Tobacco and Vapes Bill

Baroness Merron Excerpts

Committee stage
Wednesday 26th November 2025 Grand Committee

[Lord Robathan (Con)]

My Lords, I rise briefly to support my noble friend Lord Kamall on the Front Bench. I have not taken part in these debates before, but I have to say that I find it quite disturbing that we should be making laws because perhaps we do not like walking down a street where people are puffing vapes. I do not, but there are lots of things I do not like that people do, and I am not going to ban them all—well, perhaps I would, actually, but I am not going to.

Similarly, if you cannot be hooked by passive vaping, as my noble friend Lord Kamall said, I am not quite sure why we are taking it so seriously. As I understand it, vaping is not addictive; nicotine is addictive, but vaping itself is a different matter. It also seems to me that we are legislating unnecessarily. I am afraid, to broaden the subject slightly, that this will lead to yet further influxes of cheap and nasty vapes, which may or may not be, as the noble Baroness just said, influenced by other matters.

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

My Lords, I am most grateful to noble Lords for their contributions to this debate. Let me first turn to the opposition to Clause 138 standing part of the Bill, which has been proposed by the noble Lord, Lord Udny-Lister. Clause 138 amends the Health Act 2006 to insert new provisions relating to vape-free places in England. These provisions allow the Secretary of State to designate certain places and vehicles as vape-free, but only where they are also smoke-free.

The noble Lord, Lord Kamall, asked about evidence. The fact is that evidence is developing, as the noble Lord himself rightly acknowledged, but we do know that while vapes are less harmful than smoking, there is a reason why the Chief Medical Officer says:

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape”.


Vapes are not harm-free; there are legitimate concerns regarding the unknown long-term health impacts of vaping. They produce aerosol that exposes people to nicotine and potential toxicants, which poses health risks to children and medically vulnerable people in particular; for example, they can trigger asthma attacks. It is therefore important and right—I say this to the noble Lord, Lord Robathan—that the Government act to protect more vulnerable groups from potential health harms. I should also say that evidence suggests that, in adolescence, the brain is more sensitive to the effects of nicotine, so there could be additional risks for young people compared to adults.

As the noble Baroness, Lady Walmsley, said, many businesses and enclosed public places already have in place, on a voluntary basis, schemes to prohibit vape usage on their premises. We want to introduce legislative requirements to make it clear to the public where it is illegal to use vapes and to enable enforcement agencies to enforce accordingly. I know that noble Lords understand the reasons for wanting to be clear about what is and is not legal, and this Bill and the provisions in it are very much part of that.

Again, as the noble Baroness, Lady Walmsley, welcomed, the main answer to all the questions today— I will continue to go through the various amendments—is that we will be consulting on making indoor settings that are subject to existing smoke-free legislation vape free. The consultation in this area and beyond is crucial, because we also plan to consult on making some outdoor places where children are present vape free—for example, children’s playgrounds, and the outdoor areas of schools and early years settings.

The noble Lord, Lord Kamall, asked about how we will recognise the difference between harms. I can assure him that this is an area we absolutely want to get right. We do want to ensure that adult smokers who are using vapes as quit aids are doing so in appropriate places, such that they do not return to smoking. That is exactly why we will consult before making regulations and carefully consider the responses to ensure the policy seeks the appropriate balance.

Amendment 182A tabled by the noble Lord, Lord Howard of Rising, would mean that some indoor areas, for example nightclubs, would not be able to be made vape free. I am grateful to the noble Baroness, Lady Walmsley, for her views on this. As I have already outlined, vapers pose potential risks to both users and non-users, especially indoors. We had a debate in an earlier group about the workability or otherwise of designating particular areas as able to police themselves. It is quite important to say to the Committee that the vast majority—around 90% of those over 16—do not currently vape. Just because someone is in an over-18 setting does not mean that they are content to be exposed to these second-hand harms.

As discussed, this is a particular concern for medically vulnerable people whose conditions may not be in the least visible to the vaper, who I am sure does not wish to cause harm—for example, those with asthma. Additionally, people who wish to vape will still be able to do so in outdoor hospitality settings—for example, in the outdoor smoking areas of an over-18 nightclub. We have been very clear that we will not be consulting on including those outdoor areas in the scope of vape- free places.

Ultimately, the Bill grants powers to make places vape free and does not itself make any place vape free. The consultation will ask questions relating to areas that should become vape free, any necessary exemptions and any additional evidence on the second-hand harms of these products. Therefore, in our view there is no change needed to the primary legislation.

It is appropriate now to turn to Amendments 181 and 184, tabled by the noble Lord, Lord Kamall, which would seek to limit the locations that can be designated as vape free. As I have already outlined, the current power allows us to respond to evolving evidence at a later time and ensures the Bill is future-proof. The noble Lord asked about the process. I can confirm as I have done previously that the power for vape-free places will be through an affirmative regulation. That will mean, as the noble Lord knows, a debate in both places. The noble Baroness, Lady Walmsley, talked about vape-free areas being specified in the Bill. I hope I have explained why that is not the case. It is particularly important as we talk about evolving evidence that we look to the future. That is why we will be consulting and why we will turn to regulations.

The noble Lord, Lord Kamall, mentioned vape-free schools and asked whether that measure applies to children or adults. I can confirm that it is about the area rather than the people in it. So there are no limitations on people of a certain age; it is the area that would be designated.

I turn to Amendments 182 and 187 in the name of the noble Lord, Lord Udny-Lister, which relate to vape-free policies in schools and colleges in England that are made vape-free places. It is my view that these amendments are not necessary. As I have said, we have already made it clear that we will consult on making schools, sixth-form colleges and early years settings vape-free places. Public consultation will allow us to gather views from a wide range of stakeholders, including those who run education settings. Enforcement officers will have the power to issue on-the-spot fines or pursue convictions where they deem it necessary for the offence of using a vape in a vape-free place. However, we anticipate—this may be helpful to noble Lords—that there will continue to be a role for internal sanctions for pupils found vaping on the premises. Schools are already required to publish a behavioural policy.

In relation to education provisions for pupils on vaping, we have worked closely with the Department for Education to incorporate education on the risks of vaping and nicotine use in the recently updated relationships, sex and health education statutory guidance for schools and teachers; I am sure that the person referred to by the noble Baroness, Lady Bennett, will benefit from that in future.

I appreciate the points made by the noble Lord, Lord Kamall, and his intention in Amendment 183, to which the noble Baroness, Lady Walmsley, also spoke. I agree that it is important that patients receiving care in a mental health setting have access to appropriate smoking cessation tools; that is particularly true given that smoking rates among those with a long-term mental health condition are far higher than in the general population. As I have mentioned previously, in England, we are considering making inside hospitals—but not outside them—smoke-free. I appreciate and am alive to the fact that there are particular considerations in the case of mental health facilities, but I assure noble Lords that we are keen to get things right in this area and are going to follow the evidence. We want to ensure that vapes can continue to be accessible as an effective quitting aid for adult smokers; noble Lords have made strong and important points about this. As outlined, we believe that the details of any exemptions are best explored through the consultation process, although we understand the intention behind the amendment.

I hope that this provides reassurance and understanding to noble Lords that the settings that will be in scope of the vape-free policy will be fully considered by consultation and then considered under the affirmative procedure. I hope that the noble Lord feels able to withdraw his amendment.

[Lord Kamall (Con)]

My Lords, I thank the Minister for her response; I also thank all noble Lords who spoke on this group. I am grateful to the Minister for confirming that any further extension of the designation of vape-free places will be done via the affirmative procedure, which is very welcome.

I have a couple of outstanding questions; I suspect that the Minister and her department were not able to get the answers quick enough, thanks to the power of the internet or whatever, so I wonder whether the Minister could write to noble Lords on these matters. First, is there any evidence yet from studies of passive smoking in outdoor settings? As I said, the studies I looked at were all on indoor settings; nothing has been done on outdoor settings. It would be good to know what evidence the department currently has. I also ask the Minister to share that evidence, with the appropriate links, so that we can all understand it. usbI understand that the consultation is all about seeking further evidence, but it would be interesting to know what evidence the department currently has—on the understanding that the evidence is evolving, as the Minister rightly said.

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[Earl Howe (Con)]

My Lords, my noble friends Lord Howard of Rising and Lord Udny-Lister, who is unfortunately not in his place, are to be thanked for enabling us to focus on the issues around the use of heated tobacco. We have touched on this subject at earlier stages but, when previously discussing heated tobacco, the Minister promised to write to noble Lords about the evidence that her department possesses of the harms caused by heated tobacco. I am sure that is high on her agenda, but the question is crucial in the context of these amendments since, whatever the answer is, it will have a direct bearing on the use of the Secretary of State’s powers to designate locations as heated tobacco-free.

There are various published studies, as she will know. A study published by UCL found that people who switched from cigarettes to heated tobacco had lower levels of exposure to harmful chemicals than those who kept smoking, but higher levels of these toxins than those who stopped using tobacco altogether, which I guess is not a surprising finding. Other studies state that it is too soon to know how using heat—not burn—products will affect someone’s health in the long term, since research looking at these tobacco products is still, I understand, in its early stages and, in the main, funded by the tobacco industry. We therefore need clear evidence, born of independent research, on both the relative harm of heated tobacco compared to burning tobacco, as well as the absolute levels of harm that result from its use.

I am a non-smoker. I understand the concern that heated tobacco should not be a loophole for large tobacco firms to get around the law, but I am also concerned that in the absence of long-term evidence, portraying heated tobacco as being in the same category as cigarettes carries the risk of failing to reduce harm for that small percentage of smokers who wish to quit but have not taken to vapes for one reason or another.

Pending fresh research findings, I think, alongside my noble friends, that there remains a legitimate question about how the Government intend to treat spaces, both indoors and outdoors, where heated tobacco is used, and about whether they believe there is a clear proven case for including heated tobacco in the generational ban. In particular, does the Minister consider uncovered outdoor areas to be different in this context from enclosed spaces, in terms of both health risk and social behaviour? As she knows, the hospitality industry has concerns about extending the indoor smoking ban to outdoor hospitality areas such as pub gardens, and I welcome the assurance she gave on that a few minutes ago. The indication from the Government thus far is that hospitality areas will not be caught by any outdoor ban, but if that is true of smoke tobacco, can the Minister confirm that there is no similar intention as regards the outdoor use of heated tobacco?

[Baroness Merron (Lab)]

My Lords, the amendments in this group relate to limiting the Government’s ability to create heated tobacco-free places in England. I am grateful for all the contributions to the debate.

The noble Lord, Lord Udny-Lister, opposes Clause 139 standing part of the Bill. Clause 139 provides the power to designate certain places and vehicles in England as heated tobacco-free. Places can be designated heated tobacco-free only if they are smoke-free. As I have mentioned, we plan to consult on making heated tobacco-free all indoor places that are currently smoke-free. We also plan to consult on making certain outdoor spaces heated tobacco-free. As with smoke-free places, the consultation will cover children’s playgrounds, the outdoor areas of schools and early years settings, and areas outside healthcare settings where medically vulnerable people may be present.

The noble Earl, Lord Howe, asked an important question about evidence, and I will write with more detail as soon as possible. However, I reiterate what I said in debates on previous groups and elsewhere: there is no safe level of tobacco consumption and all tobacco products are harmful, including heated tobacco products. I am grateful to the noble Baronesses, Lady Bennett and Lady Walmsley, for their supportive comments. Laboratory studies show evidence of toxicity from heated tobacco and that the aerosol generated by heated tobacco devices, like other forms of tobacco, contains carcinogenic compounds. Recent evidence has also indicated that exposure to second-hand emissions from heated tobacco products is associated with significant respiratory and cardiovascular abnormalities in bystanders.

The noble Lord, Lord Udny-Lister, also tabled Amendment 185. The noble Earl, Lord Howe, asked me to repeat—I am glad to do so—that, as I have made clear, we are not planning to consult on making outdoor hospitality settings in England heated tobacco-free.

Amendment 184A tabled by the noble Lord, Lord Howard of Rising, seeks to exempt areas where it would be reasonable to expect that only over-18s are present from any future restrictions on heated tobacco places. This amendment is similar to the one already discussed in relation to vape-free places, which would mean that some indoor areas, for example nightclubs, could not be made heated tobacco-free.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I am most grateful for this discussion. I say at the outset that, although I do not support accepting the amendments, I have a lot of sympathy with a number of the points made, which I will come on to. However, while I completely understand the pressure on small retailers—I will come on to that—I struggle to accept that the Bill is the fount of all evil, which I feel is the direction we are going in. I certainly agree with the noble Baroness, Lady Bennett, who spoke about the need to see the Bill in its overall context. I associate myself with those comments.

I absolutely agree with the intention behind Amendment 191, tabled by the noble Lord, Lord Kamall, and introduced by the noble Earl, Lord Howe. I hope I can reassure noble Lords that the Government are committed to supporting businesses to implement the measures in the Bill, which much of this discussion has been about. As I have said previously, we will continue —it is a continuing thing that is not in the past—to work closely with retail bodies such as the British Retail Consortium and the Association of Convenience Stores on the implementation of the measures, which will include the development of guidance.

I heard the concern of noble Lords about what guidance will be given. Again, I understand those points but, to say it in other words, we will support retailers through this transition. As the noble Baroness, Lady Walmsley, mentioned, what is being asked of retailers is not unusual for them; they are very familiar with age verification. I will come back to that later. The measures in the Tobacco and Vapes Bill will come into force across a range of dates and therefore it is important that the associated guidance is available at the appropriate time. In other words, there will be time to make this transition and there will be support for that. We are firmly committed to publishing the guidance in a timely manner.

Turning to Amendment 188, tabled by the noble Lord, Lord Kamall, I say to nearly all noble Lords who have spoken that, although I understand the intention of the amendment, it is unnecessary. As noble Lords have acknowledged, the Government are already taking action to tackle the absolutely unacceptable rise in retail crime. The Government will not stand for violence and abuse of any kind against shop workers. Everybody has a right to feel safe at their place of work and we have long championed specific protections for retail workers.

To protect the hardworking and dedicated staff who work in stores, the Crime and Policing Bill introduces a new offence of assaulting a retail worker, which the noble Baroness, Lady Fox, referred to. The Bill also removes legislation which makes shop theft of goods to the value of £200 or below a summary-only offence. That sends a clear message that any level of shop theft is illegal and will be taken seriously. I hope that that is helpful to the noble Lord, Lord Howard.

Alongside legislative action, we are also providing over £7 million over the next three years to support multiple policing bodies to help to tackle retail crime. As I have mentioned, we will continue to work closely with retailers and will utilise the lead-in time to best support them in preparing for and implementing the measures in the Bill. This will include government communications and information campaigns to inform both the public and retail workers.

The noble Baroness, Lady Fox, asked what assessment the Government have made of the impact on small businesses. Page 82 of the impact assessment specifically addresses this. As noble Lords are aware, an impact assessment should be expected and is required for any Bill. That means that the Regulatory Policy Committee also took a view; it published an opinion on the impact assessment and provided a fit-for-purpose rating. This included a green rating for the assessments of small and micro businesses’ assessments. I hope that will be useful.

