New Autism Strategy (Autism Act 2009 Committee Report)

Baroness Merron Excerpts

Wednesday 10th June 2026 Lords Chamber

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

My Lords, I start by thanking the noble Baroness, Lady Rock, for leading this important debate and, as many noble Lords have said, for chairing a committee that was very thorough and gathered powerful evidence, including from autistic people, families, carers and professionals. I too extend my gratitude to all members of the committee. It is a very strong piece of work, which I believe will take us forward.

We welcome the final report and the recommendations and have set out our initial response. Straight away, I should say that I have heard the various views across the Chamber about the quality of the response and I have also heard very clearly the frustration that there is not an immediate strategy to replace this current one. I say that in all seriousness, not least because I will be sharing those views with the Minister now responsible for this very important area, Preet Gill MP. On that point, I apologise to the noble Baroness, Lady Browning, for not having had a response to a request for a meeting with the appropriate Minister. I will indeed pursue this.

As the noble Lord, Lord Addington, said, we turned to the noble Baroness, Lady Browning, as we so often do; I also often turn to the noble Baroness, Lady Browning, and very wise we all are in doing so. The work of the committee is indeed helping us to better understand the challenges, the opportunities and the changes that are needed. Yes, I say to my noble friend Lord Touhig that the work of the committee will absolutely inform development of the revised autism strategy, as indeed it should.

I am very grateful to noble Lords for bringing their personal experience to this debate. The noble Lord, Lord Elliott, was most open about his personal experience and we heard from parents, loved ones and, indeed, grandparents in the form of the noble Lord, Lord Sterling. This brings the subject about which we are speaking very much to life. I do agree that too many autistic people face significant challenges in education, employment, health and wider participation in society. That has lasting impacts on independence and well-being. I very much agree with the noble and learned Lord, Lord Hope, who observed early on in the debate that autistic people are individuals. Again, I very much take that point.

The response to that will be rooted not only in the new strategy but throughout the 10-year health plan and in—as we will see when it comes to this House—the Health Bill, particularly the moves to establish a single patient record, which will overcome a number of the points that noble Lords rightly raised. It is the case that, too often, people are expected to navigate very complex systems rather than simply secure the care and support they need and which would respond to their individual needs. I do not think that is so much to ask, and I am sure the committee would agree, and that does have to change. We are moving towards a needs-based approach, focused on early intervention and joined-up support around individual needs. That is central to our wider reforms, including changes to the SEND system.

The noble Lord, Lord Crisp, spoke about the model of Phoenix schools. I would certainly welcome, as would officials, more information about that. It is good to see good practice in action. I want to acknowledge the important local work that is under way. The noble Lord, Lord Wigley, spoke to this point. All of this is about building more inclusive communities where autistic people can thrive. The work that my noble friend Lady Dacres described in making Lewisham an autism-inclusive borough through its all-age autism strategy, was commendable and echoes with me. “Nothing about us without us” is, I think, good guidance.

The Autism Act was enacted in 2009 and I pay tribute to all those who went before us to make that happen. There have been subsequent autism strategies, but the reality is, as has been observed, that progress has been inconsistent and outcomes have not improved as they should have. We are very well aware—and I certainly am more so today—of the concerns raised about the importance of having an effective national strategy in place. I want to reassure your Lordships’ House that the current strategy does remain in place until it is replaced.

Noble Lords recognise, as I do, that the landscape has changed significantly since the current strategy was published in 2021. The challenges that face the health system now are much more acute. Services are seeing more patients with more complexity, and demand continues to outstrip supply. Indeed, as the noble Baroness, Lady Rock, and other noble Lords said, some 270,000 people are waiting for an autism assessment, and around 90% of them are waiting at least 13 weeks. That is why it is so important that we focus on earlier intervention and help people to get the support they need without necessarily needing a diagnosis as we expect now.

My noble friend Lady Goudie spoke about girls and women facing particular struggles. Data does show that we are seeing an increase in referrals for female diagnosis. There is, perhaps, a suggestion there that increasing awareness of this issue is supporting improvements in this area. I am very much looking forward in particular—but not exclusively—to the recommendations of the independent review on the prevalence of, and support for, mental health conditions, ADHD and autism, chaired by Professor Fonagy. It is expected this summer and will speak to the very point about how we can respond to increasing demand more effectively. It will look at drivers for that demand, about which, we must be honest, there is often not clarity, and I hope that this will greatly assist.

Now to the very important points raised with me about the Government’s plans for a future strategy and the timescales by the noble Lord, Lord Kamall, my noble friends Lady Ritchie and Lord Touhig, the noble Baroness, Lady Rock, and other noble Lords. As I said, we remain fully committed to publishing a revised and, I emphasise, cross-government autism strategy—the cross-government point being another aspect that I know the committee was very keen on. I will disappoint noble Lords somewhat, but I hope I can give reassurance that I am not going to disappoint them too much. In my view, it is important that the timetable for establishing the strategy takes proper account of the timelines of relevant cross-government reviews.

I will come back to this very shortly, but developing the revised strategy—the noble Baroness, Lady Browning, pressed this point—has to be grounded in evidence, shaped by engagement, as many noble Lords asked, and be realistic about the pressures facing the system. Therefore, we have to focus on ensuring that people can access support at the right time. On the point made by the noble and learned Lord, Lord Hope, we need to remove unnecessary barriers in a way that reflects individual needs. That means carefully considering a number of areas, including the recommendations of the committee’s Time to Deliver report, as well as, as I have mentioned, the findings of the independent prevalence and support review, which has not yet been published, and other important cross-government work, again spoken to in this debate, such as the independent Milburn review on the increase in the number of young people who are not in education, employment or training, and the insights from the consultation on SEND reform. All these will help shape the Government’s response and next steps.

Fortunately, we have these things in train and they are reporting soon, but not in time for the end of the current strategy. Therefore, I am not in favour, and I do not think any noble Lord would want me to be, of publishing a revised strategy to meet a timeline that does not now reflect the timelines that are more current, more evidence and more consideration. I want this to be the best strategy we can get. I want it to be a strategy that can deliver. In that respect, I cannot give a timeline, but I have indicated what is being considered and when those matters will be reported on.

I can assure the noble Lord, Lord Addington, my noble friend Lady Ritchie, the noble Lord, Lord Crisp, and other noble Lords, that we are absolutely engaging with those with lived experience. That is key to success. We will also consider the need for a new system to bring together information from autistic people. I think that is work we have to do.

To pick up some other points, I recently announced plans for a new cross-government mental health strategy—that will also be very relevant to this area. That will be published later this year. It will explicitly consider the mental health needs of autistic people and people with ADHD. Together with the autism strategy, all these areas of work, which are very practically focused, will support a more joined-up system for those with neurodevelopmental conditions or mental health needs.

Of course, the autism strategy does not sit in isolation, and we work closely with the Department for Education on SEND reforms ensuring that joined-up support is available across education and health and care services, as noble Lords have rightly expressed. It is key that we have the right support available at every stage of the education of children and young people. My noble friend Lady Antrobus referred to the RSE curriculum. The new RSE curriculum and guidance are quite clear that schools should ensure that subjects are accessible for pupils with SEND. It is ultimately the school’s responsibility to ensure that resources and teaching materials—I heard the point about the need for greater teacher time—are accessible for all pupils and are sensitive to pupils’ needs. I emphasise again that, no matter one’s age, we are all individuals. The consultation on SEND reform has just closed. The feedback is being considered before we set out the Government’s response and next steps. We are also taking steps now. On 5 June, we published guidance for the new experts at hand offer, and we have appointed a national panel of experts to develop new national inclusion standards and specialist provision packages.

I want to refer to some other points that were raised. I am happy to write to the noble Baroness, Lady Hollins, with further detail on her assertion that a simple change to the Care Act to require an anticipatory care plan would be one way to manage that.

I will write to the noble Baroness, Lady Rock, my noble friend Lady Dacres and the noble Lord, Lord Addington, who raised matters relating to the justice system. The final update of the neurodiversity action plan was published in February. It highlights significant progress made across the criminal justice system in supporting autistic people. I should add that to improve prison screening processes and practices, a new additional learning needs tool was introduced in October 2025 as part of the new prisoner education service. The tool identifies adjustments that might support them.

I say to the noble Baroness, Lady Hollins, that our reforms to the Mental Health Act will limit the scope to detain people with a learning disability and autistic people so they can be detained for treatment only if they have a co-occurring medical health condition that requires hospital treatment. That is something we correctly spoke about at some length during the passage of the Mental Health Bill.

The noble Lord, Lord Kamall, pressed home the need for greater training for employers. I am sure that all of us in this Chamber know that employment rates remain significantly lower for autistic people. That is not acceptable. Our £1 billion connect to work programme will support around 300,000 people. This is alongside reforms to Disability Confident. We continue to work with employers to build more inclusive workplaces. Of course, the work of the former Health Secretary, Alan Milburn, through his review will be very helpful in this regard.

The noble Baroness, Lady Hollins, raised the fact that autistic people, especially women, are at higher risk of suicide. I recognise that. In the suicide prevention strategy, autistic people, children, young people, pregnant women and new mothers are priority groups for the provision of tailored and targeted support. On the matter of training, raised by the noble Baroness, Lady Rock, mandatory training on learning disability and autism for health and care staff will support the necessary shift to empowering patients and preventing sickness rather than just treating it. Again, that is key.

I agree with the noble Baroness, Lady Hollins, that avoidable deaths are unacceptably high. We remain committed to reviewing every death notified to LeDeR and ensuring that learning from reviews is shared. On the point about local services, every integrated care board is expected to have an executive lead on LeDeR and to prioritise LeDeRs.

I am most grateful for the questions and for the way in which noble Lords have pressed the importance of the strategy. I accept that. I want to ensure that we get this right. With the assistance of the committee’s report, I know that we will.

