Maternal Mortality

Baroness Merron Excerpts

Tuesday 20th January 2026 Lords Chamber

[Baroness Hughes of Stretford]

To ask His Majesty’s Government what action they plan to take in response to the finding in the MBRRACE-UK report Maternal mortality 2022–2024, published on 8 January, that the maternal death rate in pregnancy rose by 20 per cent between 2009–11 and 2022–24.

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

My Lords, MBRRACE’s report highlights the need to improve maternity safety, to which this Government are fully committed. We have commissioned an independent investigation that will present recommendations in the spring, while the National Maternity and Neonatal Taskforce, chaired by the Secretary of State, will transform these into a deliverable national action plan to drive change. In the meantime, we are taking various actions, including piloting Martha’s rule and expanding the maternal medicine networks.

[Baroness Hughes of Stretford (Lab)]

I thank my noble friend for that Answer. She will know that the Conservatives promised to halve maternity mortality by 2025. Instead, as the report shows, it has risen substantially, with stark disparities for older women and those from BME and disadvantaged backgrounds. Between 2021 and 2023, over 600 women died either during or shortly after pregnancy—a tragedy compounded by the fact that, in the majority of cases, this was from a preventable complication of the pregnancy itself. I know the Government are taking certain actions, to which she referred. Those are welcome, but they are not being applied consistently in every area. More importantly, trusts are not required to inform NHS England of the plans they are making. In short, I say to my noble friend that there seems to be a lack of robust oversight. How will the Government ensure that the standards and new procedures that they want to implement will be implemented effectively by every trust and in relation to every pregnant woman?

[Baroness Merron (Lab)]

My noble friend is right to use the word “tragedy” in respect of maternal deaths, particularly those from preventable causes. She is also correct that, sadly, most aspects of the maternal safety ambition that was set under the previous Government are very unlikely to be achieved. We have to make sure that, for any future target, the system can deliver. As one example, the maternal care bundle sets clear standards across all services for implementation by NHS providers and commissioners, and is focused very much on the main causes of maternal death and harm, as my noble friend asks for.

[Baroness Gohir (CB)]

My Lords, the Government have launched a maternity inquiry, but we have already had lots of maternity inquiries and reports from the charity sector, such as the Muslim Women’s Network— I declare my interest as its CEO—Five X More and Birthrights, all with similar findings and recommendations. Instead of having more inquiries, why do the Government not just get on with it and implement actions? What do they expect to find that they do not already know? Can the Minister share how she is implementing existing recommendations?

[Baroness Merron (Lab)]

I understand what the noble Baroness is saying and her frustration, which I am sure many of us share. The purpose of the investigation by my noble friend Lady Amos is to pull together all the learning and all the inquiries. She has, for example, given a real voice to those affected, speaking to 170 affected family members. Those voices are what has been missing, and that cannot go on. We are determined to draw a line under where we have unfortunately been and to move forward, while taking direct actions, including, for example, a national programme to support struggling trusts to make improvements.

[Lord Scriven (LD)]

My Lords, recent Health Service Journal investigative journalism has found that the Chief Midwifery Officer wrote to trusts last year identifying gross failures in home births safety, yet the Government have chosen to keep this information private while women are pushed into unsupported births. Is it acceptable for NHS England to hide this evidence of systematic safety risk from the public when the home birth services of 14 trust have effectively ceased to exist, despite the legal duty to provide them?

[Baroness Merron (Lab)]

I am not fully up to speed with the article that the noble Lord raises, but I undertake to look at it and get back to him, because this is a very important matter.

[Baroness Manzoor (Con)]

My Lords, many NHS trusts are facing deficits in midwives. There is not a sufficient workforce. What are the Government doing to tackle this issue? New parents, and new mothers during their birth, are not being supported, and there are significant problems as a direct result of this.

[Baroness Merron (Lab)]

Midwives are absolutely crucial, and I pay tribute to them and to the wider maternity team. As of October 2025, there has been an increase of some 3.6%—that is 878 more midwives—compared to October 2024. Importantly, we are seeing the introduction of a range of initiatives to improve retention in the maternity workforce, including in midwifery. That will include mentoring and giving better advice and support on pensions and flexible retirement options, because we are keen to retain the long years of service that many midwives and other staff have.

[Lord Kamall (Con)]

My Lords, touching partly on the question from the noble Baroness, Lady Gohir, data from MBRRACE-UK shows that black women are three times more likely to die during pregnancy or childbirth than white women. Do the department and NHS England have any evidence on the reasons for these disparities that the Minister can share with the House? Will she tell noble Lords how NHS England and the department intend to tackle these disparities?

[Baroness Merron (Lab)]

I am glad to say that my noble friend Lady Amos will be very much focusing on this area. I referred earlier to the maternal care bundle, which focuses on the five main causes of maternal death and harm, as well as on setting up best practice. A number of the risk factors are particularly associated with groups who live in areas of greater disadvantage, those who have pre-existing conditions and, as the noble Lord rightly says, sadly, black women, who are three times more likely to die—something that is totally unacceptable in any day and age, but certainly now. We cannot allow this to go on. That is why we have picked up a key recommendation from the Black Maternal Health inquiry for mechanisms for surveillance of severe maternal morbidity. The first data are expected in the summer.

[Lord Patel (CB)]

My Lords, a confidential inquiry into maternal deaths is a good indicator of the quality of maternity services. The fact that the rate has gone up from 9 per 100,000 in my time to 12.8 now suggests that there is a failure of maternity services. To use an example, 155 women who had a history of psychiatric problems—mental health problems—died within a year of delivering a baby. That compares to the total number of 611 maternal deaths. It is a significant number, and yet the specialist perinatal maternity health services that are supposed to look after women with a mental health history have failed. It should be a duty on ICBs to produce a plan, so that women with a mental health history are looked after and have a care plan during pregnancy.

[Baroness Merron (Lab)]

This is absolutely crucial. I welcome that, as of June last year, maternal mental health services are available in all parts of England. We also now have 153 operational mother and baby unit beds providing in-patient care to women experiencing severe mental health difficulties during and before pregnancy. In addition, mental health services are available for women who have pre-existing mental health needs, as well as for those who experience challenges because of their pregnancy or labour. The GP check-up six to eight weeks after birth is absolutely crucial.

[Baroness Buscombe (Con)]

My Lords, something is happening. In the last decade or so, I have been watching the extraordinary increase in the number of healthy young mothers having C-sections. Why is this phenomenon—if I might call it that, though that is probably the wrong word to use—happening? Is this something that is part of the inquiry? Are people trying to understand whether it is because those in the midwifery world are afraid that natural births lead to more deaths?

[Baroness Merron (Lab)]

This may be something that my noble friend Lady Amos looks at. She is very much focused on maternity services, which will include mortality and looking at the range of options. The noble Baroness will understand that there is an important balance to be struck between the voice and choice of patients, which we respect, and safety, which must be paramount.

Rare Cancers Bill

Baroness Merron Excerpts

2nd reading
Friday 16th January 2026 Lords Chamber

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

My Lords, I am delighted to pledge the Government’s full support for this Bill. It is very much aligned with our commitments, it strengthens the research ecosystem and, most importantly—I agree with many comments today—it gives hope to patients and families affected by rare cancers. I am glad that the Bill has the support of the noble Lords, Lord Kamall and Lord Palmer, on behalf of their Benches.

I am most grateful to noble Lords for their points and proposals today. I will be reflecting on them after this debate with the Minister in this area, Ashley Dalton MP, and also Zubir Ahmed MP. I was very touched that so many Peers shared their personal experiences, whether their own or those of their loved ones. I feel that the Bill stands in tribute to the memory of so many, including the late Baronesses, Lady McDonagh and Lady Jowell. It also stands in tribute to the memory of so many who I believe have been brought into the Chamber today by the very touching words and reflections of so many noble Lords. I realise how difficult that is.

