at the cost of the voices of pharmacists, dentists and optometrists, who can take on more work, as the noble Baroness, Lady Pidgeon, said. Underneath all these clinical hierarchies sit patients, who in some ICBs struggle to be heard. Given that the Government’s plans to rewire the state include abolishing local Healthwatch organisations, how will they ensure that independent patient voices—and I mean independent, not part of DHSC or from local authorities—are listened to and acted upon at all levels?

[Baroness Merron (Lab)]

The patient’s voice is absolutely key, and that is why the Health Bill, which is currently in the Commons and will be introduced in your Lordships’ House tomorrow, is very focused on that. There will be much discussion in here. I can assure the noble Lord that patient safety, patient voice and patient experience are absolutely key, and that will be the case as we move forward to develop and further improve the NHS.

[Baroness Watkins of Tavistock (CB)]

My Lords, there is increasing evidence that access to senior nursing staff in care homes and in the community keeps people out of A&E and therefore reduces many of the problems there. What responsibility will ICBs have to ensure that they purchase district nursing and community mental health training so that we have sufficient district nurses and admiral nurses to support the elderly population?

[Baroness Merron (Lab)]

Getting the right staffing mix is key, and the noble Lord, Lord Kamall, just spoke about what was described as a hierarchy. I am more interested, as I know noble Lords here are, in the team. The noble Baroness raised a very correct point about the role of nursing staff. These are decisions to be made locally. However, the requirement is on ICBs, and they will be measured—as will be contained in the national guidance—on getting the right staffing mix and the right people in place to meet the move to community health services and reduce unnecessary attendance and bed occupancy within hospitals.

[Baroness Barker (LD)]

My Lords, in some places, the relationship between community nurses and acute hospitals is good and patients receive what they think is a care pathway. In other places, the relationship between district nurses and GPs is incredibly problematic, and instead of there being a clear care pathway there is a blockage. What are ICBs going to do to make sure that everybody gets the best distribution of services, not the worst, as happens in some places?

[Baroness Merron (Lab)]

That is indeed the intention, as the noble Baroness rightly points out. In all this and in the discussion today, which is legitimate, transparency is important. As we committed to in our 10-year health plan, we have already launched a new set of league tables so that every NHS trust is ranked against clear and consistent standards and that we can see what progress is or is not being made. That will raise standards, tackle variations in care and allow a focus, where extra focus needs to be applied, to make changes. Previously, it was far too generic. This will allow us to focus.

Neighbourhood Health Services

Baroness Merron Excerpts

Monday 7th September 2026 Lords Chamber

[Baroness Maclean of Redditch]

To ask His Majesty’s Government how they intend to measure the success of neighbourhood health services in reducing demand for hospital care and improving access to primary care.

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

My Lords, success will be measured against five minimum national goals in the neighbourhood health framework, which was published in March 2026. That will include improved access to general practice and better urgent and emergency care performance. Integrated care boards and local authorities will establish locally owned neighbourhood plans with metrics that reflect population needs. An independent national evaluation, which will be commissioned through the NIHR, started this April to support national policy and delivery of neighbourhood health and evaluate its adoption and uptake.

[Baroness Maclean of Redditch (Con)]

My Lords, I thank the Minister for that Answer. She set out the government policy, which states that local health and well-being boards will work with communities, health and care organisations and wider partners to establish outcome measures that cover the whole life course of the individual and reflect both health and social care needs. Can the Minister say how, bearing in mind the wider devolution agenda, the Government will measure neighbourhood health outcomes to allow for effective comparison between regions?

[Baroness Merron (Lab)]

The noble Baroness set out exactly what the plan is, and I am grateful to her for doing so, but I emphasise that the whole point of the independent national evaluation is that it will evaluate the whole breadth of neighbourhood health. It started in April and will run for three years. I further emphasise that it is about continual engagement and developing different ways that neighbourhood health can be successful. It will also model what the long-term outcomes and improvements can be, depending on how you do it. All that will mean working with the local ICBs to see about their progress, but they are well aware of the expectations upon them, and they will set their own ways forward.

[Baroness Pidgeon (LD)]

My Lords, if neighbourhood health services are to succeed, more care will be delivered through general practice and community settings, yet NHS funding allocated to general practice has fallen over the last decade. Will the Government consider introducing a primary care investment standard to ensure primary care can grow in line with this ambition?

[Baroness Merron (Lab)]

We do not intend to bring forward the investment standard that the noble Baroness seeks. I am aware that a discussion is going on—probably as we speak—through the Health Bill, which is about to be introduced to your Lordships’ House. That is about increasing accountability and responsiveness to local needs and improving outcomes. I say to the noble Baroness that our fear is that bringing in yet another approach, through an investment standard, risks undermining that.

[Baroness Gerada (CB)]

My Lords, since 1948, successive Governments have shifted care into the community without a simultaneous shift of people, estates or money. We have just heard that general practice now receives its lowest share of the NHS budget for a decade. Will the Minister agree to address this so that GPs can deliver continuity of care, which we know improves access, reduces demand, improves outcomes and fundamentally delivers better value for money?

[Baroness Merron (Lab)]

I say to the noble Baroness that that is what I feel the whole neighbourhood approach to the NHS is. As she is aware, it is about joining up around the person and bringing together teams, including GPs. It is important to acknowledge outcomes: we have delivered nearly 14 million additional appointments through GPs in the year to June 2026, and patient satisfaction is going up with GP access. We need to look at what the situation is as well as the concerns.

[Baroness Pitkeathley (Lab)]

My Lords, one of the most important contributions of a neighbourhood health service is in the preventive work that it does—things like exercise, smoking cessation, addiction counselling, and so on. Does my noble friend agree that it is important to measure those aspects, which reduce further the demand for hospital and primary care services?

[Baroness Merron (Lab)]

I certainly do agree with my noble friend, who sets out what is at the core of this key shift, which is one of three. There are many examples. The service in Kensington, Chelsea and North Paddington has already supported people to access the right care in the right way. It has seen a reduction of over a third in GP appointments, of over two-thirds in A&E attendances and of over half in sick notes issued, with residents reporting a 40% increase in well-being. That is what can happen when we join up around the person.

[Lord Kirkhope of Harrogate (Con)]

My Lords, I welcome the Government’s continuation with the initiatives taken by the previous Government to develop much greater online activity and contact between patients and their GPs, but how do we deal with people who are particularly vulnerable, particularly the elderly—those who do not have direct access to online activity? How can they be looked after or helped to be in touch with the new facilities that are going to be available?

[Baroness Merron (Lab)]

As this will be locally led, the priority groups will be those who are more excluded, and that may well include those who are digitally excluded. But the noble Lord makes an important point. It is not just about local care in a physical sense—indeed, we have already committed to over 120 neighbourhood care centres—but it is also about digital access, because that is how many people now access it. However, in every single case, if someone cannot, there is an alternative for them.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interest as chairman of King’s Health Partners. The Minister will recognise that, increasingly, pathways of care for the management of chronic diseases will extend across institutional boundaries, both in primary and secondary care, and will be delivered by multidisciplinary teams of different healthcare professionals. Is she content that the present regime for regulation, both institutional and professional, will facilitate that cross-institutional delivery of care and care delivered by multidisciplinary teams?

[Baroness Merron (Lab)]

As we develop neighbourhood provision, bring care closer to home and join up as the noble Lord suggested, it is key that the regulatory framework supports that as well as all the other work. We are ensuring that the regulators are able to do that. Dr Penny Dash recently did a review and we are looking at what more needs to be done.