Healthy Life Expectancy: England

Baroness Merron Excerpts

Monday 18th May 2026 Lords Chamber

[Baroness Nargund (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and I declare an interest as founder and trustee of the charity Health Equality Foundation.

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

My Lords, the fall in healthy life expectancy over the last decade is unacceptable and underlines the scale and complexity of the challenges we face. Through the 10-year health plan, we are taking action to tackle the drivers of ill health and inequality, including reviewing the Carr-Hill funding formula, to better match resources to need, and creating a smoke-free UK.

[Baroness Nargund (Lab)]

I thank my noble friend the Minister for that response. The Health Foundation’s report, Healthy Life Expectancy Trends in the UK: A Watershed Moment, published in April this year, makes it clear that healthy life expectancy is a key measure of our population’s health. The gap between the most deprived and the most affluent areas has grown, with those in the wealthiest areas now living up to 20 years longer. Social determinants of health affect healthy life expectancy—

[Baroness Nargund (Lab)]

I am coming to that. What plans do the Government have to address the social determinants of health across all government departments, because a single department cannot handle this? How can we close this gap?

[Baroness Merron (Lab)]

My noble friend’s assessment of the situation is right. That is why we are working across government on the wider determinants of health, including matters such as the Warm Homes Plan and the homelessness strategy. Alongside that, the 10-year health plan focuses on prevention and narrowing inequalities. The aim is to improve all conditions that will support longer, healthier lives across the whole country.

[Lord Krebs (CB)]

My Lords, the Minister will be aware that one of the key determinants of healthy life expectancy is diet. In the 10-year health plan, the Government have a welcome section on improving the dietary health of the nation. It was therefore disturbing to note in the Telegraph a few days ago a report that said the Government are going to pull back on these commitments. Can the Minister please confirm to the House that the Government have no intention of pulling back on the commitments to improve dietary health?

[Baroness Merron (Lab)]

It is an important area of government activity and I certainly do not recognise the comments that were in the Telegraph. I can confirm to noble Lords that we have a whole package of measures to tackle obesity, including restricting junk food advertising on TV and online aimed at children and giving local councils stronger powers to block new fast food outlets. That is still the case.

[Lord McColl of Dulwich (Con)]

My Lords, is the Minister aware that there are scientists who are propagating nonsense that nothing can be done about the obesity epidemic because it is all genetic? These people are saying that the individual cannot be relied upon to take action and that it must be the Government who do it. It is complete nonsense, because the individual can take responsibility—and, indeed, millions are taking injections to do that very thing.

[Baroness Merron (Lab)]

I recognise the noble Lord’s point. We are certainly seeking to give individuals the ability to grasp the opportunity to live well for longer and to support them in their choices. For example, in addition to the points I made to the noble Lord, Lord Krebs, we are working on restricting volume price promotions such as “buy three for the price of two” offers on less healthy food and drink.

[Baroness Pidgeon (LD)]

My Lords, given that the UK is an outlier compared to similar countries, what work are the Government doing to introduce proactive, preventive health measures, such as routine health MOTs for people, to try to reverse this trend?

[Baroness Merron (Lab)]

I welcome the noble Baroness to her Front Bench on the important matter of health and social care. I am most grateful for her question. We have to be ambitious, which is what the 10-year health plan is doing, in transforming how we tackle the biggest causes of ill health. We are going to take a whole-society approach and a whole-person approach, rather than dealing just with conditions. To the points made earlier, we will be working with individuals—as in the public—and in partnership with business and civil society.

[Baroness O'Grady of Upper Holloway (Lab)]

My Lords, ever since the Marmot report, we have known that poor-quality employment is a key driver of lower healthy life expectancy. The Employment Rights Act is a big step forward, but does my noble friend the Minister agree that we need action on asbestos removal from workplaces and public places, more boots on the ground in the shape of health and safety inspectors, and a boost to occupational health services in the UK?

--- Later in debate ---

[Baroness Merron (Lab)]

My noble friend is right. I very much welcome the provisions in the Employment Rights Act and in other areas; it is a good example of cross-government working. We are pursuing this through Keep Britain Working, which will reduce economic inactivity and focus on workplace health provision, as my noble friend says. I believe that will help address poverty and support healthy working. All those measures will help healthy life expectancy.

[Baroness Stedman-Scott (Con)]

My Lords, my succinct question is this. Given that healthy life expectancy has fallen despite record levels of NHS spending, with obesity, diabetes and poor mental health continuing to rise, can the Minister explain what specifically will be different in the Government’s approach, beyond simply increasing treatment capacity to prevent more people spending longer periods of their lives in ill health?

[Baroness Merron (Lab)]

As I mentioned in an earlier answer, this is a long-term and complex matter which has developed over a number of years. It is totally unacceptable that a woman in Hartlepool, for example, will enter ill health some 19 years earlier than a woman in Richmond-upon-Thames. It is about embedding action on health in policies across government. However, as I mentioned, it is also about redesigning the system around the three shifts: emphasis on prevention rather than on sickness, in particular, but also a move to community-based health services, so that people can access healthcare where and when they need it, and, of course, digital access, too.

[Lord Patel (CB)]

My Lords, healthy life expectancy is a mix of two data: a more precise life expectancy and a much cruder self-reporting of the stages of health. This leads to a confusing interpretation and therefore is not helpful in policy-making decisions. We have to find and seek better information about healthy life expectancy and the parameters that affect it, to be more effective in policy decisions. Does the Minister agree?

[Baroness Merron (Lab)]

I definitely agree. That is why data, particularly that which drives us to make funding decisions to get funding to where it is needed most, is absolutely crucial. I find the term “healthy life expectancy” more useful than what used to be called “life expectancy”. That, to me, was always only one side of the coin. However, I take on board the point that the noble Lord makes.

[Lord Scriven (LD)]

My Lords, people with a learning disability enter periods of multimorbidity and chronic illness 20 to 30 years earlier than those without a learning disability. What are the Government going to do to stop this national scandal?

[Baroness Merron (Lab)]

I accept that this is completely unacceptable. There are groups, including those the noble Lord rightly raises, which have an even worse healthy life expectancy. As I mentioned, we will be redesigning the system and making the shifts in the 10-year plan, in order that we target the areas and the groups that need it most. I can certainly tell the noble Lord that the most recent prevalence review on mental health will include those who have ADHD, those with autism and those with learning disability. That will take us forward, too.

[Lord Babudu (Lab)]

My Lords, can my noble friend the Minister say how the Government will achieve their shift from treating sickness to maximising prevention, as outlined in their 10-year plan, and particularly how they will shift resources, reporting and other necessary things?

[Baroness Merron (Lab)]

My noble friend is right to ask about maximising prevention, as that will be a key shift in our National Health Service. In addition to the points I have already made, we are working within the NHS to do more to support our approach to prevention. In addition to what I have already mentioned and the system changes, we will, for example, strengthen our vaccination and screening programmes, including by improving the uptake of child immunisation. We are working to improve the detection, treatment and management of the behavioural and clinical risk factors that drive this burden of disease and affect healthy life expectancy.

Miscarriage Care

Baroness Merron Excerpts

Monday 18th May 2026 Lords Chamber

[Baroness Pidgeon]

To ask His Majesty’s Government what plans they have to improve miscarriage care and support.

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

My Lords, miscarriage can have a devastating impact on women and their families, and we are determined that they receive the support they need. We committed in the women’s health strategy to improve care for women, including carefully considering the graded model of care for repeated miscarriage. The National Maternity and Neonatal Taskforce will develop the national action plan to improve maternity and neonatal safety and experiences, and it will follow the pending recommendations of the independent investigation by the noble Baroness, Lady Amos.

[Baroness Pidgeon (LD)]

There are around 250,000 miscarriages in the UK every year. Following the recent Tommy’s Graded Model of Miscarriage Care report, will the Government now review the specific requirement for women to experience three miscarriages before being able to access the support that could help prevent another loss?

[Baroness Merron (Lab)]

This is an extremely important area, and I acknowledge very much that the current situation is not working for women or their families. To emphasise, we very much welcome the report from Tommy’s miscarriage centre at Birmingham Women’s and Children’s Hospital, which is about the effectiveness of its piloted model of sporadic or recurrent miscarriage care. I visited them when I first took office and was very taken by their work. I am glad they have reported, and, as confirmed in the women’s health strategy, we shall be looking very closely at this. It will deal with and refer to the point the noble Baroness makes.

[Baroness Boycott (CB)]

My Lords, one of the issues that is going to come out this week, through a welcome report on Wednesday, is the effect of heat on pregnancies—on miscarriage and on very small babies being born. It used to be thought that this affected only women in very hot countries, but it now is realised that it affects women subjected to heat they are not accustomed to. In other words, it is just as important here as it could be in the tropics. Given that a lot of science now says that we are entering an El Niño period, which could mean tremendous heat towards the end of this year, what are the Government doing to address this and give women advice about hydration, shade, et cetera?

[Baroness Merron (Lab)]

There are a number of causes of miscarriage, as I am sure the noble Baroness is aware, and it is helpful that she brings this point to our attention. In all areas it is very important that we give advice to women about how to manage their pregnancy to—I can only put it this way—minimise the possibility of miscarriage. There is another factor regarding pre-conception healthcare. Of course, many pregnancies are not planned, and our challenge is to ensure good health for women more broadly, in the ways I have described a number of times. But we will be looking at the point the noble Baroness raises.

[Baroness Scott of Bybrook (Con)]

My Lords, given continued reports from women that they are discharged from services following miscarriage with little psychological support or follow-up care, what assessment have the Government made of whether current NHS pathways are meeting the commitments set out in the women’s health strategy? How will the improvements that these women are really looking forward to be measured in the future?