I congratulate my noble friend Lady Elliott on her tenacity and clarity in bringing forward this important Bill before the House. I associate myself with the thanks to the many campaigners and charities who have worked on this for so many years, and I know they will continue to do so. My noble friend Lady Morgan made that point particularly clearly. I say to the House, and particularly to the noble Lord, Lord Kamall, that the Government are quite clear that no patient should be left behind simply because their cancer is less common.

The national cancer plan is soon to be published— I heard what the noble Lord, Lord Polak, hopes will be in there, and he will not have to wait too long for it—and it will build on the progress of this Bill. They work very well together, because they both seek to improve outcomes for cancer patients across the country, including those with rare cancers. It is by fighting cancer on all fronts—prevention, diagnosis, treatment and research—that we will make that change.

Much has been said today, and rightly so, about a number of cancers, but I want to say a particular word on how little is currently known about the prevention, diagnosis and management of brain tumours. They remain one of the hardest cancers to treat, and we also know how crucial early diagnosis is for improving survival rates for all cancers, including brain tumours. That is why we have committed to an additional £6 billion capital investment on new diagnostic, elective and urgent care capacity. The noble Lord, Lord Patel, called for genome sequencing for brain tumours. I can say to him that the national cancer plan will include detail on how we ensure that patients have access to the latest treatments and technology, including genetic treatments.

Important points were raised by the noble Baroness, Lady Grey-Thompson, and the noble Lord, Lord O’Shaughnessy, among others, about how the £40 million commitment to NIHR funding for brain tumour research will be met. That commitment absolutely remains in place, but there is no upper limit to our funding of high-quality brain tumour research and we are committed to exceeding the £40 million target. I should also add that there is no limit to our funding of high-quality childhood cancer research.

Clinical research, rightly, is at the core of this Bill. It is one of the most powerful tools that we have. I believe that the Bill will complement the ambitions in our 10-year health plan and the forthcoming national cancer plan to embed that research across the NHS and give patients greater control. It will make it much easier for researchers to connect with patients with rare cancers and streamline the recruitment for clinical trials and will ensure our regulatory framework delivers for those who need it most.

The noble Lord, Lord O’Shaughnessy, and the noble Baronesses, Lady Finlay and Lady Browning, raised the database. The database is live across the UK; it is a UK-wide registry. I urge everyone to sign up to be part of research in order to connect with trials. The noble Baroness, Lady Browning, also asked about strengthening the orphan drug regulations. We must ensure that there is a detailed review before any decisions are made on the regulations.

I say to the noble Lord, Lord Polak, that we will ensure that we do all we can to improve how we use data for research and raise public awareness of consent. I certainly fully support the digitisation of advance consent, which he referred to.

It is key that we incentivise research and continue to support and develop cutting-edge research for rare cancers and other rare diseases through the NIHR. For example, in December, we launched a pioneering new brain tumour research consortium to accelerate research into new treatments through the NIHR, which is investing an initial £13.7 million, with significant further funding expected to be announced shortly. We are also ensuring the effective co-ordination of research from other funders and charities through the Office for Strategic Coordination of Health Research, which is chaired by the noble Lord, Lord Kakkar.

We published Transforming the UK clinical research system: August 2025 update outlining how we fully delivered against all the recommendations in the review conducted by the noble Lord, Lord O’Shaughnessy, who I thank for his work on commercial clinical trials. We will go still further to deliver on our 10-year health plan and cut clinical trial set-up times to under 150 days by March—a target driven by the Prime Minister. We are taking forward the most significant reform of clinical trials regulations in more than 20 years. We need a more efficient and adaptable regulatory framework, and that is what we will deliver.

Concerns were raised about timings of implementation and market authorisation of clinical trials. The timeframe in the Bill is a legal boundary, and we certainly expect to publish the report rather sooner. The noble Lord, Lord Mott, asked about the UK’s ranking for approving orphan drugs. The lessons learned from the review of the regulations will inform how we best approach the regulation of UK orphan medicines.

On the abolition of NHSE, work is under way on primary legislation. That will enable its functions, powers and responsibilities to transfer formally to the department. That will include responsibility for this Bill. I heard loud and clear from a number of noble Lords the wish to see a speciality lead for rare cancers in post and getting to work as soon as possible. I certainly agree on their importance. I heard what the noble Lord, Lord Blencathra, said, but this is the way we will go forward. We will ensure that that appointment is made as soon as possible.

As I said at the outset, many useful points have been made. They will be part of our consideration, but the main thing I want to say is how glad we are to fully support this Bill and how we will do all we can to help progress it. It reflects ambition and our support for the goal for the UK to be the global leader in clinical research, which noble Lords called for. This is about patients, particularly those facing rare cancers. They deserve and need greater choice, speed and opportunity to participate in vital studies. Every breakthrough is key because it means that we can maximise people’s access to the benefits. I thank my noble friend for bringing the Bill forward, all noble Lords who have contributed and all those who continue to champion its cause.

[Lord Winston (Lab)]

I apologise for keeping the House waiting a moment longer, but I want to ask the noble Baroness something very important. This has been a fantastic debate of a high standard, in the best interests of the House of Lords. There was a great focus on focused research on rare cancers, but does she agree that continued basic research on cell biology, embryology and a whole range of things about cell development, which has contributed so much to cancer research and to rare cancer research, is also important?

[Baroness Merron (Lab)]

As my noble friend said, this has been an extremely valuable, well-informed and moving debate. At present, we are focusing on rare cancers because of the nature of the Bill, but I absolutely take his point about the importance of work outside rare cancers and the overlap with that. I thank him for it.

Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Wolfson of Tredegar (Con)]

My Lords, the amendments in this group relate to two fundamental question: first, who should have the legal right to assistance under this Bill and, secondly, who should not. They are both important questions. We have heard concerns about eligibility throughout the discussion in Committee. In particular, the question of whether the person must be in pain to access assistance has been a point of contention. I think that will come up in the next group, on motivation.

I hope all noble Lords across the Committee will agree that the Bill needs sufficient safeguards to ensure that those asking for an assisted death meet three conditions: first, that they have sufficient reason to do so; secondly, that they have the mental capacity to do so; and, thirdly, that they are fully aware of what they are asking for. If any one of those conditions is not met then someone should not be able to ask for an assisted death on their part. That is because the Bill is generally—intentionally, as I understand it from the noble and learned Lord, Lord Falconer of Thoroton—a tightly drawn proposal. Therefore, it would not be right for the Bill to become law without its provisions tightly defining assistance in line with Parliament’s intentions. I know that reports of incidents in other countries where people have used assisted dying services to end their lives for reasons other than terminal illness are concerning. Therefore, I understand the reasons why the various noble Lords have put forward the amendments in this group.

I will pick up a couple of the amendments. Amendment 28, from the noble Baroness, Lady Finlay, seeks to ensure that people who seek assistance are not doing so out of financial difficulties. As I understand the course of the debates, that does not run contrary to the underlying principle set out by the noble and learned Lord, so I hope he will be able to explain how protections for those in financial difficulty would function under the Bill. Can we strengthen its provisions to ensure that those in financial difficulty who are also terminally ill are not choosing to end their life mainly because of their financial circumstances?

I also highlight Amendment 39, from the noble Baroness, Lady Grey-Thompson, which would require a heightened evidential standard for those living in care homes and nursing homes. We know from events not only but perhaps in particular during the pandemic that those living in care homes and nursing homes are particularly vulnerable. They can be taken advantage of, so I understand the noble Baroness’s motivation in probing the noble and learned Lord on whether there are sufficient protections for vulnerable residents of care homes. Amendment 38, in the name of the noble Baroness, Lady O’Loan, focuses on another particularly vulnerable group: those with certain mental health conditions.

The impetus of this legislation is concern for those who seek an assisted death because they are considered to be in distress or in pain and vulnerable. But in legislating for that vulnerable group, it is important that we do not unintentionally endanger other vulnerable people and groups. I therefore look forward not only to the contribution from the Minister, but to the reply from the noble and learned Lord, Lord Falconer of Thoroton, particularly on whether, going forward, we will receive amendments from him on a rolling basis. That would help not only those on the Committee but on the Front Bench to plan our work.