I turn to Amendment 200A, tabled by the noble Lord, Lord Howard. This would require the Government to create a financial assistance scheme specifically to subsidise the cost of purchasing age-verification technology to enforce on the sale of nicotine products. I heard the comments of the noble Baronesses, Lady Walmsley and Lady Bennett, who spoke against that amendment.

There are no plans to mandate the use of age-verification technologies to enforce the age of sale of nicotine products. It will be for businesses to decide how they ensure that they sell only to people 18 years or over, including whether to use age-verification technology to support them in this. As I mentioned earlier, as did the noble Baroness, Lady Walmsley, checking that a customer is over a certain age is a well-established and well-trodden path for retailers. They should continue to take reasonable steps and exercise due diligence to ensure that they do not sell products to anyone underage. Most retailers already follow recommended practice, and I am grateful to them; they regularly ask for identification from customers to verify their age.

To provide clarity for retailers on the types of ID that can be used, the Bill provides powers to specify in regulations the steps that may be taken to verify a customer’s age and satisfy the age of sale defence. This will include the types of digital identities that can be used, and work will continue with the Department for Science, Innovation and Technology, which is leading on this work. I emphasise that the Government are absolutely committed to supporting retailers through the changes brought in by this legislation, including through the publication of clear guidance in which they will be fully involved.

I hope that I have provided helpful reassurances and that the noble Lord will feel able to withdraw the amendment.

[Earl Howe (Con)]

My Lords, I am grateful to all noble Lords who have spoken in this short debate, including the Minister for her reply. Perhaps I could repeat that my amendment was intended as a probe to raise a set of general concerns surrounding the retail sector. I was reassured by the Minister’s reply, including her references to the provisions of the Crime and Policing Bill. But we need to bear in mind, as we debate the Bill, that retailers are not the source of the problem that the Bill seeks to address—yet they will be the ones to lose out.

The Bill is projected to cost retailers more than £1 billion in profits over the next 30 years, plus what I am sure will be a considerable amount more from the reduced footfall that many will see over time. The noble Baroness, Lady Fox, was right: there is considerable worry in the sector, which is exacerbated by the uncertainty surrounding the timetable for the Bill’s implementation. It would be helpful, perhaps when we reach the next stage of the Bill, for the Minister to give us an idea of how the Government intend to proceed as regards the processes of consultation—consideration of submissions, as well as the actual implementation—and what the outline timetable will look like. The transition needs to be as inclusive and smooth as possible, and practical guidance and support will be essential, especially for small retailing businesses. I have no doubt that the Government have this in mind, but we may need to return to it on Report, just to underline the point. Meanwhile, I beg leave to withdraw the amendment.

--- Later in debate ---

[Earl Howe (Con)]

My Lords, the Committee will be grateful to my noble friend, with his considerable experience in health policy, for the clear and cogent way in which he introduced his amendment. I am very supportive of the principles behind the amendment, as it seeks to ensure that decisions taken after the passage of the Bill are informed by robust, independent evidence and that Parliament is equipped with the relevant and authoritative information it needs to provide proper oversight of the regime for vaping and nicotine products, information that is constantly updated as the body of evidence evolves.

Critically, this principle applies equally to the Government. Proposed new subsection (5) in the amendment would require Ministers, when making regulations under the Act, to have regard to the proposed panel’s reports and recommendations. That is a sensible idea. My noble friend Lord Young of Cookham was right to remind us that there has for some time been a gap in the public health mechanisms regarding the production of such reports. If we were to recreate a mechanism of the kind suggested, the regulatory frame- work would evolve in response to the realities of science and the market rather than outdated information.

It is also important to recognise, as the amendment implicitly does, that although our primary concern here is health, regulation in this space cannot be viewed in isolation from the wider economy. When sales of currently legal products are restricted or prohibited, this inevitably impacts businesses, consumers and, sometimes, wider society, and those economic effects can themselves have unintended consequences for public health and people’s lives. There is also plenty of evidence of unintended consequences and the effectiveness of previous episodes of prohibition. The risk of a rise in consumption of illicit products is an obvious example, as is misinformation propounded on social media. The Government should make and review decisions with as clear a view as possible about those sorts of trade-offs.

For those reasons, I hope the Government will take on board the very sensible suggestion contained in this amendment.

[Baroness Merron (Lab)]

My Lords, I am most grateful for this debate, which concludes the work of the Committee. As I have said before, I certainly share the intention of the noble Lord, Lord Lansley, who tabled this amendment, to ensure that regulations are based on the best available evidence. I appreciate the consideration he has given to the amendment and the reason he put it forward.

I say in response that we continue to monitor emerging evidence, which we have much discussed, on vapes and nicotine products, including commissioning independent research through the National Institute for Health and Care Research. For example, we commissioned a comprehensive analysis of all youth vaping studies—referred to in the debate—which was published recently, and a five-year-long living evidence review that will collate the latest and most robust research into the health impact of vaping. This living evidence review is accompanied by a scientific advisory panel, which includes independent experts, appointed independently from the Government on merit, who the Government can call on for advice on the latest evidence. Further, as the noble Lord, Lord Young, mentioned, earlier this year we announced a landmark 10-year study that will include in its investigations the long-term health effects of vaping on young people’s health.

I agree with the noble Lord, Lord Lansley, that misperception of the harms of vaping is of concern; I take that point. Vaping absolutely can play a role in helping adult smokers to quit, as we have discussed, but children should not be vaping and nor should non-smokers. We are committed to carefully considering the scope of restrictions, to avoid unintended consequences and the misperception of harms, which is an area for further work.

We also fund a vaping expert panel, which provides valuable guidance for trading standards professionals on the enforcement of regulations. Under many of the powers in the Bill there is a requirement to consult before making regulations and, on 8 October, we published a call for evidence on issues where more evidence is needed before we can consult on specific proposals. We will monitor the impacts of measures brought in by the Bill and subsequent regulations. We will also be able to update regulations in future to ensure that policy is responsive to evolving evidence, should this be necessary.

It is our view that we have access to appropriate expert advice, which I know is the noble Lord’s intention, and we will consider the best available evidence in making regulations. I hope that he will feel able to withdraw his amendment.

[Lord Lansley (Con)]

My Lords, I am grateful to all those who contributed to the debate. It is both helpful and timely at the conclusion of Committee to have exactly this debate. In a funny way, perhaps we should have had it at the beginning, because it helped to fill out some of the details of the ways in which the evidence base for the vaping and nicotine product regime will be assessed and understood.

Brain Tumours: Causes and Treatment

Baroness Merron Excerpts

Monday 24th November 2025 Lords Chamber

[Baroness Mattinson]

To ask His Majesty’s Government what steps they are taking to improve the scale of research into the causes and treatment of brain tumours.

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

My Lords, research is vital to ensure that people get the most effective treatments and the highest quality care. We are committed to furthering investment in brain tumour research: between 2018-19 and 2023-24, NIHR invested £11.8 million and UKRI invested £46.8 million in this area. The new NIHR brain tumour research consortium does promise a step change, with further announcements being imminent. In addition, the national cancer plan will seek to improve every aspect of cancer care, including outcomes for those with brain tumours.

[Baroness Mattinson (Lab)]

My Lords, I thank the Minister for her reply, but I want to press for more urgency to beat this terrible disease. Brain cancer is now the biggest killer of children and adults under the age of 40 in the UK. Behind every statistic is a person, like my old friend Georgie Maynard, a mother of three who received her own devastating diagnosis two and a half years ago. Georgie has co-founded the Brain Cancer Justice group, and she is here today. She wants to know why the UK’s brain cancer survival rate ranks only 22nd out of 29 wealthy nations, why just 1% of the cancer research budget is allocated to brain cancer, and why only 12% of people with a brain tumour are able to participate in trials. In particular, the whole-genome sequencing is vital for brain tumour research, yet just 5% of brain tumour patients can access it.

Last September, the Tessa Jowell Brain Cancer Mission published its recommendations. Will the Minister agree to review these recommendations and meet with the Brain Cancer Justice group to discuss how they can be incorporated?

[Baroness Merron (Lab)]

I thank my noble friend for the opportunity to meet Georgie just before Questions. I am happy to write to my noble friend with answers to all those questions. On the last two, yes, we continue to work very closely in partnership with the Tessa Jowell Brain Cancer Mission to drive further progress against its recommendations. I will certainly speak with the Minister who deals with this area—Ashley Dalton MP, who is currently ensuring that the cancer plan can be published at the beginning of the forthcoming year—about the suggestion of a meeting. We have very much engaged with the cancer community on the cancer plan, and we continue to be keen to do so.

[Lord Patel (CB)]

My Lords, I thank the Minister for promising us a cancer plan by the beginning of next year. I hope it will be forthcoming, because it will be good to look at how cancer care will change. Regarding brain tumours, the problem is that the symptoms are often vague and mild, so early diagnosis is much more difficult. We need more research into the early diagnosis of tumours. Furthermore, we need much more research than the numbers mentioned by the Minister. One of the success stories, one hopes, in 2026 will be drug gene therapy and viral immunotherapy, which will be put through clinical trials early next year to treat glioblastoma, the major brain tumour killer. I hope we will have more funding, because £30 million, £40 million or even £50 million will not do.

[Baroness Merron (Lab)]

I want to convey to the noble Lord our ambition in this area. I completely accept the point he makes—although not all of them—about the challenge of diagnosing rarer cancers, including brain tumours. Research is absolutely vital. Last September, we announced new research funding opportunities, bringing the brain cancer research community together, because we want to drive step change for patients in the way the noble Lord seeks. Funding decisions will arise from this call, and announcements are expected imminently.

[Lord Sharpe of Epsom (Con)]

My Lords, my son survived a brain tumour, but he was lucky, because in the UK between 40% and 60% of brain tumour diagnoses happen after the patient has arrived at A&E, having often been misdiagnosed—to follow on from the noble Lord’s question—earlier. That is a much worse outcome than many for other cancers. As the Minister said, brain tumour cancers are the leading killer of people under the age of 40. Will she therefore commit to a public awareness campaign to explain some of the difficult symptoms the noble Lord just identified, and the seriousness of brain tumours? Such awareness is sadly lacking among the public.

[Baroness Merron (Lab)]

I take the point the noble Lord makes, and I am sorry to hear of his son’s—and of course his family’s—experience. One of the things we are working on is increasing public awareness of brain cancer research opportunities. That is not quite the same as the point the noble Lord made, but extending that through the NIHR’s “Be Part of Research” initiative is important. The national cancer plan will give us the opportunity to review what communications and campaigns we run with the public. That will be a good opportunity to consider the point he makes.

[Lord Scriven (LD)]

My Lords, Georgie’s brother is Charlie Maynard MP, who has been campaigning on this. One of the issues raised is that in the UK it takes significantly longer to open a clinical trial for these patients than in most comparable nations, due to the excessive administrative burden. Will the Government therefore commit to looking at a fast-track designation for trials involving cancers with unmet needs, such as glioblastoma?

[Baroness Merron (Lab)]

We certainly do need to cut more red tape on cancer treatments. For example, we recently accelerated patient access to ultrasound cancer treatment through our innovative devices access pathway pilot. That is just one way in which we will have the potential to help companies, which is crucial to bring game-changing cancer treatments to fruition and to NHS patients even faster.

[The Lord Bishop of Leeds]

My Lords, would the Minister agree that it is important to recognise and praise the treatment that is already available while challenging to do more? I was diagnosed with a benign tumour and the treatment was exemplary. On the real upside of this, I have a lot of documentary evidence that I have a brain.

[Baroness Merron (Lab)]

I have never doubted that about the right reverend Prelate, but I am sure that the whole of your Lordships’ House is very pleased that he is with us. It is absolutely right and proper to pay tribute to all those in the whole system who provide care, treatment, diagnosis, research and so on. It is a team effort, and I am glad that he has benefited so well from it.

[Lord Kamall (Con)]

My Lords, being diagnosed with a brain tumour is devastating not only for the person involved but for their family. As my noble friend Lord Sharpe said, brain tumours can lead to memory loss, cognitive changes and reduced physical ability. Those symptoms are sometimes not picked up beforehand, but even when someone is diagnosed with a brain tumour those very symptoms sometimes lead to misunderstandings among friends and family members, and can lead to isolation. Given this, can the Minister outline what steps NHS England and the department are taking to raise awareness among families and friends of all the symptoms and side-effects of brain tumours, so we can avoid those misunderstandings and ensure that the patient continues to receive care from their loved ones?

[Baroness Merron (Lab)]

It is an important point, as the noble Lord, Lord Sharpe, raised. As I said, the national cancer plan will give that opportunity to address challenges and needs such as those the noble Lord raised. We are also establishing a brain tumour research consortium through the NIHR, which will bring together researchers from different disciplines. The scientific advancements it will drive will be how to prevent, detect—to the point raised by the noble Lords—manage and treat brain tumours. That will also be of great assistance.

[Lord Winston (Lab)]

My Lords, the Government should be congratulated on trying to improve their work on brain cancer. Talking about treatment, one of the issues is that one of the greatest advances and most important areas is brain imaging using magnetic resonance imaging, PET scanning and even electrical recording in a sophisticated way, but access to these important technologies still seems somewhat deficient. Will the Minister say whether the NHS has plans to increase access to brain imaging? It seems a very important area in treatment.

[Baroness Merron (Lab)]

We certainly want to see services properly available across the country and people not being disadvantaged because of where they live or what the services are. Again, from what I know of it—we will soon see it—the national cancer plan will improve every aspect of cancer care, including outcomes for those with brain tumours and access to the services my noble friend outlines.

Mental Health Bill [HL]

Baroness Merron Excerpts

Consideration of Commons amendments and / or reasons
Monday 24th November 2025 Lords Chamber

Moved by

[Baroness Merron]

That the House do agree with the Commons in their Amendment 1.

1: Clause 5, page 11, line 22, leave out “by a constable or other authorised person”

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

My Lords, with the leave of the House, I will speak also to Amendments 2 to 21, including Amendments 19A and 19D. It is a pleasure to return this Bill to this House; I very much appreciate the support and engagement of noble Lords throughout its passage.

Let me turn first to the government amendments in the other place, other than the minor and technical amendments, which are there for clarification. We have clarified the duties on NHS bodies to make arrangements regarding advance choice documents, otherwise known as ACDs. NHS bodies must actively inform individuals about ACDs, rather than taking a minimal approach. The Bill requires that information and help are provided to people who wish to make an ACD through discussion with a suitably qualified person. NHS bodies should consider the advantages of making an ACD within 12 months after discharge and aim to provide support. Additional guidance on these duties will be in the revised code.