[Lord Kamall (Con)]

My Lords, I thank my noble friend Lady Maclean for the Question, but I want to go back to points made by the noble Baronesses, Lady Pidgeon and Lady Gerada. Successive Governments have spoken about the shift from hospital to community, but one reason it has not always happened is that there has not been a commensurate or corresponding shift in the funding. I therefore ask the Minister once again: what consideration are the Government giving to rebalancing existing funding—I stress “existing”—to deliver that shift from hospital to community?

[Baroness Merron (Lab)]

First, we are investing where it is needed, particularly on new estates and on improvement support. We are also asking ICBs to refocus their existing resources. This is not just tinkering; it is a fundamental shift—one of the three main shifts—to deliver neighbourhood health, which people very much welcome. We are also creating financial incentives. We are creating—the national evaluation will assist us more with this—funding flows and payment mechanisms, which means that savings from improved quality of care will then go into investment in new services. I say to the noble Lord that that has not always been the case in the past.

[Baroness Manzoor (Con)]

My Lords—

[Baroness Hussein-Ece (LD)]

My Lords, we know, and it is very well researched, that people with learning disabilities face enormous barriers in access to primary health care and have lower life expectancy as a result. Can the Minister assure me that these neighbourhood health services will ensure that screening and support for people with learning disabilities will be embedded in this service?

[Baroness Merron (Lab)]

I certainly can. To support that, the prevalence review, which focuses particularly on mental health services for those in the group that the noble Baroness describes, will soon come forward with its report, which will help us greatly. Certainly, there are priority cohorts, which are listed by definition, but localities can add cohorts. I very much expect that the group to which she refers would absolutely be a priority.

Childbirth-related Post-traumatic Stress Disorder

Baroness Merron Excerpts

Wednesday 2nd September 2026 Lords Chamber

[Baroness Nargund]

To ask His Majesty’s Government what assessment they have made of the study published in the British Journal of General Practice which found that thousands of women have undiagnosed post-traumatic stress disorder after childbirth every year.

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

My Lords, we take the findings of this study seriously and recognise the significant impact that PTSD after childbirth can have on women and families. Postnatal appointments provide opportunities for identification of PTSD and specialist perinatal mental health services are available nationwide to support diagnosis, treatment and professional training. The national maternity and neonatal action plan will provide further opportunities to strengthen prevention and postnatal support for those affected by birth trauma.

[Baroness Nargund (Lab)]

My Lords, I thank my noble friend for her reply and her ongoing commitment to improving women’s health and mental health. This new evidence highlights that thousands of women with post-traumatic stress disorder following childbirth may be going undiagnosed. Will the Government use this evidence to raise awareness about childbirth-related post-traumatic stress disorder and work with NICE and other stakeholders to implement screening tools for diagnosis and a pathway for specialist referral in primary care so that women can receive timely diagnosis and treatment?

[Baroness Merron (Lab)]

The key thing here is identification, because without that we cannot have treatment. Prevention of PTSD is really our starting point. I certainly agree with my noble friend that early identification is crucial and that women should be routinely asked about their mental health and birth experiences during postnatal contact. That is why training resources have been developed to support this. I can assure my noble friend that I am very keen that we continue to work with clinicians, charities and, crucially, women with lived experience, because further improvements are needed, including on how women can be identified earlier and referred for appropriate support.

[Baroness Gohir (CB)]

Can the Minister share the access rates to perinatal mental health services for Black, Asian and minority-ethnic women during and after pregnancy, and what actions are being taken to help them overcome barriers that they may face? One area that needs attention, for example, is cultural attitudes towards mental health.

[Baroness Merron (Lab)]

While I cannot give the specifics here and now, I will be pleased to get that information to the noble Baroness. She is right to highlight the need to make sure that all women have access and that all women who have PTSD or experience of birth trauma are identified. Record numbers of women are now accessing specialist perinatal mental health services—66,500 women last year in England alone. The figures I can get the noble Baroness will, however, give a much better flavour of how we are reaching groups who may well be marginalised in the way that she describes.

[Baroness Pidgeon (LD)]

My Lords, given that six out of 10 maternity units have been assessed as unsafe by the Care Quality Commission, it is not surprising that this research identifies thousands of women experiencing birth trauma. Will the Government now guarantee one-to-one midwifery care during labour and a consultant on every maternity ward 24/7 to support women giving birth?

[Baroness Merron (Lab)]

Safety is key, and so are the experiences of women and their families. The noble Baroness and the House will be well aware of the national maternity and neonatal plan, which will drive proper, sustained improvement across the system. This is what I believe we have been lacking for years, and it is why we asked the noble Baroness, Lady Amos, to conduct an independent review. She has reported on that and the maternity and neonatal plan will be announced by the end of this year. I certainly look forward to that; it is being worked on as we speak, involving both clinicians and those with lived experience, as well as campaigning organisations and all those with an interest. I am feeling positive about how we move forward, and the point made by the noble Baroness about staffing and ratios will of course be part of that.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, one of the stresses for mothers, and indeed parents, and their mental health post traumatic birth is having a child in NICU. I understand that hospitals such as Alder Hey have piloted schemes where parents have been involved with the care of their child in NICU. Organisations such as the First 1001 Days Movement and Ei SMART have seen that this can have a huge benefit both for the mental health and longer-term care of the child and for parents. What can the Minister do to ensure that NICU units beyond Alder Hey are encouraged to involve parents, and even have them staying overnight within their units?

[Baroness Merron (Lab)]

The noble Baroness is absolutely right about the involvement of parents being key, and it is variable across the country. This is not least because of the estate and the ability to do it. This is why we have invested £187 million in the maternity and neonatal estate since April of last year. I think that is a step forward; I do not think it will resolve the whole issue, but I hope it gives an indication to the noble Baroness that the point she is raising is well heard and being responded to, and that we will continue to respond to it.

[Lord Winston (Lab)]

My Lords, I think the noble Baroness is referring to a paper by Susan Ayers, who has studied this for many years. It is certainly not a new problem. In the literature, there are over 700 papers on post-traumatic stress disorder in childbirth and another 1,700 papers on it during or in childbirth. This is a long-standing problem. It is not always serious, but when it is then it needs to be taken very seriously. Most cases are relatively trivial and the national incidence is about 3.17% of women in childbirth. This is something we can handle. As the paper by Susan Ayers correctly points out, we could do something much better in primary care in this situation. I hope the Minister will take this on board.

[Baroness Merron (Lab)]

I certainly will take that on board. I completely agree that this is not a new issue, but the report shines another light on the situation. I can confirm to my noble friend that I have specifically said that early identification of issues is crucial. Yes, there is a six-week to eight-week follow-up point, but I know—and many noble Lords will be aware from their own experience in their communities and families—that it is very variable how appropriate, good and effective that is. It is not acceptable that we have such a wide range, so I will focus very much on making those improvements.

[Lord Kamall (Con)]

My Lords, I will focus on two concerns. The first is that GPs often mistake PTSD for postnatal depression, meaning that mothers do not get the appropriate treatment. The second is that at the six-week postnatal check-up, to which the noble Baroness referred, there is no approved framework for assessing women’s risk of having PTSD. As the responsible Minister, what conversations is she having with NHS England and GP organisations to make sure that these two issues are addressed?

--- Later in debate ---

[Baroness Merron (Lab)]

As the noble Lord heard in my response to my noble friend, that is exactly one of the points of focus. He is aware that, following portfolio changes, I am very specifically the Minister for Women’s Health and Maternity—there is a very special reason for that: to give that area focus—but I am also responsible for early years. The combination of all those things will be crucial. I emphasise that there are several touch points at which women vulnerable to and experiencing PTSD can be helped, supported and assessed, but we are not necessarily using them correctly. That is where I will be focusing.