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

I thank all noble Lords for their contributions to the debate. As I have said previously, I will limit any detailed comments to amendments about which the Government have major legal, technical or operational workability concerns. To that point, I would like to clarify for the noble Baroness, Lady Berridge, that that does include interaction with other legislation, on account of the Government’s clear duty to the statute book. I heard the noble Baroness make a request for government engagement. Should Parliament choose to pass the Bill, we will work with stakeholders to design a robust and effective service, but in the meantime, engagement is a matter for the sponsor.

[Baroness Berridge (Con)]

The specific issue I raised relates to a different piece of legislation for which the Minister has responsibility. Once the legislation is passed, if it is not compatible, it is too late. May I make this request? I am not requesting a meeting under the TIA Bill; I am requesting a meeting for the Royal College of Psychiatrists and Professor Sir Alex Ruck Keene under the Mental Health Act. I do not understand why the Minister cannot grant that meeting.

[Baroness Merron (Lab)]

For the reasons I have already outlined. That is why I clarified that, when I say I am only speaking about where there are particular concerns, if I do not refer to them, there are no concerns to raise for the attention of your Lordships’ House, which I would always be very clear in doing.

The noble Baroness, Lady Finlay, asked about Peers’ access to technical drafting support. To reiterate, as we all know, it is the sponsor who leads on engagement with Peers on policy content. To meet our responsibilities as a Government, we have been working with the sponsor of the Bill on amendments to ensure operational workability, were the Bill to pass. It might be helpful for the noble Baroness if I say that, where amendments were passed in the other place, there was support for the sponsor to ensure that the amendments met the test of being fully workable, effective and enforceable. In those cases, it was for the sponsor to table amendments to address any workability concerns.

[Lord Carlile of Berriew (CB)]

I apologise for interrupting the Minister, who is being extremely helpful, but one point needs to be clarified as a result of what she just said. I understood the Government to say that, if an amendment is passed on Report, assistance will then be available of the same kind that was available to the sponsor, so that the amendment can become workable in the context of the Bill and other law by the time the Bill is passed. That was a very clear understanding given to me in various quarters. Are we hearing now that that facility will not be given if an amendment is passed on Report? If so, why?

[Baroness Merron (Lab)]

I am not sure that there is that difference, but I will review the Hansard of this debate and ensure that I come back to the noble Lord and place a copy of my response in the Library. I am not entirely clear about the point the noble Lord is making. I realise that that is disappointing for him.

[Lord Carlile of Berriew (CB)]

I will intervene only once more. It seems to be fundamentally necessary that, if an amendment is passed on Report that changes something put in the Bill by the sponsor, who has had the advantage of the consultation process we have discussed at length in these proceedings, the same attention should be given to it—and I am sure that is exactly what the noble and learned Lord expects. Otherwise, we run the risk of asking people like the noble and learned Baroness, Lady Butler-Sloss—if there is anyone like her—to move the goalposts, rather than do what she really does, which is be extremely nimble between the goalposts.

[Baroness Merron (Lab)]

I am grateful for the clarification on goalposts moving. What the noble Lord is saying is correct, and there is not going to be any change to what has been said previously. I hope that he and your Lordships’ House will forgive me if I have not put it as clearly as certainly the noble Lord would have liked. I will still make a review of the words and ensure that everything is clear. I hope that will be helpful.

[Baroness Finlay of Llandaff (CB)]

I listened really carefully to the Minister. Am I to understand, in my simplistic, non-legal and non-ministerial way, that the drafting of an amendment will be down to us and the Public Bill Office? If that wording, however inadequate, is then voted into the Bill at that stage, advice on workability would be given, and therefore a further correction to vote would be at Third Reading. Is that correct?

[Baroness Merron (Lab)]

That is the normal way of doing things. I hope that too is helpful.

Amendment 27, tabled by the noble Baroness, Lady Finlay, would require a terminally ill person to have

“made independent contact with their local voluntary assisted death service for information”

in order to be eligible to request assistance under the Bill. However, the fact is that a local voluntary assisted death service is not defined, and the concept does not feature anywhere else in the Bill. Furthermore, no mechanism is provided for assessing whether this eligibility requirement has been met. That would render the Bill unworkable as drafted, and would require further amendments to ensure its workability.

Amendment 28, also tabled by the noble Baroness, Lady Finlay, would add two eligibility requirements for a person seeking an assisted death under the Bill: first, that the person was eligible for benefits from the Department for Work and Pensions via the Special Rules for end of life, the SERL process; and, secondly, that the person had received a home visit from their GP in the six months preceding their request for an assisted death. Not all terminally ill people opt to apply for, or are eligible for, certain benefits at the end of their life. Those people who do not claim would therefore become ineligible under the provision as drafted.

The Bill and the SERL system also have different definitions for end of life. The Bill defines “terminally ill” as six months to live while the SERL process uses 12 months. That would be operationally confusing. Equally, not all terminally ill people will necessarily have had a recent home visit by a GP. That again poses operational challenges for GP resources.

Amendment 28 refers to SR1, the medical evidence form that clinicians issue to evidence that a person is at the end of their life. It is unusual for forms of this nature to be put into primary legislation, and the form by itself does not establish eligibility for benefits. Furthermore, referring to the form in primary legislation could result in delivery challenges should the DWP amend that form at any point in future.

Amendment 38, tabled by the noble Baroness, Lady O’Loan, would introduce several qualifications to the eligibility criteria in Clause 1. This amendment could cause operational challenges for assessing doctors and panels. As drafted, the amendments contain undefined and unclear terminology and it is not evident how these new criteria should be assessed. Noble Lords may also note the risk that the amendments could give rise to challenge on ECHR grounds as they would lead to a difference in treatment for those who have a history of mental health conditions, suicidal ideation or self-harm. Any differential treatment would need to be objectively and reasonably justified to comply with ECHR obligations.

--- Later in debate ---

[Lord Kamall (Con)]

My Lords, this has been another rather long but interesting debate. It is important that noble Lords who wanted to speak had their voices heard. It touches on something we touched on very early. Noble Lords will remember when we debated another version of motivation and talked about coercion. A number of noble Lords put forward amendments to talk about encouragement. In that debate, we saw how difficult it was to distinguish between encouragement and coercion, to say whether encouragement is a form of coercion, and to legally define something such as encouragement.

Now we have the very same issue with motivation. In some ways, as the noble Baroness, Lady Cass, said, motivation is the internal version: it is self-encouragement or self-coercion, not wanting to feel a burden. We have debated what it means to feel like a burden. It is important that we understand the motivation. As the noble Baroness said, professionally, doctors need to do that to understand what help or assistance that patient could be given. It could be, if this Bill passes, that they are allowed or helped to progress to assisted dying, but it could be that they are offered something else that they feel very comfortable with that gives them a bit longer to live and to have that quality time that the noble Baroness, Lady Fox, talked about having with her family. When I was a Health Minister, one of the things that I learned about palliative care from the noble Baroness, Lady Finlay, when I first spoke to her was that people who live longer, even though they may have wanted their life to end “now”, appreciated that extra time with their family, once they entered palliative care, to close those unclosed things, to make up with friends and family they may have fallen out with, and to bring closure to their life before they went. It is important that we recognise that. I do not want to go back into the whole debate about palliative care, but it is important that it is seen as an option to give that closure to people, even if they do not want it and they decide, “I’ve made my mind up”. That is probably a more informed choice.

We need to be very careful about trying to define exactly what the one word that sums up the debate is. If it is about choice and only choice, pretty soon after the Bill reaches the statute book, people will say, “I only have 12 months to live. Why can’t I have the same choice as people who have six months?” Surely it is about not just choice or suffering but a combination of factors. That makes it incredibly difficult for the lawyers, but also for the medical people, to determine. We need to unpick some of that.

Noble Lords who have spoken on this group have picked up a number of issues: people feeling like a burden, mental health disorders, disabilities, and remembering that not all disabilities are visible. On that point, I welcome back the noble Baroness, Lady Campbell of Surbiton—I should know her title because she lives down the road from me; next time she sees me on the high street, she will probably prod me on that. There are also financial considerations, self-motivation and avoiding physical pain. The Bill does not require a specific motive as part of the eligibility criteria. Obviously, the whole Bill is about eligibility—the first few words are about who is eligible to seek assisted death services or terminally ill adult services—but it would be helpful if the noble and learned Lord, Lord Falconer of Thoroton, could expand on the thought process behind his very tight definition of “eligibility”.