I thank my noble friend Lady Keeley and the noble Baroness, Lady Barker, for raising concerns about the unequal application of the Human Rights Act. The Government have now made it so that registered private providers delivering Section 117 aftercare or in-patient mental health services, funded by local authorities or the NHS, are treated as carrying out public functions under the Human Rights Act and act compatibly with the convention rights. This amendment will apply UK-wide.

I turn to the amendments made by this House on police powers. I thank the noble Baroness, Lady May, for her constructive engagement and for establishing the review of the Mental Health Act when she was Prime Minister, which has brought us to this place today. We have removed the amendments made to Clause 5 that would have added police and other authorised professionals to Sections 2, 3 and 5 of the Mental Health Act. Extending police and other authorised professionals to these sections would be inappropriate—a view that is shared by the police.

We have removed Clause 50 from the Bill, which would have extended emergency police powers under Sections 135 and 136 of the Act to other authorised persons. Health and care professionals lack the training, equipment and access to rapid back-up needed to use such powers safely, and stakeholders are concerned about staff having the authority to use reasonable force. A blanket extension of powers to multiple agencies would risk confusion and delay in emergencies due to a lack of clarity over who should respond.

There are strong views on either side of this issue, and there are situations where health professionals feel that they do not have the powers they need. That is why I am announcing longer-term plans to launch a consultation into emergency police powers of detention. We will consult on the powers available to different professionals in different situations and settings, in particular—but not limited to—the operation of the emergency powers in Sections 135 and 136. The consultation will seek views on powers and joint working approaches to ensure that health and social care professionals and police have the appropriate powers to act in order to prevent people harming themselves and others when in a mental health crisis. We firmly believe that this is the right approach to a complex issue that requires careful consideration and consultation.

I turn to community treatment orders. Clause 6(3) has been removed from the Bill, as CTOs already comply with the code and have an initial six-month period. The responsible clinician may renew a CTO if there is a risk of serious harm without it and a reasonable prospect of therapeutic benefit. Following positive engagement with the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler, I can confirm that the Government will review the statutory forms that relate to CTOs, with the aim of strengthening them to ensure a clear audit trail of the reasons for applying a CTO and associated conditions.

Regulations will require that statutory care and treatment plans specify any CTO conditions and their justifications, which will also be clarified in the code. We will work with the Tribunals Service and the judiciary to ensure that the patient’s plan is considered alongside other evidence at tribunal hearings. We will clarify in the code that, where a tribunal recommends that the responsible clinician reconsider CTO conditions as it does not consider them necessary, the responsible clinician should review and, potentially, revise those conditions. The code will set out that the responsible clinician should inform the patient of their decision after considering the tribunal’s recommendation, which should be recorded in writing. We will engage on the code before publication and involve the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler, in the process. As the tribunal is responsible for considering all relevant evidence, this may include recent recommendations made at past tribunal hearings regarding the conditions placed on the person, including the detail and rationale of any current conditions.

I can confirm that since September 2025 we have increased the quantity and frequency of reporting on racial disparities in key metrics, such as detention CTOs and length of stay by ethnicity. Much of this data was previously published annually but it is now published monthly, allowing for closer monitoring of progress. The data is publicly available on the Mental Health Act annual dashboard and, along with implementation of the patient and carer race equality framework, will be used by the Care Quality Commission as part of its inspection regime.

On the debriefing amendment, I thank the noble Earl, Lord Howe, and the noble Lord, Lord Kamall, for their constructive engagement. We have removed Clause 35, which required independent mental health advocates to consult people about their in-patient experience after discharge. This removes policy duplication and additional strain on advocacy services, whose focus is on supporting detained patients’ rights. The code will clarify the processes of care planning. Supporting someone to make an advance choice document should include the opportunity to reflect on past experiences. The 10-year health plan commits to making patient feedback central to quality improvement.

The Government have tabled amendments in lieu regarding the appointment of a nominated person for a child under 16 who lacks competence, and I am most grateful to the noble Baroness, Lady Berridge, for her continued work on this. The Bill now states that an approved mental health professional, or AMHP, must appoint either

“a person who has parental responsibility … a person named in a child arrangements order as a person with whom the relevant patient is to live”

or

“a person who is a special guardian”.

If there is no suitable person willing to act, the AMHP must consider the child’s wishes and feelings when deciding who to appoint.

On the amendment tabled by the noble Baroness, Lady Berridge, to the Government’s Motion, I understand the intention to prevent a parent who has had parental responsibility limited from being appointed as a nominated person by an AMHP where a child lacks competence to make the appointment. The amendment tabled would mean that a special guardian or person named under a child arrangements order as someone with whom the child must live must be appointed. It is not appropriate for legislation to say that a particular individual must always be appointed nominated person. If they are not able, or even willing, to perform the role effectively, requiring them to take this role and ruling out other options risks harming the child’s interests.

As we know, legislation can be a blunt tool. It is far more appropriate to set out nuances such as this in the statutory code to ensure that the child’s individual needs are considered. That is why we previously agreed to set up an expert task force to consider these very complexities. Part of this role includes ensuring that clear guidance is given to AMHPs on who to appoint in a range of scenarios to avoid unintended consequences. At this late stage, in order to get this right, we should not be hurriedly working through these complexities as part of the legislation. We should develop detailed guidance, in consultation with professionals and patients, through drafting the code of practice. I therefore ask the noble Baroness not to move her amendment.

In conclusion, I hope that noble Lords will support our position and pass the legislation without amendment. I beg to move.

[Baroness Berridge (Con)]

My Lords, I will speak to Amendment 19D in my name. I thank the Minister and her officials for the frequency of their engagement on the Bill. I put on record my apology for not spotting possible issues with the Government’s Motion, to which I have tabled the amendment, much earlier. I thank the Minister and her officials for meeting with the approved mental health professionals, the professional group dealing—often late at night or at a weekend—with our sickest children, who do not have the competency to appoint a nominated person for themselves.

I specifically recognise the inconvenience to the Bill team, but this matter relates to the protection of mentally ill children and has been flagged at every stage since the Wessely review in 2018, when a consultation was suggested. In recent meetings with the Minister, I understood that what was to be achieved was that the appointment of nominated persons would reflect existing court orders made by the family court on child protection grounds. The mischief that the approved mental health professionals want to solve is that they do not want to have any discretion to appoint as a nominated person anybody not in accordance with an existing court order. They want to see this achieved through the mandatory appointment of the special guardian in priority to anybody else, the rationale being that special guardianship is usually used to avoid care orders, adoption or long-term fostering.

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[Baroness Merron (Lab)]

My Lords, I thank noble Lords for the thank yous and the appreciation for the whole team, which, as noble Lords have said, is extensive. I also appreciate the welcome for the number of improvements that we have made to the Bill by being able to work together. I am grateful to noble Lords for their contributions, as I said at the outset. We have made significant progress on the Bill. Even today, the amendments and discussions reflect the complexity of these reforms and the shared determination to deliver legislation that will make a real difference.

I will seek to address some of the points that Peers have raised—as always, I am very happy to pick up points outside the Chamber. I turn first to those raised by the noble Baroness, Lady Berridge. She asked about having strong requirements for local authorities rather than special guardians. Stakeholders, including the Office of the Children’s Commissioner, agreed that the main priority should be whether the child is under a care order—that is, the local authority has parental responsibility—and that this should be considered under a separate tier to a special guardian or child arrangements order.

I will now pick up the point that the noble Baroness, Lady Berridge, and the noble Lord, Lord Kamall, raised about why there is no use of the word “or” in the legislative drafting. On this point, I am advised that, by default, the absence of “and/or” on the page means “or” as a matter of drafting. The modern style is to say “and” when you mean “and”, but to leave—I hope that the noble Lords, Lord Meston and Lord Pannick, and some of their colleagues can assist. I will start that sentence again: the modern style is to say “and” when you mean “and”, but to leave “or” silent if the latter is what is intended. This is the key point: we are clear that it must be a single person who is appointed.

On the issue that the noble Baroness, Lady Berridge, raised about the creation of a hierarchy, we simply do not agree that a person with residual parental responsibility should always be blocked from being a nominated person, as the child arrangements order or special guardianship may be in place for reasons other than the parent being a risk to the child. However, we agree with the general principle that the AMHP should be aware of, and consider the implications of, any child arrangements order or special guardianship. In most cases, it is true that they will still appoint those people to be the nominated person, rather than the person with residual parental responsibility. It is considered that allowing flexibility allows judgments to be taken on a case-by-case basis, taking into consideration specific circumstances and what is most appropriate for the child or young person, rather than a blanket exclusion. We will provide clear guidance in the code, following consultation and engagement with experts and professionals. I hope that will allow a way forward to deal with the complexity.

The noble Baroness raised a point about a parent having malevolent intent. I stress that, if the AMHP later finds that the special guardian will be a more suitable person, the legislation allows them to terminate the appointment of the nominated person and appoint the special guardian instead. If there are any outstanding issues that I have not covered either in my speech or in this response, I will be happy to discuss those with the noble Baroness, as I have continued to do. As I said earlier to noble Lords, I believe that this discussion, these questions and the amendment all show the complexity that we are all seeking to resolve.

The noble Baroness, Lady May, asked a number of questions about the consultation. My department will lead the consultation, and we will be working with the Home Office and stakeholders to scope it. While I cannot give an exact timeline for the review, and I am sorry to be unable to do so, I can say again that before launching the consultation we are going to be working closely with the Home Office, the NHS, social care colleagues and the police to consider the options to consult on that support better outcomes for patients and the services. I will be pleased to set out further details on the timetable in due course.

The noble Baroness, Lady May, asked what happens at the end of the review. I am sure she will understand that I do not want to pre-empt the outcome of the process. However, on a future vehicle to implement the review, while obviously we cannot commit to a legislative means to do that, we will be taking forward the consultation results and outcomes when parliamentary time allows. I will be pleased to keep the noble Baroness updated on all these developments.

The noble Baroness, Lady Hollins, mentioned my colleague the Minister, Stephen Kinnock MP, who did a sterling job of taking through this legislation in the other place. She asked about his work with lived-experience groups. I say to your Lordships’ House and to the noble Baroness in particular that, after Royal Assent, our first priority will be to draft and consult on the code of practice. We will be engaging with people with lived experience, their families and carers, and with staff, professional groups, commissioners, providers and others to do this, alongside launching a public consultation. The code will be laid before Parliament before final publication. Realistically, we expect that this process will take at least a year, but the nature of our discussions means that it is important that we get this right.

The noble Baroness, Lady Tyler, asked about confirmation of an implementation timeline. While of course legislation is important, implementation is what delivers the results. We estimate, as the noble Baroness has heard me say, that full implementation will take around 10 years; that does not mean we wait 10 years but, realistically, that is how long full implementation will take, due to the time needed to train the workforce and the need to ensure that the right community support is available. Noble Lords will be aware that this timeframe necessarily spans multiple spending reviews and multiple Parliaments, so we are limited—I hope noble Lords will understand this—in the detail that can be given about future spend and timelines. I quite understand why noble Lords raise this issue.

I acknowledge the dedication and thoughtful engagement shown by Members of your Lordships’ House throughout the passage of the Bill. The amendments made by the Government reflect not only technical refinements but, importantly to me, our response to the concerns and insights that were raised by Peers, MPs, stakeholders and those with lived experience. I believe that those concerns and insights have improved the Bill’s clarity and effectiveness, and I hope that noble Lords will support these amendments. It is thanks to what I regard as exemplary cross-party working that we are in a position to pass the Bill into law and begin implementation. It is about bringing positive change as soon as possible for those whose lives are touched by the legislation that we have debated. I commend the Motion to the House.

Motion on Amendment 1 agreed.

Moved by

[Baroness Merron]

That the House do agree with the Commons in their Amendments 2 to 17.

2: Clause 5, page 11, line 33, leave out “by a constable or other authorised person”

--- Later in debate ---

Moved by

[Baroness Merron]

That the House do disagree with the Commons in their Amendments 18 and 19 but do propose Amendments 19B and 19C in lieu—

18: Schedule 2, page 81, line 25, leave out from beginning to end of line 3 on page 82 and insert—
“(3) If no local authority has parental responsibility for the relevant patient but there are one or more other persons who have parental responsibility and who are willing to act as the nominated person, the approved mental health professional must appoint one of them.”

--- Later in debate ---

Moved by

[Baroness Merron]

That the House do agree with the Commons in their Amendments 20 and 21.

20: Schedule 3, page 92, leave out lines 22 and 23 and insert—
“(c) the patient is not liable to be detained under this Act or any other legislation or by virtue of a court order.”

NHS: Wheelchair Services

Baroness Merron Excerpts

Monday 24th November 2025 Lords Chamber

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what assessment they have made of the provision of wheelchair services by the NHS and social care authorities.

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

My Lords, integrated care boards are responsible for the commissioning of local wheelchair services based on the needs of the local population. NHS England has developed policy guidance and legislation to support ICBs to commission effective, efficient and personalised services. This includes a Wheelchair Quality Framework, published in April, which is designed to assist ICBs and NHS wheelchair service providers in delivering high-quality provision that improves access, outcomes and experience.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to my noble friend, but does she recognise that the work by the Wheelchair Alliance and the All-Party Group for Wheelchairs Users would suggest that, if you leave this to local health bodies and local authorities, they simply will not improve the current inadequate and patchy service? The All-Party Group for Access to Disability Equipment has reported that

“63% of carers and 55% of equipment users said that services are getting worse”.

Given what my noble friend said about the quality framework, which I very much welcome, does she accept that nothing will change unless this is enforced from the centre, with strong performance management?

[Baroness Merron (Lab)]

I accept the observations that my noble friend has made; I know he has been a voice on this for many years. I share with him the impatience for change and welcome the work of the APPG and the Wheelchair Alliance. The NHS Medium Term Planning Framework, which was published just in October, requires that, from 2026-27, all ICBs and community health services must actively manage and reduce the proportion of waits across all community health services over 18 weeks and develop a plan to eliminate all 52-week waits. I expect that wheelchair provision and services will improve through this as well as other means.

[Baroness Watkins of Tavistock (CB)]

Can the Minister comment on whether we keep any statistics in relation to people who have to stay in hospital who avoid discharge because of the length of time taken to get wheelchairs?

--- Later in debate ---

[Baroness Merron (Lab)]

I will be pleased to write to the noble Baroness about the specific data that is available, but we know that, because of issues to do with aids and adaptations, sometimes people’s leaving hospital is not as timely as it should be. That is not in their interests. We certainly expect local authorities, for example, which have a statutory duty, to make arrangements to do so and also for ICBs to make the provision so there are not the hold-ups that the noble Baroness refers to.

[Baroness Manzoor (Con)]

My Lords, as the Minister said, the NHS provides the funding for wheelchair access, but the wheelchairs are mostly necessary in community settings and in the home, and there is a gap between social services and the NHS using different criteria to assess the health needs of the patient. What are the Government going to do to address this so that people get the service that they need?

