Neighbourhood Health and Social Care

Baroness Merron Excerpts

Tuesday 15th September 2026 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I draw the House’s attention to my register of interests.

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

My Lords, this Government support the integration of neighbourhood health and social care. Our approach to neighbourhood health brings services together so that people experience more joined-up and person-centred care, including from integrated neighbourhood teams. In March, we published the Neighbourhood Health Framework, promoting joined-up partnership arrangements between ICBs and local authorities and asking health and well-being boards to develop neighbourhood health plans for implementation from 2027-28 at the latest.

[Baroness Thornton (Lab)]

I thank my noble friend for that Answer. I felt moved to put this Question because there seems to be more hope today than for many years that local integration of social care, health and primary care might happen. With so many moving parts in the reform agenda—the Casey review, the 10-year plan and so on—there may be a danger of reform steaming ahead without the voices and views of patients, carers and those with lived experience being properly baked into the design process. I seek reassurance from my noble friend that those voices will indeed be heard and heeded.

[Baroness Merron (Lab)]

I certainly can give that reassurance to my noble friend. I am glad she recognises that our move towards neighbourhood health is not just a shift on paper but a real turnaround in how we see people and services. Coproduction is required for neighbourhood health plans, which would be all the poorer if we did not include the voices to which she refers.

[Baroness Manzoor (Con)]

My Lords, integration is harder than colocation. For instance, housing and social isolation are key detriments to health, yet they sit outside the NHS. Therefore, a social worker sitting next to a GP may be helpful, but the reality is that this social worker will not get extra money, extra access to health beds in the community or extra staff. What will the Government do to erase these difficulties, particularly when the health needs of the population are growing and the workforce has not kept pace with the complex needs of the ageing population?

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[Baroness Merron (Lab)]

The noble Baroness is quite right to talk about people having more complex needs, and, indeed, we are also living longer. However, the current health system is organised around institutions and services that are complex, disjointed and difficult to navigate, as she said. On housing, for example, I know that the health and well-being boards, which are the key to this, can design themselves to bring in services. I can think of a number which have already done that and included people from housing in the way that she describes. It is absolutely encouraged and health and well-being boards across the country are already doing that.

[Baroness Pidgeon (LD)]

My Lords, a recent workforce assessment by Skills for Care found that adult social care in England still had around 96,000 vacancies and projected that a further 410,000 posts will be needed by 2040 to meet demand. What are the Government doing to address these shortages and deliver genuine integrated patient services?

[Baroness Merron (Lab)]

We recognise the continuing challenge that we inherited in terms of workforce, but that is why we are investing in the adult social care workforce. In 2028, the first ever fair pay agreement will come in, which will be backed by £500 million of funding. It will improve pay and conditions for the workforce, which is crucial. We are also implementing the first ever universal career structure for the adult social care workforce, as well as investing up to £10 million this year in the learning and development support scheme. This, along with all the other changes, will make a massive difference to the workforce in terms of retention, recruitment and development.

[Lord John of Southwark (Lab)]

My Lords, my noble friend has already mentioned health and well-being boards, in which local government is a key participant and player. Having said that, and with the Government’s commitment to devolution in mind, can she tell us more about the role that local government will play in improvements to health and social care going forward? I am delighted to declare my interest as a vice-president of the Local Government Association.

[Baroness Merron (Lab)]

My noble friend is right to identify that, if we are going to deliver neighbourhood healthcare and make improvements in social care, we have to join up the NHS and local government. That is key to our whole approach to neighbourhood health. That is why health and well-being boards, which are responsible for drawing up the local plans for what the locality needs, will bring together and have on them local authority representation and voice, along with the NHS and others. We will manage this only by doing so, because, in order to reduce health inequalities and deliver locally, it cannot just sit with one. I am grateful to local government for what it is doing.

[Baroness Watkins of Tavistock (CB)]

My Lords, will the Minister explain how health and social care will be planned to ensure intergenerational input, in particular from young carers and young people, who often have very good innovative ideas about how to provide such services?