I must say to noble Lords who have teased the noble and learned Lord a little bit about things that he may have said in the past that we are all entitled to change our mind when we learn new facts or hear a different view. I do not see it as a weakness in an argument if someone changes their mind when they have heard new facts. I find myself defending the noble and learned Lord, but I do not think we should be too harsh. I should remind people that I am personally very torn on this Bill, and I have not made up my mind. I am waiting to see the outcome of this debate before I make up my own mind about how I vote on this.

We also heard about dignity. I teach at a Catholic university, and dignity is a very important concept in Catholic social teaching. But what is dignity? It can be subjective. One person could be told that they have to wear incontinence pads for the rest of their life, and someone else could be told, “I’m sorry, you can’t walk for the rest of your life”, but other people have quite a full life even if they face those challenges or find themselves disabled. It is really difficult to define dignity; in many ways, it is subjective.

I have read many of the papal encyclicals about all this. By the way, I am a Muslim teaching at a Catholic University; in many ways I am the diversity, if you like. It is important that we consider what we really mean by dignity. We all think we know what it means, but we all have a different perspective on what it is.

A point that has come up many times in the debate is that we hear the words “pain” and “suffering”, but they are not in the Bill. We have to ask the noble and learned Lord, the sponsor of the Bill, about the thought process behind why he decided not to put “pain” and “suffering” in the Bill so that we can all understand, given that many noble Lords have asked that question about pain and suffering, why they are not explicitly there.

I ask the Minister this very carefully. A number of times during Committee, we have put questions to the Government but they have constrained themselves as to what they answer. It is important that the Government tell us what the implications would be if the Bill were to pass into law and what that would mean for resources in the department and for decisions that the Department of Health may have to make, as well as what it might mean for other departments of government. That is important. We cannot just say, “I’m going to confine myself to these few clauses”, because this will have implications. Some will say that it may have implications for wider society—a society that allows people to take their lives earlier or encourages death. It changes the sort of society we live in. Many people will welcome that and will say it is a society of choice, while others will say, “No, we don’t want to live in that sort of society”. We have to remember the implications of this Bill.

I ask the Minister to set out the Government’s considered view. I know that the Minister will say that some of these amendments as drafted are not legally sound—we understand all that—but these are probing amendments. This is a Committee stage and the amendments are not meant to be completely technically sound. We need to know, if they were to pass and were to be tidied up by the government lawyers or the officials, what that would mean for the workability of the wider health and care system and not just in respect of these issues that we are debating or the individual clauses in the Bill. We need to have a clear view of how this will change things and of the challenges that any Government will face when a new Bill comes in. That would be helpful.

I will stop there. I have asked a few questions to the noble and learned Lord, Lord Falconer of Thoroton, about the motivations for some of the decisions that he made in drafting the Bill, but also to the Minister speaking on behalf of the Government to answer the very real implications for resources, et cetera, not only in the Department of Health and Social Care but more widely across government.

[Baroness Merron (Lab)]

My Lords, I, too, welcome back to the Chamber and to this House the noble Baroness, Lady Campbell. It is a pleasure to see her back with us and I thank her and other noble Lords for their contributions in this group of amendments.

I once again make it clear that I will keep any detailed comments limited to amendments on which the Government have major legal, technical or operational workability concerns. It is important to remind your Lordships’ House of that. I say to the noble Lord, Lord Kamall, that the Government are doing only what any Government would do, which is to be scrupulously neutral, as your Lordships would expect us to be, and to handle it in that way. If Parliament passes the Bill into law, of course we will ensure its safe and effective implementation, but until that point I am afraid that I will be sticking scrupulously to what the role of any Government would be. I am sure that the noble Lord understands.

Amendment 30, tabled by the noble Baroness, Lady Foster, was spoken to by the noble Lord, Lord Weir, and Amendment 30ZA, in the name of the noble Baroness, Lady Lawlor, seek to prevent a terminally ill person in England or Wales from being eligible for an assisted death if they are motivated by certain specified factors. These amendments would introduce uncertainty around definitions and concepts, such as what constitutes “adequate housing”. They would also create an internal inconsistency in the Bill, as they are not reflected in later provisions that set out the assessment process. Drafting difficulties and internal inconsistencies are likely to result in confusion on eligibility, and significant further consequential amendments and policy development would be needed to produce predictable legal effects.

The Government also have some further practical operational concerns, which I will note for the Committee’s consideration. The amendment’s exclusion of those

“substantially motivated by… a disability”,

while excluding terminal illness from “disability”, would be potentially complex to operationalise. It may also be that somebody has multiple motivations. It is unclear how these could be separated or who would be able to make a final judgement.

--- Later in debate ---

[Lord Kamall (Con)]

That is a fair point to be made. It is why the question was asked, and I thank the noble Baroness for answering it.

I thank my noble friend Lord Frost for provoking this debate, because there are still other arguments for using the phrase “assisted suicide”, particularly in terms of clarity. I look forward to the consideration of the arguments made by my noble friend Lord Frost from the noble and learned Lord, Lord Falconer, and the Minister.

[Baroness Merron (Lab)]

My Lords, I will be very brief. The amendments tabled by the noble Lord, Lord Frost, do not present significant workability concerns. As noble Lords will be aware, the amendments have not had technical drafting support from officials. Therefore, further revision and corresponding amendments would be needed to provide consistent and coherent terminology throughout the Bill.

Vaccine Health Technology Assessment

Baroness Merron Excerpts

Thursday 8th January 2026 Grand Committee

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

My Lords, I am most grateful to my noble friend Lady Ritchie for her thorough introduction and for securing this debate. I am also grateful to all noble Lords for their considered contributions. The subject of today’s debate reflects my noble friend’s steadfast commitment to improving access to immunisation and her tireless efforts to ensure that vaccination matters continue to receive the attention that they undoubtedly deserve. As the noble Lord, Lord Kamall, said, this is a very important debate to have and I welcome the probing that it provides.

Let me say at the outset that I believe we in the UK can be proud that we have one of the most extensive vaccination programmes in the world. We protect people across their life course and it is underpinned by rigorous scientific evidence and a commitment to equitable access—a point made both by the noble Lord, Lord Kamall, and my noble friend Lady Goudie.

The question of international comparators was raised. Our vaccination progress serves as a global benchmark for innovation and best practice, and many nations look to align their immunisation schedule with ours.

I will focus on the specifics as best I can in the time available. On the JCVI, the noble Lord, Lord Bethell, made a number of comments suggesting what I might say, and in a number of cases he will be entirely right, so I am grateful to him for shining a light on some of those points. Decisions on introducing or changing vaccination programmes are informed by advice from the Joint Committee on Vaccination and Immunisation. It is an independent and expert committee and world leader in this field, as has been recognised in this debate. It bases its advice on high-quality data, disease burden, vaccine safety and efficacy, and the impact and cost-effectiveness of programmes, and it ensures that we maintain public confidence in our policies. I know that all these things are important to noble Lords.

On the current approach to evaluating vaccines, the cost effectiveness analysis used by the JCVI compares the cost of a vaccine relative to the health benefits it provides. I appreciate that this debate is about extending beyond that, but that is what it does. It looks at the health benefits provided for a vaccinated individual and others—this point was raised in the course of the debate—and it considers direct cost savings to the health and social care system resulting from immunisation, such as averting hospitalisation and the need for social care.

My noble friend Lady Ritchie suggested that the current approach somehow undervalues prevention, can delay innovation and does not take into account benefits beyond those to the individual patient. I would put this rather differently to my noble friend, because the methodology is entirely focused on prevention. As I mentioned, the positive benefits are not just for the person who has been vaccinated but for those around them. We look to reduce the incidence of infection, and we are also mindful about the transmission of conditions and infections to others.