[Baroness Merron (Lab)]

The provision of the right type of wheelchair is crucial, but we also need to expand care options to boost independent living at home. We have done that in part through an additional £172 million for the disabled facilities grant, which goes hand in hand with people being able to live at home. This could enable around 15,600 extra home adaptations. Introducing care technology standards for those who are using wheelchairs and those who are not will also enable proper care standards and independent living.

[Lord Rennard (LD)]

My Lords, I declare an interest as the conference chair of the National Association of Equipment Providers. As a teenager, I pushed my mother everywhere in a wheelchair; we had to buy it second hand through the Liverpool Echo. Wheelchair provisions have improved greatly since then, but how can the Government work with the Wheelchair Alliance and with trade associations to ensure that retailers have skilled clinical staff who are trained to undertake assessments and prescribe appropriate wheelchairs and other forms of assistive technology?

[Baroness Merron (Lab)]

The points that the noble Lord has raised are crucial—not least that, as I alluded to earlier, one type of wheelchair does not suit everybody. That is why I am keen to see the results of the Wheelchair Quality Framework, which, as I mentioned to my noble friend, was published in April. That sets out quality standards and statutory requirements, including offering personalised wheelchair budgets, which would assist in the circumstances that the noble Lord describes.

[Lord Weir of Ballyholme (DUP)]

My Lords, I declare an interest as a frequent wheelchair user and as a member of the all-party group. Some concerns have been expressed that the competition for contracts for wheelchairs is very limited and that a number of wheelchair providers are not even submitting their names to be considered for those contracts because they feel that it is not worth their while. What action are the Government taking to ensure that there is sufficient choice within the NHS and that the market is large enough to ensure that companies will actually bid for those contracts?

--- Later in debate ---

[Baroness Merron (Lab)]

This is a very important point, not just for the supply chain but also for the technology, particularly if we are thinking about those with more complex needs; the wheelchair has to support and meet those complex needs. We know that there is a lack of investment in new models and that there has been disruption in the supply chain. While I do not seek to blame, that was a particular issue arising out of the pandemic. We are indeed working on better technology in terms of wheelchairs and other aids and adaptations and seeking to iron out difficulties in people making bids for contracts. If the noble Lord has examples, I would be very pleased to hear about them.

[Baroness Pitkeathley (Lab)]

My Lords, can my noble friend comment on the problem, which carers often report, of being unable to return the wheelchair to its source when it is no longer needed?

[Baroness Merron (Lab)]

My noble friend raises a point that applies not just to wheelchairs but to other aids and adaptations. There is indeed a very considerable issue. That is a matter for local services, but it is absolutely something that we will work with them on as part of how we improve services, because it also includes the safe and timely return.

[Lord Kamall (Con)]

My Lords, as well as the concerns raised by the noble Lord, Lord Hunt, about NHS wheelchair services, we know that, in addition, there are over 1 million wheelchair users of different types in the UK, and we know that people still face considerable difficulties in accessing health and social care buildings. Of course we understand that some buildings are old and will have to be retrofitted, but what specific conversations is the department having with charities, expert groups, owners of buildings and developers to raise awareness of the need and how to improve access, particularly for those older buildings?

[Baroness Merron (Lab)]

The noble Lord is right, and his comments about buildings apply not just to NHS buildings either but to the whole range. I can assure the noble Lord that across government we have continuing discussions about this, because it is not, as the noble Lord says, just a matter of getting the right wheelchair; it is also about them being accessible in terms of the buildings. It is also the reason that I mentioned to his noble friend about adaptations to people’s homes so that wheelchairs can be used there too.

[Lord Laming (CB)]

My Lords, does the Minister agree that one of the problems is that the need is often not identified until the person is heading for discharge from hospital, whereas if it was foreseen at a much earlier stage and there was proper co-ordinated planning between health and social care, a great deal of these delays could be reduced? Will the Minister do all that she can to improve the relationship between health and social care at local level?

[Baroness Merron (Lab)]

I would certainly agree that timely provision of wheelchairs and other aids and adaptations does support people not only to remain as independent as possible for as long as possible but to leave a hospital setting if that is in their best interests. We now have the better care fund as a framework for integrated care boards, the NHS and local authorities to make joint plans and to pool budgets for the very purpose the noble Lord mentions, which is about delivering better joined-up care. That can indeed include wheelchairs. That is a very systematic approach, doing exactly what the noble Lord is requesting.

Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

Nevertheless, given the Bill’s subject matter, there are two watchwords that we should carry in our minds, particularly in the light of the speech of my noble friend Lord Shinkwin. They are “reassurance” and “clarity”. Amendment 3 and others in this group would serve to deliver reassurance through greater clarity. That is why I suggested that the noble and learned Lord, Lord Falconer, should consider these amendments with a sympathetic eye, because they serve to put the Bill’s intentions around coercion beyond any reasonable doubt and they do so without in any way undermining the Bill’s underlying aims.

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

My Lords, I thank all noble Lords who have spoken today for their contributions on these important issues. As I have already made clear, I will keep my comments limited to the amendments on which the Government have major legal, technical and/or operational workability concerns.

On that basis, I will speak about Amendments 118 and 118B. Amendment 118, tabled by my noble friend Lord Hunt, could prevent a person from accessing assistance where there is no clear connection between their individual circumstances and the crime that their close relative is under investigation for or has been convicted of, even if the said crime took place some years in the past. Amendment 118B, tabled by the noble Lord, Lord Farmer, would expand the meaning of “close relatives” to include “friends”. It is not clear who would determine the meaning of “friends” in this context. I should also say that disclosure of personal data engages Article 8 of the ECHR and is regulated by the principles set down in the Data Protection Act. Detailed financial assessment of those connected to a person seeking assistance is likely to interfere with the privacy of those individuals, particularly where there are no signs of coercion. The necessity of doing so is difficult to assess in the round rather than considering this on a case-by-case basis.

I turn to Amendments 222 and 612, in the name of the noble Baroness, Lady Hollins. Amendment 222 proposes a new clause to oblige the Secretary of State to provide specialist psychological assessment and support for persons considering an assisted death and their families. It would also oblige the Secretary of State to establish bereavement support services offering psychological support before an assisted death to all persons concerned. The Bill does not require families to know about an assisted death in advance, so requiring the offer of psychological services to them could create an undeliverable obligation on the Secretary of State.

Amendment 612 would mandate the video recording of a person being assisted to end their own life. The amendment would also require the person to confirm in the video recording their identity, their wish to die of their own free will, their capacity and that they are acting without persuasion or coercion. The amendment would require that this recording is sent to the coroner within 72 hours of death and it would create a regulation-making power for the Secretary of State concerning the practical arrangements for the recording, storing and transmission of the recordings. Requiring that a person’s death be video recorded where they did not wish the event to be recorded could risk being a significant intrusion into their family and private life under Article 8 of the ECHR. Since the Bill includes several safeguards, this intrusion is unlikely to be considered justified, and this amendment could also raise GDPR issues and concerns.

Amendment 460, in the name of the noble Baroness, Lady Finlay, specifies a range of actions the panel must take into account when considering a person’s psychosocial and safeguarding circumstances. It includes a requirement to offer immediate access to safe housing and financial support where abuse is disclosed. As the Bill is drafted, neither the panel nor the commissioner is provided with such a function and it is not clear how this would interact with local authority responsibility for housing provision.

As for the other amendments in this group where I make no detailed comments, although they may be deliverable, some would be challenging to implement. For example, Amendment 47 would require assessing doctors and the panel to assess a person’s state of mind or private thoughts. Amendment 58 would require an assessment of indirect structural disadvantage, including poverty or lack of care. Although I raise specific workability issues with only a small number of amendments in this group, noble Lords will be aware that the other amendments in this group have not had technical drafting support from officials. The issues raised by these other amendments are rightly a matter for noble Lords to consider and decide on, but I note that the way in which they are currently drafted means that they may not be fully workable, effective or enforceable.

[Lord Falconer of Thoroton (Lab)]

My Lords, in this debate we heard deeply personal information from the noble Lords, Lord Empey, Lord McCrea, Lord Watts, Lord Polak, Lord Griffiths, Lord Carlile of Berriew and Lord Shinkwin, and the noble Baronesses, Lady Hollins, Lady Hayter and Lady Grey-Thompson. I express my profound respect for people being willing to share in that way. I make it clear that in nothing that I say do I in any way intend to disrespect any of what must have been quite difficult statements to make. I really treasure many of the things that have been said, whether for or against the Bill.

As all noble Lords engaged in the debate know, at the heart of the Bill—there is no dispute about this—the decision to have an assisted death has to be where the patient, to quote the Bill,

“has a clear, settled and informed wish to end their own life, and … has made the decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person into making it”.

There is no dispute in the Committee that there have to be appropriate and sufficient safeguards to ensure that there is no coercion.

The current safeguards in the Bill are as follows: first, a doctor has to be satisfied that the person is not being coerced. Secondly, a second doctor has to be satisfied that the person is not being coerced. Thirdly, a panel has to assess that the person is not being coerced. Fourthly, the first doctor—after a period of reflection, in signing a second declaration by the patient—has to be satisfied again that the person is not being coerced. Finally, the doctor providing the assistance has to be at the last moment satisfied that the person is not being coerced.

The two doctors who give the certificate at the beginning must both have had specialist training in domestic abuse, including training on identifying coercive control and domestic abuse, and including identifying the effect of financial control. The panel considering the matter must consist of a psychiatrist, a social worker and a senior lawyer. If either of the two doctors have any doubt about the position in relation to capacity, they have to consult a psychiatrist. Anybody who by dishonesty, coercion or pressure induces the patient to either execute a declaration that they want an assisted death or take the assistance is guilty of a criminal offence. If all that the person does by dishonesty, coercion or pressure is to induce the person to execute a relevant document, the maximum sentence is 14 years. If, on the other hand, if they induce the person to take their own life, then the maximum sentence is life.

The question before the House in this debate is whether those protections are adequate to ensure that there is not coercion. I have before me a number of amendments. Amendment 3 is proposed by the noble Baroness, Lady Finlay: she would like “independent” to come before “decision”. I wholeheartedly agree with her that the decision must be independent, in the sense that it is a free decision made by the person, unpressured or coerced in the way that I have described. I am always influenced by what the noble Earl, Lord Howe, says in relation to that; he said, “Reassure us”. There is no dispute between me and the noble Baroness, Lady Finlay, that it has to be an independent decision. Is it clear enough in the Bill? With the deepest respect to both the noble Baroness, Lady Finlay, and the noble Earl, Lord Howe, I point out that it specifically says that the person should have

“made the decision that they wish to end their own life voluntarily and … not been coerced or pressured by any other person into making it”.

With respect, I say that it is clear enough on the face of the Bill.

I turn to Amendment 45, that of the noble Baroness, Lady Fox, which would insert “encouraged” in addition to “coerced” and “pressured”. I have thought very carefully about this, and I am against putting it in. The reason is that I see the reality: somebody who is thinking about an assisted death will want to talk frequently to those who love them. They may want to talk to the multidisciplinary team which is looking after them. Let us suppose somebody says, “I really, really want to go now. Should I take that opportunity?” If somebody says, “I encourage you to make the decision that is best for you,”, what the noble Baroness is proposing is that that becomes a criminal offence, potentially imprisonable for 14 years or for life. To me, that does not seem sensible.

I turn to Amendment 46. The noble Baroness, Lady Finlay, asks for “influenced” or “encouraged” to be added. I have dealt with “encouraged”. With regard to “influenced”, the multidisciplinary team or the person’s loved ones may well—with the best motives—influence somebody to go ahead with it. I do not criticise them for that if that is what the person wants and if it helps. It seems to me, again, wholly inappropriate to go beyond “coerced or pressured”.

On Amendment 47, the noble Baroness, Lady Coffey, suggests that it should be “external or internally” pressured that one is concerned with. We can understand external pressure—that is, somebody pressurising someone else to do it, and pressure carries with it an inappropriate degree of influence—but how does one in practice deal with an analysis of what would make me, for example, want my life to end? My noble friend Lady Merron also referred to that. The pain, the lack of dignity, the sense that I am not the person that I was in front of my own children is internal pressure. It might include me thinking, “I do not want to go on with this; in part, I’ve only got two or three weeks to live, and I want it to end”. The internal pressure is making me come to that conclusion. It is impossible to ask people, in particular the law enforcement authorities, to investigate what is going on in my mind. I have thought very carefully about that. I reassure the noble Lord, Lord Ashcombe, that I have given each of these amendments very careful thought, because they are important, but, again, I do not think that is a practical solution.

Medical Nuclear Radioisotopes

Baroness Merron Excerpts

Thursday 20th November 2025 Grand Committee

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

My Lords, I congratulate the noble Baroness, Lady Bloomfield, on securing this valuable debate. I think we should judge its value not by the number of people here but rather by the quality of the contributions. This is an important issue and, as the noble Lord, Lord Patel, said, the noble Baroness introduced this in a very comprehensive way, which was extremely welcome.

The Government are committed to delivering critical services that depend on the reliable supply of medical radioisotopes, to which both noble Lords referred. I agree with the noble Baroness and her reflections on the positive health outcomes, also supported by the noble Lord, Lord Patel. These isotopes support positive health outcomes, both for diagnostics and for therapeutics. I was looking at the figures: in England alone, some 700,000 procedures are carried out using radioisotopes every single year. This figure is expected to increase, not least because of their value in the process.

There are three main uses for medical radioisotopes; each relies on different manufacture to get the desired result. PET-CT scans, primarily used for cancer and cardiovascular diagnostics, use isotopes from a comprehensive network of UK-based cyclotrons. SPECT scanners are mainly used to confirm the cancer stage, to identify blood clots and to assess organ functions. These scanners use isotopes manufactured abroad in reactors; the noble Lord, Lord Patel, drew our attention to this. This is also the case for radioisotopes that are used for therapeutics.

As the noble Lord pointed out when he expressed concerns about delays to treatment and the impact on patients—the point was well made—the UK does not currently manufacture medical radioisotopes in reactors. Instead, we have in place a supply chain with isotope sources from multiple countries to aid resilience. I will come on to the point that the noble Baroness made about when that supply chain is disrupted. This gives us access to a global network of expertise and high-quality medical radioisotopes.

The noble Baroness made a strong case in advocating for the Welsh project ARTHUR, a reactor specifically designed for the purpose of medical radioisotope manufacture. The Minister for Medical Technology and Innovation, Zubir Ahmed MP, recently met Liz Saville Roberts MP to discuss this matter, and I can assure the Committee that the Government are in active discussions about this project. I note the points made about the suitability of the area and the potential benefits of this project. The UK Government have not made a formal assessment of the project at this time but are supportive of any manufacturing capacity that can improve reliable access to medical radioisotopes, as has been called for. A domestic reactor would certainly be a welcome addition to the overall supply.