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[Baroness Merron (Lab)]

That is a very good point. Young carers are sometimes left out, to the detriment, as I said earlier, of services and policy. I bring us back to the requirement in the Neighbourhood Health Framework, which we published just in March of this year, and add to that our introduction of neighbourhood health centre schemes across the country. The voices of local people, particularly those in the higher-priority cohorts, which can include young carers, will be heard and be part of the coproduction of how we provide neighbourhood health and social care.

[Lord Kamall (Con)]

My Lords, the noble Baroness said that the health and well-being boards will be responsible for making sure that there are sufficient social care services at the neighbourhood level. Following the question of the noble Lord, Lord John, to whom will they be accountable if they do not deliver sufficient social care at the neighbourhood level?

[Baroness Merron (Lab)]

The Neighbourhood Health Framework published in March, which I mentioned, requires local systems to develop neighbourhood health plans. That will give a very clear basis for measuring impact, which we do not have at the moment. I certainly agree with the noble Lord that it is not about the quality of the plan but about the quality of delivery. That is why the framework empowers local leaders in five minimum national goals that include, for example, as we have discussed many times, improving access to general practice, as well as the join-up with social care.

[Baroness Nargund (Lab)]

My Lords, I declare an interest as a former vice-chair and trustee of the British Red Cross. I have seen at first hand how the British Red Cross delivers health and social care across communities in our country by helping people to transition from hospital to home, giving them independence at home and avoiding readmissions. Does my noble friend the Minister agree that bringing together the voluntary sector with local authorities and the NHS will help to deliver more connected, effective and compassionate social care in every postcode?

[Baroness Merron (Lab)]

I certainly agree with my noble friend on that point. That is why achieving neighbourhood health will rely critically on that strong partnership, which will include civil society, as she says.

[Lord Evans of Rainow (Con)]

My Lords, the noble Baroness did not answer the question from my noble friend the Front Bench spokesman on who will be accountable if this does not work out properly.

[Baroness Merron (Lab)]

All the local systems have their line of accountability, with which I know noble Lords are familiar. Currently, for example, ICBs report to NHS England. Subject to the passing of the Health Bill, that will now come within the department and there will be an accountability mechanism. Transparency will be a key part of that. If noble Lords have any particular concerns, I am always happy to hear them.

Patient Data: Research

Baroness Merron Excerpts

Thursday 10th September 2026 Lords Chamber

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

My Lords, I congratulate the noble Lord, Lord Patel, on securing this debate and on his acknowledgement of the importance of patient data to research and of what the Government have done to date. I also thank noble Lords for their very thoughtful and informed contributions. I very much understand the point about trust, which has been made several times. We will come back to that, but I want to assure all noble Lords of the understanding that it is not always whether people have distrust because of something factual; if they feel distrustful, that in itself is a challenge for us.

We have some of the richest health data in the world, thanks to our diverse population and because we have an NHS that has supported and cared for us for some 78 years; we are fortunate indeed. It is the case that patient data drives life-saving discoveries. The noble Baroness, Lady Brinton, spoke very personally to that point, and I know many noble Lords could also draw on their personal experience to do so. It helps us to understand disease and to develop new treatments, many of which we could never have dreamed of.

This is also essential to improving the nation’s health and prosperity; it is key to our life sciences sector, and to creating jobs, driving investment and powering innovation. Ensuring that benefits flow back to patients and the public, as the noble Lord, Lord Patel, asked for, is also, I agree, essential. That is why we have published a value-sharing framework for NHS data, and also why we will charge organisations for access.

I can assure my noble friend Lord Davies, who asked about an oversight body, that the confidentiality advisory group is the independent oversight body; I feel that is probably what he seeks. It decides whether confidential patient data can be used for research without individual consent. As many noble Lords have acknowledged, we all know that people do want their patient data to be used for research, but I completely agree that this trust is conditional on our keeping the data secure and making that known.