My noble friend also asked about changes to thresholds. I can say to her that we are actively considering the impact of changes to thresholds in vaccination programmes. Perhaps I will only be a little cautious, but there is the potential that such a change would increase the costs of existing programmes, perhaps by incentivising higher prices from suppliers. But there is a recognition of the role that such a change could play in encouraging innovation, and I know that my noble friend is very keen to see that.

I am not sure this came up too much in the debate, but it is an important point. Our use of data to establish cost effectiveness has ensured that we get value for money from manufacturers, and that has allowed us to deliver a comprehensive programme. It is important that we continue to keep that value for money.

On wider societal and economic impacts, it is the case that wider benefits can be highlighted by officials or the JCVI when advising government on vaccination programmes, but it is also true that it does not account for the impact of vaccination that I have heard all noble Lords call for. A key reason for this—the noble Lord, Lord Bethell, pre-empted this—is that the wider benefits cannot be quantified consistently across all vaccination programmes. There is currently a lack of available high-quality data on socioeconomic benefits. As the noble Lord said, robust data may be available for very few programmes. Basing decisions on wider benefits would create disparities whereby vaccination programmes with high-quality data and wider benefits were considered more valuable. So we do not have the basic situation to achieve what we all want.

There are also many uncertainties when modelling socioeconomic benefits. Unpaid care was mentioned, for example; I think my noble friend Lady Goudie referred to it. Quantifying the impact on that would be extremely complicated, and there is no clarity on how estimating or modelling this or other impacts should be approached. That concern was echoed by NICE when it did an appraisal on this very topic in 2022, and it agreed to maintain the approach that it currently takes.

On the point about supply that I mentioned earlier, there can also be a risk that by adding wider benefits into formal evaluation methods we send a signal to suppliers that we could be open to paying higher costs for the same vaccines or medicines. I see noble Lords both nodding and shaking their heads, which is the purpose of a debate.

There are additional ethical concerns. As was mentioned, vaccination programmes for working populations, important though they are, could be preferred over programmes for those who are not economically active. That is not a basis on which we would want to proceed because it would exacerbate inequalities and undermine the equity of our approach.

I recognise that my noble friend Lady Ritchie has raised this Question as part of a focus to broaden vaccination access. That is a goal to which we are absolutely committed. We have been putting plans into action to provide new programmes—for example, launching programmes to protect infants and older adults against RSV. Just this month, we announced that a vaccine against chickenpox would go into the routine childhood immunisation schedule. That is expected to save the NHS some £15 million a year in costs for treating vaccinations.

The important matter of improving uptake has been raised. We are delivering vaccinations in new ways via community pharmacists, and pilots for administering vaccinations within health visits are starting this month. Through this targeted outreach, we offer an opportunity to increase uptake and reduce inequalities by providing vaccinations to those who might not otherwise access vaccinations. We are also working with healthcare professionals so that they can confidently discuss immunisation with concerned patients, because it is vital to tackle vaccine information. We are exploring innovative delivery models and delivering trusted messaging, to take up the point made by the noble Lord, Lord Rennard, who spoke about other influences that we would not welcome.

A number of questions have been asked, and I will be glad to write to noble Lords to pick up their specific points. I realise that my remarks in general will not be the ones that my noble friend and other noble Lords will have hoped for, but I hope I have been able to outline some of the difficulties while appreciating the points that have been made.

[Baroness Ritchie of Downpatrick (Lab)]

Before my noble friend sits down, I ask that she and her ministerial colleagues in the Department of Health and Social Care give particular attention to establishing the independent committee to evaluate the existing vaccine health technology assessment process so that the impact of vaccines on the economy, education and wider society can be seen clearly.

--- Later in debate ---

[Baroness Merron (Lab)]

I understand why my noble friend is raising that, but NICE is seen as a world leader in that regard and has processes in place to review its processes and methods to ensure that they remain fit for purpose. I am not entirely convinced, as my noble friend will see, that we need to establish an independent committee, but doubtless she will pick up this point, and I will be pleased to hear from her further on it.

Committee adjourned at 4.50 pm.

Puberty Suppressants Trial

Baroness Merron Excerpts

Thursday 18th December 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I begin by thanking the Government for their sensitive language in handling this delicate issue. I recall the noble Baroness, Lady Cass, telling the House that puberty blockers are currently licensed only for much younger children with precocious puberty or older adults with certain cancers. Trials are therefore needed to determine whether they are safe for adolescents with gender incongruence and to understand the interaction with the different processes of puberty. I understand that children taking part in the trials must have their parents’ consent, but can the Minister clarify two points that are clearly raising concern? First, what is the maximum and minimum age of children taking part in these trials? Secondly, what assurances can the Government definitively give that children taking part in these trials will not experience fertility issues or loss of sexual function or any conditions that are irreversible later in life? I also wish all noble Lords, staff and officials a merry Christmas, happy Hanukkah, happy new year and, as our American cousins say, happy holidays.

[The Parliamentary Under-secretary of State, Department of Health (Baroness Merron) (Lab)]

My Lords, I am grateful to the noble Lord for acknowledging the sensitive language. This is indeed a sensitive issue. For all the division and divided opinion that I know there is, there is also a determination—including across the House, I am sure—that we get this right. The clinical trial is just part of the PATHWAYS study. With regard to the clinical trial, it is extremely unlikely that anyone under the age of 11 will qualify as a potential participant and it runs up to the 16th birthday, so I hope that that is helpful. Can the noble Lord remind me of his second question?

[Lord Kamall (Con)]

What assurance can be given so that any health developments under these trials are not irreversible?

[Baroness Merron (Lab)]

I thank the noble Lord. Before participants enter the trial—and it is an extremely high bar, as it should be; there will be at least 226 participants required, but that is not a target and there will be no drive to get up to that number—certainly any possible impacts such as those the noble Lord describes will be fully discussed and mitigations will be explained and made available, particularly in terms of fertility. I absolutely take the point that the noble Lord raises.

[Baroness Cass (CB)]

My Lords, we are faced with a situation where, for 15 years, clinicians in this country have told children and young people that these medications are safe, fully reversible and indeed life-saving. Last year, they were rightly banned from clinical practice. However, the upshot is that now, of the 75 children a month who are coming to the new services, about 20% are getting these medications and, worse, testosterone and oestrogen from unlicensed and unregulated sources—and those are the ones we know about. In addition, referrals to the new services have dropped from 200 a month to only 30 a month, so we think that a large number of those young people are also being harmed through those mechanisms.

We are concerned about this much broader harm; children are voting with their feet now. Does the Minister agree with me that, for the very tiny number of young people who clinicians believe will ultimately have a long-standing gender incongruence and will therefore be eligible for this trial, it is better that they get their medication under careful clinical supervision rather than on the dark web? Secondly, does she think that this trial will be a way of attracting that broader group of young people back into the NHS who do not need medical treatment but need holistic wraparound care?

[Baroness Merron (Lab)]

Let me first say to the noble Baroness how grateful we are for her continued professional attention and sensitivity in dealing with this. There was a cross-party approach to the Cass review, and I pay tribute to Sir Sajid Javid, the former Health Secretary for seeing the need for this. We have always been supportive of the Cass review. I agree with both points that the noble Baroness has made. The fact is that this is about the need to face up to what the review found: shocking levels of unprofessionalism, a lack of clinical oversight and puberty blockers being prescribed to children without sufficient evidence. That was not safe and not beneficial and it could not go on.

[Baroness Thornton (Lab)]

My Lords, I first join my noble friend the Minister in congratulating the noble Baroness, Lady Cass, and I also congratulate my right honourable friend the Secretary of State, for the transparency with which this has already been dealt. Members will be aware that, across parties and across both Houses, there was a briefing that involved all the scientists who will be carrying out this research. Can my noble friend assure the House that that transparency and information giving will continue?

[Baroness Merron (Lab)]

I can confirm to my noble friend that the transparency will continue and I am grateful for the comments that she made about my right honourable friend the Health Secretary, who I believe has not just been transparent but extremely honest. I very much welcome that.