The noble Baroness understandably highlighted the severe shortage of a specific medical radioisotope in 2024. I agree that this was caused by a global disruption to its manufacture. The underlying issue was that several nuclear reactors used for its manufacture were undergoing critical repair work. As noble Lords can imagine, these repairs are normally planned ahead and co-ordinated to ensure that there is always enough capacity to deliver critical isotopes. However, the safe running of reactors will always determine whether they will be taken offline for repairs. In this instance, critical repair work was identified and meant that multiple reactors were closed down at the same time.

Due to a diligent response from the Department of Health and Social Care, NHS England, industry and the NHS services impacted, I am glad to say that the patient impact from this severe shortage was limited. I am grateful to all those who worked to ensure this. However, it underscores the need for multiple available sources of medical radioisotopes. A Welsh reactor—or perhaps a Scottish one, although I would rather not dwell on the argument around the devolved Governments and locations—could be an important addition to this supplier base.

Also raised were the issues with the supplies for PET-CT scanners earlier this year. I can give an assurance that, when there are specific supply issues, such as the one the noble Baroness referred to that impacted north England and the Midlands, the department works with suppliers to recover supplies and services. We are aware of the difficulties and issues that both noble Lords have raised. I hope that response is of some assistance.

We are working to support services and improve outcomes for patients. The noble Baroness said that the Government should explore long-term solutions, so let me outline some of these actions. First, we are committed to a thriving life sciences sector and the development of high-skilled jobs in that sector. The Government have made up to £520 million available through the life sciences innovative manufacturing fund; that is available for any private manufacturing proposal, including for medical radioisotopes in the UK.

Medical radioisotopes support life-saving services, including for diagnostic tests; this Government are committed to supporting the improvement of these services. Therefore, we have announced £6 billion of additional capital investment over five years across new diagnostic, elective and urgent care capacity. This includes funding to increase capacity for both testing and reporting across community diagnostic centres and hospitals.

In early 2026, which is nearly upon us, the Government will publish their national cancer plan. This will set out how we will improve diagnosis, treatment and waiting times in order to improve outcomes for cancer patients and increase survival rates. UKRI, the UK’s national funding agency for science and research, also supports the overall service delivery and has recently invested £32 million for novel total-body PET-CT scanners. All these interventions will, as I say, improve the situation for patients and improve services.

In conclusion, as the noble Lord and the noble Baroness have called for, this Government are committed to ensuring robust and reliable supplies of medical radioisotopes to deliver critical services. We are supporting the development of manufacturing and delivery capabilities in the UK, where this is appropriate, alongside working closely with international partners and suppliers. We are also committed to the economic and industrial development of the UK science sector. That is why we have made available investment funds that are open for applicants who are looking to expand or improve UK manufacture of medicine and medical technology products. This includes UK-based manufacture of medical radioisotopes or their adaption for diagnostic or therapeutic applications.

[Lord Patel (CB)]

I know that intervening on the Minister is unusual in a short debate, but we are not exactly short of time. I think the Minister said that if we had a reactor, it would be a useful addition. It would not be a useful addition; it is a necessity. She did not define any solid plans—unless I missed them—where the Government have a clear intention to establish a nuclear reactor for producing radioisotopes. There is a promise that we will have good contractual agreements with the supply chain lines that the Minister mentioned—I cannot make the Minister’s speech, but I am asking the question—but those cannot be guaranteed because there are only six reactors in the world and they are more than 50 years old. Maybe the Minister could comment on that.

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[Baroness Merron (Lab)]

I understand the noble Lord’s point. The point I am trying to make is that a supply chain is important. I was indeed careful in my choice of words, not least because, as I mentioned elsewhere in my speech, the Government have not made a formal assessment of, in this case, the ARTHUR project. So I am limited in how far I can go on the most obvious presentation before us today, but I understand the point made by the noble Lord.

I thank the noble Lord, Lord Patel, and the noble Baroness, Lady Bloomfield, for raising this important matter, which is important for the whole of the Government.

Tobacco and Vapes Bill

Baroness Merron Excerpts

Committee stage
Monday 17th November 2025 Grand Committee

I suggest to the Minister that we need a nuanced approach here, not a blanket approach. I very much hope that she will take on board the points that noble Lords have raised in this important debate.

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

My Lords, I thank noble Lords for bringing forward these amendments. For the convenience of the Committee, I will speak to them as a group. I am also grateful for noble Lords’ contributions and reflections throughout.

The clauses within Part 6, to which these amendments refer, taken in their totality will ban advertising and sponsorship of tobacco products, herbal smoking products, cigarette papers, vaping products and nicotine products. By doing this, it will bring all these products in line with tobacco. There has been—as the noble Baroness, Lady Walmsley, helpfully made reference to—a significant growth in awareness of vaping promotion, with some 55% of all children aged 11 to 17 aware of promotion in shops in 2025, which is up from 37% in 2022. It is unacceptable that children are exposed to vape adverts on the side of buses and in shop windows as they make their way to school or elsewhere. It is also unacceptable that a family going out to watch football could be exposed to vape branding on the kits of players who should be role models to children.

The noble Baroness, Lady Bennett, raised nicotine pouches. There are currently few restrictions on the advertising of these products, and they are highly promoted in shops and on social media. As a demonstration of this, awareness of nicotine pouches has risen from 38% in 2024 to 43% in 2025.

I understand why the noble Baroness, Lady Walmsley, asked about non-nicotine vapes. However, the reality is that non-nicotine vapes may be used as a gateway to nicotine vapes. In addition, nicotine could be manually added to the device. We have to take all that into account and, on that basis—to go directly to her question—we do not plan to include them in a consultation.

The noble Lords, Lord Johnson and Lord Moylan, spoke about the banning of vaping and nicotine products being deliberately branded and advertised to children. That is of course a manifesto commitment. We are doing it, as I have said a number of times, to stop the next generation becoming addicted to nicotine.

We also know that there is strong support among the public for doing this. Measures to restrict vape advertising are supported by some 77% of adults in Great Britain, who are keen to see bans on the advertising and promotion of vapes, so we will not be consulting on the whole matter of advertising. I can say to the noble Baroness, Lady Bennett, that addictive products of the nature she has described should never have been handed out for free. The Bill will address this by ensuring that free samples of these products cannot be given out to adults and children of any age.

The Government have already published a thorough impact assessment of the measures in the Bill, including the effect of the prohibition on the advertising and sponsorship of vaping and nicotine products. I say to the noble Baroness, Lady Fox, that the advertising ban aims to reduce the risk of young people being exposed to vape promotion and advertisements, not the ability of adults to buy vaping products.

I reassure the noble Lord, Lord Howard—and I say this to all noble Lords—that we are committed to helping adult smokers to quit. That is best led by the appropriate health authority, such as the NHS. The noble Lord, Lord Bourne, was right to say, “If you don’t smoke, don’t vape”. We will return to this in a later group, but I can tell him that the Bill allows public health authorities to take certain steps to promote vapes as a means of smoking cessation. That is the right place for this to be.

Further to that, the NHS can provide tailored advice to the individual with the necessary behavioural support. We have invested an additional £70 million in 2025-26 to support local authority-led stop smoking services in England to help people quit smoking, and we will continue to run targeted campaigns to help current smokers quit.

The noble Earl, Lord Howe, asked about an assessment of how the bans will impact businesses, smoking cessation services, et cetera. We will continue to monitor the impact of these changes following implementation.

With that, I hope the noble Lord, Lord Howard, will be able to withdraw Amendment 160.

[Lord Moylan (Con)]

Since the noble Baroness has said so clearly that the purpose of the advertising ban is to prevent information being communicated to children and young people, and that that was a manifesto commitment, why does the ban have to be drawn so widely? Clause 119 has a list of defences that can be advanced for those who are accused of breaching the various preceding clauses on advertising, but none of them says that it is a different matter if the communication is with adults. Is this not drawn far too widely to be justified by her laudable ambition?

[Baroness Merron (Lab)]

I am glad that the noble Lord regards it as a laudable ambition. We will come to exemptions in the next group, and I look forward to doing so.

[Baroness Fox of Buckley (Non-Afl)]

I, too, am slightly confused by this. I was reading something the other day from the DCMS, boasting about the creative industries, and one of the big and most profitable parts of the creative industries in this country is advertising and marketing. It is considered to be something we are proud of. Lots of products have age issues. If you are a cider producer, you have to advertise, but you do not want a six year-old drinking it. We have discussed things such as fizzy drinks, so I appreciate this. This appears to be a blanket catch-all. It does not seem to take up the ways we have learned, in the advertising and marketing world, how, in a society that has children in it at the same time as adults, you can have a sensible restriction on advertising sometimes without depriving everybody of the gain of the advert. NHS information, while useful, is not the same as marketing choice, giving people ideas of the options they might have with vapes, which are not all the same product.

[Baroness Merron (Lab)]

I thank the noble Baroness. This kind of question also comes up in respect of other products: for example, the 9 pm watershed, in terms of the advertisement of high-fat, high-sugar, high-salt foods in order that that advertising is not affecting children and young people. So, this is a constant discussion: that is not a criticism but an observation, of course. What is interesting to me in respect of tobacco is that the evidence found that partial bans are not as effective as a comprehensive ban when it comes to the aim, ambition and intent to reduce tobacco consumption. Similar assumptions can clearly be drawn on vapes. I hope that helps in terms of clarifying the point I am making, even if it may not satisfy the noble Baroness, which I understand.

[Lord Howard of Rising (Con)]

I beg leave to withdraw the amendment.

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[Earl Howe (Con)]

My Lords, in this group of amendments we have seen a logical continuation of our debate on the previous group, since in their various ways these amendments pose the question of what are the appropriate constraints to place around products that are of considerably less concern in a health context than tobacco products. We are back in the realm of deciding what is proportionate and how to secure better clarity and consistency in the operation of the Bill’s advertising and design provisions.

Although he has not been here to speak to it, my noble friend Lord Udny-Lister’s Amendment 161A struck me as a point worth raising. It would protect designers and creative professionals from being criminally liable based on mere suspicion or indirect association because it would work to raise the threshold of proof of intent. One could imagine that in some cases it could be difficult to prove that someone designing an advertisement had reason to suspect that it would be published. In any event, is it right that someone who has been asked by their employer to design a vape advertisement should be criminalised because they know or believe it may be used in some context? I am afraid that the word “draconian” comes to mind.

On my noble friend’s Amendment 161B a very similar thought came to mind. Are the Government really saying that the offence of designing an advertisement for a vape merits a prison sentence? There are mixed messages coming out of the Government at the moment. How should the sentencing provisions in this part of the Bill be read alongside the provisions of the Government’s Sentencing Bill? What is the overall message? The Sentencing Bill will require almost all sentences of less than 12 months to be suspended. On the one hand, the Government are creating imprisonable offences, and on the other, they are saying that people should not actually go to prison, even if they are sentenced to it. At the very least, the Minister needs to explain to the Committee why the sentence on summary conviction is to be different in Scotland than in Northern Ireland, which might have been a point my noble friend Lord Udny-Lister would have made.

Turning to my Amendment 167 and the very well worded amendment, if I may say so, from the Liberal Democrats, the underlying purpose of each is the same, which is to urge the Government to regulate, rather than ban, vape advertisements so that in narrow clinical contexts, such as smoking cessation clinics, they can be deployed for public health purposes. Amendment 168A in the name of my noble friend Lord Howard of Rising has a very similar purpose.

In Amendment 169 I am asking the Government to consider a further exemption for advertisements located discretely in specialist vaping shops. Why not allow that? As my noble friend Lord Moylan has asked in his Amendment 170, why prohibit such specialist shops providing information online subject to suitable age-gating checks? That in turn raises a further question from my noble friend in his Amendment 168. In adult-only environments, why should displaying an advertisement for a vaping product be against the law given that, as we need to keep reminding ourselves, vapes are and will remain legally available for purchase by anyone aged 18 or over? Why are the Government treating vape advertising in exactly the same way as tobacco advertising? What is the justification? Amendment 170A from my noble friend Lord Howard asks that question in a different form. Why should we not allow factual product information to be provided at point of sale in an age-restricted area in suitably licensed premises?

Finally, Amendment 172A from my noble friend Lord Udny-Lister would prevent overreach. It would ensure that brand restrictions target only genuine attempts to promote nicotine or tobacco, not completely unrelated products such as clothing or other merchandise. I think my noble friend has identified an issue that requires clarification from the Government, and I would welcome the Minister’s comments.

[Baroness Merron (Lab)]

I am most grateful to noble Lords for bringing forward this group of amendments, which reference Part 6 provisions, and for the contributions that have been made.

I will start with Amendments 161A and 161B, which are tabled in the name of the noble Lord, Lord Udny-Lister. The current drafting of Clause 114 makes it an offence, when acting in the course of business, to design an advert that would promote a relevant product and be published in the UK. If an organisation knows or has reason to suspect their advert has a promotional purpose or effect and will be published in the UK, it has committed an offence by designing the advert.

I say to the noble Earl, Lord Howe, that the inclusion of “has reason to suspect” is deliberate, not least because it mirrors the approach taken in the existing Tobacco Advertising and Promotion Act. This wording is designed to avoid loopholes and to ensure that those who are involved in the design of ads cannot evade responsibility by claiming ignorance where it is clear from the evidence that they had reason to suspect what they were designing an advert for. I hope the noble Earl will understand that we will, therefore, not seek to weaken existing legislation or allow any uncertainty that could be exploited.

I turn to Amendment 161B. I sympathise with the intention to align penalties across the UK but, of course, it is important that we respect Scotland has a separate criminal justice system. There are maximum penalties for this type of offence; they are fixed in line with the criminal justice system in each jurisdiction. I hope that that is helpful to the noble Earl, Lord Howe.

I turn to Amendment 172A, which was also tabled by the noble Lord, Lord Udny-Lister. It seeks to restrict the scope of the offence of brand sharing. Brand sharing, also known as brand stretching, is a form of indirect advertising and should be seen as such, not least because it promotes the use of a service or product by putting its branding on other products or services or vice versa. The clause is drafted in a manner that already limits the offence that could be created under this power to cases where the purpose or effect is to promote a relevant product. Brand sharing, as defined in the Bill, would be unlikely to capture the types of case about which the noble Lord is concerned in his amendment; it is our view, therefore, that this amendment, as it stands, would introduce unnecessary complexity.

I turn to Amendment 168 in the name of the noble Lord, Lord Moylan. The Bill as drafted takes decisive action to ban the advertising and sponsorship of all vapes and nicotine products, delivering on our clear manifesto commitment to stop vapes being advertised to children—something on which the noble Baroness, Lady Northover, spoke. The ban is essential to creating what we seek: a strong, consistent regulatory environment; and to provide clarity for businesses and enforcement bodies. I can say to the noble Baroness, Lady Walmsley, that guidance will be produced on advertising.

This Bill already includes defences for the limited circumstances in which advertising would be appropriate. As I have said in our debates on earlier groups, we are not considering any other exemptions for adult-only spaces, not least because of the risk of loopholes; these were referred to by the noble Baroness, Lady Northover. However, I take this opportunity to correct a statement that was made in the other place: this prohibition will apply to all advertisements for relevant products, not just those for specific products. In practice, this means that anyone acting in the course of business could commit an offence if they promote a relevant product, whether that is a generic product, a category of products or a specific branded product.

