Covid-19: Day of Reflection

Baroness Merron Excerpts

Thursday 20th March 2025 Lords Chamber

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

My Lords, I too congratulate the right reverend Prelate on securing this important and touching debate, which was somewhat inevitable, considering the subject. I acknowledge her ongoing dedication. Since chairing the UK Commission on Bereavement and the publication of the report, the right reverend Prelate and the commission have continued to champion this important issue. I am very happy to agree to the meeting that she requested.

I am grateful to the noble Lord and the noble Baroness on the Front Benches, not only for sharing their personal experiences and reflections, which is what this subject is about, but for raising the points that they did. I know that they, like me and the right reverend Prelate, want to improve support for those who are bereaved.

The right reverend Prelate made the very good point that there is bereavement through the loss of a loved one, but there is also bereavement through the loss of what might have been. One such example of that, writ large, is those who have long Covid—and I am sure that we can all think of others. It is always right to think about loss in those terms. As has been said, we all have and will experience grief through the course of our lives. It is absolutely vital that bereaved families and friends have access to the support that they need, and when they need it. That can come from a variety of sources, as noble Lords have described, and I will return to that later.

I assure your Lordships’ House that the Government are looking for the best ways to support those in grief, including those bereaved as a result of Covid-19. On behalf of the Government, I also associate myself with the thanks to those who provided services with full public spirit, no matter what sector they were from. Whether private, public, charitable or voluntary, they were public spirited to the core and they kept us going. I am deeply grateful. I also reiterate the condolences to all those who were bereaved and all those who suffered loss of some kind and have been affected by the pandemic.

Noble Lords have referred to the day of reflection. This year marked the fifth such event since the outbreak of the pandemic. As we have heard, it is a significant milestone and an opportunity to form one’s thoughts, memories and actions as we remember all those who were affected.

The noble Baroness, Lady Morgan of Cotes, chaired the UK Commission on Covid Commemoration to consider appropriate ways to remember those who have died and how we should mark such a sombre time in our history. Of course, it is not history for those who are bereaved; it continues to be with them. I thank the noble Baroness, Lady Morgan, and the commission for their extensive work in speaking with those who are most impacted by the Covid-19 pandemic, including representatives from bereaved family organisations. I am grateful to those organisations for their work.

The commission’s first recommendation of 10 is that:

“A UK-wide day of reflection should be established and held annually on the first Sunday of March”.


On 9 March this year there were more than 200 events in communities across the country, and we saw how important this day was to so many. The noble Lord, Lord Kamall, asked about a day of reflection in the future. We see how much this day matters to people and how many communities took part, and I thank all those local organisations and communities for contributing to that. We very much hope that will create a foundation for future years.

The day of reflection allowed people to remember the many losses in a way that was appropriate and meaningful for them. It struck me to be very much in contrast to our experiences during the pandemic, which for that period of time were ones of isolation, separation and the loss of the lives we used to lead. There was close working with charities, faith groups and other voluntary, community and social enterprise organisations. That was very much the mark of the day of reflection, and I appreciate the role of those organisations, not just in the day of reflection but in supporting those who experience grief. I am sure we all pay tribute to them and their work.

In Sheffield the city council continues to work in partnership with Compassionate Sheffield, which aims to improve people’s experiences of life, loss and death. Access to support is certainly important; it has been referred to throughout this debate. To give just one example, of which noble Lords will be aware, the Government are prioritising funding to expand NHS talking therapies. That is something to which people can self-refer, or they can consult their GP in order to get to that point, and it is a tremendous service for people.

The noble Baroness, Lady Brinton, rightly referred to the issue of children and young people’s mental health. Again, I mention the expansion of mental health support teams in schools, putting in place Young Futures hubs, which will provide access to mental health support, and the recruitment of 8,500 new mental health workers to treat children and adults. In all these ways, we hope to support children and young people who are bereaved.

On the point the noble Baroness, Lady Brinton, raised about PPE, we are responding to each of the reports from the inquiries, and that will be dealt with. I totally agree about keeping people safer and the matter of Zoom. That has provided comfort in a way we could not possibly have anticipated. I noted her comments about ads for very cheap funerals, and I will raise them with the appropriate ministerial colleagues.

The noble Lord, Lord Kamall, talked about culture. Indeed, different religions and communities have different cultures. As he will know, in the Jewish tradition, it is tradition to sit shiva for around a week, where support can be freely given by visiting the home of the bereaved. As my noble friend Lady Anderson reminded me, it is hard to get a group of people together and not feel some form of celebration while giving that support. All these models are ones that we can look to.

On the points made about long Covid—which is a very real issue and will not be going away—we have invested £314 million to expand treatment and rehabilitation services and established 100 long Covid services for adults and 13 specialist paediatric hubs for children and young people. They assess people with long Covid and direct them into ways of care, to provide the right support, treatment and rehabilitation. We have also invested £50 million in 22 research projects for long Covid. In all this, I hope people can be reassured that we continue to support people.

On the question about adding bereavement to the national curriculum, we are reviewing the RSHE curriculum and will look carefully at responses to the consultation on the draft revised RSHE statutory guidance, which ended in July. I will take a particular interest, with my ministerial colleagues, about where that sits.

My department brings together government colleagues to discuss bereavement as part of a government working group on bereavement. It is a forum to share best practice. Today’s debate will feed into that very well. We take the reports from the UK Commission on Bereavement very seriously and continue to engage with them.

On the right reverend Prelate’s point about end of life, dying well is a fundamental right in regard to human dignity and compassion. We have a responsibility to ensure the best possible care. That includes supporting families and carers, including young people, who are involved in that.

NHS England has developed guidance to support ICBs with their duty to commission palliative care services within integrated care systems. That guidance requires commissioners to ensure that significant access to bereavement services be available for families and carers, including children and young people.

I turn to ongoing research. The pandemic made clear the need for bereavement services to offer both practical and emotional support, as noble Lords have referred to. Noble Lords will not be surprised that not everybody knows about these services. Many services are particularly not reaching those from ethnically diverse communities. Through the National Institute for Health and Care Research, the Government have commissioned a study investigating how to improve bereavement services for those from ethnically diverse groups. That includes those from black African, black Caribbean, Pakistani, Bangladeshi, Indian, Somali, Chinese and Roma backgrounds. I certainly look forward to the study’s findings, which will be published later this year.

Finally, we need to take an evidence-based approach to health, and NICE balances best care with value for money across the NHS. Decisions on whether NICE will create new or update existing guidance are overseen by a prioritisation board chaired by NICE’s chief medical officer, and the prioritisation board is considering bereavement as a potential topic for guidance development.

In reiterating my sympathies to all those who were bereaved and all those who continue to be affected directly or indirectly by the Covid-19 pandemic, I feel that it is incumbent on us to look to make further progress on bereavement support services. I look forward to continued cross-government working—and, I am sure, cross-party working—to achieve this.

Pharmacy Opening Hours

Baroness Merron Excerpts

Thursday 20th March 2025 Lords Chamber

[The Lord Bishop of St Albans]

To ask His Majesty’s Government what assessment they have made of the impact of the potential reduction in pharmacy opening hours.

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

My Lords, this Government recognise that pharmacies are an integral part of our communities. There are processes in place to monitor opening hours and their impact, and core hours of either 40 or 72 hours would not be affected by the proposed action by one trade body. Options are available to patients to access alternative pharmacies or distance-selling pharmacies. We will make an announcement shortly on a funding settlement for the years 2024-25 and 2025-26.

[The Lord Bishop of St Albans]

I thank the Minister for her response. Will His Majesty’s Government publish the independent economic analysis of the pharmacy funding crisis? Also, last summer we nursed my brother-in-law as he died. We had to access medicines, often at short notice. That was very difficult, even in a built-up urban area with many pharmacies around. In rural areas, it is far more difficult. What assessment have His Majesty’s Government made of any limitation of opening hours on health outcomes in rural areas?

[Baroness Merron (Lab)]

I will of course discuss the right reverend Prelate’s request for publication of information with Minister Stephen Kinnock, who has been working very hard with the sector in resolving matters on funding.

On opening hours, as I have said, there are core hours, but there are also additional supplementary voluntary hours that community pharmacies can choose to do. There is also a whole range of ways in which people can access pharmacy services—notwithstanding the point the right reverend Prelate made about his personal experience—including being able to contact distance pharmacies, which can provide things through online contact, by telephone call or by other means.