[Baroness Barker (LD)]

My Lords, the backdrop to this research is an extensive international religious nationalist campaign against women’s rights and LGBT rights. Since this research has been designed according to standard research protocols, has been approved by the NHS ethics committees and will be carried out by professionals who are bound by professional regulation, does the Minister agree with me that those professionals should be enabled to get on with their job free from ideological interference?

[Baroness Merron (Lab)]

I do agree with that point. We are seeking to protect the safety and interests of children and young people through evidence, and it is right and proper that we get on with that. As the noble Baroness has said, this is a trial; it is being led by King’s College London and the South London and Maudsley NHS Foundation Trust. It has been carefully checked by independent scientists who advise the NIHR and by the MHRA and it has also received approval from a research ethics committee. I would say that we are treading cautiously and correctly in this area, because all that matters is the safety of children.

[Baroness Falkner of Margravine (CB)]

My Lords—

[Lord Sandhurst (Con)]

My Lords, I understand the concern about illicit provision on the dark web, which is a very serious matter and difficult to manage. None the less, I must ask what provision is being made to meet potential claims for damages from young people like Keira Bell in the future who sustain permanent damage to sexual function and emotional well-being after being on the trial?

[Baroness Merron (Lab)]

It is probably helpful to say that no one is required to be on the trial. Nobody will be accepted on to the trial unless there is an extremely rigorous and clinically led judgment about whether a young person is suitable. On the point about transparency, all that information is available online and I would urge noble Lords to look at it. The temporary ban was brought in by the previous Health Secretary, Victoria Atkins, and, in my view, it was absolutely right that we made it a permanent one. However, the issues remain, and we must work out how best to support children and young people who suffer gender incongruence.

[Lord Paddick (Non-Afl)]

My Lords—

--- Later in debate ---

[Baroness Falkner of Margravine (CB)]

My Lords, in the case that children cannot consent, which is widely acknowledged, given the age of the children, we know that single-parent consent will be permissible for the PATHWAYS trial. We also know from litigation to date on these vexed matters that parents are going to court to ascertain whether a single parent can consent to this. Will the Government review single-parent consent and insist that both parents must give consent to these potentially irreversible changes, where children’s consent is not possible?

[Baroness Merron (Lab)]

As the noble Baroness rightly says, children, by definition, cannot consent to being on the trial, so places will require parental consent as well as the assent of young people. I can assure your Lordships’ House that, as I have already mentioned, there are strict eligibility criteria to join the PATHWAYS clinical trial. Part of the assessment by the professionals making the decision about engagement involves the role of parents, including whether there has been any undue pressure and a whole range of considerations. I urge the noble Baroness to refer to the details of how young people will be accepted on to this trial. I must emphasise that no person will be guided towards it who should not be. We are seeking young people; there is no requirement.

NHS: Winter Preparedness

Baroness Merron Excerpts

Tuesday 16th December 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I want to ask the Minister about two cohorts in respect of which there are concerns about vaccination levels. The first is front-line health workers. Is the Minister aware of what percentage have been vaccinated and what action is being taken to improve the uptake of vaccinations, particularly among those front-line health workers? I know that there are stories and concerns expressed in the press about the rate of vaccination. On the second cohort, will the Minister tell the House which socio-economic or ethnic groups have the lowest update? What targeted plans does the department and NHS England have to increase uptake rates in these groups?

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

First, we have started earlier and done more than ever before to prepare for the winter pressures. The good news is that the flu vaccines are working well to protect people against severe disease, and they are certainly working well in comparison to how they used to. In fact, we are the first country in the world to show vaccines working this well. On the uptake of vaccinations, 60,000 more NHS staff have been vaccinated this year than last year, which is extremely welcome. We have delivered over 17 million flu vaccines, which is tens of thousands more than we had delivered this time last year. We have a particular programme of communication and support and availability to those groups which are less likely to take up vaccinations. Vaccinations are our best line of defence against RSV and flu. I will be pleased to provide more detailed information to the noble Lord.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, given that not all babies are currently able to benefit from protection under the two-pronged approach to the RSV programme, what efforts will be made to ensure that other babies, such as those born to unvaccinated mothers, who remain at risk, will be included in any extension to the RSV vaccination programme?

[Baroness Merron (Lab)]

I know my noble friend is very familiar with the maternal RSV programme, not least because of her campaigning, for which I pay tribute to her. It only began in September, and it is already proving successful. We want to see more pregnant women being vaccinated; we have updated and made available information resources in 30 languages for better access to vaccinations. We encourage maternity services to have early discussions with pregnant women about vaccination, and we ensure that training is in place to allow staff to have the knowledge and confidence to address concerns and build confidence. I hope that this answer is helpful not just to my noble friend but to the noble Lord.

[Lord Scriven (LD)]

My Lords, I do not believe for one moment that the Minister is complacent. In answer to the question from the noble Lord, Lord Kamall, the reason why the staff vaccination rate is up from last year is because it was at an all-time low of less than 30%, down from 2020 when it was 75%. There are still 750,000 healthcare workers who have not had the flu vaccine and who are unprotected. Based on that figure, what extra steps will the Government take to further incentivise take-up by NHS staff to prevent the crippling of service delivery when it most needed?

[Baroness Merron (Lab)]

The noble Lord is quite right. We have to protect our staff, who are under immense pressure and are not just at risk from flu but seeking to tackle the extra pressures of industrial action. We are focused on making vaccines available to staff in the easiest way possible. We will continue to do so. I should add that we are considering options on implementing advice to expand vaccinations to the over-80s and, in particular, older adult care residents to ensure that any change has the best possible impact. It is important that we continue to drive vaccination rates up. That will protect staff who are providing the care. As the noble Lord said, we also have to continue our programme to encourage NHS staff to take up the vaccine.

[Lord Stirrup (CB)]

My Lords, one of the biggest winter pressures on the NHS is the forthcoming strike, which will have an impact on patients, of course, but it will also have a further extremely damaging impact on the crucial consultant cohort which has to cover throughout these periods, many of whom are now simply looking for a way out. What is going to be done to improve the morale and retention of this vital resource?

[Baroness Merron (Lab)]

In my view, the BMA has chosen Christmas strikes to inflict damage on the NHS at a moment of maximum challenge. It has refused to postpone them to January, which would have helped patients and other NHS staff, as the noble and gallant Lord referred to, to cope over Christmas. At present, our position is that the offer that we made to prevent those strikes happening has not been accepted, as the noble and gallant Lord will know. We are now reviewing where we are going to go. We completely understand the effect on morale and the exhaustion among staff who are covering. We are managing that to the best of our ability. I am most grateful to NHS staff in supporting us to be ready for winter and tackling the industrial action’s effects.

[Lord Harper (Con)]

My Lords, can I press the Minister a little on the reasons why NHS staff are reluctant to get vaccinated? The noble Lord, Lord Scriven, drew attention to the very low vaccination rate. What are the top reasons for those barriers? What is the Minister doing about it as a matter of urgency, given the significant numbers of people contracting flu this season?

--- Later in debate ---

[Baroness Merron (Lab)]

Among NHS staff, as in other groups, there is a vaccine hesitancy. It is not specific and particular to NHS staff but, as we have discussed a number of times in this Chamber, there is perhaps a misunderstanding about vaccines’ efficacy. We also have to acknowledge that conspiracy theorists across the internet continue to have a hold. We saw that throughout Covid. Our job with NHS staff, as with members of the public, is to make it easy and possible to get vaccinations, and to make people feel confident and informed about why they need them and how they support not just them but the people around them. That is particularly important for NHS staff. The noble Lord will be aware that we cannot demand that people have vaccinations, but we absolutely want to encourage maximum take-up.

[Lord Watts (Lab)]

My Lords, many parents shielding their children who have had serious illnesses are having to pay up to £90 each for a Covid jab. Many of those families do not have those resources, so their children are put at risk. Will the Minister look at that?