[Lord Moylan (Con)]

I think the noble Baroness has addressed Amendment 170. Does she therefore not share the view of the noble Baroness, Lady Walmsley, which was, as I understood it, that my Amendment 170 is unnecessary because there is nothing in the Bill that prohibits specialist vape retailers communicating on the internet? I would like clarity on that.

[Baroness Merron (Lab)]

Of course; I am going to come on to the point about online advertising.

Amendments 167 and 169, tabled by the noble Lord, Lord Kamall, Amendment 168A, tabled by the noble Lord, Lord Howard, and Amendment 171, tabled by the noble Baroness, Lady Northover, all seek to create exemptions to allow for the promotion of products for the purposes of smoking cessation—something that was also spoken to by the noble Lord, Lord Young. As I mentioned on the previous group, I repeat the assurance to noble Lords that the Bill as drafted will allow certain public authorities to continue to take steps to promote vapes as a means to quit smoking. This is a matter that I will come back to on Report.

The offences in Part 6 apply only to those acting in the course of business. For example, following the passage of the Bill, local stop smoking services will still be able to take steps to promote vapes to smokers as a less harmful alternative. The noble Lord, Lord Young, raised an important question about GPs and pharmacists having such a facility. I assure him that we will be further reviewing whether the Bill provides the necessary approach considering the points that he made.

I also mention something relevant to an earlier group—I may be stepping a little outside of things here, but I remember the noble Baroness, Lady Fox, in particular, making this point. The advertisement offences will not prevent a retailer offering verbal smoking cessation services to their customers. While I am sympathetic to the intention to ensure that vapes remain accessible and visible to adult smokers, there are already strict rules in place for nicotine vape advertising. Under current legislation, it is illegal to advertise nicotine-containing vapes on television, radio, most online platforms and in newspapers and magazines. Companies are not allowed to market a vape as a smoking cessation product or to make medicinal claims about products unless these have been authorised as a medicinal product by the MHRA. As noble Lords have heard me say many times, we believe that promoting smoking cessation is best led by the appropriate health authorities, including the NHS, which can provide tailored advice to the individual with the necessary behavioural support.

I should be clear that all tobacco products are harmful to health, including heated tobacco, which contains tobacco and generates aerosols with carcinogens. The department therefore does not recommend the use of heated tobacco products to quit smoking.

I turn to Amendment 170 from the noble Lord, Lord Moylan—

[Lord Lansley (Con)]

Forgive me for interrupting, but I did not quite follow. Where in the Bill is the reference to the ability to place an advertisement for a product that is authorised as a medicinal product, where it also happens to be a vaping product? I do not know where that is to be found in legislation.

[Baroness Merron (Lab)]

I will be happy to come back to the noble Lord and be precise about that while I am going through the rest. If I do not get the opportunity to do so, I will of course write.

I turn to Amendment 170 from the noble Lord, Lord Moylan, and Amendment 170A from the noble Lord, Lord Howard. I am sympathetic to the intention of ensuring that consumers have the information they need to make a purchase. This was spoken to by not only the noble Lord, Lord Moylan, but the noble Lord, Lord Johnson, and the noble Baroness, Lady Fox. However, Amendment 170 is not necessary because retailers, as I have said, will continue to be able to provide the necessary factual information about products to enable purchases. Amendment 170A is also not necessary because the Bill does not prohibit businesses displaying the categories of information that this amendment refers to, as long as the information is not promotional.

The noble Lords, Lord Johnson and Lord Moylan, referred to online providers. The Bill builds on existing legislation and effectively bans all advertising of relevant products, including online. On the particular point raised by the noble Lord, Lord Johnson, we expect enforcement bodies to take a proportionate approach, as they currently do with the advertising of tobacco products.

The noble Lord, Lord Howard, asked about government engagement. We will continue to engage with independent vaping associations and other vaping businesses, but I remind him and the Committee, as I said probably on day one, that the UK Government are committed to Article 5.3 of the World Health Organization Framework Convention on Tobacco Control, which means the protection of public health policy from the vested interests of the tobacco industry. So I have not met and will not meet British American Tobacco.

I will need to write to the noble Lord, Lord Lansley, and will be glad to do so. I hope this will allow the noble Lord, Lord Howard, to withdraw Amendment 161A.

[Lord Howard of Rising (Con)]

I beg leave to withdraw.

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[Baroness Walmsley (LD)]

My Lords, I will speak first to my Amendment 176. As the noble Lord, Lord Kamall, said, his Amendment 178 does something very similar. As I have often said, policy should be based on evidence, so this amendment seeks to tease out exactly what evidence the Government plan to use when designating a new area as smoke-free.

The Government have already said that their consultation on further smoke-free areas will focus on schools, playgrounds and hospitals. It is fairly clear that areas in and close to schools should be smoke-free, in the same way that local authorities now have powers to prevent the opening of new fast-food outlets near schools because of the health dangers of much of their sales.

However, some playgrounds are very large and it is possible that a parent waiting on a bench for a child, well away from the play equipment, may want to smoke a cigarette—if they are of legal age, of course. Although it would set a bad example, it would be hard to understand the level of risk to the children playing; it would depend how far away they are. As for hospitals, many of them have already designated their grounds as smoke-free, although it has been hard to enforce. Many of us will have seen people smoking outside St Thomas’ Hospital, underneath the “No smoking” sign. Many hospitals have distinct outdoor smoking shelters. The matter is complicated, which is why my amendment probes the Government on the criteria they will use.

On the other hand, Amendments 175 and 179 seek to specify in the Bill the areas that can be designated as smoke-free. This could restrict the Government from acting in other areas in future. Obviously, we want the same rules in all parts of the UK, to save confusion. There are several reasons why the Government should not be limited in this way, and they must bear in mind the different circumstances that prevail in different areas. For example, as the noble Baroness, Lady Bennett, mentioned, there are many children on beaches, and discarded cigarettes are a real litter problem, according to coastal local authorities. As she said, transport hubs may also come into focus, because of the crowded conditions in many of them, especially at certain times of the day such as rush hour. We think the Government need flexibility on this issue. Indeed, somebody might be more affected by second-hand smoke in a transport hub than at the far side of a very large playground, which is why I would like to see an evidence test.

We do not support Amendment 177 in the name of the noble Lord, Lord Udny-Lister, as the Government may want to restrict smoking in uncovered hospitality areas in the future. However, if they do so they will have to explain the reasons why, and we could debate it then. The fact is that the prohibition on smoking in indoor hospitality venues has proved very popular with customers and landlords alike and has certainly not had a damaging effect on footfall or expansion of the sector. The same might apply to uncovered hospitality areas in the future, if they are considered for the ban.

[Baroness Merron (Lab)]

My Lords, as we have heard, all the amendments in this group seek to limit the powers in the Bill to make additional places smoke-free in England. On Amendment 176, tabled by the noble Baroness, Lady Walmsley, we know that passive smoking, whether indoors or outdoors, poses a risk to health. The rule of thumb is: if you can smell cigarette smoke, you are inhaling it. This is particularly important for children, pregnant women and those with pre-existing health conditions such as asthma or heart disease, which may not be visible to the smoker.

However, despite these well-known and very well-evidenced harms, trying to ascribe specific harms to locations is somewhat challenging, as this debate shows. For example, as the noble Baroness, Lady Walmsley, mentioned, in a large children’s play area it is difficult to evidence that exposure to second-hand smoke has caused a specific harm in a specific place. I can assure noble Lords that we are extremely mindful of this. Therefore, the test referred to in the amendment is overly restrictive, technically very difficult to do and not necessary, given the extensive evidence of harm to vulnerable people. It would also likely lead to a scenario in which we are unable to protect the most vulnerable in society from the harms of second-hand smoke.

Similarly, on Amendment 178, tabled by the noble Lord, Lord Kamall, as I mentioned, we know the harms of passive smoking. There is strong indirect evidence but, as I said, it can be difficult to demonstrate this evidence in specific locations. Again, this restrictive test would prevent areas where there are harms of second-hand smoke to children and medically vulnerable people from becoming smoke-free. Furthermore, as this amendment would apply in England only, it would leave England with more restrictive smoke-free provisions than the devolved nations. 

Amendments 175 and 179 were tabled by the noble Lord, Lord Kamall. As we have made clear but I would like to reiterate, in England we plan to consult on extending smoke-free places as and when. In the first instance, it would be to the outdoor areas of schools and early years settings, children’s playgrounds and healthcare settings. I can assure the noble Lord, Lord Kamall, and the noble Baroness, Lady Walmsley, that all proposed smoke-free locations will be subject to consultation both now and into the future and that regulations will be subject to the affirmative procedure. We will be guided by public health advice. The noble Baroness, Lady Bennett, rightly observed that the powers within the Bill allow us to respond to evolving evidence at a later time, particularly where there is evidence of clear harms to children and vulnerable people.

On Amendment 177 tabled by the noble Lord, Lord Udny-Lister, we have made it very clear—I am glad to take the opportunity to do so again, not least because the noble Lord, Lord Kamall, raised this—that outdoor hospitality settings will not be in scope of the consultation on smoke-free places. We fully recognise the balance that is needed to protect the most vulnerable as well as ensure that businesses are not financially impacted. We are confident that we have the balance right in deciding the places, which I have already outlined, on which we plan to consult.

However, the powers in the Bill, as has been observed, allow for additional places to be designated smoke-free in the future, subject to further consultation and parliamentary debate. The landscape may change significantly on tobacco legislation, as it has done over the years. Evidence and attitudes may also shift, again as we have seen over the years, so it is sensible to ensure that the Bill is future-proofed and can respond to evolving evidence. I therefore ask the noble Lord to withdraw this amendment.

[Lord Kamall (Con)]

My Lords, I am grateful to the wide range of noble Lords who spoke on these amendments. These are clearly intended as probing amendments, at this stage, to understand—as the Minister herself agreed—these wide sweeping powers to designate additional spaces as smoke-free. We are grateful because we were concerned about the level of scrutiny there would be. The Minister assured us that there will be consultation and that any changes will be by regulation following the affirmative procedure. We are very grateful for that and that perhaps answers some of the probing amendments that we have in future groups. For now, I beg leave to withdraw the amendment.

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[Baroness Northover (LD)]

My Lords, I will speak to Amendment 186 in my name. I thank my noble friend Lady Walmsley for her support. This amendment would ensure that all pavement licences granted by local authorities are required to be smoke-free. Some noble Lords will remember that this House voted in support of this issue previously, but I will briefly cover the background for those who are less familiar with it.

Pavement licences were introduced during the pandemic when mixing inside was prohibited. They allowed hospitality venues to expand their seating outside at a time of great difficulty. We worked across parties to ensure that these outside spaces, as an extension of inside, should, like the interior areas, be smoke-free to protect the public, including children, and staff. We secured that, despite the familiar refrain that hospitality would go to the wall and so on. Then the industry indeed got to the Minister and the DCLG and, without consulting the Department of Health, this was ended. It is such a familiar story.

Meanwhile, outside areas proved very popular and became permanent fixtures in 2021. At that time, the House voted in favour of the amendment from the noble Lord, Lord Faulkner, regretting that smoke-free pavement licences had not been adopted by the Government. This amendment honours that vote.

When pavement licences were first introduced, there was a requirement that some seating in the designated area was smoke-free. However, unless outside spaces are vast—we do not expect that on a pavement—having smoking and non-smoking tables next to each other means that everyone experiences second-hand smoke exposure due to drift.

The LGA backed our campaign to make all these areas smoke-free. Some councils decided that they would make the spaces being smoke-free a requirement of pavement licences, which was perfectly acceptable within the regulations, such that there was no requirement to have a smoking section. So far, 11 councils have introduced 100% smoke-free conditions in pavement seating. This includes cities such as Liverpool, Manchester and Newcastle. Evidence from these local authorities shows that the scheme is popular with customers and businesses alike, protecting public health without having adverse economic impacts.

There is no risk-free level of exposure to second-hand smoke. Second-hand smoke is an irritant for people struggling with asthma or other lung conditions, and associated health effects from second-hand smoke include stroke, lung cancer and heart disease. I hope that hospitality settings are included in the consultation for smoke-free extensions for the Bill. Polling shows that 40% of people said that they would be more likely to visit pubs and restaurants if smoking was banned in outdoor seating areas.

Hospitality is an important sector of our economy, but the notion that it is somehow economically dependent on the continued consumption of tobacco and allowing smoking in outside spaces requires further examination of the evidence. These arguments were made when public places were made smoke-free in the first place. Now, few people could contemplate pubs and restaurants once more being full of cigarette smoke. All the same arguments were made about banning smoking in public places and that places would go under—not so. In fact, the debate helped encourage people to give up, as opposed to smoking more at home. Making pavement licences smoke-free, which has proved such a success in many areas, feels like a step in the right direction.

I will comment on other amendments in this group. Amendment 180, regarding cigar lounges, points to an interesting case. Where we make exceptions and create loopholes, they have the potential to be exploited. Following the powerful speech of the noble Baroness, Lady Ramsey, it seems that there has been a very liberal interpretation of the notion of “sampling” that goes beyond what Parliament intended in the 2000s. She pointed to the real health consequences of cigar smoking and the potential risk to staff. I point noble Lords to what the NIH—the National Institutes of Health—and the National Cancer Institute say on this:

“Yes. Cigar smoke … contains toxic and cancer-causing chemicals that are harmful to both smokers and nonsmokers. Cigar smoke is possibly more toxic than cigarette smoke … there is more … tar in cigars than in cigarettes”.


They say that there is no safe use. There are higher rates of lung cancer, coronary heart disease and lung disease than among those who do not smoke, and similar levels of oral cancer and cancer of the oesophagus as for cigarette smokers. Anybody can look this up for themselves; I suggest that, in terms of there being “no risk”, noble Lords should do so. We should do nothing to create loopholes in this Bill, and I look forward to hearing what the Minister says about that.

The noble Lord, Lord Kamall, and the noble Earl, Lord Howe, have challenged the proposition that Clause 136 stand part of the Bill. I listened with great interest to the discussion on why they wanted to probe smoking for artistic purposes. Of course, it used to be the case that smoking was a mainstay in films—I think of Humphrey Bogart smoking a cigarette in “Casablanca”, looking very cool with Ingrid Bergman melting before him. I would welcome hearing from the Minister what the Government plan to do in relation to this, because it came across as something that was very cool. We also do not want non-smoking actors to be led into a smoking habit. We hear about instances of that, where actors were not addicted but became addicted as a result of their roles. I know that the National Theatre has a smoke-free policy and that there are alternatives to smoking tobacco that can be used to portray it.