[Baroness O'Loan (CB)]

My Lords, I would like to ask the Minister about two issues. First, has any research been done on the effect of early discharge on the subsequent development of PTSD after a traumatic birth? Mothers are now routinely sent home from hospital within hours of giving birth, which leaves them very little recovery time, particularly when they are going home to difficult family circumstances. The second issue is the wider context of education. When mothers have a baby and are having things such as flashbacks about the birth, they can be afraid that they are going mad. If they are afraid to declare these things and are unable to articulate them, they will continue to try to work with them, and we will end up with a situation in which very tragic events can occur. There is a need, even today, for wider education for women about the fact that, when you go home with your new baby, particularly your first baby, you do not necessarily have to find that you can do everything perfectly and that, where you have serious mental health issues, you must be able to seek help.

[Baroness Merron (Lab)]

The noble Baroness is right to say that, and that there is no shame in seeking mental health support. The most recent CQC maternity survey showed an upward trend in women accessing mental health services, which may reassure her. Just last year, there was an upward trend in respondents being offered mental health support. Some 90% were offered it, so the offer is there. I also feel it is being offered in a way that normalises it, which is important. It is also important to reduce the situations in which a traumatic birth may take place. We must hang on to that. As the noble Baroness said, education is part of that more positive way forward in supporting mothers and babies.

Healthcare Sector: Clinicians

Baroness Merron Excerpts

Wednesday 22nd July 2026 Lords Chamber

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

My Lords, we are committed to supporting NHS staff to innovate and translate new ideas into improved patient care. We have recommissioned the NHS Clinical Entrepreneur Programme for a further five years. We have also published NHS intellectual property guidance for NHS staff and organisations, which was last updated 24 years ago. Healthcare innovators can also benefit from the wider investment into innovation that is outlined within the 10-year health plan and the life sciences sector plan.

[Lord Hintze (Con)]

My Lords, may I please—

[Baroness Nargund (Lab)]

I thank my noble friend the Minister for her reply and welcome the Government’s commitment to innovation, but the actual programme has supported only a small fraction of the NHS workforce so far. I have met so many doctors, nurses and other healthcare professionals in my career with innovative ideas that could improve patient care, reduce costs and improve productivity. Yet too often, these ideas get nowhere because there are no clear, accessible pathways to develop them, and we are losing out on so many innovators and innovations that would benefit not only our patients but the Treasury. Does my noble friend the Minister agree that we now need an NHS entrepreneurship workforce strategy that could truly make our NHS the Silicon Valley of health innovation? If so, what steps could the Government take to give every NHS staff member protected time, training, mentoring incentives and accessible, clear pathways to develop and scale their innovative ideas?

[Baroness Merron (Lab)]

I certainly agree with my noble friend that there is a rich seam of intellectual capital among the 1.5 million NHS staff in our country. I am glad to say that the clinical entrepreneur programme is already a world leader in healthcare entrepreneurship, as my noble friend looks for. It has supported over 1,800 NHS staff and 690 start-ups, and it has raised more than £1.2 billion. We have now doubled the baseline annual funding for the programme. Yes, I agree that a clear pathway to adoption is vital, so we are expanding the health innovation networks, because they will provide the necessary support.

[Lord Hintze (Con)]

My Lords, I apologise to the Minister and to the House for my breach of protocol. There is a serious question here. Innovation is a very important part of what the NHS does, and it is very good at it, but I am keen to understand what we are doing to allow our consultants and doctors to innovate to get the backlog under control. I speak from personal experience, but I am not going to talk about my hip, my heart, my kidneys, and goodness knows what else. The point is that many of these individuals cannot clear their backlog because they fear that they are going to be hauled before the CEO of the NHS for breaching their budget. That is an issue.

[Baroness Merron (Lab)]

That is exactly the reason why we need to encourage innovation and take advantage of all the improvements now available to us, including AI. It is by modernising our approach that we will move forward greatly. That is why we are building the practicalities, as I described in my Answer just now, as well as a culture of innovation. We are also providing the ability to see adoption, because people are rightly concerned if time is spent on innovation but the product or service never comes forward. We are changing a number of points to improve that.

[Baroness Pidgeon (LD)]

My Lords, in a growing number of hospitals, clinicians are using at-home bladder cancer testing to reduce the number of cystoscopies and speed up diagnosis. Can the Minister expand on how the Government will help clinician-led innovations such as this to spread across the NHS, so that access does not depend on where a patient lives?

[Baroness Merron (Lab)]

Yes, I am very pleased to do that. I point to the National Healthtech Access Programme, which is exactly what the noble Baroness is seeking. It is a route for cost-effective and clinically effective technologies, such as the one the noble Baroness describes, so that we can see the best benefit to patients and the best value, and that supports more equitable access. NICE is currently assessing three projects, including using AI in histopathology for the diagnosis of prostate cancer and breast cancer, to give two examples, and we will shortly see the publication of those results.

[Lord Patel (CB)]

My Lords, the Minister quite rightly alluded to the clinical entrepreneur programmes, and she might want to say a bit more about how successful they have been. Does she agree that, for these programmes to succeed in making clinical departments more innovative, we need strong academic departments working together with universities and teaching hospitals?

[Baroness Merron (Lab)]

I certainly agree with that, because there are many aspects to this. On the successes of the clinical entrepreneur programme—some of which I have mentioned—we now know that, as of June, that over 10,500 occurrences of innovation are being adopted by organisations. That has resulted in the creation of over 5,100 jobs, and 448 NHS staff have been retained by, or have returned to, the NHS to be part of the programme. This is an extremely active area that will greatly contribute to services for patients: better care and safety, as well as tackling waiting times.

[Lord Kamall (Con)]

My Lords, can I ask about entrepreneurs who are not clinicians but have a product or service that could improve health or social care? For them, there is no obvious front door to the NHS, so they spend ages trying to get into the system at primary care, trust or ICB level, and, sadly, some give up or go abroad. Could I suggest that the new Minister for Technology and Innovation, when they are appointed, creates a front door or one-stop shop to triage those who approach them? They could distinguish between salespeople with no real product, those who have a product but need more support, and those who have a fantastic product that could save lives now and that we could pilot as quickly as possible. Can the Minister make that suggestion to the new Minister for Technology within health?

--- Later in debate ---

[Baroness Merron (Lab)]

Those important discussions will take place. I refer the noble Lord to the Life Sciences Sector Plan, which followed on from the 10-year health plan and which addresses exactly the point he rightly makes. I also refer him to the updated NHS intellectual property guidance, which provided organisations that provide or commission NHS services with much clearer routes to identify, protect and commercialise innovation. That, along with a number of other steps we are taking, will do what he seeks, which is important.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, some three months ago I visited the Institute of Cancer Research at the Royal Marsden Hospital. I met several clinicians and research scientists, who were clear that innovation was vital in bringing forward therapies to deal with the various types of cancer. But they said that there was one gap: in the funding for university research. So, as a follow-up to the question from the noble Lord, Lord Patel, what additional funding will the Government provide to university research to ensure that new therapies can come that will accelerate improvements in cancer care?

[Baroness Merron (Lab)]

I will of course raise the points made by my noble friend and the noble Lord, Lord Patel, about funding for universities. But, as I mentioned, it is worth saying more broadly that the life sciences sector leads the drive for investment into the UK economy. For example, the sector raised the third-highest amount of equity finance in 2023 among comparator countries, leaving us behind only the United States and China. That gives some idea of the status and the activity in the UK, and I am glad that we continue to build on it.

People with Learning Disabilities: Acute Illness

Baroness Merron Excerpts

Monday 20th July 2026 Lords Chamber

[Lord Scriven]

To ask His Majesty’s Government what assessment they have made of the recommendations in the National Confidential Enquiry into Patient Outcome and Death report Acute illness in people with a learning disability, published on 11 June; and whether they intend to ensure those recommendations are implemented by NHS Trusts.