--- Later in debate ---

[Baroness Merron (Lab)]

In terms of the renewed women’s health strategy, we are going further than just mental health, important though it is, and taking a new and better whole-life course approach, right from the availability of contraception all the way through to and including menopause, because this is all part of life’s reproduction journey. That will greatly assist. On miscarriage and mental health, we have established mental health services in all areas of the country, which are available for those with pre-existing mental health needs. Bereavement counselling is also widely available for those who experience baby loss. We have also set up maternal mental health services to provide care for those who have moderate, severe or complex mental health difficulties arising from loss or birth trauma.

[The Archbishop of Canterbury]

My Lords, baby loss can be one of the most difficult experiences for any person, but especially for NHS staff who work in or around maternity and neonatal care settings. Can the Minister outline for us what specific support is in place in the NHS for staff who experience baby loss that recognises this additional need?

[Baroness Merron (Lab)]

The most reverend Primate makes a very sensitive point, which is of course correct. That is why NHS England has published a new policy to support NHS employees who are affected by baby loss, including paid leave. Our development through the Employment Rights Act will apply to NHS workers, including giving leave from work. We are currently consulting on the detail of this. It is about acknowledging the extreme effect on individuals of losing a baby, no matter at what stage.

[Baroness Nargund (Lab)]

My Lords, I welcome the Government’s commitment to review the graded models of care so that women can be helped, regardless of the number of miscarriages. How will the Government make sure that the needed services, particularly for support as well as investigations, are equitable throughout the country and not subject to a postcode lottery?

[Baroness Merron (Lab)]

The 10-year women’s health strategy is absolutely focused on ensuring that services and support are available equally, no matter where people live. They are variable, and that is not where we want them to be. I have just spoken about the bereavement services, for example. As of January this year, all ICB areas are expected to provide a seven-day-a-week bereavement service across maternity settings. That was not in place earlier, and it gives a sense of the trajectory.

[Lord Patel (CB)]

My Lords, in an era of more personalised medicine, it is important to note that the care of women who have miscarried is dependent on several factors: the gestation age when miscarriage occurs, the age of the mother, and any existing diseases. It is not just about the number of miscarriages the mother has had when the investigation starts. There should be more personalised aftercare for every mother who loses a baby.

[Baroness Merron (Lab)]

I hesitate to say “of course”, but the noble Lord is of course right. As I mentioned earlier, there is a range of reasons why miscarriage may be taking place. It therefore requires that whole-system approach, but also the life-course approach that I spoke of. I am also glad that through our research arm, the NIHR, we are funding research through Tommy’s, which we have spoken about already, on the beneficial effects of progesterone, to give one example. It is important that we continue, as we are doing, to invest in this research.

[Baroness Foster of Aghadrumsee (Non-Afl)]

I am sure the Minister is aware that Northern Ireland now provides up to two weeks of statutory leave for those who endure miscarriage before 24 weeks. Are she and her colleagues in government looking at that across the UK?

[Baroness Merron (Lab)]

That is exactly why there is provision in the Employment Rights Act. We are consulting on the detail of how we can most effectively make it work, but it is quite right to do that, and I am glad we are following this example.

[Baroness Deech (CB)]

My Lords, it is widely reported that maternity services are in crisis—in fact, an inquiry is ongoing. Could it be that women suffering from miscarriage get less priority when maternity services are overstretched and as busy as they could possibly be, as we have read? Would it not be better if maternity services were improved once we get the result of the inquiry? Then there would be time and more patience to deal with the women suffering miscarriages, who are probably in the same area of the hospital as the maternity wards.

[Baroness Merron (Lab)]

The noble Baroness, Lady Amos, will report next month, and we are grateful to her for conducting an independent investigation. The National Maternity and Neonatal Taskforce and all its expert reference groups—a number of noble Lords are kindly taking part in that, alongside those with lived experience and clinicians—are getting on with the work of how we improve maternity and neonatal services. We will not have to wait long for the noble Baroness’s report. We will look not just at her recommendations but at where there are gaps and, should reference to miscarriage be one, we will of course seek to fill that gap.

Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

Committee stage
Friday 24th April 2026 Lords Chamber

I am not going to detain the House further— I wanted to give a speech of five to six minutes—but I hope that both the Minister and the noble and learned Lord, the sponsor, will take what I have said from this Front Bench in the constructive way that it is meant, and that they and others will consider carefully how the Bill has progressed and not progressed before taking any further steps in the coming Session.

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

My Lords, as noble Lords are very aware, the Government remain neutral on the Bill and on the principle of assisted dying. This is a Private Member’s Bill, not government legislation. On issues of societal change, as we have discussed, Private Members’ Bills have long been a vehicle to handle matters of sensitivity and important matters of conscience, as in this case.

As I made clear during my remarks at Second Reading and throughout Committee, my role, alongside that of my noble friend Lady Levitt, has been to help to ensure that, if passed, the Bill would be technically and legally workable. Sixteen sitting Fridays were allocated for debate on the Bill and, as my noble friend the Chief Whip has said consistently, it was for the sponsor of the Bill and your Lordships’ House to determine how to use that time.

We know that assisted dying is an emotive topic, and we recognise that there are deeply held views on all sides of the debate. We have spent many hours debating this important matter and, while noble Lords across the House have often differed on matters of principle and policy, I believe that there is a desire in the House to do the best for people at the end of their lives, at their most vulnerable.

[Baroness Coffey (Con)]

My Lords, this has been a really helpful debate. I am quite sad that we did not get to Committee at all, but never mind. I am conscious that we are in a Session where eight Private Members’ Bills have become Acts of Parliament, and I place on record my thanks to the Ministers, in particular the noble Baroness, Lady Blake of Leeds, who has often stepped in for Ministers. I am grateful to her for that.

According to information provided by the House of Lords to me—it could give me information covering only to the end of February—651 Peers have turned up on one of the Fridays we have spent considering this Bill, 87 of us have turned up for every single Friday and 16 of them have spoken today. Some 516 Peers attended at least one day at Second Reading, while 327 turned up for both. There has certainly been interest in this Bill but, I am sure and appreciate, there have also been frustrations on both sides that we could not make more progress in that time, particularly during the 13 days in Committee—recognising that the House did not go into Committee today.

One of the things that it is important to consider is how we address things more quickly. I do not just mean looking at the brevity of speeches. In fact, on the first day in Committee, the noble and learned Lord, Lord Falconer of Thoroton, thanked me for the brevity of my speech. We need to see how we can more quickly address things such as DPRRC reports, particularly when we debate Private Members’ Bills. I am conscious that the noble Lord, Lord Pannick, referred to several things in that report, and I know that the noble and learned Lord, Lord Falconer, has acted on some of them—although perhaps not to the committee’s satisfaction. However, in the committee’s second report, there remain three clauses that it felt should be removed from the Bill. The noble Baroness, Lady Finlay, the noble Lords, Lord Goodman and Lord Rooker, and I had done quite a lot of work trying to address the DPRRC’s recommendations, including coming up with potential for others in that regard.

There has been only one point today when I thought Standing Order 31 might need to be invoked. We should reflect that we have been able to do this, even when it has got a bit tense. I assure the House that I have been working on spreadsheets and trying to get more groups together to try to get through this. I have actually been surprised that we have not got through that many groups on a Friday when I have been encouraging people to make progress, because I believe it is important we do so. As I say, however, I have no doubt that a lot of this has been done with great sincerity. With that, I beg leave to withdraw my amendment.

Women’s Health Strategy

Baroness Merron Excerpts

Thursday 23rd April 2026 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I thank the Minister and I, too, welcome the women’s health strategy, as it includes many important objectives. In communities up and down the country, we have seen the devastating toll of sustained failures to invest in and deliver better women’s health. Women’s lives, families and economic productivity are damaged when they do not receive treatment in a timely way. Indeed, this also happens when menopause difficulties are ignored. This is because vital services remain understaffed and underfunded, while women and girls go without the care they need.

In 2022, we had the previous women’s health strategy, which had similar important goals to this one with similar delivery mechanisms and the same reliance on local systems to make it happen. Yet four years on, the problems remain stubbornly in place, with half a million women suffering long waits for gynaecology, patchy access to services, women reporting that they are not listened to, women not being given pain relief when they need it and serious conditions diagnosed too late. These facts must give the Government pause for thought that perhaps things need to be done differently this time.

Medical misogyny is still a perverse and unacceptable norm in the health service and that requires a culture change, which is notoriously difficult to achieve. How does the Minister’s department plan to go about it?

This strategy is being implemented when the NHS is already stretched and ICBs are facing cuts while, at the same time, taking on some of the responsibilities of the disappearing NHS England. Now we also have soaring inflation, due to Trump’s war in Iran. In this climate, can we reasonably expect the strategy to deliver meaningful change? I really hope so.

Although the issues affecting women’s health generally are numerous, the NHS failures in maternity services are the most widely reported and deeply shocking. Review after review has uncovered the same failures across the country: a failure to listen to women, a lack of time for training, inadequate staffing levels leading to staff burnout, a lack of proper assessment, poor management of risk and a failure to learn lessons when things go wrong. All this is leading to a rise in perinatal mortality, with the figures showing inequality between different groups, such as those on lower incomes and some ethnic minority groups. How will that be tackled by the strategy?

That is why the Liberal Democrats recently launched our maternity secure package to make Britain the safest place in the world to give birth. We want every maternity unit in the country brought up to a good or outstanding level of safety. That could be done by guaranteeing one-to-one midwifery and specialist doctors on every unit. Will the Minister consider incorporating these proposals into the new strategy?

On medical misinformation, many people now get their health advice online, particularly via social media. Long waits for NHS services and GP appointments are pushing people into getting their so-called information this way, but advice on those platforms does not adhere to clinical standards or guidelines, which is leading to rampant medical disinformation, with sometimes disastrous results. There is some evidence that this is a particular issue in women’s health, where gaps in scientific knowledge and public awareness are being exploited. Does the Minister have any plans to tackle that?