We know also that the depictions of smoking and vaping in the media increase the chance that young people will take up the habit, regardless of whether it is a positive or negative depiction. I realise that noble Lords are simply probing to elucidate what the Government are planning, and I look forward to hearing what the Minister says, but I also hope that the Minister is sympathetic to my Amendment 186. I also look forward to what she says in relation to the amendment from the noble Baroness, Lady Ramsey.

[Baroness Merron (Lab)]

My Lords, the amendments in this group seek to change the detail of exemptions and powers on smoke-free places. I am grateful both for the debate and the amendments, which raise a number of issues.

I start with the amendment introduced by my noble friend Lady Ramsey on behalf of my noble friend Lord Faulkner, who tabled it. It seeks to remove the existing exemption that allows individuals to sample cigars and pipe tobacco indoors in an enclosed and ventilated area in a specialist tobacconist. This amendment was also spoken to, although in a different way, by the noble Lords, Lord Johnson, Lord Murray and Lord Strathcarron. Tobacco is, as I have said, a uniquely harmful product. I sympathise with the aims of the amendment and agree with the intention. However, specialist tobacconists, as we have heard in the debate, are currently exempt because of the specialist nature of their trade. These businesses make up a very small percentage of the market in the UK.

I can assure my noble friend Lady Ramsey that there are a number of restrictions to the current exemption. For example, the sampling area is legally required to be enclosed, clearly signed and appropriately ventilated to prevent smoke spreading to non-smoking areas. Other tobacco products such as cigarettes cannot be sampled. I was interested to hear the example that my noble friend Lady Ramsey brought before the Committee. I know she will understand that I cannot comment on very specific circumstances, but this may or may not be a matter for enforcement. I am sure that my noble friend will look into that further.

It is important that the Bill balances the public health aims within it while ensuring that small and medium-sized businesses are not unnecessarily financially impacted. Ultimately, given our ambition to prevent future generations taking up smoking, we anticipate, as we have said in previous groups, that in the long term specialist tobacconists will have to pivot their business models. Given this, we expect the exemption currently in place, which we are not seeking to change, to be used less and less over time. I give the assurance that we will continue to monitor this niche market to ensure there is not a targeting of young people or an exploitation of the exemption. Of course, as this exemption is in regulations, it is possible to review this in the future, if required.

The noble Lord, Lord Strathcarron, asked about impact assessments. Any further impact assessments that are required will be prepared in advance of any legislation which is the normal process where there could be economic impacts. The impact assessments will be reviewed by the regulatory policy committee—again, in accordance with normal practice.

The noble Lord, Lord Kamall, and the noble Earl, Lord Howe, have indicated that they oppose Clause 136 standing part of the Bill. The clause recasts an existing regulation-making power that was found in the Health Act 2006. It allows the Secretary of State to make regulations permitting performers in England to smoke during a performance. The intention of the clause is to provide simplification and offer greater consistency with the Bill’s other provision. In practice, it is our assessment that this will not make a real difference, which I know is of concern to the noble Earl.

Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Wolfson of Tredegar (Con)]

My Lords, this is the first debate in Committee on this important Bill so I hope that the Committee will allow me to take a minute or two to set out the approach of the Official Opposition. As my noble friend Lord Kamall and I said at Second Reading, the Official Opposition have no collective view on this Bill. Although each Member of the Opposition Front Bench will have their own view on the Bill, we will support noble Lords across the House in their scrutiny of the Bill. We will also table a small number of additional amendments where we feel that parts of the Bill need probing further. We will not seek to delay the passage of the Bill, nor will we seek to hold up progress in Committee. Instead, we will seriously engage in detailed scrutiny of the Bill so that we can collectively deliver the best possible piece of legislation.

In that regard, I respectfully pay tribute to the noble and learned Lord, Lord Falconer of Thoroton, for demonstrating his openness to improving the Bill already by tabling amendments that we hope to get to today and which reflect concerns that have been raised by noble Lords. I speak for all my colleagues on the Opposition Front Bench when I say that I look forward to working with him to ensure that we send a better Bill back to the other place.

The amendments in this group relate to the territorial extent of the Bill. My noble friend Lady Coffey is seeking to remove references to Wales in the Bill so that it would apply only to England. While I am not entirely persuaded that making this an England-only Bill is necessary per se, these amendments raise important questions about devolution. The core question for the noble and learned Lord, Lord Falconer of Thoroton, is why the Bill does not apply to the whole of the United Kingdom on the one hand or only to England on the other.

At the heart of this is, as the noble and learned Lord, Lord Thomas of Cwmgiedd, said—although various Acts of Parliament may put us to sleep, a speech by the noble and learned Lord never does; I was listening very carefully—that these amendments speak to the devolution settlement that we work with and the inconsistencies and confusions of that settlement. The noble and learned Lord used the word “complexity”. It is extremely complex. In this area, we have the problem that criminal law is not devolved to Wales whereas health is devolved. To pick up the point made by the noble and learned Lord, with which I respectfully agree, declaring the appropriate interest, Wales should not be regarded as inferior to Scotland. That is a point of general application.

The Scottish Parliament, as noble Lords know, is currently considering its own legislation on this topic. I hope that noble Lords have picked up that the Scottish Bill is significantly different in key ways—most markedly in the definition of terminal illness. In Scotland, it lacks the “six months to live” test which, whatever view we take, is at the heart of the Bill before us. The definition of terminal illness in the Scottish Bill is:

“For the purposes of this Act, a person is terminally ill if they have an advanced and progressive disease, illness or condition from which they are unable to recover and that can reasonably be expected to cause their premature death”.


I am not quite sure about “premature” in that context in all cases, but that is what the text says.

Leaving aside the point that those resident in one part of the United Kingdom will therefore have different rights to assistance under the law from those in another region of the United Kingdom should both Bills pass, I see the point that my noble friend Lady Coffey is making. If the people of Scotland may choose whether to have a law for terminally ill adults who wish to end their lives, why—I ask rhetorically, so to speak, looking forward to the response of the noble and learned Lord, Lord Falconer—should people in Wales not have the same choice? This is the key question that the noble and learned Lord has been presented with by this group of amendments.

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

My Lords, I welcome the opening comments of the noble Lord, Lord Wolfson, which were helpful. I thank noble Lords for this debate.

I want to set out some points about the role of government Ministers. As noble Lords are well aware, the Government remain neutral on the principle of assisted dying and on the passage of this Bill. Whether the law in this area should change is absolutely and rightly a matter for Parliament. I and my noble friend Lady Levitt will speak in Committee as government Ministers responsible for ensuring that the Bill, if passed, is legally robust, effective and workable. To that end, I will not be providing a government view on the merits of proposed changes. Those are rightly a matter for noble Lords to decide. Throughout Committee, my remarks will focus only on amendments where the Government have significant workability concerns. I hope that this will be of assistance to noble Lords in their consideration of amendments. Where no comment is made, any workability concerns are less significant. The Government are unable to confirm at this stage that the current drafting of those amendments is fully workable, effective or enforceable.

Turning to the amendments in this group—

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[Baroness Merron (Lab)]

The noble Lord will be aware, as will your Lordships’ House generally, that Ministers have been absolutely consistent in setting out the right and proper role of officials, as is usual for a Private Member’s Bill. I will refer to that shortly. Also, if noble Lords have individual concerns, they are welcome to raise them with me.

The amendments in this group seek to restrict the eligibility criteria to apply to individuals in England only, rather than in England and Wales, as at present. These amendments would have minimal legal effect unless they are coupled with amendments to later clauses. Clause 1 is largely declaratory. This group of amendments would conflict with later operative provisions in the Bill unless consistent amendments are made to later provisions. 

I will pick up a few of the points that have been raised. The noble Baroness, Lady Coffey, raised a number of points about engagement and I would be pleased to write to her further. I have done my very best to ensure that all the questions that she laid have been answered. I hope she will accept my apologies if that is not the case, but I have certainly endeavoured to do so. I will also review points made by other noble Lords in this debate, where they are relevant to the Government.

The noble Baroness, Lady Smith, raised a question regarding legislative consent Motions. As would be expected, UK government officials have discussed these matters with Welsh government officials, and the management of the legislative consent process in the Senedd is, of course, a matter for the Welsh Government.

In closing, I will make a few general comments about engagement.

[Baroness Smith of Llanfaes (PC)]

On the LCM point, the Legislation, Justice and Constitution Committee in the Senedd has made a statement about it not having received enough information on the conversations between the UK and Welsh Governments about why certain clauses do not engage with the LCM process. Can the Minister respond directly to that point about why this information has not been shared with the Senedd?

[Baroness Merron (Lab)]

I will certainly look into the matter that the noble Baroness raised and would be pleased to write to her. However, the first point I wanted to make here was about engagement with the Welsh Government. Of course, Ministers themselves have not met with the Welsh Government in relation to this Bill, as again would be expected, as it is not a government Bill. I know that the sponsors have met with the Welsh Government to discuss the policy intent and to negotiate which clauses require a legislative consent Motion.

The sponsors are also leading engagement with Scotland and Northern Ireland while—on the point made earlier by the noble Lord, Lord Harper, and others—UK government officials are providing technical support to support the sponsor and are engaging with Welsh government officials to discuss technical matters in relation to clauses that require a legislative consent Motion or those to which Wales has requested that further changes are made. Officials have regular meetings; they can be as frequent as weekly, as was the case at some points over the last few months.

[Baroness Grey-Thompson (CB)]

The noble Baroness mentioned that the role of Ministers is to ensure that the Bill is legally robust, effective and workable, but surely safety has to play some part in that as well.

[Baroness Merron (Lab)]

I am sure it would be expected that safety is absolutely paramount. The point I am making—and I look forward to hearing from my noble and learned friend—is that our position in government here is not to deal with matters of policy. As I have said, we are restricted to areas to which any Government would be restricted.

We will absolutely work with the Welsh Government, NHS England and the NHS in Wales to understand the impact of any changes to the law and the provision of healthcare services in Wales, during the coming stages of the Bill.

[Lord Falconer of Thoroton (Lab)]

My Lords, I make a declaration of interest: I have an assistant who is funded by Mr Bernard Lewis and who helps me on this Bill. I make a declaration that Dignity in Dying paid for the printing of the material that was circulated to Peers in my name before this process commenced.

I compliment the noble Baroness, Lady Coffey, on the short way that she introduced the important issue. I very much hope that I can put to rest most of the misconceptions that were expressed during this debate.

As everybody agrees, criminal law is not devolved to the Welsh Senedd. Therefore, any change in criminal law has to come from the UK Parliament. You cannot proceed with assisted dying without changing the criminal law. Therefore, the UK Parliament has to provide a legislative change for that.

Healthcare is rightly devolved to the Welsh Ministers and the Senedd. The Bill makes provision in England for Ministers to produce regulations on how assisted dying will be implemented and regulated in England. Clause 42 requires Ministers to produce such regulations. It is wrong, as part of the devolution settlement, to require Welsh Ministers who are responsible for health in Wales to do that. It is for the Welsh Government to decide what provision to make. Unlike Clause 41, which relates to England, Welsh Ministers are given the option to introduce such regulations as they see fit. Those regulations will permit the assisted dying process to be introduced in Wales, in the National Health Service, and for Welsh Ministers and the Welsh Government to provide whatever provision for it in regulations that they see fit.

The noble Lord, Lord Wolfson, asked why we are legislating for England and Wales but not Scotland at the same time. It is because we are doing exactly what the noble Lord, Lord Gove, asked me to do—and I am so glad he did—which is to respect the devolution settlement. Will the noble Lord let me finish? Then I will come back to him.

The way this structure works is that, first, we in this Parliament determine whether the criminal law should be changed. Secondly, the Welsh Government are given the power to introduce regulations. That power should normally be given to Welsh Ministers by an Act of the Senedd. Therefore, a legislative consent Motion has been proffered by the Welsh Government for the Senedd to decide whether it would be willing to give us consent to legislate in an area that would normally be legislated for in the Senedd.

The LCM—legislative consent Motion—in the Welsh Senedd covers the following. I give these details for noble Lords to consider them at their leisure: Clause 40, which gives Welsh Ministers power to issue guidance; Clause 42, which gives Welsh Ministers power to regulate how this is to be introduced in the health service in Wales and with what regulations; Clause 51, which gives the Welsh Government power to talk about and make regulations about the Welsh language; Clause 54, which gives them a general power to make regulations; and Clause 58, which gives the Welsh Ministers and the Welsh Government power to introduce certain of the provisions.

The sponsor in the other place and I have discussed this arrangement with the Welsh Government, and by that I mean Welsh Ministers and Welsh officials. We have done what the Welsh Government would wish us to do to respect devolution. We have taken these powers in the Bill, subject to Parliament, so that there is not a position where, after this Bill is passed, Welsh Ministers lack the power to introduce regulations if they choose to do so.

I have listened to this torrent of points about Wales saying it has not been thought out. I say with suitable humility that we have thought it out and sought to reflect what good devolution practice would require. I do not invite people to come back, but please think about what I have said and consider—

--- Later in debate ---

[Baroness Coffey (Con)]

I would be grateful if any advice that has been given to the noble and learned Lord by officials is shared with the Committee. It is helpful, when determining legislation, to understand that, and it would be especially helpful if the Government, who have said they are getting involved only on legality and practicality, were to express their view. They will not even tell the Welsh Government what their view is, and that is very concerning.

[Baroness Merron (Lab)]

My Lords, I just emphasise my previous comments. I think it would be extremely helpful for this debate if I were to write to the noble Baroness setting it all out as she requires, following my previous Answers to Written Questions that have been laid.

[Baroness Coffey (Con)]

I hope that the department will take a better attitude in determining things such as freedom of information requests. We have already had from the Cabinet Office whether it is now in the public interest to declare information that it holds. I hope the Government—I can see that the Deputy Chief Whip is on the Front Bench—will take this away, because it is a serious matter. This is one of the most important Bills that we will consider in this Parliament, and it is important that we have transparency and a full understanding that is shared across the Chamber. With that, I beg leave to withdraw the amendment.

--- Later in debate ---

[Lord Kennedy of Southwark (Lab Co-op)]

As a final point, I agree with the noble Lord. As Government Chief Whip, I take my job very seriously. I love the House, and I want to do this properly. I assure the Committee that I hear noble Lords’ sentiments. I know how long it has taken on the Bill. I know that views are sincerely held on both sides. I will work in the usual channels to deal with these matters.

[Baroness Merron (Lab)]

My Lords, I am grateful for the insightful contributions that have been made to this debate. I will be very concise on the point. In summary, it is our view that workability concerns are less significant, although the Government are unable to confirm at this stage that the current drafting is fully workable, effective or enforceable. As noble Lords will understand, the amendment has not had technical drafting support from officials.

On this point, if the amendment is passed in isolation, it is likely to have minimal legal effect, as Clause 1 is essentially declaratory rather than operative. The remainder of the Bill would refer to the capacity to make a decision, which, as noble Lords will be aware from the Bill, is to be read in accordance with the Mental Capacity Act 2005.