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

My Lords, we welcome the National Confidential Enquiry into Patient Outcome and Death’s report and its recommendations. NHS England has circulated learning from the report across the health and care system for regional teams to share it with integrated care boards. NHS accountability arrangements are in place, and immediate improvement actions are under way, including the reasonable adjustment digital flag. The Government are committed to high-quality care for people with a learning disability.

[Lord Scriven (LD)]

My Lords, enough is enough. Currently, with everything in place, people living with a learning disability still die on average 20 years earlier than their non-learning disabled peers. The key missing part of the jigsaw is a statutory independent review of every such death, legally compelling NHS trusts and other providers to implement the improvements identified. Why are this Government content to rely on the toothless, non-statutory reviews that have changed nearly nothing, and allow this 20-year life expectancy gap to continue?

[Baroness Merron (Lab)]

I certainly accept the point, and I am not quibbling about the number, because 19 years, which is where we are now, is totally unacceptable. In addition, there is the high percentage of avoidable deaths, which I know the noble Lord is very alive to. While I share the view that this is unacceptable, I would not put it all down to reports. I can say that there are strong expectations of ICBs. As I have mentioned, they are kept to account, and we are continually ensuring that the death of every autistic person and those with a learning disability that is notified is reviewed. The new national-level patient dataset will certainly provide what I would call a single point of truth, which has not been there in the past.

[Baroness Finlay of Llandaff (CB)]

My Lords, the report highlights that, for almost two-thirds of these patients, there was no assessment of mental capacity. However, when people are ill and frightened, mental capacity is incredibly important for being able to communicate with people, to make a diagnosis and to monitor a response to treatment. Without communication, of course the outcomes are worse than they might otherwise be. How will the Government improve the assessment of mental capacity across the board and implement the recommendations in the report?

[Baroness Merron (Lab)]

Guidance was issued not many months ago on this point, and I expect to see improvements. The report found that well under 50% of patients or their carers were asked about reasonable adjustments. It is not acceptable, but that is why we have brought in the mental capacity assessment guidance and the reasonable adjustment digital flag. These will make a major difference.

[Lord Harper (Con)]

My Lords, in her Answer, the Minister mentioned accountability. Given that the report demonstrated that the gaps are very significant, with something like 50% of hospitals not even being able to record a patient’s learning disability on their digital record, what are the Government doing to track progress on hitting these recommendations, and what are the accountability measures? If trusts do not deliver this quickly, who gets fired?

[Baroness Merron (Lab)]

There are financial sanctions for providers that could be brought into play. On accountability, delivery is monitored through NHS governance and assurance processes. This includes the NHS operating framework, annual assessment of ICB performance, regional oversight and review of local delivery plans.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the tragedy is that Lord Rix many years ago pointed out the same problems and no progress has been made. My noble friend is putting faith in ICBs, but she knows that their resources will be reduced in terms of headcount. Going back to the question by the noble Lord, Lord Harper, does she not think that accountability needs to be placed with NHS trusts? They need to be required to establish specialist teams, which we know lead to better outcomes, and have a response in relation to communications. Should we not be putting responsibility where it actually lies, rather than relying on ICBs to commission this?

[Baroness Merron (Lab)]

I have to vary a bit on that point from my noble friend, who I know brings a tremendous interest to this area. It is right that local services are locally provided, but I do not accept the analysis that this is handing it over to an unaccountable local provision. I outlined to the noble Lord, Lord Harper, the specifics of accountability. All the actions that are identified in the inquiry’s report will make major progress. I assure my noble friend that we will keep this continually under review. I am sure that there are always improvements that we can make, and we are committed to doing so.

[Baroness Pidgeon (LD)]

My Lords, specialist training in the care of people with a learning disability is critical to reducing avoidable mortality. Will the Government fund dedicated senior clinician roles in learning disability medicine across community, acute and mental health settings to provide the leadership that is necessary to improve healthcare outcomes for this population?

[Baroness Merron (Lab)]

There are a number of aspects to that area. We have greatly increased the mandatory training requirement and the numbers who have been trained. The noble Baroness also points to the importance of a multidisciplinary approach. We have seen an increase in nursing staff in that regard. It is a matter for the local provider to decide, but the workforce plan, which we will be seeing soon, will be very helpful in this regard.

[Lord Kamall (Con)]

My Lords, the report identifies significant variation in the recognition and treatment of acute illness among people with learning disabilities. The Minister talked about guidance, but could she be more specific? What specific help does her department aim to give to those areas, trusts or ICBs deemed to be underperforming? Given the new Prime Minister’s pledge on further devolution, how will the department resolve that tension between local decision-making and central government intervention, especially in underperforming areas?

[Baroness Merron (Lab)]

That is the reason for the accountability measures that I have outlined. I should add that transparency is absolutely key to that. The guidance that we have issued about supporting the identification of people with learning disability is important; we are at that basic level. That is where we have started, but it will push this forward. Further to my answer to the noble Baroness, Lady Finlay, the guidance for acute hospital staff, for example, included standardised mental capacity assessment forms; they were not in place previously. Each ICB is required, via statutory guidance, to have an executive lead on learning disability and autism.

[Lord Scriven (LD)]

My Lords, every question that has been asked has shown that the system is failing: people are still dying. The key point is that the accountability mechanism is missing or is too diluted to work. Why do the Government allow this system, which kills people early, to continue? What has the Minister not heard in this debate that assures her that the system is working and that it will somehow change for the better? Evidence and history tell us that the system is broken.

[Baroness Merron (Lab)]

I hope that I have already agreed with the noble Lord and others about the progress that needs to be made in this area. I have certainly not said that it is acceptable—it is far from acceptable—and the questions have been very helpful in identifying that. The learning disability improvement standards support NHS trusts to measure the quality of care that they provide. All the areas that I have suggested and more are taking us forward. I gave the commitment —and I mean it—to keep these things under review and to seek to improve wherever we can. We look forward to working with the noble Lord in doing so.

Modern Service Framework for Dementia and Frailty

Baroness Merron Excerpts

Thursday 9th July 2026 Grand Committee

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

My Lords, I start by congratulating the noble Lord, Lord Weir, on securing this debate. It has clearly engaged so many and I, for one, am pleased about the positive reaction. He mentioned at the outset that we are all agreed. I am sure that this outbreak of unanimity is always helpful when trying to make progress.

A number of noble Lords, including the noble Baroness, Lady Wyld, and the noble Lord, Lord Kamall, just now, spoke about the personal impact—as did the noble Lord, Lord Weir, and all other noble Lords—on the person but also on their families, their communities and those around them. That is very much at the core of the modern service framework. The noble Baroness, Lady Wyld, described the challenge of a lonely, crisis-driven system. That is not how it should be, and it is not serving as it should.

I want to set out at the beginning that everyone with dementia and frailty, and their loved ones, deserves high-quality, compassionate, joined-up care and support. Indeed, I say to the noble Baroness, Lady Wyld, that the framework will take a view of the whole person and the whole system. That is the way in which we will deliver. I am grateful, not just for the welcome but for the description of this as a golden opportunity, which the noble Lord, Lord Weir, talked about, and as a once-in-a-generation opportunity, as the noble Baroness, Lady Wyld, said. We absolutely recognise the points being raised by all noble Lords because the system we have has to, and will, change.

That is why we are developing and will deliver the first ever modern service framework for frailty and dementia. It will be all about the outcomes—to pick up some of the points asked. It will be a blueprint for how we develop that shift that we are all seeking. It will also work across both health and care settings, which is absolutely crucial. It is important that the MSF is delivered in this way because it acknowledges that dementia and frailty so often coexist. They are hard to distinguish and there is no need to do so. The MSF will also outline, when we look to the future, how we harness the innovations that have the potential to transform care.