Pharmacies are key to making healthcare fit for the future, but we want to make sure that they are completely accessible. We will work with them to make sure that they, as largely private businesses, do so.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my interest as chairman of King’s Health Partners. Just to build on the point made by the right reverend Prelate, what assessment have His Majesty’s Government made of the impact on population health outcomes of the intersection between limited access to primary care services and diminishing availability of pharmacy services?

[Baroness Merron (Lab)]

I know the noble Lord talked about primary care more generally, but the assessment on pharmacies is that there is quite a good coverage. Some 80% of the population live within a mile of a pharmacy and, as I say, there are other online and not-in-person ways of contacting pharmacies. The Pharmacy Access Scheme provides financial support to pharmacies in areas where there are fewer pharmacies. Local authorities, along with ICBs, continue to monitor changes, look at provision and have the ability to intervene where necessary. On all these counts, in respect of primary care provided through pharmacy, which is so important, we continue to monitor the impact across ICBs. With regard to a particular assessment, I will gladly write with more details to the noble Lord.

[Lord Kamall (Con)]

My Lords, the Minister has rightly talked about some of the alternatives, particularly when hours are limited. Can I ask her about some of the long-term thinking in the department on the future of pharmacy services? We know that some chains, for example, have in-store pharmacies. What thought has been given to more of these partnerships—and also, perhaps, pharmacies as part of future primary healthcare centres? While many people may want a bricks and mortar pharmacy, those who use the NHS app, for example, may be happy to order repeat prescriptions and have them delivered or pick them up from a local location.

Patients are also more open to ideas of online consultation. We have seen Royal Mail trialling delivery by drones in remote areas. There is a whole host of things happening in other sectors that the pharmacy sector and other parts of our health and care sector can learn from. What is the department learning from this innovation in other parts of the economy?

[Baroness Merron (Lab)]

The noble Lord makes some very constructive points and illustrates further the point that there are many ways to deliver pharmaceutical services. I can assure him that we are exploring how pharmacy can best be positioned—and indeed levered—to fit our ambition for a neighbourhood health service within the NHS 10-year plan. More will be heard about that soon.

The noble Lord will also be aware that one of the challenges that community pharmacies raised with us is about funding, which was cut or held flat between 2015-16 and 2023-24, representing a cut of some 28%. That is why we have concluded the consultation about funding; we will shortly announce the outcome, looking at how these private businesses can operate in the market. We are keen to ensure that they play their part and continue to work very constructively with them.

[Lord Scriven (LD)]

My Lords, the financial year ends in two weeks, and the ongoing delay in this year’s financial settlement for pharmacists has created a cash-flow problem and exacerbated the financial issues, which means that on average eight community pharmacies a week are closing. In December the chief executive of Community Pharmacy England wrote to Ministers asking for a remedial injection of cash to help cash flow and keep pharmacies open. I gently ask the Minister why Ministers have so far ignored that request.

[Baroness Merron (Lab)]

I feel that the most constructive response I can give to the noble Lord is the response of the Secretary of State, who has made it quite clear in Parliament that discussions will conclude shortly and an announcement will be made in the normal way. That will be via an open letter to contractors, which will be published on GOV.UK. I hope the noble Lord will understand that I cannot say more until our engagement with Community Pharmacy England, the representative body, comes to a conclusion. I can add for the benefit of noble Lords that NHS England commissioned an independent economic analysis of the cost of providing pharmaceutical services. It has informed the consultation with the sector and will be published in due course.

[Baroness Wheatcroft (CB)]

My Lords, is the Minister concerned that GPs’ tendency very easily and readily to sign repeat prescriptions increases the demand on pharmaceutical services? Does she agree that there should be a much more rigorous review of repeat prescriptions on a regular basis?

[Baroness Merron (Lab)]

I appreciate the noble Baroness’s views. Indeed, community pharmacies in England are dispensing around 1.1 billion NHS medicines with a value of over £10 billion each year. Prescribing is of course a clinical decision. We are nevertheless keeping an eye on the situation, of course. What matters is that people seek help, and I am very glad to say that pharmacies are playing an increasing role in the availability of assistance, so people do not always have to go to GPs, particularly for some of the more common conditions.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, does my noble friend agree that community pharmacies play a vital role in addressing NHS waiting lists through the administration of the vaccination programme—whether it is influenza or the Covid-19 vaccine—and thereby contribute to the reduction in the waiting lists that are faced by many hospitals throughout the UK? Will all efforts be made by government to ensure that the challenges faced by community pharmacies at present will be resolved in the near future?

[Baroness Merron (Lab)]

I certainly agree with my noble friend’s point. I hope that she has noticed my enthusiasm for the role that pharmacies play. The introduction of Pharmacy First was a tremendous contribution to some common-sense approaches so that people who have common conditions can more immediately access services. Many of us will have experienced that. As I have said, we will conclude matters shortly and look forward to making the decision about future funding known ASAP.

NHS Dentistry

Baroness Merron Excerpts

Wednesday 19th March 2025 Lords Chamber

[Lord Young of Cookham]

To ask His Majesty’s Government what steps they are taking to improve access to NHS dentistry.

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

My Lords, we are tackling the challenges for patients trying to access NHS dental care by providing 700,000 more urgent dental appointments per year, with integrated care boards delivering those extra appointments from 1 April 2025, which is not long away. We will recruit new dentists to the areas that need them most and to rebuild dentistry in the long term we will reform the dental contract with the sector and shift to focus on prevention and the retention of NHS dentists.

[Lord Young of Cookham (Con)]

I very much welcome the 700,000 extra appointments, which will begin to make an impact on the 2.2 million people who now need urgent care, but did the noble Baroness read the leader in the Times on Monday which said

“the scandal of NHS dentistry has dogged successive governments without resolution”?

It mentioned the 30,000 children each year who go to hospital to have rotten teeth extracted under anaesthetic and the 18 million adults and children who cannot access an NHS dentist. Does she agree that at the root of this problem is the 2006 dental contract, which has driven dentists out of the profession? When might a new contract be introduced? Given that the most effective public health measure is to add fluoride to the water supply where it does not exist naturally, when will she roll out the programme that has begun in the north-east?

--- Later in debate ---

[Baroness Merron (Lab)]

As the noble Lord suggests, tooth decay is the main reason that five to nine year-olds are admitted to hospital. That is a scandal, and one that we are seeking to tackle. My ministerial colleague, Stephen Kinnock, has made reform of the dental contract an early priority and continues to collaborate with the British Dental Association and other representatives on what is, of course, a shared ambition to improve access to treatments for NHS dental patients. I wish I could give an exact date to the noble Lord; I am not in a position right now to do so. On water fluoridation, as the noble Lord said, an extra 1.6 million people across the north-east will benefit from a water fluoridation scheme following quite a lengthy process and that will start in 2027-28.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, dental problems put extra pressures on A&Es, particularly at the weekend when it is difficult to get access to a dentist. Does she recall that a group of dentists has suggested that we should create 40 mini-A&E centres around the country, under the NHS, open seven days a week? I believe that suggestion worked its way through to the Minister. If she is not able to give an immediate answer, would she write and put the reply in the Library for others to see?

[Baroness Merron (Lab)]

As I said, it will be ICBs delivering the extra 700,000 urgent dental appointments each year. They will be best placed locally to decide how to do it. It may well be through the means that my noble friend said, but the duty on them will be to ensure that those are available. The appointments will be most heavily weighted towards the areas where they are needed most, although appointments will be available across the country. I welcome my noble friend’s suggestion but how the extras are provided will be a matter for local decision-making.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister comment on whether serious consideration will be given to debt relief for newly qualified dentists? They could then work as salaried employers for the NHS and deliver more than the 700,000 appointments we are aiming at, because we have such a long backlog. That would really support children’s dental care immediately.

[Baroness Merron (Lab)]

I welcome the suggestion from the noble Baroness, and I will raise that with the Minister, Stephen Kinnock. What I can say is that strengthening the dental workforce is absolutely central, as we have to rebuild NHS dentistry in this country. Integrated care boards have started already to recruit for dental posts through a golden hello scheme. That means that up to 240 dentists will receive payments of £20,000 across three years to work in those areas that need them most. Already, as of 10 February this year, 35 dentists have commenced in post, a further 33 dentists have been recruited, and hundreds of job posts are currently advertised. There is a long way to go, but we have made a very strong start.

