Respiratory Syncytial Virus: Vaccination Programme

Baroness Merron Excerpts

Tuesday 9th September 2025 Lords Chamber

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Suicide Reduction

Baroness Merron Excerpts

Monday 8th September 2025 Lords Chamber

[Baroness Ritchie of Downpatrick]

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

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

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

[Baroness Ritchie of Downpatrick (Lab)]

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

[Baroness Merron (Lab)]

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

[Baroness Browning (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Scriven (LD)]

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

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

[Baroness Merron (Lab)]

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

[Baroness Watkins of Tavistock (CB)]

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

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

[Baroness Berger (Lab)]

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

[Baroness Merron (Lab)]

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

[Lord Stirrup (CB)]

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

[Baroness Merron (Lab)]

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

[Lord Oates (LD)]

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

[Baroness Merron (Lab)]

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

Prostate Cancer

Baroness Merron Excerpts

Wednesday 3rd September 2025 Lords Chamber

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Diabetes: 10-Year Health Plan

Baroness Merron Excerpts

Thursday 26th June 2025 Lords Chamber

[Baroness Humphreys]

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

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

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

[Baroness Humphreys (LD)]

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

[Baroness Merron (Lab)]

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

[Baroness Williams of Trafford (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Patel (CB)]

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

[Baroness Merron (Lab)]

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

[Lord Rennard (LD)]

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

[Baroness Merron (Lab)]

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

[Baroness Altmann (Non-Afl)]

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

[Baroness Merron (Lab)]

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

[Lord Scriven (LD)]

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

[Baroness Merron (Lab)]

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

NHS and Social Care: Joint Working

Baroness Merron Excerpts

Thursday 26th June 2025 Lords Chamber

[Baroness Pitkeathley]

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

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

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

[Baroness Pitkeathley (Lab)]

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

[Baroness Merron (Lab)]

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

[Baroness Watkins of Tavistock (CB)]

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

[Baroness Merron (Lab)]

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

[Lord Lansley (Con)]

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

[Baroness Merron (Lab)]

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

[Baroness Burt of Solihull (LD)]

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

[Baroness Merron (Lab)]

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

[Baroness Burt of Solihull (LD)]

Yes, I am.

[Baroness Merron (Lab)]

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

[Lord Rook (Lab)]

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

[Baroness Merron (Lab)]

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

[The Lord Bishop of Sheffield]

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

[Baroness Merron (Lab)]

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

[Baroness Stedman-Scott (Con)]

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

[Baroness Merron (Lab)]

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

Perinatal Mental Health

Baroness Merron Excerpts

Wednesday 25th June 2025 Lords Chamber

[Baroness Berger]

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

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

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

[Baroness Berger (Lab)]

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

[Baroness Merron (Lab)]

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

[Baroness Gohir (CB)]

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

[Baroness Merron (Lab)]

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

[Lord Scriven (LD)]

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

[Baroness Merron (Lab)]

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

[Lord Patel (CB)]

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

[Baroness Merron (Lab)]

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

[Baroness Williams of Trafford (Con)]

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

[Baroness Merron (Lab)]

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

[Baroness McIntosh of Hudnall (Lab)]

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

[Baroness Merron (Lab)]

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

NHS: Private Equity

Baroness Merron Excerpts

Wednesday 25th June 2025 Lords Chamber

[Baroness Altmann]

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

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

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

[Baroness Altmann (Non-Afl)]

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

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

[Baroness Merron (Lab)]

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

[Lord Winston (Lab)]

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

[Baroness Merron (Lab)]

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

[Lord Hodgson of Astley Abbotts (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Scriven (LD)]

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

[Baroness Merron (Lab)]

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

[The Earl of Effingham (Con)]

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

“We would be mad not to”.