I say to the noble Lord, Lord Weir, that I am grateful for the engagement that we have had with such a wide range of stakeholders, including those with lived experience, and carers, without whom we could not develop this in the right way. They also include clinicians, adult social care, the NHS and charity partners. As noble Lords will have seen, the immediate findings from the noble Baroness, Lady Casey, on social care made some immediate recommendations on dementia, and we have embraced them straight away. That includes the establishment of a new dementia leadership role in the department with the power to drive action forward. I agree with the noble Lord, Lord Kamall, on the tests that he set; I am totally on board with those. It is only by action, outcomes and change for the better that we will be able to judge it. Otherwise, it is just a piece of paper, and there is no point in doing that.

On the question about timelines from the noble Lord, Lord Weir, we seek to publish the full modern service framework by the end of the year, as recommended by the noble Baroness, Lady Casey; we are glad to accept that. To answer the question from the noble Lord, Lord Kamall, it will set national standards and redirect NHS priorities, because we cannot pretend that we can do this as things are.

There has rightly been a discussion about clinical data, which the noble Lord, Lord Kamall, raised, and performance matrix. There are many interventions to consider as we improve dementia and frailty care. That is why we are considering all options—I emphasise that. We want to look at the interventions with the best evidence and outcomes. Through the MSF, we will set standards, so we can measure against them, on how interventions should be used, and we will review the metrics and performance data necessary to monitor these standards.

I turn to the question of timely and accurate diagnosis, which we know is vital to delivering excellent care. It is, in effect, a gateway to vital advice, information and support. That is why we are committed to recovering the dementia diagnosis rate to the national figure of 66.7%. Importantly, that includes a validated diagnosis of dementia subtype—it is important not to just lump everything together. The framework will look at how we improve diagnosis waiting times, which are too long in many areas, as well as addressing unwanted variation in dementia diagnosis rates across the country and across different groups, as raised by the noble Lord, Lord Kamall, and my noble friend Lady Nargund.

The noble Lord, Lord Weir, referred to the Ready for the Cure report, which deals with research and access to treatments and is very pertinent to the immediate recommendations of the noble Baroness, Lady Casey. I can say in response that, through government funders such as NIHR, we continue to invest in dementia research, including speeding up the development of potential treatments, which was also much called for in today’s debate.

The noble Lord, Lord Weir, rightly raised the risk factors and the noble Baroness, Lady Wyld, talked about the Lancet commission, which has been very helpful in identifying global risk factors for dementia and the extent to which they are reducible. The NIHR-funded dementia and neurodegeneration policy research units are supporting the development of our understanding of where we have an opportunity to reduce risk. I will be pleased to keep updating the House on that ongoing work.

The noble Baroness, Lady Pidgeon, asked about easier access to trials. We are working to fast-track clinical trials, because we want to drive global investment in life sciences as well as provide opportunities for individuals. I have spoken about the acceleration of the development of medicines. I say to the noble Lord, Lord Kamall, that we have made the UK an infinitely more attractive place for clinical trials, not least by stripping out bureaucracy and unnecessary obstacles. We have reduced the period to way below the 150-day ambition that we set.

We are ensuring, as my noble friend Lady Nargund asked, that research opportunities are available, irrespective of who people are and where they live. The women’s health strategy makes particular reference to the point she raised on the link between menopause and dementia. The NIHR continues to work on funding for applications for research into any aspect of human health and care, including that link. Our investment continues. We have already adopted the target of 2,000 people participating in dementia trials within the next five years; it currently stands at 377. I believe that by improving the UK’s attractiveness for dementia trials, we will be able to drive forward improvements beyond what we have currently.

There was a number of particular points, and I will be very pleased to write to noble Lords on specifics. All the specifics raised today are key to how we improve the potential of the MSF, and we are keen to continue to work on that.

The Government absolutely recognise, and are with noble Lords on, the need to improve diagnosis and to have that robust data and the access to innovative treatments. I believe that the modern service framework will deliver that and drive them forward, as well as the other provisions, in a way that we do not have access to now. It is a time to be positive, and I am glad noble Lords spoke in that way, because I, too, share that feeling.

Committee adjourned at 4.01 pm.

Fracture Liaison Services

Baroness Merron Excerpts

Monday 6th July 2026 Lords Chamber

[Lord Black of Brentwood]

To ask His Majesty’s Government what progress they have made in delivering on their policy to ensure universal coverage of Fracture Liaison Services in England by 2030, including implementation plans, timelines and milestones for rollout.

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

My Lords, our 10-year health plan committed to rolling out fracture liaison services nationwide by 2030 and outlines our vision for a more devolved health service. We have cut the number of NHS planning guidance targets from 130 in 2022 to 18 in 2025, and that has given local leaders greater flexibility to adapt and serve local needs. Expectations have been set through the new women’s health strategy that ICBs prioritise community-based models when commissioning new fracture prevention services.

[Lord Black of Brentwood (Con)]

My Lords, I apologise to the Minister for bringing her back yet again to this issue. However, it is now two years since the former Secretary of State said that a national fracture liaison service rollout would be one of the Government’s first actions in office. Two years on, we are still waiting for something—for anything—to happen, and people have died as a result. I have two questions for the Minister. First, does she really believe, in the light of all the evidence she has been given, that it is still possible to achieve universal coverage by 2030? Secondly, if she does, do the Government have funding to make it happen and a timetable and implementation plan which she will publish? If the answer to either of those questions is no, would it not be better to be honest and say that the Government have dropped their commitment?

[Baroness Merron (Lab)]

The noble Lord does not need to apologise for raising this extremely important matter. I am grateful for his campaigning on this, as I am to other noble Lords. There has been a lot of progress. In answer to his first question, I believe that it is possible, not least because all but two ICBs in the new, reconfigured groups have fracture liaison services already, with some having more than one. With respect to his specific request, as with other policies, I cannot give him exactly what he asks for, but I have already referred to some of the Government’s actions. We are looking, through the UK National Screening Committee, at screening women for osteoporosis, and a public consultation is about to start. We are cutting waiting times, and we have expanded community diagnostic centres and DEXA scanners. These, along with a whole range of other measures, show real commitment to tackling the matter that the noble Lord rightly raises, which affects lives and costs lives.

[Baroness Pidgeon (LD)]

My Lords, people from deprived areas have a 25% higher risk of fractures, spend longer in hospital recovering and die in greater numbers after hip fractures. The rollout of fracture liaison services is important to help tackle health inequalities. The Minister mentioned 2030, but how can this be rolled out faster to make sure that we help all these communities?

[Baroness Merron (Lab)]

We have rolled this out further, as we inherited a more limited coverage of fracture liaison services than we have currently, and we are looking at how to improve access. As I said to the noble Lord, 23 out of 25 ICBs have at least one fracture liaison service. We will push this forward through various means, including the Best Practice Guide for NHS Frailty Pathways, which recommends comprehensive neighbourhood-level frailty plans, and the modern service framework, to mention a couple of ways. I have to emphasise that this is about a complete change in the delivery of NHS services, from which fracture liaison will greatly benefit.

[Baroness Lane-Fox of Soho (CB)]

My Lords, I declare an interest as a patron of Day One Trauma Support and as someone with a relatively high knowledge of fractures. How does the Minister expect the new fracture liaison services to embed charities and other organisations on a fully funded basis, as they are vital in working alongside the health service to make sure that rehabilitation goes smoothly and that people from all backgrounds have the best chance of recovery success?