It is possible to fight back. In order to be helpful, we are calling for the following for the Minister’s consideration. The first is a new kitemark for health apps and digital tools that are clinically proven to help people to lead healthier lives, regulated by the GMC. The second is a big effort by the NHS, with a ring-fenced budget, to dominate the health advice social media ecosystem and algorithms, with clinically approved information in plain English. That could improve patient care and save staff time and costs. The third is a new verification requirement for any social media account claiming to be written by a medical professional.

I have a few more questions before I finish. In line with the 10-year health plan’s objective to make care more local, is the Minister confident that women in every area will benefit from a family health hub, as promised, without the threat of closure or cuts, especially in this time of reduced resources for ICBs?

How will the new system linking feedback from patients to provider funding work? Will the results for each unit be made public? Will improved staffing be funded to achieve the promise that women no longer face long waits for diagnosis for conditions such as endometriosis? Will we be able to hear from the Minister in the education department about the promised menstrual education programme to ensure that girls are better equipped to recognise the difference between healthy and unhealthy periods, and will the programme be evaluated by the girls receiving it? Finally and most importantly, will women themselves be involved in developing the implementation plans for the new measures in the strategy and coproduction of their communication with other women?

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

I thank the noble Lord and the noble Baroness on the Front Benches for their warm welcome for this renewed women’s health strategy. It represents a major shift in this country and, as the noble Lord, Lord Kamall, said, it recognises the fact that women’s voices have not been heard. It is shocking, although sadly not surprising, to know that some eight out of 10 women report not having been listened to. The noble Baroness, Lady Walmsley, talks about a culture change. The biggest culture change that we can make is to embed women’s voices into women’s healthcare, and that is exactly what we will do.

This strategy gives women and girls voice, choice and power over how they receive their healthcare. When we say that we are transforming care as part of the 10-year health plan, we mean it. I absolutely agree with the noble Lord that strategy is one thing, but delivery is another.

I was asked why this is different from the 2022 strategy. Let me first acknowledge the importance of the 2022 strategy: it was the first time we had a women’s health strategy. I spoke to the women’s health ambassador, Dame Lesley Regan, about this, and she told me that, with this renewal, we have embedded women’s healthcare in the NHS in a way that has never happened before. I have been moved and struck by the responses I have had from stakeholders, women, parliamentarians—the list goes on—because their voices were heard.

I will pick up some of the points; I am sure that a number of the points raised will come up. The matter of waiting times is key. They have improved, as the noble Lord, Lord Kamall, said—the number of patients on gynaecology waiting lists is down by over 25,000 in the same period—but there is much more to do. If I had to make just one point about this women’s health strategy, it would be that this is not the end of it but the start of the continuum of work we have been doing. How will we drive down waiting lists? I am very excited to say that, when we launch the NHS online hospital next year, we will prioritise gynaecology pathways. It is one of the limited number of pathways that there will be.

We are prioritising gynaecology for treatment in surgical hubs. We are piloting gynaecology pathways in clinical diagnostic centres, which are now in place up and down the country. We are increasing relative funding to incentivise more gynaecology procedures, as and when they are clinically appropriate. Those things are very practical and, alongside shorter waits and more convenient gynaecological care for patients, they will make that shift not only in practice but in culture.

One way in which this strategy is different from the 2022 strategy is in its considerable emphasis on measuring impact, which noble Lords have asked for. If we cannot measure something, we do not know what it is. There are three overarching measures of success: reversing the decline in healthy life expectancy, which was seen to decline in the 2010s; improving healthy life expectancy in the poorest regions to at least 61 years of age; and reducing the time that women spend in poor health, particularly for women experiencing the greatest health inequalities. That will be measured in the short, medium and longer terms. I would be happy to provide further information if required.

Women’s voices are a key focus, again in both practice and culture. We are establishing a women’s voices partnership, which means that women’s organisations, particularly those representing the more marginalised, will be able to influence national decision-making. We have described it as a direct line to Whitehall; in other words, this is not the end of the conversation. We have consulted very widely and will build on what was done with the 10-year health plan—that will continue. This has been welcomed.

In particular, we are introducing patient power payments as a trial. We will see how this goes, and I look forward to monitoring it. It will link provider funding to women’s experiences, particularly in gynaecology services, and whether a service is found wanting. The noble Lord asked about including those who are often excluded, and I absolutely agree with him. Again, culturally—to the noble Baroness’s point—women will not just have to come forward with a complaint. They will be asked, “What is your experience of care?” That is crucial. It may be that the care was excellent but the experience was terrible, and I think many of us will know about that. If that is the case, the provider will have money withheld. As I said to a former Health Minister, how do you make real change? You do it through finance, funding and systems. The money will be withheld, but it will come back into the improvement of those services. So women will not lose out, but that provider will have its feet held to the financial fire.

On the important matter of redress, we are carefully considering the work done by the Patient Safety Commissioner, and I am glad that she welcomed the women’s health strategy. I re-emphasise my deep sympathy with those who have been harmed, and I recognise the harm to those individuals and the families. We continue to look at the recommendations for redress and, as soon as we are able to make a comment, we will of course do that. In view of the time, I will just say that reducing inequalities is hard-wired throughout the women’s health strategy.

[Baroness Verma (Con)]

My Lords, on osteoporosis and post-menopause in particular, we could save a lot of money in the health service if interventions came in earlier. I am very concerned that we do not talk enough about this, and we certainly are not looking particularly at lower-income households and women, especially from minority communities, who do not always have diets that enable their bone health to be good. Will the Minister tell us what she is doing there?

[Baroness Merron (Lab)]

I would be pleased to. This is an important point because MSK conditions disproportionately affect women. We are investing in diagnosis, and this financial year we are funding 21 new DEXA scanners in priority locations. That will mean some 60,000 scans per year, so we will be upping the game in that respect. On the noble Baroness’s important point, we aim to use polygenic risk scores to identify those at higher risk. It is about being proactive, not reactive. A study by Our Future Health, which is currently focused on cardiovascular disease, will be expanded to osteoporosis and dementia in the future. As your Lordships’ House knows, we will roll out fracture liaison services in every part of the country, and we have set an expectation for ICBs to roll out community service models in line with the 10-year plan.

[Baroness Blackstone (Lab)]

My Lords, I declare an interest as the chair of the Royal College of Obstetricians and Gynaecologists trust board, which greatly welcomes this strategy. But will the Minister agree that a well-resourced workforce is vital if we are to deliver it? In this context, is she aware that an RCOG survey finds that one in five obstetricians and gynaecologists is considering leaving the profession, citing burnout, poor working conditions and, above all, staff shortages. It would be helpful if she could tell the House, in this context, exactly when the workforce plan that I know she intends to publish will actually be completed and come out. I am sure she will agree that this plan is absolutely central to delivering the new strategy that we all welcome so much.

[Baroness Merron (Lab)]

I thank my noble friend for echoing the warm response we have had from the Royal College of Obstetricians and Gynaecologists and from a number of the other royal colleges. I put on record my thanks to the royal colleges, including RCOG, for their engagement throughout to help us get to where we are. That is another reason I have confidence in this renewed strategy.

I absolutely agree with my noble friend about the centrality of the workforce and the need for a comprehensive workforce plan. The trajectory, which I looked into, is on the way up for consultants in obs and gynae: we have 3.8% more than we had in 2025 and—I was rather shocked by this figure—81.5% more than we had in 2018. That is not to say the matter is over. The workforce plan will be published in the spring—we are currently in that season, so that gives some idea to noble Lords. We have discussed in this House many times how long spring goes, but we are definitely still there.

I have just one other point. I do not wish to speak for my noble friend Lady Amos, who is conducting an independent inquiry into maternity, which the noble Lord, Lord Kamall, also referred to, but I am sure she will have a number of things to say, including about workforce.

[Lord Patel (CB)]

My Lords, my interests are well known in regard to women’s health. I congratulate the Minister on this report, which I think is a good one. The gaps are in how, in some places, it will be delivered on. But I also recognise her personal commitment to improving women’s health, and I applaud that.

I hope she will forgive me, but I observe that the strategy is called The Renewed Women’s Health Strategy for England, so there is a suggestion that there was one before. And the Command Paper number is 1558. That was the year Queen Elizabeth I came to the throne, so I presume the strategy had not been renewed since then—but I joke.

The important point I want to make is related to research. Many of the issues recognised in the report are because of failure of research, conducted over a long period of time, in better understanding the biology and molecular basis of these diseases. They are treated empirically, and when they are treated empirically, the treatment cannot always be right. We need a strategy in research that focuses over a longer period on better understanding the biology of some of these diseases and finding treatments for them. One way to do this is not by project grants in areas of research, as this report suggests, but by promoting long-term research through what are known as programme research grants. These are given over a longer period of time and competitively allocated into academic institutions to address the issue of understanding the biology of diseases in women’s health and find treatments.

Polygenic risk scores sound sexy, but they will not be the answer. They are exactly what they say they are: they are based on scores. Some of them are evidence-based, and some are not. What we need is better evidence. My suggestion and question to the Minister is this: would the Government look at the possibility of investigating, with their research institution, developing programme grant funding for a longer period for research in women’s health? If she would like a more detailed conversation, I would be delighted.

[Baroness Merron (Lab)]

I am very grateful, as ever, for that offer and the engagement of the noble Lord. To his point about Command Paper 1558, I do not think that is the year the first one or this one were published. I understand there have been that many Command Papers, but this is a cracking one, and I am glad that the noble Lord has welcomed it.

Research is extremely important, as the noble Lord identified. Through the strategy, our approach will be to research and development that actually works for, but also empowers, women. That is why I am glad we will be launching a femtech challenge fund. We want to accelerate the adoption of innovations and make sure they transform women’s healthcare. There is also an accelerator for female founders, and that is also key. I can confirm that the NIHR will be applying its new sex and gender policy. That will make sure that research is inclusive—as it has not always been in the past, as the noble Lord says—and is representative of women, and I welcome that.