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

[Baroness Merron (Lab)]

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

[Lord Patel (CB)]

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

[Baroness Merron (Lab)]

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

[Baroness Altmann (Non-Afl)]

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

[Baroness Merron (Lab)]

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

Medical Devices and Blood Safety and Quality (Fees Amendment) Regulations 2025

Baroness Merron Excerpts

Wednesday 18th June 2025 Lords Chamber

Moved by

[Baroness Merron]

That the draft Regulations laid before the House on 3 April and 29 April be approved.

Relevant documents: 23rd and 25th Reports from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 17 June.

Motions agreed.

Care Workers: Foreign Worker Visas

Baroness Merron Excerpts

Wednesday 18th June 2025 Lords Chamber

[Baroness Fraser of Craigmaddie (Con)]

I beg leave to ask the Question standing in my name on the Order Paper and declare my interest as chief executive of Cerebral Palsy Scotland.

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

My Lords, the Government are reducing reliance on international recruitment in adult social care and working to improve domestic recruitment and retention. In England, we are introducing the first fair pay agreement for adult social care, implementing the first universal career structure and providing £12 million this year for staff to complete training and qualifications. These changes will help attract staff to the sector, and provide proper recognition and opportunities for them to build their careers.

[Baroness Fraser of Craigmaddie (Con)]

I thank the Minister for her Answer and apologise if it feels like Groundhog Day, because I know she answered a very similar Question from the noble Lord, Lord Wood, on Monday. As the Minister well knows, solving the recruitment and retention crisis in this sector is long term, will take cross-party work and has many regional variables. In her Answer, she referred to what the Government are able to do in England, but in Scotland, where at the moment a quarter of rural and island carers come from outside the UK, we have a real issue. One provider said to me, “It’s not just about money. Despite paying above-average wages, we haven’t interviewed a British person for over three and half years”. In many rural and remote areas, agency staff are both unaffordable and unavailable. Will the Minister feed back to her colleagues in the Home Office that any cliff edge or one-size-fits-all approach that fails to take into consideration regional challenges threatens to devastate an already fragile service?

[Baroness Merron (Lab)]

First, I pay tribute to the noble Baroness for her leadership of Cerebral Palsy Scotland. As I know she is aware, adult social care is devolved, which is why I made reference to England only. I am very happy to raise the points the noble Baroness made with the Foreign Office—sorry, with the Home Office.

[Noble Lords]

Oh!

[Baroness Merron (Lab)]

Well, I will raise them with whoever the noble Baroness likes.

The other point that comes to mind is that we will also be discussing with our colleagues over the border how they can boost the domestic workforce, because it is so important that we do, and that we reduce reliance on international recruitment.

[Lord Turnberg (Lab)]

My Lords, my noble friend may have hinted at this already, but one of the ways in which we might encourage retention and attraction to the job of being a care worker is to ensure that they have a nationally registered professional qualification. Is that going to be the case?

[Baroness Merron (Lab)]

There are a number of ways that we are promoting opportunities to develop skills and knowledge, which will improve morale but also the attractiveness of working in adult social care. To that point, I am particularly pleased that apprenticeships are available for young people, so that they may see the benefits of working in the social care service.

The three main areas are an expanded care workforce pathway; the launch of the adult social care learning and development support scheme in September, which will allow funding for eligible care staff to complete courses and qualifications; and the new level 2 adult social care certificate scheme, which has been backed up by some £12 million this financial year. In all of this, we are seeking to professionalise and recruit—as well as retain—valued social care staff.

[Baroness Barker (LD)]

My Lords, the spending review promised £4 billion for social care, but not until 2028-29, and it is being carved out of the NHS. Until then, there is nothing in the spending review, so all that is going to happen is that social care employers will have bits and bobs of sporadic announcements of limited pots of funding. How on earth can they build a skilled workforce which is adequate and up to the demands that are going to be placed on it?