[Baroness Merron (Lab)]

That is absolutely key, as the noble Baroness says. We have to look at the way that we are working. I emphasise again that we are looking at how we can roll out the modern service framework, which will really push this forward. That will involve full consultation with the groups that the noble Baroness rightly mentioned. She spoke about funding. I cannot give specifics without knowing them, but we will be further delivering this already improved service, as well as taking other supportive actions. These include asking local authorities to include menopause in the NHS health check later this year, which will help greatly with earlier identification.

[Lord Winston (Lab)]

My Lords, the noble Lord asks a very important Question. Can the National Health Service make sure that there is a checklist for all fractures, just as an aircraft pilot does when he is taking off? There are numerous examples in the NHS—I speak from personal experience—of patients not being screened for bacteria before they go down to theatre. That should be a routine check. Further, it is very common for patients to be discharged from hospital when there is a lack of liaison between the hospital and local services. Sometimes, a wound may not be dressed for several days until somebody visits, where there is a risk of bone infection. This is a very serious and common problem.

[Baroness Merron (Lab)]

I understand my noble friend’s point. He referred to checklists. Requirements are in place; I believe he is suggesting that they are not always followed, so I will certainly pick that up. As we move towards a neighbourhood health service, I feel ever more confident that we will attain the right standard of care, along with cutting waiting times. For example, we will make sure that, by 2028-29, for the first time, 80% of community health service activity should take place within 18 weeks. That has not been the case thus far.

[Baroness Chisholm of Owlpen (Non-Afl)]

My Lords, there seems to be a problem for men suffering from prostate cancer, who are also likely to get osteoporosis. Last week, my noble friend and I heard from a consultant neurologist who said that there is not a joined-up approach going back to primary care. The GP should be aware that these people are more likely to have fractures, but they are quite often having these fractures without having been told that that is a possibility, and they are not then getting the care that they need. We need a bit more joined-up thinking, if that is possible.

[Baroness Merron (Lab)]

I understand that point well and I am grateful to the noble Baroness for raising it with me separately. Similar to my response to my noble friend, I will gladly follow that up.

[Lord Kamall (Con)]

My noble friend Lord Black specifically asked about fracture liaison services implementation plans, timelines and milestones on progress towards universal coverage in 2030, to which the Government have committed. To double-check, does the Minister agree with the principle that there should be a published implementation plan, and that timelines should be published and annual milestones set?

[Baroness Merron (Lab)]

I am sure noble Lords would welcome that, and I have heard that call in here, but the noble Lord will know that that is not something we do with every single policy; rather, we take the steps to actually make them happen. The commitment and progress are there, and that will continue.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, unfortunately, at the moment, progress has almost flatlined—I think it will take 38 years to get to the 2030 target. My noble friend said to me on 9 June that the Government have not set milestones. If there are not such milestones as those just referred to, how is the department monitoring this, and will it speed up to reach its own target?

[Baroness Merron (Lab)]

As I have said, delivery will be through ICBs. Of the new clusters, we know that only two do not have fracture liaison services. As my noble friend is very aware, ICBs are held to account through NHS England. Of course, when we make a change through the NHS Bill, that will come within the department. There are many ways we drive progress, including cutting waiting times, opening new community diagnostic centres, investing in DEXA scanners and upping the game on osteoporosis screening, as well as on medication and research. In all these ways, we are contributing to the development of the service that I know my noble friend seeks.

National Maternity and Neonatal Investigation

Baroness Merron Excerpts

Monday 6th July 2026 Lords Chamber

[Baroness Pidgeon (LD)]

My Lords, this is another week and another traumatic and difficult-to-read report about the state of maternity services. Behind it are thousands and thousands of women and families deeply affected by these service failures. I thank them all for their contributions to this report, as well as the noble Baroness, Lady Amos.

Women are not being listened to, heard or believed, with serious consequences for safety and quality of care. Racism and discrimination are embedded throughout the maternity and neonatal system. Services are not responsive to the changing profile of women giving birth and the increase in medical interventions during birth. Antenatal, birth and labour, neonatal and postnatal services are just not joined up. From Somerset to Blackpool, the safety of having a baby has become a lottery. Women are silenced and staff who raise the alarm on unsafe care or systemic discrimination are crushed by a culture of fear. We need to see genuine accountability throughout the NHS and the investment necessary to make Britain the safest country in the world to have a baby.

I have a number of questions for the Minister. I welcome the Government’s commitment to a national maternity commissioner, but can the Minister confirm that this post will go to an independent expert and not a political appointee? Will the Minister reassure us that action will be taken before December, rather than waiting for the taskforce to report on its plans? Will the Government guarantee safe staffing at all hours in every maternity ward in the country, so that no woman has to give birth in an unsafe unit?

This inquiry has, once again, raised the issue of poor bereavement support across the NHS after pregnancy or baby loss. The national bereavement care pathway seeks to resolve this by ensuring high-quality and consistent bereavement care across the UK. The trauma of baby death and pregnancy loss can last a lifetime. Parents’ memories of the care they receive at that moment will stay with them for ever. Good bereavement care can help parents and families navigate their bereavement journey, while poor care can just add to the trauma of loss.

The first moments after a baby dies can be the only opportunity parents have to make memories with their baby, and there is only once chance to get this right. After a baby dies, parents often face really tough decisions, and they cannot make informed decisions about their baby without clear and compassionate communication from healthcare professionals. I therefore ask: will the Government roll out all five national bereavement care pathways, including for miscarriage, and actively monitor implementation across the health system? Will they ensure that suitable bereavement rooms are available in all trusts, not as a “nice to have” but as part of dignified trauma-informed care? This would be a step change for so many families.

There is so much more I could say on a topic that has shocked us all. All families, wherever they live and whatever their ethnicity, must be supported to have their babies safely. This has clearly not been the case for too many years. This is the point where things must change, and I really look forward to the Minister’s response.

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

My Lords, we know—and we can never acknowledge it enough—that women, babies and families across the country are being harmed, traumatised and let down by a broken system. I am grateful to both Front Benches for the way in which they have received this report and for their support, and their acknowledgement of the role we have taken in government.

The noble Baroness, Lady Pidgeon, talked about trauma lasting a lifetime, and that is indeed the case. When I have met women and families who have been affected, that is what has stuck with me: the trauma never goes away. I also accept the correct challenge from the noble Lord, Lord Kamall, that the judgment will be on what has changed, not on what is written. We are very conscious of that, and I am grateful to him for reminding me of it.

Before turning to the helpful questions from the noble Baroness and the noble Lord, I will make a few comments. I too want to express my gratitude to every woman, family member and member of staff who came forward to give evidence to the noble Baroness, Lady Amos, and her team, who heard from thousands of people who showed great courage and determination to share their experiences, painful though they were, and conducted their investigation with immense sensitivity and care. The noble Baroness, Lady Amos, diligently brought together evidence from families, staff, 12 local investigations and all the past reviews, and her review shows systemic, repeated failures by our maternity and neonatal system. It has also given us the opportunity and determination to break that cycle.

As I know your Lordships’ House will agree, it is also important that we acknowledge the very positive role that so many staff and families have played in providing the necessary care.

It was most helpful that some of our immediate actions were acknowledged. But, on top of those immediate actions, some of which have been mentioned today, we have ongoing actions. We have been tackling avoidable brain injuries and maternal deaths through dedicated programmes and packages. We have already begun the expansion of Martha’s rule to all maternity and neonatal units, to give families and patients the right to request a second opinion where there are concerns.

Among other things, we have also introduced a perinatal culture and leadership programme, which is important to develop a safety culture and a learning and support culture for the leadership across all units, and an early warning system to better identify safety concerns. Importantly, because continuity of care is something that has been highlighted a lot, we are providing £10 million of recurrent funding to ICBs for this very purpose, in particular to provide midwifery continuity of care for those women who live in the most deprived neighbourhoods and who are at risk of poor outcomes.