[Lord Rennard (LD)]

My Lords—

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[Lord Rennard (LD)]

My Lords, the promised extra 700,000 appointments will mean just two extra appointments a month for each NHS dentist in England. The Health and Social Care Select Committee concluded in 2023 that the current dental contract is not fit for purpose, so will a new dental contract stop penalising dentists who take on more units of dental activity or patients with more complex dental needs?

[Baroness Merron (Lab)]

The noble Lord makes a very strong case for reform of the dental contract. The Minister concerned is very alive to the points he makes but, again, I will draw his attention to them. I do not quite recognise the figure that the noble Lord referred to on the number of extra appointments. If I can give just one example: out of 700,000 extra appointments, in the Midlands that will mean 143,424 extra appointments. I also emphasise that it is 700,000 extra appointments every year. If the noble Lord would let me have the figures to which he referred, I would be very happy to look into them.

[Lord Glenarthur (Con)]

My Lords, there used to be a number of eminent dentists in your Lordships’ House. I am thinking of Lady Gardner of Parkes and Lord Colwyn. I believe there are none now, so do the Government have any plans to fill this gap and ensure that the dental service is represented in your Lordships’ House?

[Baroness Merron (Lab)]

There is a cavity that needs filling. I defer to the usual channels, the senior leadership, the leaders of all parties, the Convenor of the Cross Benches, and all the other bodies that decide who should be in this House.

[Lord Kamall (Con)]

My Lords, I say to the noble Baroness that when it comes to comedy, she is doing an excellent job as a Minister.

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[Baroness Merron (Lab)]

I can assure the noble Lord that I took his comments in good heart, which is exactly how they were intended. He touches on an important point, which is that this is not just about the number of dentists but about how many units of NHS dentistry they are doing. Again, we are very aware of that—which goes to the noble Lord’s question earlier as well—and we are seeking to resolve it through the reform of the contract. We have found that the previous Government’s dental recovery plan did not go far enough, because it has left many people still struggling to get an NHS appointment. The noble Lord asked about conversations with the Treasury, but perhaps some of that speaks for itself in that we have a rescue plan providing more urgent dental appointments. We are reforming the dental contract and not waiting to make improvements, because we are already increasing access and incentivising the workforce to deliver more NHS care.

NHS England Update

Baroness Merron Excerpts

Wednesday 19th March 2025 Lords Chamber

[Lord Scriven (LD)]

My Lords, the Government, with their sovereign right, propose the abolition of NHS England. Although the method of delivery is a matter for the Secretary of State to propose, governance changes in themselves will not achieve better outcomes. These Benches will continue to point out that chronic operational issues in the NHS cannot and will not be dealt with effectively until the Government show the same speed and determination to deal with the social care crisis. The Minister must know that you cannot have 13,000 hospital beds full of people medically fit for discharge and pretend that a change of who sits in what chairs in the governance of the NHS will solve that issue. When will the Government commit to a timetable to restart the cross-party talks to deal with this important issue?

The paramount—indeed, the sole—objective of any organisational change to the NHS must be demonstrable improvement of patient experience and outcomes. The Government assert that this change will improve efficiency and streamline services. However, assertions alone are insufficient. We require rigorous evidence, not mere conjecture.

Therefore, I am going to ask the Minister five questions. First, and most importantly, what detailed analysis has been conducted on the projected impact of this abolition on patient outcomes? We require more than abstract pronouncements. For instance, how will it improve cancer treatment? What will these changes do to improve access to GP services? How will they improve local integration, particularly when 50% of funding for ICBs will be reduced across the board?

Secondly, what specific legislative changes are required to abolish NHS England and redistribute its functions? I note that the Secretary of State pointed out that the Government could predominantly go ahead with these changes but that legislation is required, so will the Minister explain to the House exactly what legislation will be required to bring about this change? Will she give a commitment that no redundancies will take place until legislation has been passed and these changes have been given the go-ahead by this House and the other House?

Talking of redundancies, my third question is: what are the estimated costs of redundancies associated with the abolition of NHS England, including not only financial implications but the potential loss of expertise and institutional knowledge? Furthermore, will the Minister indicate whether any departing executive has been offered a severance package exceeding statutory redundancy limits and, if so, how many? What justifications are there if such arrangements have been made?

Fourthly, how will the Government ensure continuity of service during the transition period? Any disruption to patient care is unacceptable, so when will there be a robust plan that outlines how essential services will be maintained, how staff will be supported and how the public will be kept informed?

Finally, in line with what the noble Lord, Lord Kamall, said, what mechanisms will be put in place to ensure ongoing accountability and transparency in the newly restructured healthcare system? How will the Government measure success—not just of the times in which people are seen but that these changes have contributed to improvements in patient care? The Government are the custodians of this vital public service and have a duty to ensure that any changes to NHS structures are driven by evidence, guided by principle and focused relentlessly on improving the lives of the people it serves. They must proceed not blindly but with clarity, so I look forward to the Minister’s answers.

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

My Lords, I am grateful to both Front Benches for their reflections and their support for the direction of travel, in certain areas. I am pleased to see the noble Lord, Lord Scriven, in his place and I wish him a full recovery. I note that the noble Lord, Lord Kamall, welcomed the moves on value for money, freeing up from bureaucracy and the need to put the patient at the centre. I am glad that he did that, because that is exactly what this is about: better services and cutting duplication.

It is probably worth my reflecting on the sentiments expressed in the other place by my right honourable friend the Secretary of State for Health and Social Care when he referred to the question of why we are doing this. The independent investigation by the noble Lord, Lord Darzi, was called for by this Secretary of State not long after we came into government and discovered a situation beyond what I think anyone had anticipated. The noble Lord, Lord Darzi—this relates to the point that the noble Lord, Lord Scriven, made about evidence—traced the current crisis back to the 2012 top-down reorganisation of the NHS and the establishment of NHSE. He stated that it had

“imprisoned more than a million NHS staff in a broken system”.

There are twice as many staff working in NHS England and the Department of Health and Social Care today as there were in 2010. In 2010, the NHS was delivering the shortest waiting times and the highest patient satisfaction in history. When we came into government last year, it was the exact opposite: the longest waiting times and the lowest patient satisfaction in history.

You can add that up: taxpayers pay more, and they get less. We have been left with two very large organisations. I see that there are some former Ministers from the department in the Chamber today, which I am glad about. I will not speak for them, but they might also reflect that they will have noticed duplication and layers of bureaucracy that have stifled the progress and the patient treatment, patient focus and patient experience that we all seek to improve. The noble Lord, Lord Kamall, talked about the need for us all to coalesce around the interests of the patient, with which I certainly agree. Over the next two years, the intention is to bring NHS England into the department entirely. That will make significant savings of millions of pounds a year. To noble Lords who have raised some questions about whether the money will flow down to the front line, I say that it will cut waiting times faster and deliver our plan for change.

The matter of staff came up, and I will come back to that. I acknowledge that there are talented, committed public servants who work at every single level of the NHS and the Department of Health and Social Care, including NHS England, with whom I have had the privilege of working over the past eight months under this Government. I was previously a Minister in the department in the last Labour Government. This is about the system, not the people. I say that to reassure those who are employed both at the department and in NHS England.

The noble Lord, Lord Scriven, asked some important questions about staff reductions and when redundancies would potentially take place. There are currently 19,000 staff across NHS England and DHSC; across both, we are looking to reduce the overall headcount by 50%. Conversations have already begun with the trade unions on this change, and we will of course continue to engage with them throughout the process. As the noble Lord, Lord Scriven, rightly observes, abolishing NHSE—a non-departmental public body—will require primary legislation, so we are working with the usual channels to ensure that we have an appropriate legislative timetable to allow us to do things in a timely way, while safeguarding what is an ambitious legislative programme that has already been set out. We are already getting on with the job immediately, which also answers the point raised by the noble Lord, Lord Scriven, about bringing NHSE back into the department.