On the point about the long-term research and programme grant, as we develop this work I will ensure that my colleague, Minister Ahmed, builds this in. I also offer the noble Lord a discussion, because this is an important point.

[Baroness Sugg (Con)]

My Lords, I welcome the commitment in the strategy to women’s health hubs:

“Where high quality women’s health hubs exist, they will continue to lead service delivery. In other areas we anticipate there will be a dedicated space within broader neighbourhood health centres”.


However, the guidance for neighbourhood health centres states that gynaecology is a minimum requirement, which is welcome given the waiting lists, but the women’s health hubs are not. Will the Minister explain the Government’s plan for women’s health hubs? How are they supporting and expanding the ones that are open, and how are they ensuring that women across the country do not face a postcode lottery for care?

[Baroness Merron (Lab)]

The whole point about the strategy is to ensure that the last point about a postcode lottery does not apply. Access to NHS Online will help hugely with that because it will not matter where you are. If you are referred to the NHS online hospital, you will be able to access the best without initial travel. That will help hugely.

On women’s health hubs, we are building on the pilots that were established. We are now asking integrated care boards to integrate women’s healthcare properly into neighbourhood health centres. It is a big push in the 10-year health plan and, obviously, because this is aligned with it in the women’s health strategy, it is about neighbourhood health, which I know the noble Baroness is a strong voice for. We will also develop more guidance for integrated care boards about how they provide quality and the right amount of speedy and appropriate healthcare for women in neighbourhood settings, which may well be through women’s health hubs. They have taught us a lot. I think we can probably move even further than women’s health hubs, so in that respect the pilot has been extremely helpful.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in responding to the Front-Bench questions, the Minister referred to holding providers’ feet to the financial fire. I believe that she was referring to the part of the strategy that says it will empower women to have a stronger say by asking them to say whether, based on their experience, money should be withheld from providers or where it should be invested. This is returning to the idea of competition, which has done such damage to our health and education systems. Surely if a service is struggling, it needs support; taking money away from it is going to be a real problem. We know that services very often struggle in the most economically deprived areas. Does the Minister agree that reducing funding has never improved a medical system or made it safer, more accessible or better?

[Baroness Merron (Lab)]

That is an interesting invitation to consider. It would probably be helpful if I reiterate or explain better the points about the patient power payments. As I said in response to the Front Benches, its strength—by the way, I emphasise that it is a pilot—is that women’s voices are the voices that are least heard, and we know that creates the biggest problem in women’s healthcare. We know that just asking women what they think—we will be doing that, and we will be transparent in publishing the results, which will drive improvement—will not be enough. The reason for the financial point is that if the provider—it could be a private or a public provider—is not providing the right service then why can women not be heard on that? What will happen is not a cut in funding but the direction of an amount to go into the improvement of the service. In other words, at present there are no consequences for giving poor service. I do not see why women should have to put up with that.

[Baroness Nargund (Lab)]

My Lords, having served as a front-line doctor in women’s health for more than 40 years, 30 of them as a consultant gynaecologist in the NHS, I warmly welcome the new women’s health strategy and congratulate my noble friend the Minister on her efforts in making it happen. I also applaud the Government for the commitment to address the gender health gap and to tackle health inequalities in our country. Will the community hubs function as genuine one-stop clinics, with ultrasound and other facilities, to give women the diagnosis that they need without any delay, and will they take into account the needs of the local population so that women from lower socioeconomic backgrounds and ethnic minorities are not left behind?

[Baroness Merron (Lab)]

I am glad that my noble friend, with her professional experience, welcomes the women’s health strategy. I assure her that community diagnostic centres are absolutely key, as I mentioned earlier, to the ambition and intent to shift care closer to home and improve women’s experience. By their very design, they are streamlined and more convenient; they offer a wide range of tests, often in a single visit and, increasingly, same-day testing and consultation, where that is clinically appropriate. There are about 170 CDCs operating across the country; many have extended hours to fit around people’s lives—and, on the point about inequalities, we are working with local systems to make sure that they are located and developed according to the needs of the population.

[Baroness Altmann (Non-Afl)]

My Lords, I, too, welcome the Government’s women’s health strategy. I know that the Minister is passionate about it.

I want to return to the first question, on osteoporosis. In her answer, the Minister talked about the rollout of fracture liaison clinics across the country—Scotland and Northern Ireland already have 100% coverage. She mentioned the 10-year plan but did not mention that by 2030 the Government still intend to have rolled out FLCs across the country. Can she confirm that that date still exists and is still a commitment? I welcome the DEXA scanners, too—but could she comment on the comments made by some radiographers that there are staff shortages in operating those and say whether there is anything that the Government can do about it?

--- Later in debate ---

[Baroness Merron (Lab)]

I am pleased to confirm to the noble Baroness the date of 2030, which she rightly gave. I thank her for her welcome for the strategy and kind comments.

On the matter of the workforce, I again refer to the workforce plan, which we will see shortly; it will take account of the very point that she makes. I also refer to the use of technology, because this is not about standing still—it is about enhancing what technology we use, which will drive productivity improvements. With the kind of improvements that we have been talking about, we estimate an up to 21% increase in productivity, which will make a big change and take pressure off the workforce.

[Baroness Hyde of Bemerton (Lab)]

My Lords, I, too, warmly welcome this strategy and thank my noble friend the Minister for all her hard work and persistence with it. It touches on many aspects of my experience but, in the interests of brevity, I shall focus my questions and comments today on endometriosis, having waited eight years myself for diagnosis. I am delighted that the strategy includes a new programme to help young girls to grow up understanding menstrual health and when to seek help. Knowing when to seek help would have saved me many years of monthly agony, vomiting and fever, convulsed on a cold bathroom floor. I note the commitment that women with fibroids and endometriosis will be listened to at first presentation. I have had many bad experiences of clinicians over the years, so I ask my noble friend how we ensure that primary care practitioners listen at first presentation and how we embed that so that future generations of primary care practitioners continue to do so, to save many women the kinds of experiences that I and other people I know have had.

[Baroness Merron (Lab)]

I am sorry to hear of the experience my noble friend has had, and I am sure continues to have in some way. Her experience is reflective of so many women. The education programme for girls about their menstrual health, in which we are investing an additional £1 million, will be delivered through schools and community settings and is absolutely important. If I had to say one thing about the strategy, I would say to women—to us—that we do not need to put up with this. In saying that, you do not always know what is normal, and that is where education comes in and why this is so crucial. Heavy periods are potentially a sign of a number of conditions, including endometriosis, fibroids and others. We will also be working with GPs to improve diagnosis, and we have already introduced “Jess’s Rule”, where, if somebody presents three times with the same or an exaggerated condition, the GP will be required to review it.

[Baroness Shawcross-Wolfson (Con)]

I would like to add my thanks to the Government and the Minister personally for the commitment and work done to renew the women’s health strategy. Other noble Lords have mentioned maternity services. Could the Minister tell us a bit more about the timetable for the conclusion of the review from the noble Baroness, Lady Amos, and how the new maternity and neonatal taskforce will then translate her recommendations into action and fully integrate maternity and neonatal services into this women’s health strategy, as the Royal College of Midwives has called for?

[Baroness Merron (Lab)]

I thank the noble Baroness. The noble Baroness, Lady Amos, has recently published an interim report. She has been meeting hundreds of families and the national call for evidence is still going on. In the next few months, she will give her final report. The Secretary of State has already chaired a new maternity and neonatal taskforce to develop a new action plan.

We have also not waited to take action on maternity and neonatal care. We have recruited 800 more midwives. We have invested over £140 million to address critical safety risks in terms of the estate, and we are also rolling out guidance to tackle the leading causes of maternal death. This is absolutely crucial and that is why it is taking such a high priority.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026

Baroness Merron Excerpts

Tuesday 21st April 2026 Lords Chamber

Moved by

[Baroness Merron]

That the draft Regulations laid before the House on 26 February be approved.

Relevant document: 54th Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 15 April.

Motion agreed.

Cancer Outcomes in the UK

Baroness Merron Excerpts

Tuesday 21st April 2026 Grand Committee

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

My Lords, I congratulate the noble Lord, Lord Patel, on securing this excellent debate. I thank him for bringing his considerable expertise and careful consideration—as he always does, as other noble Lords have said—to these matters. He has assembled a pretty daunting selection of noble Lords, for which I am also grateful.

I thank all noble Lords for their contributions, which have been incredibly well informed, personally felt and thoughtful. There is much that I will share and examine further with my ministerial colleagues. Sharon Hodgson, the Minister for Public Health and Prevention, is driving forward the implementation of the cancer plan. To pick up the specific point about GPs, I note that Stephen Kinnock, the Minister for Care, is the responsible Minister for that area; I will raise the searching comments from the noble Baroness, Lady Gerada, with him.

I appreciate how personal and affecting the debate is for so many—if not everybody—whether they have said it or not, either directly or indirectly. That has inspired us much. By using the word “inspired”, I am quoting the noble Earl, Lord Howe; I was delighted to hear him talk about the cancer plan as an “inspiring read”—he really should review books—and “excellent”. The noble Earl’s assessment of it being a jigsaw is absolutely spot on, and that has been acknowledged throughout.

I will do my best to respond to a number of points. I suspect that I will not manage to do so entirely, but I hope noble Lords will be assured that their comments and questions will be taken up.

For me and noble Lords here today, strategy is one thing but implementation is the main thing. Many noble Lords, including the noble Baronesses, Lady Bottomley and Lady Bloomfield, the noble Lord, Lord Patel, and others challenged the point about implementation, so I will speak briefly about that. There will be a reformed national cancer board. It will be accountable for delivery and include cancer experts. It will track progress, update Ministers and monitor the impact, including—following the points raised by my noble friend Lady Nargund—by dealing with inequalities; that will be key in its monitoring. Updates will be published annually on the national cancer plan’s progress. I look forward to more challenge and engagement from noble Lords in relation to that.