I will do my best to answer the questions asked by noble Lords. The noble Lord, Lord Kamall, asked about the timeline for Leeds and Sussex. Donna Ockenden, who will be chairing those reviews, is currently engaging with the families on terms of reference, which will include timelines. We will not be waiting for the publication of the findings to make changes. As they emerge, those issues will be shared with us, so that we can act.

In answer to the question from the noble Lord, Lord Kamall, the new maternity triage standards will be implemented by June 2027. There must be clear board oversight in place of the operation of the triage system, including regular reviews of waiting times and actions to improve the necessary services. The role and remit of the maternity commission is being urgently considered by the National Maternity and Neonatal Taskforce. The commissioner will co-chair the taskforce, which will drive all the change as well as setting it out.

On workforce pressures, we are not waiting. There is £10.6 million investment funding in an additional 1,000 temporary roles to help newly qualified midwives to join the NHS, which is extremely important. So, we are not waiting for the 10-year workforce plan. However, the taskforce will take into consideration wider work, including the 10-year workforce plan.

With regard to concerns raised by Bill Kirkup about what is referred to as “normal birth ideology”, women have to be able to make the right decision about what is safest and best for them. No woman should ever feel pushed into a particular type of care. The words “normal” and “natural” are perhaps not particularly helpful in this setting. We are talking about vaginal births; what matters is what is best and what is safest, and I am certainly very grateful to Bill Kirkup for all this work.

The noble Baroness, Lady Pidgeon, asked further questions about the commissioner, which were helpful. The selection and appointment process will be considered as part of the process of establishing the role.

Questions were asked on action being taken before December, when the report of the taskforce will be available. As I mentioned, immediate actions are already being driven forward. These actions were already under way over the last two years and as part of the immediate response to the recommendations of the noble Baroness, Lady Amos. Where we can, we have already actioned work, and, where we need further work done, that will be developed over the next few months, at pace.

The noble Baroness raised a good point about the rollout of bereavement pathways, including for miscarriage. We are rolling out all five strands of the national bereavement care pathway. All trusts in England have signed up to implement the core standards of the national bereavement care pathway. That is relevant in this case and, across other areas of bereavement, is of particular concern.

As I draw my remarks in this section to a close, let me give noble Lords a sense of the urgency. The taskforce and its supporting expert reference groups are meeting tomorrow to discuss the findings of both the Donna Ockenden report, on which we had a Statement last week, and the report by the noble Baroness, Lady Amos. Next Tuesday, the taskforce—which is spearheading all this and chaired personally by the Secretary of State—will be meeting to discuss next steps for the action plan. To the questions from the noble Baroness, Lady Pidgeon, about the commissioner’s role, the Secretary of State has already said that he wishes that the maternity and neonatal commissioner will co-chair the taskforce with him. That would be a very welcome move.

I hope that I have dealt with the questions and, more than that, given a sense of the pace and seriousness, as well as the action that I know we all seek.

[Baroness Blackstone (Lab)]

My Lords, I declare an interest as the chair of the Royal College of Obstetricians and Gynaecologists board of trustees. The RCOG desperately wants to see an improvement in the services that mothers and children are getting in maternity. I do not know whether the Minister is aware that some 68% of all clinicians are working hours way beyond their contracts, and 25% of them are talking about leaving the profession within five years because of a fear of burnout. Obviously, everything must be done to prevent that happening. Does the Minister agree that workforce planning is central here, including better integration between the work of doctors in maternity and midwives? There should not be barriers between the two; they should be working in units together and dealing with high-risk cases. In that context, will some decision be made pretty soon about when a redesigned workforce tool will be available for obstetricians in particular? They desperately want to see that as soon as possible and do not want to have to wait maybe as long as a year before an action plan is completed.

[Baroness Merron (Lab)]

My noble friend allows me to say how grateful we are to the Royal College of Obstetricians and Gynaecologists for its continuing work, as we are grateful to our many partners who are committed to driving through change. We are working particularly closely with RCOG in developing routes forward. I agree with the points that my noble friend made. Most NHS maternity staff—and other staff, but we are talking about maternity staff—are providing exceptional care. It must be very difficult for them to hear about and read these findings. Our job is to support them with the right culture and leadership, and to equip them and support them to listen and learn. It is important that we have the right skills mix among consultants, to whom my noble friend refers, and retain them, because they are absolutely key. We will continue to work with RCOG accordingly.

[Baroness Watkins of Tavistock (CB)]

My Lords, like others I recognise the kindness and compassion that the majority of staff in our health service deliver, but as the Secretary of State for Health and Social Care rightly said:

“We must break the cycle of recommendations sitting on a shelf gathering dust”.


The Minister has already made it clear that the reviews currently planned will continue. I wondered whether they might be postponed or cancelled, but, as they are not going to be, will we ensure that we stop looking further and actually implement what is necessary now, in particular more senior midwives on duty at night? As well as employing more midwives, can we look, through the NHS workforce plan, at putting both general nurses and mental health nurses on fast-track midwifery courses so that we have experts in other areas working in midwifery?

[Baroness Merron (Lab)]

I know that the noble Baroness, Lady Amos, made the kind of comments to which the noble Baroness refers. The National Maternity and Neonatal Taskforce will certainly look at all these areas and, as I mentioned, those reviews will continue. I emphasise that we have to bring this cycle to a close. That is exactly why the former Secretary of State commissioned the noble Baroness, Lady Amos, so that we would bring together a coherent, fully informed list of national recommendations. That is indeed what we have, and we have already actioned a number of them. To the points that the noble Baroness made, that work will continue and will not be held up.

[Baroness Adams of Craigielea (Lab)]

My Lords, I will follow on from the excellent question and suggestions from the noble Baroness, Lady Watkins, about specialist nurses being fast-tracked into midwifery. Donna Ockenden’s report found that many student and newly qualified midwives feel they do not have the necessary level of skills to deal with complex cases. What conversations will the taskforce or the commissioner have with the Royal College of Midwives about the training pathway for midwives? Currently, the Royal College of Midwives does not seem to see any need for a return to nurse training.

[Baroness Merron (Lab)]

I am fully aware of—I will put it tactfully—the difference of opinion in this regard. This morning, I was speaking with one of our main advisers, who did not feel it was necessarily an answer to go down the road of midwives being nurses—I know the noble Baroness did not say that—and I bow to that experience, but for me it raises the complexity.

It is important to emphasise a point about which I have been concerned for some time: about a third of student midwives have no role to go to. The noble Baroness is right, but some of it is about basic experience, and nobody can gain experience without putting the years in—that is a fact. That is why getting the new funding, up to £10,000 per post, means we will keep students in the profession and give them the chance to develop the very important expertise to which the noble Baroness refers. Further, having multidisciplinary teams and the right people means that you can manage whatever complexity. There is no way that any one person can deal with all complex cases. Every case has a high degree of individuality, as I know the noble Baroness is aware.

[Baroness Thornton (Lab)]

My Lords, “welcome” is not quite the right term to use about these reports, but they are indeed absolutely essential. I need to declare that I am the maternity lead, as a non-executive member, at the Whittington Hospital, and I will be at the conference as a member of one of the reference groups tomorrow.

Several years ago, when Donna Ockenden produced her first reports, we set up what we called the Ockenden cafes in the Whittington, to which we invited all the multidisciplinary teams, plus mums and patients and people who had been involved over a period of time; it was an enormously valuable and uplifting experience for all of us involved in the maternity care of the women in our area.