The noble Lord, Lord Kamall, raised a very good point about the need for better understanding, clear lines and transparency. One of my learnings since we announced the abolition of NHSE was that, unfortunately, some members of the public thought that meant we were abolishing the NHS. I would like to reassure anybody in this Chamber or outside it that we are not doing that at all: we are committed to the National Health Service, as we have always been throughout our history as a party, and we will continue to strengthen it. However, what that said to me relates to the point the noble Lord made. People do not care about structures, and why should they? What they are interested in—and I completely endorse this—is what it does for them. Can they get that appointment? Can they get that treatment? Can their child get access to dentistry, or whatever it is? That is what people want.

Actually, this is a tremendous opportunity to be clearer and more straightforward about what those lines are, and I certainly look forward to doing so. The noble Lord, Lord Kamall, is right about the need for a change in culture, and I think that applies to a whole range of issues.

This measure has been considered and, as I explained, was born through experience and evidence. It will fit as part of the 10-year plan, to which the noble Lord, Lord Kamall, referred, and I thank him for that. On when that will be published, I will say only that I hope the noble Lord will not feel he is kept waiting for much longer. I am very grateful to everybody who gave input to the consultation—the biggest one ever in the history of the NHS.

The noble Lord, Lord Scriven, rightly asked for a number of details about impact; there will, of course, be a full impact assessment with the legislation. He asked particularly about improvements overall, which is what we seek. Currently we have two organisations, many layers and duplication. I cannot think of one organisation that can boast all that—I do not say boast in a positive way—and say it is at its most efficient in delivering for whoever the service users are.

All of it will translate to improvements on the front line, which is what we are talking about. As I mentioned, as I often do, earlier in Questions, we believe that decision-making locally—done in the interests of the local population, with their involvement and reflecting their nature—is crucial. Noble Lords will be aware that, on the advice of the report by the noble Lord, Lord Darzi, we reduced the numbers of targets in the planning guidance from 32 to 18, to free up local areas to better meet the local requirements. Again, we see the direction of travel.

The noble Lord, Lord Scriven, asked about senior management and severance packages. Of course, I cannot comment on individuals, but I emphasise that, in the cases of those who announced their resignation, it was just that, so all the normal arrangements would apply.

I hope we can continue to work together to improve the structure, support the staff and, most importantly, keep patients at the centre, so that they see improvements from this change and the recognition that two organisations are duplication and this needs to change.

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[Baroness Thornton (Lab)]

I am just asking the question. What is the likely timescale for when investment might be released? I am thinking particularly about technology and investment in infrastructure, as a non-executive director of a hospital, a large part of which is still a Victorian build.

[Baroness Merron (Lab)]

I thank my noble friend for her reflections on what has gone before and her welcome that the opposition parties can work with us to put this into a better place now. With respect to change and productivity, and a further extension to the point raised by the noble Lord, Lord Kamall, about culture, I can say straightaway that the Government have a 2% productivity growth target in 2025-26. That is immediate. We are not waiting to make this change, because if we do not improve NHS productivity and efficiency, we will not be able to deliver the three shifts needed to future-proof the NHS and support the Government’s growth mission.

We have already invested more than £2 billion in NHS technology and digital in 2025-26, which will help with essential services and drive productivity in hospitals, such as the one that I know my noble friend serves very well. That will free up staff time, ensure that all trusts have electronic patient records, improve cybersecurity and enhance patient access through the NHS app. That is before we even make this change.

We have already achieved a lot in the past eight months, but that is why we have to continue with this reform. We have delivered the 2 million extra appointments that we promised, months ahead of schedule, we have cut waiting lists by 193,000, and, as I said earlier, we have committed to 700,000 extra urgent dental appointments, just to name some. We know about the importance of change, which the noble Lord, Lord Scriven, asked me about, and that my noble friend calls for. That is why we will always continue to take bold steps where we have to, and not shy away.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, the point is well made about duplication, bureaucracy and excessive cost. Can the Minister give us an assurance, though, that we will not move from excessive bureaucratic centralisation to political centralisation? There are few politicians who are clinicians, sophisticated managers or financiers. This is the largest employer in the world, with extraordinarily dedicated and talented individuals concerned. They will not be happy to think that they will be organised on the whim of whoever is the latest Minister.

The right reverend Prelate the Bishop of London used to be the Chief Nursing Officer—there are many people who have worked at high levels in the NHS. We need to be confident that there will be an evidence-based, rational system at some distance from party-political considerations, because the viciousness of health debates about hospital closures, boundaries and other matters knows no bounds. We do not want by-elections to become involved in non-party-political matters.

The noble Lord, Lord Waldegrave, and even the noble Lord, Lord Clarke, and I, were very happy with an NHS executive which was part of the department. However, the role of the chief executive was not the same as the role of the Secretary of State. I hope the Minister can give us some assurance.

[Baroness Merron (Lab)]

I am very pleased to give the reassurance that the noble Baroness seeks. When we reflect, the disastrous 2012 top-down reorganisation certainly did not depoliticise the NHS—it made it less efficient and less able to treat patients on time.

This is not about politicisation; this is about responsible government. I add—without embarrassing anybody—that a number of former Conservative Health Ministers have said to me, and to my colleague Ministers and the Secretary of State, how much they welcome this and how they wish that they had taken this step. That, for me, as well as the tone of the contributions from the Front Benches today, provides the reassurance the noble Baroness seeks.

[Lord Kakkar (CB)]

My Lords, I draw the House’s attention to my registered interest as chairman of King’s Health Partners. In the announcement made by the right honourable Secretary of State for Health in the other place, there was particular emphasis on identifying that in this period of transition, NHS England will focus on ensuring that local providers are better able to cut waiting times and to organise their finances appropriately. But NHS England has many other functions beyond those two important ones, and they will need to be delivered in what is a substantial transformation in reabsorbing NHS England into the Department of Health and Social Care. What reassurance can the Minister give your Lordships’ House that functions such as the recently integrated Health Education England function into NHS England, the NHS Digital function and many others, are going to be properly supervised and delivered during this period? They are as essential, in many ways, as delivering on waiting times and organising finances.

[Baroness Merron (Lab)]

The noble Lord is right to talk about NHS England in all its functions. Bringing it together with the department will not diminish those functions but will allow them to be delivered rather more effectively than they are currently. At the head of the transformation team is Sir James Mackey, the new chief executive of NHS England, working with Dr Penny Dash as chair. Both individuals are well respected across the sector for their outstanding track records, not least on turning round NHS organisations, in Jim’s case, but also on balancing the books, driving up productivity and driving down waiting times—exactly what is needed. But I agree totally with the noble Lord, and we are going to ensure that the necessary functions are continued; it is the way they are delivered that we are changing.

[The Lord Bishop of London]

My Lords, I declare my interest as indicated by the noble Baroness, in that I am a former government Chief Nursing Officer. Following on from the noble Lord’s point, this is a very significant change not just to the NHS but to its workforce. We know from looking back that when there is a reorganisation of the NHS, attention and funds are distracted away from the front line and patient care. The announcement came on the same day as the publication of the NHS staff survey results, which highlighted that only 31% felt that there were enough staff to enable them to do their job, and that 45% felt unwell due to work-related stress. What action will the Government take to make sure that there is not a management distraction, through this reorganisation, away from the front line and patient care in particular? How will staff be supported during this transition, not least those who, I suspect, fear that their jobs are now under threat?

[Baroness Merron (Lab)]

I recognise what the right reverend Prelate is saying. I myself have experienced change in large organisations, and change is never easy. We are talking about job losses; we cannot shy away from that. But it is appropriate that I re-emphasise the reassurance of our respect for and thanks to all those talented and hard-working staff in both the department and NHSE. We will, as I said, work with trade unions on this change in order to be fair and transparent and to deal with it properly. Of course it is uncomfortable, and people naturally find it difficult.

It is also important to look at the benefits. Currently, we have rather too much micromanagement, which frustrates progress and staff. Reducing that is one of the liberations that this will provide, so we can innovate and get on with caring for patients.

On maintaining people’s morale, this is a big challenge for us because morale has not been good at all, so we will pay particular attention to this as we publish the workforce plan later in the summer. This work continues. Senior managers and transformation team are very alive to the points the right reverend Prelate has made, and they will continue in that regard.

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

My Lords, I am very conscious that a number of noble Lords want to get in. Can all keep their questions brief? I will take the Liberal Democrat contribution first and then Labour.