I anticipate coming later to discussions on amendments to Clause 3, as noble Lords have referred to, as those amendments would change the operation of the Bill. I will comment on proposals when we come to the relevant debate. These issues are, of course, rightly a matter for noble Lords to consider, deciding which test is to be used.

[Lord Falconer of Thoroton (Lab)]

I will deal first with the central issue in this debate, which is the amendment from the noble Baroness, Lady Finlay. The wording currently mentions:

“A terminally ill person in England or Wales who … has the capacity to make a decision”.


The noble Baroness proposes that “capacity” should be changed to “ability”. From what the noble Lord, Lord Wolfson, says, I understand that we should read that with Amendment 115, although there is another amendment that the noble Baroness proposes in relation to Clause 3. But I accept what the noble Lord says in relation to Amendment 2.

With the greatest respect to the noble Baroness, Lady Finlay, she is suggesting that we remove “capacity” and replace it with “ability”. The noble Lord, Lord Sandhurst, put his finger on it when he said that “capacity” is well known to the law. You could not possibly have a Bill that did not refer to capacity because what it means, in the eyes of the law and of people in practice, is the ability to make the decision. As the noble Lord, Lord Blencathra, said, if you do not have capacity, you cannot make the decision. That applies right across the doings of human beings, and the law recognises that. If, therefore, you replace “capacity”—

Goodmayes Hospital Mental Health Facility

Baroness Merron Excerpts

Thursday 13th November 2025 Lords Chamber

[Baroness Berger]

To ask His Majesty’s Government what assessment they have made of failings at Goodmayes Hospital mental health facility.

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

My Lords, what happened at Goodmayes Hospital was totally unacceptable and I offer my sincere condolences to Alice Figueiredo’s family and loved ones, who have suffered an unimaginable loss. The trust failed in its basic responsibilities to Alice, and I expect—and we are working to ensure—that it will prioritise the safety of its services. I understand that the trust has taken steps to improve services and reduce risk, including changes to ward environments, better training in suicide prevention and investment in recruitment and retention.

[Baroness Berger (Lab)]

I thank the Minister. It was back in July of 2015 that Alice Figueiredo took her own life using a bin bag from a shared bathroom. She was just 22 years old. Recently leaked documents reveal that, just four months later, another young woman from the same ward attempted to harm herself in an almost identical manner. However, these are not isolated incidents. In 2023, three women died in a Priory psychiatric hospital within two months. I ask my noble friend the Minister: what are the Government doing to ensure that therapeutic care is provided, and lessons are really learnt, so that we do not see any further tragic loss of life from any aspect of the mental health in-patient estate?

[Baroness Merron (Lab)]

I am grateful to my noble friend for raising this in this way. National guidance is being developed, which is expected soon—in January—on plastic bag use in mental health settings. The Thirlwall inquiry has also recently reviewed progress against the important recommendations of the report of Professor Williams, which were very much addressed at the role of healthcare regulators of NHS bodies and the CPS. In addition, the NHS national oversight framework now gives a transparent assessment of the performance of every trust in England, which means that those with the greatest challenges or concerns will receive enhanced support. In addition, it means that the CQC, as we move it to a new intelligence-led model, is able to conduct rapid response inspections where concerns are identified, so that we can get on top of problems before they produce the tragic consequences my noble friend refers to.

[Baroness Murphy (CB)]

My Lords, would the Minister agree with me that, while it is 10 years since Alice Figueiredo died, we know that resources in mental health services in-patient units—in terms of human resources particularly, but the number of beds they have access to as well—have deteriorated dramatically? We heard very potent evidence during the passage of the Mental Health Bill this year of the serious consequences that have arisen from this. What are we going to do to improve the quality and quantity of resources available to mental health units, so that occurrences like this do not recur?

[Baroness Merron (Lab)]

As the noble Baroness will be aware, I take a broader approach. The current in-patient model is totally outdated and cannot address adequately the inherent risks in the mental health in-patient system, so we have to move to new models of care which are integrated in the community. Those changes will be made as part of the 10-year plan. Importantly for me, that will mean a new era of transparency as well as that rigorous focus on patient safety and care and also hearing and acting on patient and staff voices.

[Lord Scriven (LD)]

My Lords, from these Benches we also send our condolences to Alice’s family and loved ones. Considering that the judge noted that North East London NHS Foundation Trust’s finances were in an “absolutely parlous state”, what assessment have the Government made of the direct link between severe financial distress in NHS mental health trusts and the ability to maintain fundamental patient safety standards, such as ensuring rapid environmental de-escalation and adequate staffing levels?

[Baroness Merron (Lab)]

Of course, these matters are extremely important. On the specific trust, I am sure the noble Lord will be aware that there are particularly unacceptable issues that have been happening there. I gave the Answer straight off to my noble friend that it is in fact totally unacceptable. Looking to the future, following this terrible tragedy, the trust has replaced its leadership and is making improvements to services. The most recent CQC inspection found that services were well led and that they have improved. However, acute adult wards remain in the category of requiring improvement, as does its overall rating. I assure the noble Lord that we are continuing to work with the trust to raise its game.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I am sure the whole House will join in sending condolences. I am pleased that the Minister identified improving the performance at the CQC as an important step in preventing these tragedies from happening in the first place. She will know that Penny Dash reviewed the performance of the CQC and made a number of recommendations particularly relevant to mental health providers. Some progress has been made against that, including establishing a chief inspector for mental health, but there are still steps that need to be taken. The single assessment framework is at the moment still too input heavy and inadequately addresses outcomes in mental health. There are still expertise gaps and recruitment is challenging, and there are backlogs in risk, with persistent delays in reinspections for high-risk mental units. Can the Minister say, given today’s outcome and discussion, what steps she will take to address these very serious issues?

[Baroness Merron (Lab)]

These are very serious issues, and we continue to work on them. We are also very grateful to the Health Services Safety Investigations Body, whose reports highlight extremely important concerns and safety recommendations, with an aim to help us improve in-patient mental health services. Therefore, I can say to the noble Baroness that we are in the process of formally responding to those recommendations made within this report, in addition to the changes I have referred to. As the Mental Health Minister, I am invested in making sure that we continue to drive forward improvements to patient safety and accountability.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, given the testimony presented by my noble friend Lady Berger, what assurances can my noble friend the Minister provide to your Lordships’ House to underpin the Mental Health Act by way of financial spend, to ensure that it is protected for mental health services to deal with all the challenges that have happened over the last number of years and into the future?

[Baroness Merron (Lab)]

The Mental Health Bill, which is, I hope, within touching distance of Royal Assent, is absolutely crucial. It is a reform of an Act which was 41 years old; it will undoubtedly be crucial. I am grateful to many noble Lords for their participation in getting us to the right place. It will deliver on our government commitment to modernise the legislation. I hope my noble friend is aware that implementation is absolutely key, but there are rightly a number of points within the Bill—which I hope will become an Act—which will take effect only when services are in the right place. It would be wrong to do so without it.

[Lord Kamall (Con)]

My Lords, the incident at Goodmayes Hospital, and others raised by the noble Baroness, Lady Berger, such as the tragic case of Kate Szymankiewicz after her daughter’s death at Huntercombe Hospital in 2022, all raise profound concerns about the treatment of vulnerable patients. Families have described the care that their loved ones received as cruel and more akin to the treatment of prisoners than that of patients. The Minister has spoken of guidance, regulation and new models. Given all these concerns in hospitals such as Goodmayes and Huntercombehlh, I ask the Minister: what conversations is the department having with trusts and ICBs to instil a culture where patients are treated with compassion and dignity and, where it is safe, patients have proper access to their families?

[Baroness Merron (Lab)]

That is absolutely at the core. I will just say, as an example on this particular tragic case, that NHS England still meets regularly with the trust, and the last meeting took place two weeks ago—it conducted a mid-year review. There is also a recommendation for a memorandum of understanding on investigating healthcare incidents where there is suspected criminal activity, which is something we have really got to consider. That will mean that there can be action following incidents such as this, where there is reasonable suspicion. Again, having a handle on it, monitoring it, keeping accountability and having the guidance are key to prevention as well as improvement after these terrible and tragic events.

Learning Disabilities Mortality Review Reports

Baroness Merron Excerpts

Thursday 13th November 2025 Lords Chamber

[Lord Scriven]

To ask His Majesty’s Government what assessment they have made of the effectiveness of learning disabilities mortality review (LeDeR) reports in improving life outcomes for people with learning disabilities.

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

My Lords, we are committed to reducing the health inequalities faced by people with a learning disability and autistic people. Through our 10-year health plan, we are working to improve access to, and quality of, care, delivering holistic, place-based support. LeDeR annual reports support this aim by compiling insights from local reviews into the deaths of people with a learning disability and autistic people. These insights help ICBs and providers to make improvements to care.

[Lord Scriven (LD)]

As the Minister will know, the learning disabilities mortality review was commissioned a decade ago, yet people with learning disabilities still die more than 20 years younger than the general population, and 42% of those deaths are avoidable—twice the rate of the general population—so it is evident that the LeDeR process is not creating the systematic changes required. With that in mind, will the Minister commit to meeting me and a small group of people to explore what new enforceable systems are required to end these tragic and unacceptable early deaths?

[Baroness Merron (Lab)]

These are indeed tragic deaths, and avoidable in a number of cases, as the noble Lord rightly says. I can do better than agree to meet him and his colleagues—I have already got agreement from Minister Zubir Ahmed, who is responsible for this area and will be very pleased to meet them.

[Baroness Finlay of Llandaff (CB)]

My Lords, will the Government commit to working further with the National Mental Capacity Forum? One of the leads that comes out in this report is a failure to implement adequately, particularly in giving support to people. Parents are often very important in providing support to a person with learning difficulties, but when that person is an adult they can feel excluded, and they are often very worried as to what will happen after they have died and the person remains alive.

--- Later in debate ---

[Baroness Merron (Lab)]

I understand the point that the noble Baroness makes—it is quite right. We will continue to take account of and work to support parents and those they care for in the way that she describes. Certainly, I will also discuss with the Minister continuing the work with the organisation to which she refers.

[Lord Addington (LD)]

My Lords, to slightly widen the Question, would the Minister look at the fact that anybody who has a communication problem has historically had very bad results, compared with the rest of the population, when dealing with the National Health Service? Those with a hearing impairment would be a classic example. Will the Government have a good look across the whole spectrum of those who have some form of communication difficulty and try to get those medical professionals briefed in different forms of communication for that very important interview?

[Baroness Merron (Lab)]

Again, I certainly accept the important points that the noble Lord is making. It is unacceptable that there are health inequalities and poorer life outcomes. Indeed, action could be taken. That is why our 10-year health plan recognises these inequalities and identifies particularly those with disabilities as a priority group for more of that holistic, ongoing support. Key to that will be the development of neighbourhood services, where such groups will be prioritised.

[Lord Kamall (Con)]

My Lords, I thank the noble Lord, Lord Scriven, for shining a light on this really important issue and for repeating the stat that people with learning disabilities and autism in England die almost 20 years younger than the rest of the population. That in itself is shocking, whatever your views.

The charity Mencap has cited a number of barriers that are stopping people with learning disabilities getting good-quality healthcare. These include failures to recognise that a person with a learning disability is unwell and staff having little understanding about learning disabilities in themselves. Could the Minister update the House on what specific steps the Government are taking, and with which partners they are speaking, to address these concerns?

[Baroness Merron (Lab)]

It bears repeating that it is shocking that people are dying on average up to 20 years earlier. As I have said, that is unacceptable. We work very closely with Mencap and other organisations, but what we are doing already is, for example, to the point that the noble Lord raised, improving identification of people with a learning disability on GP registers. In particular, a reasonable adjustment digital flag is being implemented in care records to make sure that support is appropriately tailored. In other words, if we do not know who people are and where they are, we cannot provide the support. That is an unacceptable reason.

[The Lord Bishop of London]

My Lords—

--- Later in debate ---

[The Lord Bishop of London]

I thank the noble Lord for giving way.

My Lords, according to the learning disabilities mortality review of adults with a learning disability who died in 2023, 25.6% had a care package that did not meet their needs. We know that local authorities continue to face significant challenges to providing adult social care services. Can the Minister say what action the Government are taking to support local authorities as they respond to more complex needs to make sure that every person, including those with learning disabilities, has the correct care plan?

[Baroness Merron (Lab)]

As the right reverend Prelate says—or is it the most reverend Primate?

[Noble Lords]

Nearly!

[Baroness Merron (Lab)]

I am sure that all this will be clarified—but I will be delighted to change my reference. Indeed, this is extremely important, which is why we have a learning disability improvement standard to support NHS trusts, why each ICB has an executive lead on a learning disability and autism and why, among other things, we are rolling out the Oliver McGowan mandatory training on learning disability and autism.

[Lord Blunkett (Lab)]

My Lords, I was not sure who I was giving way to, but I am glad that God is on my side. Does my noble friend agree that, as part of that neighbourhood approach, two things should happen? The first is joined-up services, including good training for support workers where supported housing is concerned. Secondly, the major changes in abolishing NHS England should retain services at place level, rather than have the bureaucrats overseeing them.

[Baroness Merron (Lab)]

I agree with the points that my noble friend raises. Indeed, local provision is the responsibility of local trusts. I assure him that a huge part of our work is about improving care pathways and seeing people as a whole person. Part of the failing previously, I think, has been not to see those with learning disabilities and/or autism as whole people with a range of needs, just like anyone else, with those needs being specific to them. Certainly, moving from hospital to community under the 10-year plan will be a great assistance in that.

[Lord Sterling of Plaistow (Con)]

My Lords, everybody knows that this subject is dear to the Minister’s heart but, from my experience over many years, the workforce gets very nervous of having disabled people working with them. Employers and other people will give support, but the employees themselves have to feel comfortable with having disabled people working alongside them. Is the Minister able to do something about that?

[Baroness Merron (Lab)]

The noble Lord makes good points and I am glad that he does so. I have just had a word with the Minister from the DWP, who has confirmed—I am sure that the noble Lord will welcome this—that the DWP is working with employers on this. I can also say that, among staff generally, over 3 million people have completed the first part of the Oliver McGowan mandatory training, which is the Government’s preferred package. I am sure—in fact, I know—that that training is making a considerable difference in meeting the point that the noble Lord raises.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, one of the problems the Minister has talked about in developing pathways is identification and data sharing. Could she be specific about the improvements that are being made within the 10-year plan to ensure that people with various learning disabilities—it is a huge umbrella term—are better identified and that that identification is shared across different health and care services?

[Baroness Merron (Lab)]

First, the learning disability improvement standard supports trusts in setting out the guidance on safe and—I emphasise—personalised high-quality care provision as a general umbrella, but specifically the reasonable adjustment digital flag is going on to care records, which makes sure that people receive the right tailored care. For example, by improving the identification of those with a learning disability on GP registers, which I think is key, we are promoting an uptake of annual health checks, which are absolutely vital for identifying undetected conditions early. That means that there can be health action plans following these checks.