[Baroness Merron (Lab)]

Perhaps I could assist by clarifying that the spending review, which allows for an increase of over £4 billion of funding available for social care, is by 2028-29; it is not a matter of waiting for that long. That is in comparison with 2025-26. I hope I was helpful to your Lordships’ House in identifying a number of actions we have already taken to professionalise, upskill and allow people to build careers in the social care workforce. That is absolutely crucial. That, aligned with stopping international recruitment in this area—with a period of time for transition of some years—will shift to improve and increase the adult social care workforce in this country.

[Lord Kamall (Con)]

My Lords, while there are legitimate concerns over the levels of immigration, it is important to recognise the contribution that immigrants have made to our great country, not least to recall that after the war, our public services were saved by immigrants, especially from Commonwealth countries. We should not forget that.

My question is about the NHS and Care Volunteer Responders programme, which was set up during the pandemic and extended to adult social care in 2023. Unfortunately, the Government recently closed the volunteering service without an obvious alternative. While I recognise that volunteering will not make up for workforce shortages, what action are the Government taking to ensure that those who wish to volunteer in the social care sector can make a worthwhile contribution?

[Baroness Merron (Lab)]

While I absolutely agree about the value of volunteering, as we have discussed before, I should make clear that volunteering is not a substitute for employment on the right pay, the right terms and conditions and with the right status. I also absolutely agree with the noble Lord about the contribution that has been made by those from overseas to supporting our care services, and indeed by all care workers.

As we have discussed in this Chamber, the scheme was not simply closed. It was something that was appropriate for when we were in a pandemic but not for now. In fact, we have introduced a whole range of measures which I will be very pleased to remind the noble Lord of, to ensure that we can have more volunteers who are better used and more highly regarded. They are a complement to our workforce, and very valuable they are too.

[The Lord Bishop of London]

My Lords—

--- Later in debate ---

[The Lord Bishop of London]

My Lords, as we have heard, concerns around low pay and insecure contracts are long-standing in the social care sector. The Minister made mention of the fair pay agreement; can she explain how this will ensure that a living wage, living hours and living pensions will be paid to staff among the private social care providers?

[Baroness Merron (Lab)]

As noble Lords will be aware, the Employment Rights Bill establishes a framework for fair pay agreements. That will mean an agreement through which adult social care sector pay, as well as other terms and conditions, will be established through negotiating bodies. The negotiations will be reached by employers, workers’ representatives and others, in partnership. That will provide the opportunity to negotiate this in a responsible manner and help address the recruitment and retention crisis in the sector and support the delivery of high-quality care.

[Lord Laming (CB)]

My Lords, I am sure the Minister will agree that we have an enormous challenge to overcome the belief that all you need to do this work is a kind heart. A kind heart is important, but there is a huge range of skills that are necessary over and above that. It is important therefore that we do all that we can to provide the opportunities to develop these skills and work incredibly hard to improve the status of these workers.

--- Later in debate ---

[Baroness Merron (Lab)]

I wholeheartedly agree with what the noble Lord said. I find that a kind heart is a good thing in most professions, but we also require more skills in many professions. That is why we have set out and launched a whole range of new measures in skills, training and development—and paying and treating people properly will also hugely raise their status.

Medical Devices and Blood Safety and Quality (Fees Amendment) Regulations 2025

Baroness Merron Excerpts

Tuesday 17th June 2025 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Medical Devices and Blood Safety and Quality (Fees Amendment) Regulations 2025.

Relevant document: 23rd Report from the Secondary Legislation Scrutiny Committee

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

My Lords, I am grateful for the opportunity to debate these regulations, which I think can fairly be described as routine. The Medicines and Healthcare products Regulatory Agency charges fees for most of its services and, to ensure continued cost recovery, updates its fees every two years. This regularity provides certainty to customers and enables better financial planning. This statutory instrument helps to achieve this by doing three things.

First, it updates the fees that the MHRA charges in relation to its activities in regulating medical devices and blood components for transfusion. These fees were last updated in April 2023. The implementation date for the proposed changes is July 2025 and they will ensure cost recovery until 2027. This will apply UK-wide, with the fees being the same across the United Kingdom. The total cost to those who pay the MHRA’s fees from this instrument is estimated to be £0.7 million per year after inflation.