[Baroness Tyler of Enfield (LD)]

My Lords, I will be brief. With such a strong emphasis in the Statement on reducing duplication and bureaucracy, can the Minister say what consideration is being given to fusing NHS England’s regional offices with the remaining ICBs that come within their geographical area? It strikes me that there is scope for savings there.

[Baroness Merron (Lab)]

All of this will be looked at by the transformation team, because it is a considerable change. I thank the noble Baroness for that contribution, and I will ensure that it is heard.

[Baroness Rafferty (Lab)]

My Lords, can my noble friend the Minister kindly confirm that the role of the Chief Nursing Officer for England will migrate to DHSC?

[Baroness Merron (Lab)]

My noble friend will know—as I am sure the right reverend Prelate knows—that the Chief Nursing Officer has always played a role in advising Ministers; that the case was long before the establishment of NHS England and will continue long afterwards. The chief executive, Sir James, has announced his new transformation team, and that includes NHS England’s Chief Nursing Officer.

[Lord Markham (Con)]

As a former Health Minister, I too welcome this move, but the devil is in the detail. The point made about the NHS regions is completely right: that is another layer which will stop hospitals being freed up in the way the Secretary of State said he wants to happen. There is the question of whether lots of merged entities will be demerged again. As we all know, it is the uncertainty which hits productivity in the meantime, when people are naturally worried about their jobs.

I would really like to press the Minister on when we will see the detail behind the plan. When will it be produced, and when can we give the staff the information they need, so they know their position? Until that happens, the uncertainty will, unfortunately, hinder productivity and stop the changes we all want to see happening.

[Baroness Merron (Lab)]

I understand that point and the noble Lord’s wish for dates, which I am not able to give him, as I am sure he will appreciate. These reforms are not about front-line staff losing their jobs; we are talking about people employed directly by the department and the NHS. The noble Lord referred to the Secretary of State, and I would add that other arm’s-length bodies also need to be leaner than they are today.

I understand the problem, and we are going to work very closely with staff organisations, but it is not a neutral situation. Staff are suffering from box-ticking, duplication and red tape, which prevents them doing their job properly. Their morale is not good in this case—in any case. We do not want to add to that, but we do want to give them hope for the future.

[Baroness Butler-Sloss (CB)]

After the transformation team has completed its work, who will take over the duties that the noble Lord, Lord Kakkar, referred to in his question?

[Baroness Merron (Lab)]

That will be declared in due course, once the work has been completed.

[Baroness Sugg (Con)]

My Lords, I spent yesterday morning at the women’s health department in Mile End hospital—I know the Minister is a great champion, and I highly recommend a visit. What will the NHS England update mean for the women’s health strategy, and, specifically, for NHS England’s commitment to eliminating cervical cancer by 2040?

--- Later in debate ---

[Baroness Merron (Lab)]

It will not affect commitments to women’s health. As we have said, women’s health remains a priority. The noble Baroness will know that there are some 600,000 women already on the gynaecology waiting list; that is far too long for women to wait. Women’s health hubs are part of the solution, and I continue to champion those with the integrated care boards.

[Lord Turnberg (Lab)]

My Lords, I am delighted to support the direction of travel towards patients first. I wonder if there are savings to be made. We can concentrate on the gap in social care, where I suspect much of the NHS is so interdependent. Social care is so badly funded, and we need to do something there.

[Baroness Merron (Lab)]

As we discussed earlier, the provision of social care and housing has a huge impact on quality of life and discharge from hospital. As my noble friend will be aware, the noble Baroness, Lady Casey, will be commencing her look into social care, to report to us all on the immediate and long-term changes that are needed and to build cross-party consensus.

[Baroness Freeman of Steventon (CB)]

My Lords, since NHS Digital was merged with NHS England, NHS England staff have been running absolutely critical data and digital infrastructure. During this period of uncertainty, we are bound to be in danger of losing some staff with expertise that is difficult to replace. What are the Government doing to make sure that these jobs are absolutely safeguarded and that this expertise is not lost?

[Baroness Merron (Lab)]

Nobody should worry about data or their privacy. Our job is to improve our ability on data, and this change will not affect that. Indeed, part of the 10-year plan will include a move from analogue to digital, because we recognise the importance of data and digital change in improving healthcare. This change will give us a better opportunity to implement that.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I congratulate the Government on removing a powerful and unelected body—the world’s largest quango. What the Government have done is so important democratically, given that the Secretary of State says, “The buck stops here”. However, it is not a silver bullet. There is no NHS England in Wales—my neck of the woods—and the buck stops with the Senedd, but the Welsh health service is in a terrible state, with wastage of money, red tape, bureaucracy, and smoke and mirrors about where money is being spent. Does the Minister agree that that can happen even when the buck, apparently, stops with the politicians?

[Baroness Merron (Lab)]

I am not sure if that was a question about politicians or Wales. We work very closely with the devolved Governments, as the noble Baroness will be aware. On her point about politicians, we take our responsibilities very seriously. That is why we have recognised the problem and are acting.

Safe Housing and Hospital Discharge

Baroness Merron Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Thornhill]

To ask His Majesty’s Government what steps they are taking to improve collaboration between integrated care boards and housing providers to address barriers to safe housing and support timely hospital discharge.

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

My Lords, the Government recognise that the availability of safe housing contributes to timely and effective hospital discharge. We published a new policy framework for the £9 billion better care fund in January. Integrated care boards and local authorities have to work together, with involvement from local housing authorities, to agree joint plans to deliver joined-up care. The £86 million uplift to the disabled facilities grant this year can provide around 7,800 additional home adaptations.

[Baroness Thornhill (LD)]

I thank the Minister for her Answer and welcome what she has said. It is absolutely clear now that the lack of supported housing is a major factor in delayed discharge from hospital and that integrated care boards are part of the solution. Can the Minister explain why, only last week, the Government made the shock announcement of a 50% cut to the core funding to these very boards? Surely they should be integral to creating solutions to this costly, damaging and seemingly intractable problem.

[Baroness Merron (Lab)]

As the noble Baroness will be aware, this Government want to see provision and decision-making directed by local leaders. She and the House will be aware of the financial situation which we have inherited. I reiterate what I said about the £9 billion committed to the better care fund, which includes £5.6 billion to integrated care boards and around £3.3 billion to local authorities.

[Baroness Warwick of Undercliffe (Lab)]

My Lords, 73% of delayed discharges from mental health hospitals are due to a lack of appropriate supported housing step-down services. With bed occupancy rates of 94%, the increasing pressure is driving up the inappropriate use of out-of-area placements. What plans do the Government have to ensure that there is enough supported housing to meet the demand for step-down services?

[Baroness Merron (Lab)]

My noble friend made particular reference to mental health care. She will be aware of the discussions that took place at Second Reading and in Committee on the Mental Health Bill. I am sure we can all agree that an out-of-area placement is not ideal, although there are some circumstances in which it has to be the case. In the progress of that Bill, we will be attending to the point that she makes. I agree with her that the delays attributed to housing are significantly higher, at 17% for patients who are discharged from mental health settings. This remains a challenge that we are focused on.

[Lord Best (CB)]

My Lords, has the Minister considered the proposal from the Centre for Ageing Better for good home hubs, where older people whose homes are inaccessible, cold and unsafe can get all the advice and support they need on adaptations that can make such a difference—the stairlift, the walk-in shower, better insulation—thereby enabling them to live longer independently and to take the pressure off the NHS and care services?

[Baroness Merron (Lab)]

The noble Lord puts the case strongly for the process of home adaptations. As I have already mentioned, we have provided an immediate in-year uplift to the disabled facilities grants of some £86 million, which will enable people to adapt their homes exactly in the way that the Centre for Ageing Better describes, and I welcome its work. I should say that it is the responsibility of local authorities to ensure that they are supporting applicants through the process of home adaptations as much as possible. We are always looking at ways to improve the process and share good practice, so I welcome the contribution of the Centre for Ageing Better.

[Lord Blunkett (Lab)]

Will my noble friend confirm that very few integrated care boards are either integrated or about care? Much of the work that should be going on is going on with health and well-being boards, which are a combination at place level of the relevant local authority and the health service at the point where delivery takes place.

[Baroness Merron (Lab)]

My noble friend has given me an invitation to agree with him. As he knows, it would be quite inappropriate to suggest that integrated care boards are not integrated or about care—that is their focus—but I appreciate his view on the matter. I do agree with him that much good work is done on the health and well-being boards. This all says to me that local decision-making, and local provision for local populations with their particular dimensions and demands, is the best way forward. My final point on this question is that local systems have to agree plans to achieve more timely and effective discharge from hospital, and to work with local authorities to develop those plans.