However, I want to ask my noble friend about MIS, the Maternity Incentive Scheme, which is now in its eighth year and, as she will know, is designed to get maternity units to improve year by year and through that win some investment in their hospitals. Has that been factored into what might happen next?

[Baroness Merron (Lab)]

I thank my noble friend and all her colleagues for the work they do. We have many examples across the country of first-rate care and great initiatives like the one my noble friend spoke of, which really takes on board one of the problems the noble Baroness, Lady Amos, found: that the voices of women and their families, and of staff, were just not heard or acted on. That is the one thing that comes through.

To the question, would the abbreviation be MIS in this case?

[Baroness Thornton (Lab)]

Yes, MIS.

[Baroness Merron (Lab)]

We have two “MISs” that we often talk about: MHIS and MIS. I will ensure that MIS is considered, but it is probably worth saying that we are already developing a tool for assessing the quality and experiences of care being provided for women using maternity services, through the patient reported experience measure. To the point made earlier by the noble Lord, Lord Kamall, that is one of the ways we will ensure that women and their families can actually see, feel and know the difference.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interest as chairman of King’s Health Partners. In addition to addressing workforce concerns and driving a much-improved culture in the delivery of maternity services, the physical environment in which maternity services are delivered is critically important. These are very frequently delivered in some of the worst parts of the NHS estate in such a way that the holistic nature of the services that need to be provided is not available at a single site. Can the Minister confirm that the NHS capital budget identified for this spending period is going to be protected so that these matters might be addressed?

[Baroness Merron (Lab)]

The noble Lord makes a very accurate observation. Perhaps I can go a bit further than he is asking me, because just last week we announced an additional £41 million of safety funding to improve the estate. That is on top of the £145 million that was previously announced, so that will give a great opportunity to really improve the estate, which is crucial for safety as well as experience.

[Lord Redwood (Con)]

My Lords, my sister died at birth, so I remember well the impact this has on families. What more can the Government and the NHS do to help those families who have lost a baby in such painful circumstances, or who are now bringing up a disabled child as a result of medical difficulty?

[Baroness Merron (Lab)]

I am very sorry to hear of the loss the noble Lord experienced and of the deep effect on his family; I am sure he still lives with that feeling. I think the greatest gift we can give is to reduce the risk of something going in the way that it did in his family, and that we avoid all avoidable risks. That is exactly what this work is about, and that would be the right thing. For those who are affected, I mentioned the bereavement pathways. In terms of support that ICBs arrange across the country, there is a much greater awareness of the need to support people when they need it most.

[Baroness Tyler of Enfield (LD)]

My Lords, both the report of the noble Baroness, Lady Amos, and the Ockenden inquiry identified poor leadership cultures—defensive cultures, dismissive cultures and doctor-knows-best cultures. The noble Baroness already referred to the voices of women and their partners being ignored, particularly when they are complaining of pain. Is the Minister satisfied that the various important recommendations, provided they are implemented and seen through, will fundamentally address and change this culture?

[Baroness Merron (Lab)]

It is a challenge to take on a deep-rooted culture, but we are doing that and it will require action at every level, without doubt. The main thing, as the noble Baroness said, is putting women, babies and their families at the heart of care. This has not been the case. NHS England’s chief executive brought all trust chief executives to London on the day the report was published to discuss the urgent actions trusts can take on this and to focus on the next 100 days. All perinatal leadership teams have also completed a culture and leadership programme, which I believe will strengthen collaboration across maternity and neonatal services. Those are just two of the actions we will take, but this is absolutely fundamental to all the system changes.

[Lord Winston (Lab)]

My Lords, I listened to this short debate with a bit of amazement. We are looking at the end results, but we need to look a little further up the channel. My noble friend Lady Blackstone touched on a very important point, as indeed did the noble Baroness, Lady Pidgeon, which is much more crucial than we may perhaps understand. First, as has been said, these people come to hospital not to access maternity services but to have a baby. They are not ill. That is different from the rest of the NHS, even though they are in the NHS. What we are partly seeing here is a cultural situation that is a problem throughout the NHS, not just in maternity services. It is bad in maternity services for the obvious reason that, in the main, these people are healthy, although some are not terribly fit. We are losing the plot a bit.

For example, the noble Baroness, Lady Pidgeon, said that there is a need for much better psychological support, and I agree. We tend to forget that a woman who is having a baby, even a normal baby who is fully alive, is losing a life within her uterus. She feels a loss when that happens. It may not be expressed as a loss—it is expressed as happiness—but it is an extraordinary change of feeling, which psychiatrists know is very common in maternity. We forget that this affects not just women but men as well.

We also sometimes assume, as we have done in this report—certain things are obvious—that it is much better not to have a caesarean section. That has been suggested, but it turns out that a caesarean section is safer than a vaginal delivery, if you want to be absolutely safe. This has been shown through various studies. I am not advocating caesarean section, of course, but I am pointing out that we sometimes deplore it when it may actually be a useful thing to do.

We have to understand that we are looking at not a broken service but a service under great stress, and we have to deal with that. The noble Baroness, Lady Blackstone, pointed out that its manning is very inadequate. It needs to be a consultant-led service and people have to stay in overnight, but there is not always enough conversation between midwives and obstetricians. There needs to be much closer understanding between the two. Above all, the culture should be one of kindness. Kindness is what we must ensure.

[Baroness Merron (Lab)]

I absolutely agree with what my noble friend said about kindness; when we had the Statement last week, we discussed compassion as well. It is disappointing to have to talk about it, because it should be a given, but we have found that it is not. I totally agree that pregnancy is not an illness—I was once quoted as very sharply telling an interviewer that. I am not aware that it is, and it is not, but it is worth restating, in my view. On the role of men, I am very careful to speak about women and families; that is the right thing. I also clarify that, in this Statement, I do not believe anybody is suggesting that one form of birth is preferable to another. I think we would probably all agree that it is about the form that is safest and the right one for the circumstance.

[Lord Patel (CB)]

My Lords, I thank the Minister for the Statement today and the noble Baroness, Lady Amos, for her excellent report. We have many reports now describing the tragedies occurring in maternity services. I hope this report will be the final one before we go back to delivering the best maternity care, as we used to. It was world leading.

I am privileged to have been an obstetrician for nearly 40 years of my life, delivering many thousands of babies—normally, as people refer to it, and by caesarean sections, which are done when there is an indication to do so. We expect the mothers to enjoy normal deliveries, but also to enjoy the delivery when they must have a caesarean section. The greatest privilege I had was to hand a baby to a mother and see the first look on the mother’s face, which is unbelievable; I had the privilege to witness that first-hand, long before partners would see it. It is important that we deliver world-class maternity services and, therefore, that what the task force comes up with has the standards to be delivered. I hope it will be mandatory for those standards to be followed, monitored and audited against. It should be possible, at the mother’s first visit to the antenatal clinic, to have a plan for how her pregnancy will be managed by midwives and obstetricians. It should also be possible to have every maternity unit audited, as used to happen, when things go wrong involving the mother and the families—and to have a plan for how that will be tackled. I hope that will be the answer.

[Baroness Merron (Lab)]

I am sure we were all touched to hear what the noble Lord said. It must be a privilege to have done what he has done, and to have affected so many lives—those at their beginning but also the lives of the women themselves and their families. I am sure we are all grateful to him for that. The work of the task force, and of the expert reference groups—I am so grateful to the noble Lord, as well as my noble friend Lady Thornton, for taking part in one of them—will be to develop a plan of action, not just for how it will happen but for how it will be audited. Perhaps I should say that key to all this is accountability. The Secretary of State himself said in the Statement that what stuck with him from one of the bereaved mothers he spoke to was that accountability is what drives change. Certainly, when it comes to the regulators, that is why we are also taking action to improve.