On outcomes, as we have heard, the best way is to diagnose and to treat early to improve outcomes, which is why the cancer plan sets an ambitious goal to meet all cancer waiting times standards by 2029. We are already making strides towards this goal—not least by reducing the NHS waiting list overall by 405,000 since July 2024—but we have a very long way to go in this area of cancer.

The point about inequalities—whether we are talking about race, deprived communities or any other significant factor—came up so much, and rightly so. The noble Baronesses, Lady Redfern, Lady Bottomley and Lady Nargund, and the noble Lord, Lord Patel, among others, referred to this. As was said, the improvement of care for deprived, disadvantaged or less equal communities will be monitored through the NHS cancer waiting time standards. Data is published at integrated care board and provider level, and the NHSE acute provider table of all 134 providers supports this transparency. It is about getting attention to where it is needed most.

The cancer plan’s central ambition is to transform survival rates, committing to 75% of patients diagnosed from 2035 being cancer-free or living well within five years. What an ambition that will be to achieve. It will be the fastest rate of improvement in cancer outcomes this century and lead to an additional 320,000 lives saved over the course of this plan—and of course, for every life saved, many more are affected.

On diagnostics, one way in which we can achieve our ambitions is by improving cancer diagnosis in the community—the noble Lord, Lord Taylor, spoke to this point. As noble Lords have acknowledged, last week we announced plans to open four new community diagnostic centres in England over the next year, while also announcing that a further 32 of the 170 CDCs that are currently providing valuable diagnostic capacity will be expanded and enhanced. They are a major move towards a neighbourhood health service.

By extending new capacity—which was referred to by the noble Baroness, Lady Bloomfield—we are also optimising our cancer screening programmes to catch it earlier. I make particular reference to HPV, which was raised by the noble Baronesses, Lady Watkins and Lady Walmsley, and the noble Lord, Lord Patel. From this year, young people who missed out on the vaccination at school can have it administered from a pharmacy. That is to help us move to the elimination of cervical cancer by 2040. I really welcome that. It is about recognising that some people have missed out and providing the service easily and locally in the trusted pharmacy.

My noble friend Lady Ramsey and the noble Lord, Lord Stevens, referred to the national lung cancer screening programme. This will be fully rolled out by 2030, inviting more than 6 million people and identifying at least 23,000 cancers at an earlier stage. I am glad that the noble Lord, Lord Stevens, made the point that those who are more disadvantaged are benefiting from this to a greater degree. Disadvantage is being matched with greater and disproportionate—as in the right amount of—care and attention, and I hope we will see more of that.

On the matter of treatment, I say to the noble Baroness, Lady Redfern, that we will be taking a new approach: more patients will be able to access specialist training centres; by 2028 the NHS app will be the front door for managing our healthcare, and it will have a particular resonance for cancer care; and by 2035 we will bring together genomic and lifestyle data with the all-important single patient record, which will provide the kind of joining up that noble Lords have referred to.

I turn to the important matter of workforce, which was referred to by many noble Lords, including the noble Baroness, Lady Walmsley. I share the frustration of the noble Earl, Lord Howe, about the effect of industrial action on the service to patients and the kind of progress that we seek to make.

The noble Baroness, Lady Walmsley, almost asked me, “When is spring?”, and my noble friend Lady Blake whispered, “It’s still quite cold outside”. But there is indeed to be the publication of the 10-year workforce plan, which will set out a multi-disciplinary approach and will pay greater attention to the role of the workforce. I very much look forward to it supporting this cancer plan, as well as others.

My noble friend Lady Rafferty asked about the training of clinical staff. We will establish new national training standards for surgeons, in particular surgeons in robotic surgery. Over the first three years of the cancer plan, we seek to create some 5,000 learning and training opportunities for people per year in cancer-critical roles. That shows its importance in our approach.

As noble Lords have said, we have to take steps to seize and embrace research breakthrough. I am sure that the noble Lord, Lord Stevens, will take this back, but Cancer Research UK has rightly pointed out that, if we shift the dial on outcomes, that requires us to target rarer cancers, which noble Lords have referred to, where progress has often been slow. As your Lordships will know, we are fully implementing the Rare Cancers Act and are glad to do so. That will make it easier for patients to take part in cutting-edge clinical trials, the importance of which my noble friend Lady Paul spoke to. I can tell my noble friend Lady Warwick that we will appoint a national specialty lead who will advocate for rare cancer patients and oversee the delivery of research in England.

A new cancer trials accelerator will increase the speed and reach of trials. Up to 10,000 personalised cancer vaccine doses will be delivered through clinical trials by 2030. To respond to my noble friend Lady Paul, the Government have committed to reducing the set-up time for clinical trials to under 150 days, to earn the UK the real honour and practicality of being a world leader. We will streamline the implementation of proven technology, as well as boosting access via our new national healthtech access programme.

Just as we are targeting rarer cancers, we will also target specific groups—to which I have already referred—to ensure greater progress. That requires the use of data and data collection, which the noble Lord, Lord Kakkar, spoke about. The national cancer plan includes, for example, real-time pathway analytics, streamlined cancer metrics to expose unwanted variation, which is absolutely crucial, and providing trusts and cancer alliances with more granular and actionable data. Without data we cannot target where we need to go.

As noble Lords know, April is not just part of spring; it also marks the publication, last week, of our renewed women’s health strategy, in which we set out actions to expand genomic testing for those with a lifetime risk of breast and ovarian cancers. We will also look to improve the detection of endometrial cancer. I am grateful to my noble friend Lady Nargund, who spoke to the important matter of gynae cancers.

On linking women’s health to AI, I hope noble Lords will recall that we now have the EDITH—Early Detection using Information Technology in Health—trial, which will see nearly 700,000 women take part in a world-leading trial to test whether AI can increase the number of cancers detected in the national breast screening programme. To the point on workforce, this will also mean that the radiographers will be key, but we will need not two but one for each case—that is how we can harness AI. I agree with the noble Lord, Lord Evans, about the great improvements that AI can make, including in back-office functions. My noble friend Lord Drayson also spoke to the importance of harnessing the benefits of AI, and I assure noble Lords that we will continue to do that.

I will make a couple of final comments on innovation, productivity and funding, but, before I do, I will comment on prevention. Noble Lords have referred to this. We will stop as many cancers as we can by—these are just examples—cracking down on illegal underage sunbed use, eliminating cervical cancer through HPV vaccination, tackling obesity and creating the world’s first smoke-free generation. I am grateful to noble Lords, including the noble Baronesses, Lady Ramsey and Lady Walmsley, for welcoming the Tobacco and Vapes Bill. It is a step change in our work and will save thousands of lives.

On productivity, and on a point raised by the noble Lord, Lord Patel, we estimate that we will see up to a 21% gain in productivity as we invest in digital and robotic automation-enabled histopathology—pronouncing that is where I need the noble Lord, although it is also my writing—pathways, with further capability enhancement by AI. So we are not standing still on productivity and workforce, and I agree with the noble Baroness, Lady Finlay, about the importance of bringing together strategies and approaches. We will achieve in the cancer plan only by doing that. The noble Baroness rightly raised the issue of palliative care.

On funding and resources—the noble Lord, Lord Kakkar, raised this—there are significant commitments, and I will mention just some of them: £10 million a year for children and young people to be able to access their treatment without financial penalty; £200 million for cancer alliances to improve performance; and £2.3 billion in diagnostics, which should deliver 9.5 million additional tests by 2029. I think that gives a sense of our commitment.

My noble friend Lady Ritchie asked about resourcing for innovation. I assure my noble friend that we are working with education colleagues in the way that she asked, and there will also be a plan in place, which we are developing, for how we resource innovation. I am grateful for her comments.

This was such a rich debate. I feel I have picked out themes, and I will reflect, as will my ministerial colleagues, on the very real and informed points that noble Lords have made. The thing I did sense is that we all want this national cancer plan to work. I look forward to continued scrutiny, contribution and expertise from noble Lords. Lastly, I once again thank the noble Lord, Lord Patel.

Midwives: Graduate Guarantee

Baroness Merron Excerpts

Tuesday 21st April 2026 Lords Chamber

[Baroness Walmsley]

To ask His Majesty’s Government what progress they have made towards achieving the graduate guarantee for newly qualified midwives.

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

My Lords, the graduate guarantee creates additional temporary registered midwife roles and enables newly qualified midwives to apply to join the NHS workforce. This supports the transition from education to employment. Since September, over 850 of these roles have been created, backed by £8 million. This includes part-time and full-time jobs. NHS England is working closely with universities and employers to align graduate numbers with vacancies through improved workforce planning, enhanced support for students and co-ordinated local recruitment.

[Baroness Walmsley (LD)]

I thank the Minister for her Answer. The graduate guarantee is very welcome but, already, 31% of newly qualified midwives do not have a job or are on fixed-term contracts. First, how will the Government ensure that workforce planning is aligned to the number of posts available so that the skills of newly qualified cohorts are not wasted? Secondly, given the concerns about unsafe workloads in midwifery and maternity services, how will midwives have the time to discuss with their clients health issues such as diet and vaccination?

[Baroness Merron (Lab)]

On the second point, the noble Baroness is quite right: it is important that midwives have that time. That is what we anticipate will be the case—I refer her to the forthcoming workforce plan, which will improve the situation. With regard to the position that the noble Baroness describes, I agree that this needs sorting out, and I recognise the figures that she has shared. That is why we have brought in the graduate guarantee scheme—so that we can get people from their training and education into the NHS and can ensure that midwives are recruited on the basis of looking to the future rather than of the existing headcount. So we are future-proofing this.

[Baroness Rafferty (Lab)]

My Lords, the graduate guarantee applies also to nurses but, sadly, the provision is quite patchy. What steps are the Government taking to support employers to recruit newly qualified nurses?