[Lord Kamall (Con)]

My Lords, NHS data from last month revealed that there are about 13,800 people who are medically fit for discharge, which is up from 12,000 patients awaiting discharge on 1 December. As other noble Lords have said, we know that that causes a bottleneck in hospitals that is not good for patients while they wait to go home. As has been said, one way to reduce that bottleneck is the greater use of virtual wards, allowing people to stay in their home for longer, to be monitored in their home and to receive care. The Minister has answered this question to a certain extent, but can she tell us more about the Government’s overall plan for virtual wards, not just in this case but for physical and mental health care, in order to ensure that we can get more patients out of hospital beds and into their homes, where they can receive the care they deserve and be constantly monitored?

[Baroness Merron (Lab)]

I am glad that the noble Lord shares my enthusiasm for virtual wards. I shall expand on what they are: they allow people to be not in hospital but in their own home, whether it is their personal home or whether their home happens to be in a care home or some other setting, by the use of technology that allows them to be monitored. I recently saw an excellent example of that, and the liberation that it provides for individuals who would much rather not be in hospital is key. The noble Lord will know that, in the 10-year plan, the move from hospital to community is a key pillar, and we will soon be reporting on that. I certainly share his enthusiasm.

[The Lord Bishop of London]

My Lords, the VCSE sector plays a critical role in discharge planning. The Minister may know of a project in Warrington, where a social prescribing link worker and the VCSE team are integrated into the discharge team, and are therefore able to support people on discharge. The pilot has been positive, not least in that it has reduced readmission into hospital. Could the Minister say what support the Government are giving to integrated care boards so that they can enable this type of innovative provision? Can she reassure us that the aspiration to cut the ICBs by 50% will not impact on that potential?

[Baroness Merron (Lab)]

I very much commend the innovation and the commitment of people locally in the way that the right reverend Prelate describes. ICBs would be wise to work closely with the third sector in order to provide support and to tackle the very real challenges. With regard to decisions on how they use their funding, it is for ICBs to take into account the needs of the population and provide accordingly. As I say, it would be a wise ICB that took advantage of the innovation and the commitment in its local area.

[Baroness Tyler of Enfield (LD)]

My Lords, does the Minister think that there is a case for further guidance or even legislative change to ensure that ICBs—those left standing anyway—are actively improving integration between the NHS and other stakeholders, such as housing and local government? We all understand that social care is vital to successful discharge plans. Is the Minister able to say how many ICBs have senior representation from social care or local government on their boards?

[Baroness Merron (Lab)]

As the noble Baroness is aware, ICBs bring together local government and local health services. While I cannot be as specific as the noble Baroness asks, I will be very happy to look into that. There is not just an expectation but a requirement, as I said, to agree plans locally, which means more timely and more effective discharge. Certainly, the better care fund is crucial, so I feel that we are going in the right direction. This is a matter that we constantly have under review, and we are always looking for ways to improve delivery.

Soft Drinks Industry Levy

Baroness Merron Excerpts

Tuesday 18th March 2025 Lords Chamber

[Lord Rennard]

To ask His Majesty’s Government what assessment they have made of the success of the Soft Drinks Industry Levy in comparison to voluntary sugar, salt and calorie reduction and reformulation measures.

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

My Lords, the soft drinks industry levy has nearly halved the sugar in soft drinks. By uprating the levy, as was announced in the Budget, we will ensure it remains fit for purpose and drives further restrictions. The voluntary programme has delivered meaningful product change and learning on what more is possible. We continue to drive reformulation through promotion and advertising restrictions, which are showing promising results. We will continue this momentum to create a healthier generation.

[Lord Rennard (LD)]

My Lords, the levy has reduced considerably the number of children who would otherwise have been admitted to hospital for dental extractions. Two-thirds of the public support an expansion of the principle of this levy to other high-sugar foods, with revenue raised funding children’s health programmes. Will the Minister commit to supporting the Recipe for Change campaign, which is backed by over 50 health charities and medical colleges, given that if the proposed sugar and salt levy in Henry Dimbleby’s National Food Strategy was implemented it could avoid more than 320,000 cases of type 2 diabetes over the next 25 years?

[Baroness Merron (Lab)]

I understand why the noble Lord raises this: he, like me, wishes to reduce obesity rates. Although the soft drinks industry levy is showing success, it is much harder, as he will be aware, to apply the same in respect of food, simply because of its formulation: there is no other sugar in soft drinks beforehand, whereas there is in food. Although I understand the pressure to do this, and we continue to do more, it is not quite as straightforward to draw the direct comparisons, as I know he understands.

[Lord Rooker (Lab)]

I remind my noble friend that the voluntary system for the reduction of salt, which was organised by the Food Standards Agency before I joined it, was so successful that the World Health Organization held its international conference in London in 2010 because it had been so successful on a voluntary basis. Of course, this was before the noble Lord, Lord Lansley, removed nutrition from the Food Standards Agency. The voluntary system can work substantially.

[Baroness Merron (Lab)]

My noble friend is right: voluntary schemes can indeed work well. In addition to crediting my noble friend for his work with the Food Standards Agency, I can tell your Lordships’ House that voluntary reformulation has encouraged sugar reduction by around 15% in cereals, 13% in yoghurts and 29% in milk-based drinks, and contributed to a reduction in salt intake. Of course more can be done to improve everyday food and drink, and we continue to work by whatever means necessary and within all sectors of industry to do just that.

[Baroness Manzoor (Con)]

My Lords, the Minister will know that sugar has been substituted with glycerol in slushy drinks—these are iced drinks that are particularly for children. This is having an adverse health impact, particularly on young children. According to recent press announcements, a number have been admitted to hospital. Can the Minister say what the Government are doing to educate parents and to address this issue?

[Baroness Merron (Lab)]

I thank the noble Baroness for raising this very important point. The Food Standards Agency is considering very carefully the findings of the review mentioned in the media, to which she referred. In the meantime, parents are strongly encouraged to follow the advice that slushy drinks should not be given to children under four years old. Retailers are also advised to make adults fully aware of this guidance if they seek to buy them for children. In addition, although the symptoms of intake are usually mild, it is important that parents are aware of the risks, particularly at high levels of consumption. I thank the noble Baroness for shining a light on this matter.

[Baroness Bennett of Manor Castle (GP)]

My Lords, research by the First Steps Nutrition Trust shows that parents believe that baby foods are strongly regulated. In fact, there is no legal threshold for the amount of sugar in baby foods in the UK; there is only a threshold for the amount of added sugar. If a large quantity of concentrated fruit juice is added, we end up with baby foods that have implicit labels on them suggesting that they are healthy but they contain more sugar than Coca-Cola. In the UK, 61% of two to five year-olds’ energy comes from ultra-processed foods. Will the Government look to get significant, important regulation for baby foods?

[Baroness Merron (Lab)]

I understand the point that the noble Baroness raises. This is one of the areas that we are looking at. She also raised ultra-processed foods. As she may be aware, the Scientific Advisory Committee on Nutrition has reviewed evidence and stated that further research is needed as to whether ultra-processed foods are unhealthy due to processing or to an unhealthy nutrient content. We have discovered that we need to separate the two. That will also assist on the point that she raised about baby foods.

[Lord Kamall (Con)]

My Lords, although sugar taxes and levies are examples of top-down state solutions to tackle obesity, I will ask the Minister about grass-roots, bottom-up solutions. She will know of non-state local civil society projects that work in communities to encourage healthier lifestyles, such as BRITE Box in south London, which offers recipes, ingredients and budgeting advice to help low-income families cook and eat more healthily. Can she tell your Lordships how the department works with such local projects to tackle obesity and how that best practice has spread to other communities? Could she also write to me with a list of some of the projects that her department is aware of, so that all noble Lords could learn a bit more?

[Baroness Merron (Lab)]

I would be very pleased to write further to the noble Lord on this matter. I pay tribute to all of those community third sector organisations that work in line with government direction to reduce obesity. There are many aspects to this: it is not just about what community organisations can do but, for example, about implementing TV and online advertising restrictions for less healthy food. In all these ways, we will be able to make progress to reduce obesity.