[Baroness Merron (Lab)]

My noble friend will be aware that we take advice from the Joint Committee on Vaccination and Immunisation about to whom, when, and where jabs are available on a range of matters, including Covid. The committee keeps that constantly under review. Our immediate threat is in respect of flu and RSV; in particular, flu cases are rising, which is why we are closely monitoring the situation, as well as having prepared more extensively and providing more additional support than we have ever done before.

[Baroness Bennett of Manor Castle (GP)]

My Lords, when it comes to influenza, the focus is often on droplet transmission, but there is also evidence of aerosol transmission, with the deeper lung deposition resulting in greater potency in initiating infections. That means that ventilation and air filtration are hugely important. How would the noble Baroness assess the levels of air ventilation and air filtration in hospitals and other medical settings, and, more broadly, in schools? Are the Government looking to improve that to help deal with all the respiratory infections that we face?

[Baroness Merron (Lab)]

I cannot give the noble Baroness a specific answer, but I will be very happy to write to her. She will know how much improvement needs to be made to the estate. She will also be aware of the extra money that the Government have committed. Those decisions are local matters, but she raises a much wider and national matter, and I will be pleased to write to her further.

Women’s Health Strategy

Baroness Merron Excerpts

Tuesday 16th December 2025 Lords Chamber

[Baroness Sugg]

To ask His Majesty’s Government what plans they have to improve women’s healthcare as part of their renewed Women’s Health Strategy for England.

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

My Lords, this Government are committed to prioritising women’s health as we reform the NHS and have been clear that women’s health will never be neglected again. The renewed women’s health strategy will reflect on delivery since 2022, address gaps and go further on totemic issues, including health inequalities and women not feeling listened to, particularly when experiencing pain. The strategy will set this out in the context of the 10-year health plan.

[Baroness Sugg (Con)]

I thank the noble Baroness for that answer and for her championing of women’s health in her role. She will know that women’s health hubs have been shown to be successful in reducing gynaecological waiting lists and speeding up women’s access to care, and were highlighted as a real success in the 10-year plan. The Minister is a strong supporter of the hubs, but, while most areas now have some form of provision, the rollout has been patchy, meaning that not all women can access their services. Given the removal of the mandatory requirement for ICBs to establish hubs, what steps are the Government taking to ensure that the women’s health strategy maintains a clear commitment to the long-term sustainability of women’s health hubs as part of their improved neighbourhood health services?

[Baroness Merron (Lab)]

I very much share the noble Baroness’s assessment of the value of women’s health hubs. She will know that I have taken a considerable personal interest in this. The target to establish a women’s health hub in every ICB was the purpose of a time-limited pilot established by the last Government, and that target was met. Women’s health hubs are absolutely effective when it comes to improving access to and experiences of care for women. I have promoted them as the best example of community-based and joined-up healthcare. That is why, as the noble Baroness will have seen in the 10-year health plan, the women’s health hub in Tower Hamlets was specifically highlighted as a best-practice example of neighbourhood health, and we continue to support ICBs to improve their delivery of women’s health hubs.

[Baroness Burt of Solihull (LD)]

My Lords, the latest data from October this year shows that there are over 576,000 women on gynaecology waiting lists and there were 130,000 new referrals in October. How will the Government address this unacceptable wait in the refreshed strategy?

[Baroness Merron (Lab)]

My examination of the gynaecology waiting lists shows a gradual decline since August 2023. However, I absolutely agree with the noble Baroness that the waiting lists are far too long: it is unacceptable. We are now seeing 57% of gynaecology referrals being seen within 18 weeks, compared with 62% across all specialities. I do not want to hide behind improvement, welcome though it is, but we also know that almost nine out of 10 women on the gynaecology waiting lists are waiting for an outpatient appointment. That is why the big change through the 10-year plan is absolutely crucial, as we move from hospital to community. In the women’s health strategy renewal we will be focusing very much on improvement of gynaecology care. I share the noble Baroness’s view on that.

[Baroness Finlay of Llandaff (CB)]

My Lords, looking beyond gynaecology at women’s healthcare overall, do the Government recognise the importance of public health messaging? Breast cancer is the leading cause of mortality in 30 to 50 year-olds. Often it is diagnosed late, yet there are some important public health initiatives such as good diagrams in women’s changing rooms in large stores. I hesitate to mention the name of one chain —although I am tempted to—where there are excellent diagrams to help women understand that, if they have any symptoms at all, they should seek help. There are similar messages about mental health in places that women go. It means we are dealing with women in a more holistic way, irrespective of age.

[Baroness Merron (Lab)]

The noble Baroness is absolutely right, and we are taking every opportunity to find the right ways to communicate with women about their healthcare. If I had to give a big message, it would be, “Don’t not put up with it”. That is a basic challenge to get across, because so many women do put up with health challenges when they should not. Many women’s health challenges have become normalised—“It’s just part of life, it’s your age” and so on—and I am very keen that, in the renewed women’s health strategy, we will take on that myth and also take on the services to match that.

[Lord Kamall (Con)]

My Lords, I thank my noble friend for this Question and pay tribute to her consistent championing of women’s health issues. I also thank her for discussing the particular concerns behind this Question with me. I am sorry to return to gynaecology, but the Royal College of Obstetricians and Gynaecologists has raised concerns that cervical screening coverage remains well below NHS targets. Cancer Research says that low attendance is particularly evident in particular groups: the youngest as well as the oldest age group, and women from poor socioeconomic and ethnic minority backgrounds. Can the Minister update the House on how we can reach those women and encourage them to come forward for screening, particularly by working with local charities and community organisations that understand their communities far better?

[Baroness Merron (Lab)]

This is a very important point. The 10-year health plan restated the aim of eliminating cervical cancer by 2040 through the improved uptake of cervical screening and HPV vaccination. To the specific point, which is such an important one, in June—not many months ago—we announced that screening providers can offer home testing kits to underscreened individuals in the exact groups that the noble Lord refers to. I believe this will help tackle deeply entrenched barriers that keep some people away from life-saving screening. I am sure the whole House will reflect on the wise words and advice of His Majesty the King in imploring us all to take up the screening opportunities that there are. I certainly agree with that.

[Baroness Royall of Blaisdon (Lab)]

My Lords, as noble Lords will know, women over the age of 50 are particularly susceptible to fractures as a result of osteoporosis. The Government have announced that they are going to have fracture liaison services throughout the country by 2030. I wonder whether, as part of the women’s health strategy, the Government could begin the rollout of the fracture liaison services urgently.

[Baroness Merron (Lab)]

As my noble friend rightly observes, the Government have committed to rolling out fracture liaison services across every part of the country by 2030. We already expect musculoskeletal services to be fully incorporated into integrated care planning and decision-making. I am also glad that, since 2022, NICE has recommended two new drugs for treatment. The women’s health strategy will look at what gaps there are in the original strategy, but this is one area in which progress is already committed to.

[Lord Cameron of Chipping Norton (Con)]

My Lords, does the Minister agree that the women’s health strategy should be clear that female genital mutilation is an abhorrent practice and a crime? Has she seen the article in the British Medical Journal suggesting that it should be rebranded as “female genital practices” and somehow normalised? Will she be clear that the Government will have no truck with this and that the Department of Health will produce a proper rebuttal, so that this argument does not gain any traction in our country? It is a worry that this is happening to young British girls, whether here or overseas. We have to stop the practice and carry on the good work that the Government I led put in place.

[Baroness Merron (Lab)]

I am grateful to the noble Lord for his clear and powerful points. I certainly agree about the abhorrence of this practice and its total unacceptability and illegality in our country. I can say to him that this is a cross-government matter. I work closely with Ministers in other departments and will continue to do so to ensure that policies across many departments deal with the matter of FGM in the way that he describes. We cannot allow it to have any continued existence in this country.

Resident Doctors: Industrial Action

Baroness Merron Excerpts

Monday 15th December 2025 Lords Chamber

[Lord Scriven (LD)]

My Lords, I thank the Minister for putting the Statement before us, but do so with a measure of frustration—a feeling shared by countless citizens. This frustration with the ongoing and deeply damaging resident doctors dispute is directed at both parties, the Government and the British Medical Association leadership. We are witnessing a breakdown in negotiation, a failure of common sense and, critically, a failure of duty towards the patients who rely on the National Health Service.