We are committed to moving from a system of data sharing, in which copies of people’s data are sent to researchers, to a system of data access by default, using secure data environments. The noble Lord, Lord Patel, spoke to this very point. Perhaps I can give some further outline and further reassurances and pick up a number of the questions. On any key questions that I cannot answer because of time, I will be glad to write to noble Lords.

The noble Lord, Lord Patel, said that NHS England now uses secure data environments—SDEs—as the default route for accessing data for research. Its network brings together around 300 local and regional datasets that were not available previously. The Health Data Research Service—HDRS—will build on that foundation by developing a much clearer route into the system and more consistent processes. That is important more broadly because, although investment in secure data environments had begun previously, and services were being established, we are now taking the system from where it was—as has been said, it was somewhat fragmented—to a coherent approach. I can say to your Lordships’ House that a simpler, safer and more accountable set-up is where we will get to by the end of this Parliament.

In answer to the point raised by the noble Lords, Lord Patel and Lord Weir, last year we commenced powers to allow us to mandate information standards and to create binding rules across both GPs and trusts. Yes, there is more work to do, but I think that sets us absolutely in the right place. There are some examples of very good practice. We can look to Greater Manchester, where they have linked GP and hospital data. This is not commonplace, because it is GPs who currently decide, on a practice-by-practice basis, how their patient data are used. We are currently running a programme of national engagement with GPs on the use of patient data, and we will use that to work with GPs and other primary care professionals to improve the use of GP data in the future. Our new guidance on enabling safe access to UK human genomic data demonstrates that we expect human genomic data to be accessed through secure data environments—and, I would emphasise, only by approved researchers.

I agree with my noble friend Lady Gill that we have to act swiftly and robustly where things go wrong. Of course, we minimise that possibility, but we have to be realistic.

I am grateful to the noble Lord, Lord Tarassenko, for setting out the facts on Biobank, to which my noble friend Lord Davies also referred. I will not repeat the points he made, because I share his analysis.

On the federated data platform, I say to the noble Baroness, Lady Bennett, that it is not used for research; it supports NHS operations and direct care. This means that opting out of sharing your health data for research and planning will not stop your data being used by the FDP to support your care. That is an important reassurance to those who wish to opt out of sharing their health data. As I mentioned, the FDP contract will be reviewed ahead of the February 2027 break clause.

I say to the noble Baroness, Lady Freeman, that the issue of gaining and maintaining trust is key. That means giving people meaningful choices over their data. So, following public engagement, we are reforming how people can opt out of having their data used for planning and research, and making it clearer and simpler, so that they do not feel bound should they not wish to participate.

As noble Lords have said, it is true that people generally support the use of patient data when they understand who is using it, why it is being used and for what purpose. I accept that awareness remains low, so we have to be transparent about its purpose, as well as maintain strong safeguards and involve the public in decision-making.

On the safeguards about which I have spoken, we want to make it easier for legitimate researchers to access data. The Sudlow review described just how long it can take for approved researchers to access health data. That is an issue. So, through the NIHR, we are investing around £1.7 million a year in research and research infrastructure. Alongside that, the NHS data and analytics academy is developing the workforce of data engineers, analysts and other specialists we need, as per the point of the noble Lord, Lord Patel, in order to turn this into better treatments and care.

Our NIHR reforms mean that clinical trials are being set up some 47 days faster than last year. But we want to go further and faster, which is why we have established the HDRS. I say to the noble Baroness, Lady Murphy, that the question of dementia research will indeed be one for the HDRS.

The noble Lord, Lord Mair, asked about HDRS. Processes will indeed be streamlined. On the matter of funding, I say to him that the future funding model is to be developed and we certainly will take into account the patients and the public. I am sure that is something we will want to develop further.

This has been a helpful debate. We are moving towards a coherent strategy. A number of other questions were raised, including from the noble Lord, Lord Kamall, and others, and I will be glad to follow up on those. For now, I hope this will take us forward and that we can all move to using patient data to better manage how we provide our health services.

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—

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[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.