Secondly, the instrument introduces a fee for a new, optional service: a regulatory advice meeting for medical devices. In addition to publishing guidance and addressing written inquiries, this new service will further support manufacturers in their understanding of the application of the UK’s regulatory framework to their products. I am glad to say that this service was well received in the consultation. It will be mainly for those developing novel and/or complex products where the application of legislation is not as straightforward or easily understood as it might be. We have had many discussions on removing obstacles to getting products to market which support better care for patients. I hope that this will make a contribution in this regard.

Thirdly, the instrument will introduce a new payment easement for small and medium-sized enterprises for the MHRA’s medical device clinical investigation fees. While this easement will not reduce the overall fee, which would require cross-subsidisation, it will enable the fee to be paid in two instalments, providing flexibility and, I hope, supporting the businesses concerned.

It might be helpful if I highlight the important role that the MHRA plays in safeguarding public health and the importance of the agency continuing to be properly funded to deliver its role. The MHRA is a world-leading regulator of medicines, medical devices and blood components for transfusion in the UK. It plays a vital role in protecting and improving public health. It is, I suggest, an engine for UK growth and innovation; it is certainly an indispensable part of the UK health system and plays a major role globally, working with international partners.

The principles for how the MHRA charges fees are set by HM Treasury in its guidance, Managing Public Money. The basic principle is to set statutory fees to recover full costs. This means that the regulated bear the cost of regulation and that the MHRA does not profit from fees or make a loss that would then have to be subsidised by government departments or the UK taxpayer. It is, of course, standard practice for government bodies that operate on a cost-recovery basis to update their fees. It is also standard practice for other regulators, which is the reason why I described this statutory instrument as “routine”.

All fees are set by taking into account various factors that reflect the cost of the activity—for example, the activities involved in delivering a service, the time taken and the number and grade of staff involved. This process is informed by the recording of staff activity, which is the practice of monitoring and recording certain activities performed by the MHRA’s staff to establish how long they take and, so, how much they cost. In addition, also in line with the HM Treasury guidance, the MHRA includes the costs of necessary corporate overheads and system investments. Regular fee uplifts ensure financial sustainability and enable the MHRA to deliver the responsive, efficient service that its customers rightly expect.

It is worth noting that this instrument does not change the MHRA’s fees in relation to medicines regulations. Given the different legal positions in relation to the powers to make regulations about fees relating to medicines, medical devices and blood components for transfusion, two statutory instruments have been used for the MHRA’s fee uplift. A second instrument for human medicines fees has, therefore, already been laid before the UK Parliament and the Northern Ireland Assembly and has already come into force.

In summary, ensuring that the MHRA is sufficiently resourced will help it to deliver its services more reliably and to provide patients, the public and industry with the service that they expect. I beg to move.

[Lord Scriven (LD)]

My Lords, I thank the Minister for outlining the purpose of these regulations so eloquently and succinctly. It is clear that the change to the fee structure for regulating medical devices and medical products is part of a realm of profound importance both to public health and to the future of healthcare in the UK. As Liberal Democrats, we unequivocally support a robust, efficient and well-resourced Medicines and Healthcare products Regulatory Agency, but it is important that our regulatory bodies possess the financial stability to ensure the safety, quality and efficacy of medical products and blood safety, which touch the lives of millions throughout the year.

I am not going to speak on these regulations at great length; I just want to tease out a couple of issues about which I would like a little more information from the Minister. First, increasing the fees will mean that costs will be covered automatically. What mechanisms are in place to ensure that efficiency and effectiveness are in place, rather than just ballooning costs that it would be assumed the industry would absorb? I am not clear from reading the impact assessment or the regulations exactly how the Government will ensure that the cost really is the cost and is not excessive cost.