--- Later in debate ---

[Baroness Merron (Lab)]

Through NHS England’s student movement tool, forecasting on the workforce and national analysis are being undertaken to assess the areas of risk—my noble friend is right to raise those concerns. That is shared with NHS England’s regional teams so that they can manage and monitor workforce positions directly with providers.

[Baroness Manzoor (Con)]

My Lords, I welcome the comments made by the Minister. However, she will be aware that, as well as having a shortage of midwives in place—and we have seen the terrible effects of poor service delivery in antenatal and postnatal care—we have a significant shortage of health visitors, who give advice regarding immunisations, development, feeding and so forth. Some of those health visitors have caseloads of up to 1,000 families. That is not sustainable and, frankly, is quite dangerous. What are the Government going to do to address this?

[Baroness Merron (Lab)]

Again, I refer to the forthcoming 10-year health and care workforce plan, which will take a multidisciplinary approach. I certainly share the noble Baroness’s views about the value of health visitors. As we move services into the community and develop the neighbourhood health service, that will require the greater use of roles such as health visitors. Ultimately, this is a local matter about local employment of staff to meet local need.

[Baroness Burt of Solihull (LD)]

My Lords, given the concerns about unsafe workloads in maternity services, how do the Government justify a situation where qualified midwives are available but not being brought into permanent roles?

[Baroness Merron (Lab)]

That is the very reason why we have brought in this guarantee, because it provides an immediate route into employment for those who are newly qualified. A number of things about that are important, including reducing the risk of graduates leaving the profession because they cannot find jobs. The reason why there are an additional 850 time-limited or temporary roles is to get people in under existing budgets but also to get staff to enter the workforce where there are not immediately permanent vacancies. It is a strong way to address the point that the noble Baroness raises.

[Lord Kamall (Con)]

My Lords, as we have heard from other noble Lords, we have two situations. One is that 31% of newly qualified midwives have been unable to secure posts; the other is that we have well-documented shortages. The Minister talked about the graduate guarantee, but are there any other initiatives available to midwives and nurses who may wish to take up these jobs? Other noble Lords have talked about the number of hours that midwives have to work. How do we make sure that we retain existing midwives so that some are not leaving by one door as others are coming in by another?

[Baroness Merron (Lab)]

I was about to answer the noble Lord’s first question by talking about retention and then he helpfully raised retention. Retention rates for existing midwives are improving, as is the number of midwives. That includes a mentoring scheme, strengthening advice and support on pensions, flexible retirement options, and publication of menopause policies and guidance to support midwives to stay in work. We also have unit-based retention leads to focus on this and provide support to midwives. I think that is a really important initiative.

[Lord Sahota (Lab)]

My Lords, given that the National Health Service is always short of nurses and midwives, do the Government have any plans to bring in any overseas nurses and midwives to fill the jobs?

[Baroness Merron (Lab)]

The issue is more a misalignment of numbers than a straightforward shortage, as the number of midwives has increased. There was a 2.6% increase in January 2026 compared to the year before, so the trajectory is good. The misalignment, as I have explained, is that we are dealing with a situation where midwives are being trained but they cannot get jobs. That is what we have to bring together and what we are doing through the graduate guarantee scheme.

[Baroness Prentis of Banbury (Con)]

My Lords, does the noble Baroness share my concern that there is an increasing trend towards encouraging women to give birth in large hospital centres further from their homes and does she agree that an increase in midwives—as well as in obs and gynae professionals of all sorts—would enable us to behave more like France and Germany do, for example, and aim for units of between 2,000 and 4,000 births a year?

[Baroness Merron (Lab)]

Obviously, what matter most are patient safety and patient satisfaction, and I am very much looking forward to the independent report from my noble friend Lady Amos in this regard, because she is focusing on that. I am sure that she will consider the best place. I cannot comment on whether the noble and learned Baroness’s assertion will be the best option here, but there was a separate call for evidence under the workforce plan so that we could hear directly from maternity and neonatal staff.

[Lord Wigley (PC)]

My Lords, does the Minister accept that while patient safety is, of course, the primary thing, there is also a very strong obligation to ensure that promises made to young people going in for training are fulfilled? We are aware of these challenges in Wales. Surely there needs to be a more integrated approach to workforce planning to ensure that in future we do not get this embarrassing situation.

[Baroness Merron (Lab)]

I certainly agree with the noble Lord. I know he will understand that I can refer only to England in this context, but I take his point about Wales. I mentioned earlier that this situation very much needs sorting out and that is what we are doing. We are working closely with employers and universities. We are improving workforce planning, enhancing support for students and co-ordinating more local recruitment activity. As I have outlined, plenty of work has been undertaken and I am sure we will continue to monitor and do more.

Tobacco and Vapes Bill

Baroness Merron Excerpts

Consideration of Commons amendments and / or reasons
Monday 20th April 2026 Lords Chamber

Moved by

[Baroness Merron]

That this House do agree with the Commons in their Amendments 28A, 28B, 28C, 29A, 29B and 29C.

28A: Clause 43, page 22, line 9, leave out “Section 37 has” and insert “Sections 37 and (Fixed penalty notices: Wales) have”

--- Later in debate ---

29C: Clause 44, page 22, line 36, leave out “section 38 has effect as if it” and insert “sections 38 and (Fixed penalties in Wales: use of proceeds) have effect as if they each”

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

My Lords, Amendments 28A, 28B, 28C, 29B and 29C were tabled by the Government in the other place to correct an error arising from amendments made in your Lordships’ House on Report. Without these amendments, trading standards officers in Wales would lose the ability to issue certain fixed penalty notices for the existing offence of proxy purchasing for a short period of time. The error would also have prevented trading standards in Wales from being able to issue fixed penalty notices for the sale of tobacco to those under the age of 18 before the smoke-free generation policy takes effect on 1 January 2027. This is in contrast to England where trading standards will be able to issue fixed penalty notices for these offences. This was obviously an unintended error and, if left unresolved, would have created a difference between the enforcement regimes in England and Wales. I am pleased therefore that we have been able to resolve the issue with these six narrow amendments, and I hope noble Lords will be supportive in their considerations. I beg to move.

[Lord Naseby (Con)]

My Lords, I understand the background, having been involved in the early stages of the Bill. Nevertheless, it upsets a great many people in that industry that the Government have not listened to the strong representations of the retailers and those who have knowledge of the industry. We have a situation now where we have a £200 penalty, which is huge by any yardstick, for the revised incidences. We are expecting a new Welsh Government fairly soon, and they may not be too happy with what has now been amended. However, I will say no more than that I think the time will come when the present Government and—I am sorry to say—those on my own side who believe in this idea as a whole will accept that it is totally out of date in relation to what is happening in the world. What we really need is a proper understanding of how we educate people not to take up smoking.

[Lord Kamall (Con)]

My Lords, I should be clear that, given this Motion brings forward an amendment that corrects a technical error and the Government have explained their rationale, we will not oppose it.

[Baroness Merron (Lab)]

My Lords, I again thank your Lordships’ House for its attentive scrutiny throughout the passage of the Bill. I pay tribute to the Front Benches and to noble Lords on all sides of the House.

I say to the noble Lord, Lord Naseby, that, as I have explained and his own Front Bench has confirmed, these are purely technical amendments to make this area of the Bill workable. It is a matter that had much debate. I assure the noble Lord, as I have done on a number of occasions, that we have worked closely with retailers and will continue to do so. I appreciate that he is not a supporter of the Bill, and it is on that point that I differ with him.

I urge all noble Lords to accept these amendments and note that this afternoon marks the end of the Bill’s journey through Parliament. This is a landmark Bill that will create a smoke-free generation, and it will be the biggest public health intervention in a generation. I assure all noble Lords that it will save lives. I commend it to the House.

Motion A agreed.

Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026

Baroness Merron Excerpts

Wednesday 15th April 2026 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Health and Social Care Act 2008 (Regulated Activities) (Amendment) Regulations 2026.

Relevant document: 54th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, this statutory instrument makes an important change. It will amend the 2014 regulations so that the treatment of disease, disorder or injury, known as TDDI, is brought within the regulatory scope of the Care Quality Commission. This change will be for the treatment of disease, disorder or injury provided in sports grounds or gymnasiums, or under temporary arrangements at sporting or cultural events, where it is delivered for the benefit of those taking part in or attending those activities.

Let me start by clarifying what this is and what it is not. This regulated activity relates not to the task being carried out but to who is doing it. It is the assessment and treatment of physical or mental state when provided by a specifically defined list of healthcare professionals, as per the CQC’s website. The scope of this activity requires those carrying it out to be listed healthcare professionals registered with the appropriate professional body, such as the General Medical Council, the Nursing and Midwifery Council or the Health and Care Professions Council. When a healthcare professional uses their professional title, qualification and skills to assess and treat a person for a disease, disorder or injury, they must be registered with or employed by a company registered with the CQC.

Providers carrying out the treatment of disease, disorder or injury at events may include independent ambulance services that employ paramedics, doctors and nurses, and which are commissioned to attend an event such as a music festival, marathon or football match and be on hand in case anyone there experiences a medical emergency.

Perhaps I can give some context. Members will recall the tragic events of 22 May 2017, when the Manchester Arena bombing killed 22 people and injured more than 1,000 others. The subsequent inquiry uncovered serious failings, including inadequacies in the provision of healthcare services at the arena. The inquiry noted that these shortcomings may have been present at other venues across the country, in part because of the absence of appropriate regulation. A central finding of the inquiry was absolutely clear: the Department of Health and Social Care should consider changes to the law to enable the CQC to regulate healthcare delivered at events. The CQC has itself outlined additional concerns about the quality of care provided at events. It has heard serious allegations of unregulated provision resulting in severe patient harm.

The Government, as noble Lords would expect, are committed to acting on the inquiry’s recommendations and strengthening public safety. I recognise that these changes are overdue, but it was important that they be carefully considered in order to understand the impacts. I am pleased that they have now been laid before us.