[The Lord Bishop of London]

My Lords, we know well that diet and nutrition, and the infrastructure from which we can access the food that we eat, determine our health. These things continue to be unequal. The proportion of household income required to afford to follow the Eatwell Guide is 11% in the least deprived areas and 45% in the most deprived areas. What consideration will be given in the NHS plan to these wider issues—including the merits of reformulation policies—to improve the critical determinants of health?

[Baroness Merron (Lab)]

The right reverend Prelate is right to speak about the additional levels of ill health and obesity; a child of 11 in the most deprived areas is twice as likely to be obese as those in the least deprived areas. I can certainly assure her that the 10-year plan, which is soon to be made available, will take account of inequalities in all their aspects, including nutrition and food.

[Lord Bird (CB)]

Is the Minister aware that, according to the BMA, 50% of people who suffer from cardiac arrest actually suffer from food poverty in the first instance?

[Baroness Merron (Lab)]

I thank the noble Lord for that point. He will know that the Defra-led food strategy will assist us across government in tackling this.

[Baroness Walmsley (LD)]

My Lords, I will follow up on the question from the noble Baroness, Lady Bennett of Manor Castle, about the regulation of foods for babies and toddlers. Is the Minister aware that some of the fruit and vegetable pouches marketed for babies from four months onwards—despite the advice that they should not be weaned until they are six months old—contain more sugar per 100 millilitres than Coca-Cola? Some toddlers’ teeth are being rotted as they emerge from their gums. When will the Minister take action on this?

--- Later in debate ---

[Baroness Merron (Lab)]

The noble Baroness reminds us that one of the major causes of children having to report to A&E is dental decay. That is why I am glad that we have announced plans for over 700,000 urgent dental appointments, as well as for supervised tooth-brushing. To the specific point that the noble Baroness makes, she is indeed right about the progress that needs to be made. We have recently responded to the House of Lords Select Committee inquiry into food, diet and obesity, as I know she is well aware. We will have a debate on that formal response on 28 March.

Primary Healthcare Facilities

Baroness Merron Excerpts

Monday 17th March 2025 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what steps they are taking to accelerate the construction of primary health care facilities to facilitate patients moving from hospital to community care.

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

My Lords, the Government are committed to fixing the front door of the National Health Service. This includes working with providers to deliver the primary care infrastructure required to enable a neighbourhood health service. We have already taken steps, including providing over £100 million of capital funding in 2025-26 to upgrade GP buildings—the first dedicated national capital fund for primary care since 2020. Spending plans for future years will be confirmed later this year.

[Baroness Pitkeathley (Lab)]

I thank my noble friend the Minister for that helpful answer. The limited capacity of GP premises, as highlighted in the Darzi report, is hindering the service’s ability to meet growing patient demand for face-to-face contact with the general practitioner and the primary care team, as well as obstructing the move to community care. Therefore, I have two specific questions for the Minister. First, will the Government make primary care infrastructure a priority when the very welcome new housing developments are being planned? Secondly, will the Government encourage the use of existing community premises, such as community centres and village halls, which could be temporarily adapted for primary care purposes until sufficient, purpose-built centres are available?

[Baroness Merron (Lab)]

I can assure my noble friend that we are working closely with the Ministry of Housing, Communities and Local Government to raise the importance of primary care provision in the planning process, as my noble friend has highlighted. That is to influence the direction of local plans, as well as maximise contributions from developers. We very much support using existing community spaces, which is a creative solution to deliver primary healthcare services, and we are exploring through the 10-year health plan how to further support the integration of services into the wider public estate to improve access. Indeed, we will consider all solutions, including the ones that my noble friend highlights.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister will, I am sure, agree that, beyond physical infrastructure, one of the most important impediments to ensuring that there is effective integrated care between secondary and primary care settings is the question of regulation—professional and institutional regulation—which is quite different across those institutional boundaries. What plans do His Majesty’s Government have to look at the question of regulation to improve integrated care as part of their broader review of the delivery of healthcare in our country?

[Baroness Merron (Lab)]

The noble Lord is right to highlight regulation. Of course, there are many other aspects beyond physical infrastructure: for example, the use of technology, which also supports the subject on which we are speaking. All these matters are being considered as part of the 10-year plan and I am sure we all look forward to that reporting.

[Baroness McIntosh of Pickering (Con)]

My Lords, is the Minister aware that there is a network of community hospitals which survives? Will she therefore use some of the funds to ensure that these community hospitals remain in place, so that, after a stroke or treatment, patients will be made fit to enable them to return home?

--- Later in debate ---

[Baroness Merron (Lab)]

There are indeed many aspects of community care, as the noble Baroness refers to in terms of community hospitals. I emphasise that we are moving towards a neighbourhood health service, with more care delivered locally to create healthier communities, to spot problems earlier and to help people stay healthier for longer. It is of course up to local health systems to decide how best to serve their local communities, and services will vary according to where they are across the country.

[Baroness Tyler of Enfield (LD)]

My Lords, as part of the shift from hospital to community, what specific plans do the Government have to set up more walk-in diagnostic centres and polyclinics as a way of allowing quicker and easier access to joined-up healthcare for patients, giving them greater control and reducing current pressures on GP surgeries and hospitals?

[Baroness Merron (Lab)]

We will be providing further details in the national implementation programme, but I can say that neighbourhood health guidelines have already been published to help ICBs, local authorities and health and care providers to continue to progress neighbourhood health. We will trial neighbourhood health centres to bring together a range of services, and others that the noble Baroness refers to, to ensure that healthcare is closer to home and that patients receive the care they deserve when and how they need it.

[Lord Kamall (Con)]

My Lords, we know that the Government are keen to encourage more investment into our national infrastructure—which these Benches welcome. Given that, what conversations are the Department of Health and Social Care and the Treasury having with pension funds and other funds on investing in neighbourhood primary health and care facilities, and indeed in other parts of our system of health and social care?

[Baroness Merron (Lab)]

Although I cannot give a specific answer to the noble Lord on that point, I will be happy to look into it. As I mentioned earlier, in our discussions with the Ministry of Housing, Communities and Local Government we are, for example, looking at how we can lever greater contributions from developers who are working on new developments, where they will be providing much-needed health services and infrastructure. So we are taking a creative approach because we recognise the need to do more.

[Baroness Winterton of Doncaster (Lab)]

My Lords, my noble friend referred to creativity and the noble Baroness on the Lib Dem Benches talked about facilities in the community. Well, in Doncaster, we are already ahead of the game, as Mayor Ros Jones has worked with the local health community to provide a “health on the high street” facility, which will not only reduce pressure on the hospital but make it easier for patients to access services and, crucially, help regenerate the city centre. Will my noble friend join me in congratulating Mayor Ros Jones on this initiative, but also work with the local community to address the issue of urgent repairs that are still needed at the hospital?

[Baroness Merron (Lab)]

I am very pleased to congratulate Mayor Ros Jones on this initiative, as I would be pleased to congratulate such initiatives up and down the country. My noble friend is right to talk about the great benefits to local communities, which I myself remember, as will my noble friend, from the previous Government, in terms of walk-in health centres, which made a huge difference. To the point about repairs to the local hospital, it is vital, if we are to create the right NHS going forward through the 10-year plan, that we repair and rebuild the healthcare estate, which has a very considerable backlog maintenance bill after years of underinvestment. That is why the Chancellor confirmed extra investment for the backlog of critical NHS maintenance and repair upgrades.

[Lord Laming (CB)]

Does the Minister agree that success depends on quite sophisticated co-ordination of different services employed in different organisations? That includes not just community nurses but home helps, specialist hospital-type equipment, the whole range of adaptions to property, and the like. Can the Minister assure the House that these things will be properly considered as we go forward to try to improve the movement from hospital to the community?

[Baroness Merron (Lab)]

I certainly agree and can reassure the noble Lord that this is the case. I know that your Lordships’ House will have heard me speak previously about the very considerable investment that the Chancellor committed to in the Budget to provide adaptions for people’s houses in order that they could be cared for at home. I also say to the noble Lord that integrated care systems infrastructure strategies have been developed, which will create a long-term plan for future estate requirements and investment, while community health services also provide for planned and urgent care close to home, including clinics, care homes and, to the point raised by a previous noble Baroness, community hospitals.