Secondly, it is clear in the impact assessment that most of those who gave feedback to the consultation question were against these fees. How have the Government taken into consideration the reservations, not just of the “no” element but in particular that the fees were seen in some cases to be disproportionately high and to exceed inflation? How has that developed? Why are these costs disproportionately high and why do they exceed inflation?

Finally, it is important to increase the fees to ensure the agency’s work can continue but, critically, the impact assessment demonstrates a lack of concrete detail on how these increased fees will translate into tangible improvements in these MHRA services. Although the rationale for increased fees is often framed around enhancing regulatory efficiency and speed, the document provides insufficient assurances of the measurable commitments as to how the additional revenue will be specifically utilised. There is no clear framework for accountability that demonstrates how these funds will lead to faster approvals or increased safety. How will the department measure such improvements? In particular, what improvements are expected on the back of this fee increase?

These regulations are a serious matter. They impact on the health of our nation and, to some degree, the vibrancy of our life sciences industry, but we must ensure that our regulatory framework is not only robust but forward thinking and truly serves the best interests of every patient in the UK by ensuring that the increased cost will both increase efficiency and, we hope, improve the services that the MHRA provides.

--- Later in debate ---

I think we all agree that the MHRA plays a critical role in ensuring the safety, effectiveness and quality of medical devices and blood components in the United Kingdom. It is in everyone’s interest that the agency is properly resourced and capable of meeting its obligations. Although we on these Benches support the principle of cost recovery, we believe that the approach should be proportionate, carefully assessed and subject to clear oversight. Let me be clear: we do not raise these questions because we oppose these regulations. None the less, we urge the Government to proceed with care to ensure that the fees are fair, that innovation is supported and that the regulatory burden does not risk deterring investment or undermining the UK’s position in global life sciences. I know that all parties want to see the UK at the forefront of the global life sciences industry. I look forward to the Minister’s response.

[Baroness Merron (Lab)]

I am most grateful to both noble Lords for their constructive contributions and their support for these measures. I welcome their questions and will do my best to respond to them.

I will first make a few general points that may assist. Noble Lords acknowledged the role of the MHRA, the essential services it offers and the crucial role it plays. It is also understood that it needs financial backing to do that. Therefore, in supporting these regulations, we will enable the MHRA to continue to contribute to the Government’s health mission and to balance its responsibilities to maintain product safety and champion innovation. As the noble Lord, Lord Kamall, said, that is so important to us as a country and an economy, as well as to the National Health Service.

The MHRA is not alone in how it is funded. Most regulators levy charges for their work, and—in response to the question about international comparisons—it is also accepted international practice for healthcare product regulation to follow this trajectory; for example, the European Medicines Agency and the US FDA also charge fees. I certainly feel that the cost recovery approach, which neither noble Lord questioned as a fundamental, ensures that services are paid for by those who use them rather than by the taxpayer—namely, patients.

The noble Lord, Lord Kamall, raised some questions about small and medium-sized enterprises. While I understand that increases in costs can place more relative strain on SMEs compared with larger companies, the MHRA has existing SME payment waivers and easements, and the instrument creates a new SME payment easement for some fees for the medical device clinical investigation service. We have sought to be responsive in this regard.

On supporting innovation and maintaining the UK’s attractiveness as a place to develop and launch medical products, I certainly want to see the UK as the go-to country for that. It does this in several ways— for example, by providing scientific advice and stream- lining regulatory processes to help reduce costs and the time to market. This is a high priority within our Government.

The noble Lord, Lord Scriven, raised questions relating to where costs have exceeded inflation, why this is and what the Government are doing about it. All fees are set to recover costs and it is the case that some services were found to be underrecovering more than others, so this is putting it back in the right place. It is not related directly to inflation but to the real costs and, in some areas, there are concerns about that.

[Lord Scriven (LD)]

Maybe I was not clear in my questioning. It is not about where it goes but this: if there is an automatic assumption that industry will cover the cost, what mechanisms are in place to make sure that there is efficiency, rather than a bloated approach where people think that, as costs will be recovered, they can do whatever they wish? That was the question, particularly regarding the inflation issue.