To turn to what the amendment will do, the 2014 regulations exempted the treatment of disease, disorder or injury provided at sports venues or gymnasiums or under temporary arrangements from regulation. This SI removes this exemption. It will bring the provision of this treatment at events into line with provision in hospitals, clinics, ambulances, GP surgeries, community services and care homes where it is already registered. This means that any provider delivering the treatment of disease, disorder or injury at an event must register with the CQC and must comply with the same robust regulatory standards that apply elsewhere in the health system. Of course, some of the providers will already be registered to provide this treatment in other settings, which will make the process quicker for them.

I should say to noble Lords that there has been some misunderstanding about what is covered by

“the treatment of disease, disorder or injury”.

It includes a wide range of treatments, from emergency interventions to ongoing care for long-term conditions. I wish to be clear that the treatment of disease, disorder or injury does not include first aid. First aid remains outside the scope of CQC regulation.

By making these changes to the 2014 regulations, the Government will make true our commitment to fulfilling the recommendations of the Manchester Arena inquiry and the drive to improve patient safety. I beg to move.

[Lord Lansley (Con)]

I shall speak briefly to this statutory instrument and ask a number of questions, if I may, to which I hope the Minister will be able to respond. I think that I understand the structure of what is proposed and the exclusion of first aid so that it is not covered, but when I look at the providers that are likely to be affected, I am trying to work out carefully which are the providers concerned. I am assisted by a friend who is part of the Faculty of Sport and Exercise Medicine and who said that it had undertaken a survey.

It seems to me that many of the people who responded to that as healthcare professionals may well be working in registered providers already, so they may be concerned about the need to register in relation to the services that they provide at events but in fact they do not need to register. However, the event organisers themselves may need to register if they bring healthcare professionals on site in order to provide services that go beyond first aid at their event. I am trying to understand how, when the department went out and identified 89, or whatever the number was, potential providers that were not already registered, it ended up with a figure of 36, which seems very low. It certainly bears no comparison to what those who are working in the sector believe would be the number of presently unregistered providers. We need to understand who these 36 are, the character of those providers that the department has identified and why there is such a discrepancy between that and what others have been saying. I would be grateful if the Minister would tell us much more about that.

As a practical example, are all football clubs, or the major football clubs in the Premier League, the Championship and so on, already registered with the CQC? Clearly, they, as organisations, provide continuing healthcare to their players. Do we not need to worry about any of that? Is an event like one of the big festivals that take place already registered, because it has put a team together in order to provide more than simply first aid? Perhaps we are worrying about a need for registration when actually we do not need to worry so much.

I have only one other question. An essential part of the follow-up to the Manchester Arena inquiry was the preparation of an event healthcare standard. Would the Minister be kind enough to update us on that process? Where does it stand and when might we see its publication for consultation?

--- Later in debate ---

[Lord Kamall (Con)]

A number of noble Lords have raised concerns, and I am going just to outline or repeat a few of them. The first is that the department’s own assessment acknowledges that the costs associated with registration and ongoing compliance are estimated, for newly regulated providers, as being between £99,400 and £994,000 per annum. They are quite accurate figures, but let me rephrase that: it could be nearly £100,000 or nearly £1 million. We know that most forecasts are wrong, but a factor of 10 is rather a wide range. I have to admit that that raises concerns about the understanding of these regulations.

But more concerning is the evidence from the Faculty of Sport and Exercise Medicine suggesting that many clinicians working in event medicine may reconsider their involvement if these regulations are implemented as proposed—as the noble Baroness, Lady Grey-Thompson, raised. As other noble Lords have said, events medical providers support the principle of these regulations but warn that they could lead to a reduction in workforce capacity, with the potential unintended consequence of reducing safety. My noble friend Lord Herbert referred to that unintended consequence.

There are also concerns that, where providers withdraw from delivering this regulated medical care, events may instead have to rely on first aid provision, as we have heard from a number of noble Lords. That falls outside the scope of CQC regulation. Well-run events such as Wimbledon, Royal Ascot, the Silverstone Grand Prix and the Glastonbury Festival currently manage most medical incidents on-site. But we could see a shift away from properly staffed medical provision, which risks increasing demand on already stretched NHS services off-site.

Stakeholders, including the Sport and Recreation Alliance, have highlighted a lack of comprehensive engagement with the sector to date. Given the unique characteristics of event medicine, it is essential that any regulatory framework be developed in close consultation with those who deliver care on the ground. However, I have been told by some medical professionals that the CQC is being selective in who it wants. I was told a similar story to that told to my noble friend Lord Markham: when three or four CMOs asked for a joint meeting, the CQC person refused and insisted that they wanted to meet only one of the CMOs. When I hear this, frankly, it gives me no confidence in the CQC or its consultation process. Let me be clear: I do not use those words lightly, but the CQC should be doing proper consultation and not refusing meetings.

I recognise the efforts by the previous and the current Government and the CQC to fix its previously poor reputation. Last year, in the mental health debates, these Benches supported the Government in resisting the appointment of a separate mental health commissioner, because we agreed that the mental health part of the CQC was getting its house in order. Indeed, I met today with some people from the CQC on transitional care, and I was very impressed with them.

However, when I am told that for this regulation the CQC suggested that an additional 36 organisations would require registration, compared to an estimated 25,000 in the survey by the Faculty of Sport and Exercise Medicine, this, as my noble friends Lord Lansley and Lord Markham, and the noble Baroness, Lady Grey- Thompson, said, demonstrates a massive gap in understanding that needs to be addressed. Once again, I am sorry when I say this, but it gives the impression of the CQC being out of its depth.

I am sorry if that is not exactly the ringing endorsement that the Minister was hoping for, but I also know that she has been willing in the past to meet to discuss legislation, and we have worked constructively together in the time we have both been on our respective Front Benches. So, in that constructive spirit, I will make three suggestions, which in fact touch upon those that that were made by other noble Lords.

First, we need to see meaningful CQC engagement with sector representatives, our national governing boards, the chief medical officers in sports groups, the Faculty of Sport and Exercise Medicine and the Faculty of Pre-Hospital Care to ensure that any inspection framework is sector-specific and not simply lifted from the hospital sector. Imposing a CQC regulatory framework suitable for hospitals is inappropriate for pop-up clinics at park runs, cycle races or pitch-side at rugby. Let us be frank: the CQC does not have any existing knowledge of working in these sectors at that level, and it should be listening rather than seeking to impose.

Secondly, we should consider expanding the current employer/employee CQC exemption to athletes, performers and officials whose healthcare providers meet strict occupational health standards regardless of the patient’s contractual arrangement, as other noble Lords suggested.

Thirdly, although I understand that the Secondary Legislation Scrutiny Committee has raised concerns about the time taken to bring forward these regulations, given that the CQC is not exactly inspiring confidence from those who organise sports and other events, could the Government possibly ask the CQC to wait until the event healthcare standard being led by the Faculty of Pre-Hospital Care has been published? In addition, if and when it becomes apparent that the CQC has indeed underestimated the size of this and the cost to the sector, would they be prepared to perhaps extend that December 27 deadline, if appropriate?

However, really to emphasise the point that the Government are listening, I know we have asked for individual meetings, but a much better suggestion would be a round table with interested noble Lords, with the relevant Minister from the department—obviously we would love to have the noble Baroness, Lady Merron, there as we always enjoy her consultations— and the CQC, so it can stop being selective about who it speaks with and can actually listen to CMOs and other medical experts from across the sector. They are not doing this to score points; none of us is doing this for that reason. We agree with the principle, and we want this to work, whichever party and whichever Bench we work on, but we are concerned that the CQC’s approach will lead to the unintended consequence of the withdrawal of appropriate medical provision at these services.

It is quite clear that all noble Lords support the goal of improving public safety at events. All noble Lords have heard the concerns from public events medical experts, and all noble Lords hope that the Minister has listened to their concerns and will agree to the modest requests they have made in today’s debate.

[Baroness Merron (Lab)]

My Lords, I am most grateful for the debate today. I will make a few general points.

I very much welcome the points and the concerns that noble Lords have been willing to outline. I also want to acknowledge that I have heard the understanding of why we are doing this. I know that we all understand the intent, and I understand the numerous questions— I make that as a comment, not as any criticism—trying to understand the workability. I very much welcome them. What I take from this debate and what I will share with Minister Ahmed as the Minister for Patient Safety is that clearly there is considerable concern. To refer to what the noble Lord, Lord Addington, said about fault lines, I think this is about fear of fault lines, but even fear of fault lines is fear enough, so I absolutely take that point.

Let me say at the outset that, if noble Lords had not asked for it, I would have suggested having a round table for interested Peers. It will indeed include officials from the department and the CQC. Ministerially, because it is Peers, I would want to be there in any case. I am sure that Minister Ahmed would want to be there too, but my anxiety is to get on with the meeting, so I will happily have a discussion with him, but I certainly want to be there. If noble Lords remain concerned about a lot of the points, we can tease them out there.

--- Later in debate ---

[Lord Markham (Con)]

If I may, I hope this may be helpful: the confusion that I have heard is over whether a doctor, for a CQC registration at their GP surgery, can use that to volunteer on a point-to-point racecourse, as an example, or whether they have to separately register with the CQC to be a volunteer on the racecourse and pay the £1,000. Again, if that comes in the letter, that is fine, but that is one of the main points of confusion.

[Baroness Merron (Lab)]

On all these areas, as I said, I am happy to meet with noble Lords in person. To be honest, I think that that would be more helpful, not least because we are talking about scenarios and we have a note of the questions that noble Lords are raising. I would be delighted to go through them. Again, in the responses today, I am probably going to be repeating some of what I said earlier and I am not sure that that will take us forward, so I would rather that we held those points for a meeting, if noble Lords are agreeable.

With that, I thank noble Lords. This has been a very valuable debate. It shows the work that needs to be done and we will be pleased to do that. I thank all noble Lords for their considered contributions and support of the principle of why we are here.

Motion agreed.