[Lord Turnberg (Lab)]

My Lords, the biggest problem is the shortage of GPs. We are losing them faster than we are recruiting them. What plans do the Government have to increase the number of general practitioners?

[Baroness Merron (Lab)]

I am glad to say that recently, as my noble friend will be aware, we concluded the annual consultation on the GP contract and the committee voted in favour of the contract for the first time in four years. That will provide a way forward in terms of strengthening provision, prevention and the integration of services, which I hope will lift morale and the attraction to being a GP. We want to see consistent growth. There are now over 1,000 more full-time equivalent doctors working in general practice compared with January 2024. We have committed to training thousands more GPs across the country and recruiting over 1,000 newly qualified GPs through an £82 million boost to the additional roles reimbursement scheme.

Mental Health Bill [HL]

Baroness Merron Excerpts

Monday 17th March 2025 Lords Chamber

Moved by

[Baroness Merron]

That the Bill be considered on Report in the following order: Clauses 1 to 3, Schedule 1, Clauses 4 to 23, Schedule 2, Clauses 24 to 39, Schedule 3, Clause 40 to 56, Title.

Motion agreed.

Food and Feed (Regulated Products) (Amendment, Revocation, Consequential and Transitional Provision) Regulations 2025

Baroness Merron Excerpts

Wednesday 12th March 2025 Lords Chamber

Moved by

[Baroness Merron]

That the draft Regulations laid before the House on 29 January be approved.

Relevant document: 17th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument). Considered in Grand Committee on 10 March

Motion agreed.

Apricity Fertility Closure

Baroness Merron Excerpts

Wednesday 12th March 2025 Lords Chamber

[Baroness Owen of Alderley Edge]

To ask His Majesty’s Government what assessment they have made of the effect of the closure of Apricity Fertility on 1 January on the patients who were undertaking treatment with them.

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

My Lords, the Human Fertilisation and Embryology Authority advised the department about the closure of Apricity in December. Apricity did not fall under the HFEA’s regulatory remit, as it was only a digital service. I urge anyone seeking fertility treatment to check that the clinic they are using is HFEA licensed. I advise affected patients in this case to check their consumer rights and engage with trading standards, if needed. More broadly, the HFEA is helpfully providing advice.

[Baroness Owen of Alderley Edge (Con)]

My Lords, Apricity Fertility advertised itself as:

“The UK’s Top Virtual IVF Clinic”.


As the Minister pointed out, it was not regulated by the Human Fertilisation and Embryology Authority, which by law can regulate only UK-licensed fertility clinics, which are the premises where treatments take place. Will the Minister commit to a review of the HFEA’s powers to ensure they are appropriate for digital services?

[Baroness Merron (Lab)]

As the noble Baroness will be aware, in November 2023 the HFEA published Modernising Fertility Law, in which it made a number of recommendations for urgent change, including around its regulatory powers. I will meet the HFEA chair and CEO tomorrow, and we will further discuss the regulatory challenges that the HFEA faces. I assure the noble Baroness that the Government are currently considering the HFEA’s priorities, including its role with digital clinics such as the one referred to, should an opportunity for legislative reform arise.

[Lord Winston (Lab)]

My Lords, the noble Baroness, Lady Owen, asks a most important Question, and I am grateful to my noble friend the Minister for answering it at least partially. I argue that much more of an answer is needed. Apricity advertised a success rate that was literally impossible; indeed, it was more than double the national success rate. Again and again, patients are being sucked into in vitro fertilisation—which may not always be the best treatment for them, just because they are infertile—because they think they will have a better chance of success than they actually have. It is time to be much more rigorous. As my noble friend the Minister is seeing the HFEA chair tomorrow, will she ask her how well the HFEA feels it is auditing the results it gets from clinics? In my view, many clinics are exaggerating, in all sorts of ways, what the success rate is.

[Baroness Merron (Lab)]

My noble friend raises an extremely important point, which I will of course cover in my meeting tomorrow. It may be of interest to know that the Advertising Standards Authority and the HFEA issued a joint enforcement notice in 2021 to ensure that fertility clinics and others were aware of the advertising rules and were treating consumers fairly. That remains in place. The ASA periodically reviews compliance with its rules. Its recent review in the fertility sector found far fewer absolute claims than it had found previously and that the level of compliance is good. That is not to say that it is good in all cases, and I agree with my noble friend’s point.

[Baroness Barker (LD)]

My Lords, the law governing human fertilisation and embryology in this country built on the outstanding work of Baroness Warnock. It was carefully crafted so that it rests on principles that endure, but it was designed in such a way that it could be regularly updated to deal with advances in scientific knowledge and changes in society. Does the Minister agree that this is an indication that we have come to a point where that legislation needs to be reviewed? In order to do that, will the Government commit to beginning the process of consultation that must take place before any legislative review comes to this Chamber?

[Baroness Merron (Lab)]

I agree with the noble Baroness’s observations. The legislation goes back to 1990. We are in 2025, and there has been an advent of many new technologies, techniques and business models—for example, the noble Baroness, Lady Owen, referred to Apricity—that were never imagined just a few years ago, let alone in 1990.

The majority of clinics are privately owned. Many are part of large groups with external finance. Elements of fertility care and associated treatments are increasingly offered online or outside HFEA regulation. There is a huge challenge here. That is why we are in discussion with the HFEA, and we will be in discussion tomorrow.

[Lord Kamall (Con)]

My Lords, the Minister will recall that in 2022 the previous Government published the 10-year Women’s Health Strategy for England. During the consultation process, it came out that access to fertility services differs greatly across the country—possibly one of the reasons that many women went to Apricity in the first place. Part of the solution that was proposed to tackle these disparities was a target to establish women’s health hubs. I understand that the current Government have decided not to go ahead with these women’s health hubs. My question is not why, but how the Government envisage tackling these disparities without women’s health hubs. What is the strategy for doing that?

[Baroness Merron (Lab)]

Women’s health hubs—which are a huge success and we continue to support and promote them, without any shadow of a doubt—do not deal with fertility treatment in the way this Question is discussing. I gently point out to the noble Lord that, as he rightly said, commitments were made to improve access to fertility services, which is very variable across the country. They were made under the last Government’s women’s health strategy but, regrettably, were not delivered. It now falls to us to look at how we can improve both availability and quality, and to equalise what is available, which is a huge challenge. This continues to concern me.

[Baroness Deech (CB)]

My Lords, I declare an interest as a former chair of the HFEA. The problem the Minister has referred to is increasing commercialisation. Vulnerable patients are more or less captured by clinics—for example, by being charged ever-increasing amounts for the storage of their embryos. How can the Government get to grips with the market element in an area that is largely private? Can they encourage the NHS? I know the difficulty of taking on more. What legislation can there be to control this commercialisation and the huge amount earned by the private doctors?

[Baroness Merron (Lab)]

The noble Baroness and other noble Lords are quite right in what they are reporting on the change. Fertility treatment is now overwhelmingly obtained through private means. It is in a very different place from the rest of healthcare in our country.

On the point the noble Baroness made—I am grateful for her contribution in view of her previous service in this area—there are many claims made, for example, about egg freezing. It is crucial that anyone considering freezing their eggs understands that there is an optimum age for freezing, that it is a serious medical procedure and that the risks should be taken into account. That chimes with the point made by my noble friend Lord Winston.

The market has changed—it has very much become a market. The demand is huge and has multiplied many times over the decades. We are not in a situation where we have either the regulation or the NHS provision to deal with that. I assure your Lordships’ House that we are working with NHS England, particularly on the variability up and down the country.

[Baroness Manzoor (Con)]

My Lords, the Minister is right that the market has changed, but the legislation has not been kept up to date; nor has it kept up to date with patient expectations, developments and the way those services are being provided for some of these women. Often, some of these women are vulnerable. Can the Minister say exactly what the Government will do to update not only the regulations but the law?

[Baroness Merron (Lab)]

In my discussions, I will consider the publication Modernising Fertility Law, which, as I said, the HFEA put forward in November 2023. In it there are a number of recommendations for urgent change, which I am taking extremely seriously. Most patients are funding their own treatment, which is why we have to make a shift. In 2022, 27% of IVF cycles were funded by the NHS; that figure fell from 40% in 2012. That gives some idea of the scale of the challenge. I consider it unacceptable that access to NHS-funded fertility services is so variable across the country.