[Baroness Merron (Lab)]

That is understood. I am going to come on to that, because I think it is important. Of course, with any uplift in fee, I would expect that to be the case, but I have a particular response as I continue. The uplifts we are speaking about today ensure ongoing, reliable delivery. They are necessary for the continued delivery of initiatives that promote growth and innovation. We are not just standing still; we are looking to the future. To the noble Lord’s point, industry has been clear that it supports these fee uplifts as long as they are accompanied by reliable performance.

Although noble Lords have not specifically raised this, I add that the MHRA recognises that there have been some delays in some of its regulatory services of late and these delays were felt by those who pay fees. I am pleased to say that, from 31 March this year, all backlogs were cleared that relate to its statutory functions. Throughout its work to eliminate these backlogs, the MHRA put patients first and prioritised licence applications according to public health need, including those needed to avoid medicine shortages. Importantly, the MHRA is working to ensure that this continues, so that we have predictable, optimised and sustainable services across all the functions.

I can assure the noble Lord, Lord Scriven, that the MHRA is taking steps to improve its performance and efficiency, not least because it does not wish to get into the situation of a backlog again. This includes a modernised RegulatoryConnect IT system and improved agency structures and processes. On accountability, it will also publish performance targets and report against them online and in its annual report and accounts. There are also mechanisms in place for monitoring the impact of these changes. Ministers, including me, meet the MHRA regularly and the MHRA and the department monitor the impact via stakeholder feedback and ongoing performance and finance reporting. I assure the noble Lord, because I know it is a particular interest, that we have key performance indicators in place to monitor the delivery of these services.

I return to the point about small and medium-sized enterprises that the noble Lord, Lord Kamall, raised. In most cases, SMEs are dependent on grants from the NIHR and others, so there is no cost to them as a company when they submit an application to the MHRA. The noble Lord also asked about the assessment of increased fees on SMEs. Benchmarking fees compared to those of other regulators is somewhat difficult, to be quite honest, because of the difference in the way that the regulators operate and their different funding models. For example, a different model is where the regulator is subsidised, which is not the case here. With regard to employer national insurance contributions, the noble Lord is correct that the MHRA is subject to the increases in employer national insurance contributions. The agency believes that these fees will cover the costs of the increase in NI contributions. If there are any shortfalls, efficiency savings will have to be used to manage them appropriately.

[Lord Scriven (LD)]

If fees equal cost, I am not clear how calculations have been made that say that the NIC increases have not been put into that cost to be part of the fee increase, because it is a known cost. I am not clear why that suddenly becomes a potential cost reduction or inefficiency gain within the service.

[Baroness Merron (Lab)]

I may not have been as clear as I would like to have been. I will try again. The national insurance contributions increase is an increased cost and that will have been factored into the new fees that are being put forward. The gentle challenge from the noble Lord, Lord Kamall, was about whether the MHRA could manage it. I am saying that if there were any difficulty in management, it would not be a case of putting up the fees further; it would be a case of managing efficiency costs within the MHRA.

[Lord Scriven (LD)]

Just for clarity, is the NIC cost known and has it been included in these fee increases? It is an important point. I do not want to push the Minister in terms of the actual figures, but I assume that the NIC figure is known and has been included in this fee increase. Therefore, there would be no need for the agency to deal with any difference, because it is a known figure and will be in the fee structure.

[Baroness Merron (Lab)]

I am just waiting for a bit of inspiration.

[Lord Scriven (LD)]

Does the Minister want me to continue talking?

[Baroness Merron (Lab)]

Perhaps it would be best on this occasion if I review what the noble Lord has said and what I have said and write to him to clarify anything that is not quite clear.

In conclusion, I thank noble Lords for their contributions and for their support for the MHRA to ensure that it has the resources that it needs to continue delivering reliable services and can deliver its important public health role.

Motion agreed.