First, let me address the actions of the Government. The manner in which this dispute has been handled is, frankly, not best practice. We have seen periods of silence followed by 11th-hour media interventions by the Secretary of State. This pattern suggests not a serious negotiation but a high-stakes, last-minute political gamble, PR approach. The way the reported details of the last-minute offer were put before the public and resident doctors serves only to deepen this suspicion. This approach disrespects the process and the professionals involved. Given that the issues addressed in the Government’s 11th-hour offer have been known since the general election, why did the Government choose a high-stakes, last-minute intervention, rather than presenting the offer within a calm, realistic timeframe that could have facilitated constructive consideration by resident doctors?

Further, I must express my dismay at the tone sometimes employed by the Secretary of State. Using rhetoric that seeks to divide resident doctors from the public is counterproductive. This dispute will not be solved through grandstanding but through respect and meaningful compromise. The Government must reflect on their tone and timing.

However, the frustration I feel over the Government’s handling is matched in equal measure by my frustration over some of the tactics and demands employed by the BMA leadership. The pursuit of this round of strike action, especially scheduled at the most challenging time of the year, is, in my view, deeply irresponsible. The BMA has a singular responsibility that transcends typical union negotiations. Their members are the direct custodians of people’s health. We are currently grappling with two severe pressures on the NHS: the rising tide of flu and the deliberate scheduling of this strike to coincide with the Christmas period. To choose this time, when hospital rotas are already thin and the NHS is under maximum strain, is totally unacceptable. It shows a disregard for the welfare of the most vulnerable patients. We on these Benches wish to thank the consultants, those resident doctors who decide to go into work, and the other dedicated staff who will keep our NHS safe during this unnecessary strike, for doing the right and decent thing.

The core demand pushed by the BMA leadership is full pay restoration. While I acknowledge the significant financial pressures facing resident doctors, a demand for full restoration to a prior decade’s real-terms value is neither achievable nor reasonable in the present economic climate. By focusing the entire dispute on this single maximum pay demand, the BMA leadership is allowing the Government to ignore the far more crucial systematic issues that genuinely plague resident doctors and threaten the future of the NHS workforce.

This failure is a stain on both parties. The Government must return to the table with a genuine commitment to a multi-year funded plan that addresses the systematic non-pay issues, and the BMA leadership must immediately reassess the morality of its current strike schedule and shift its focus from an unrealistic pay demand to achievable reforms in training and conditions.

I have two further questions for the Minister. The recent offer included a promise to create up to 4,000 extra speciality training posts. However, the BMA leadership has claimed that these posts are simply being cannibalised or repurposed from existing locally employed roles. Will the Minister confirm categorically that these 4,000 places represent genuinely new, funded training opportunities that increase the total number of doctors retained in the NHS career structure and are not merely a reclassification of existing roles?

Given that the pay restoration demand is deemed unachievable, how will the Government—outside of pay—guarantee fundamental reforms to the working time directive enforcement, the quality of training rotations and the rota planning to ensure that resident doctors are used efficiently for patient care and for the development of their skills, thereby making a medical career in the NHS sustainable and attractive?

Our healthcare system cannot afford this deadlock. I urge both sides to put down their political weapons, swallow their pride and focus on the real-world issues before the consequences become truly tragic.

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

My Lords, the Government have made a comprehensive offer to resident doctors to resolve their disputes. I listened closely to the assessment of the Government’s performance made by the noble Lords, Lord Kamall and Lord Scriven, and it is not a reflection I agree with. This has dominated the agenda, and the Secretary of State has taken a proactive and collaborative approach with the BMA resident doctors committee. For example, he has had 18 meetings and seven phone calls with the BMA; he has sent 10 letters; and there have been dozens of meetings with officials.

I cannot recognise the suggestion of a hands-off, confrontational approach: the Secretary of State has consistently chosen to do everything he can, particularly to cancel the Christmas strikes, which are timed for the most damaging period of the year. The Secretary of State even went as far as to extend the BMA’s strike mandate, giving it time to call off strikes while it consulted its members and an option to rearrange if the offer was rejected. I am astounded that the BMA rejected the offer that was put before it. It was a comprehensive offer to resident doctors to resolve their disputes, providing those currently applying with more training job opportunities, prioritising UK-trained graduates, and it would have put money back in the pockets of resident doctors. Among a whole range of things that noble Lords have rightly acknowledged, the rejection of the offer means that NHS colleagues will be cancelling Christmas plans to cover shifts and patients will have their operations cancelled as the NHS prepares for the worst.

The noble Lord, Lord Kamall, asked: what happens next? In these circumstances, it is a very powerful question. The Government will consider our next steps, with our first priority being to deal with strikes. I reassure noble Lords that the focus of the department and the NHS will be on getting the health service through the double whammy—as has been well referenced by noble Lords—of flu and strikes. We have already vaccinated 17 million people, which is 170,000 more than last year; we will continue to work intensively with front-line leaders to prepare for the coming disruption.

On the offer, the BMA asked us to create more training places, which is what we would have done. The offer would have created 4,000 new speciality training posts for resident doctors over the next three years, with an additional 1,000 for this year. Under this deal, more doctors in non-training roles would have had the opportunity to progress their careers and become the consultants and GPs of the future we all want to see. Sadly, this offer is no longer on the table, thanks to the rejection by the BMA membership. That is why our focus has to be on dealing with strikes and getting through.

Our operational response is to mitigate the impact of any industrial action. We should acknowledge, as we have heard from the Front Benches, that flu rates are the highest they have been in the last five years for this time of year. I am sure that all noble Lords, while recognising legitimate concerns about access to training places, will remain concerned that an offer that would have made a real difference has been wholly rejected and strikes are going ahead. In response to the noble Lord, Lord Scriven, I do believe there was a way out and the BMA membership has chosen not to take it.

On the estimated cost of strike action, the July strikes cost the NHS around £250 million. If those costs repeat themselves for November and December, strike action will have cost around £750 million in this year alone. The cost of the five-day resident doctors’ strike in July could have paid for training for over 1,600 GPs over three years or 28,000 hip and knee replacements. But, again, the Government’s offer has been rejected so we will have to make our first priority dealing with the strikes.

Through the Employment Rights Bill, we want to create a positive and modern framework for trade union legislation; we want productive and constructive engagement; we want to respect the democratic mandate of unions; and we want to reset our industrial relations. For me, this sets us back considerably, sadly, and that has been clearly acknowledged. What do strikes do? They suck up time, resources and energy, and the costs for the NHS, as I have already stated, are around £250 million. While we have made a number of offers and acknowledged legitimate concerns, I do not believe that that has been treated in the way it should have been.

The noble Lord, Lord Scriven, asked about the 4,000 roles. That was in response to the BMA, which asked us to create more training roles, which was a fair request and exactly what we would have done. It would have created 4,000 new speciality training posts for resident doctors over the next three years, with an additional 1,000 this year. It would have meant more doctors in non-training roles having an opportunity to progress. But, as a Government, it is our duty to consider our next steps, and our first priority will be to deal with the strikes.

[Baroness McIntosh of Pickering (Con)]

My Lords, will the Minister respond to the question asked by the noble Lord, Lord Scriven: are these genuinely new training places? I put this question last week and did not really get an answer. I understand that resident doctors are concerned about the inability to plan ahead for training places, and want to have a place that will last for up to a year or longer. They are at the age where they want to put down roots and probably marry and have a family, but because of the way training is organised, that is not possible.

Furthermore, I am not quite sure if it was a 29% or 30% pay increase in any one year, but whatever it was, I understand that this still leaves resident doctors with an under-pay performance of less than 17% compared to 2009. They are being paid less than a train driver, a tube driver or even an Uber driver. I believe we owe them the respect they deserve. My father and brother had to work every Christmas or new year. In my father’s time it was every other night and weekend on call. We have come a long way since then, but we need to give the British-born doctors who want to train a priority in the system which is not being shown to them at the moment.

[Baroness Merron (Lab)]

The noble Baroness has just made a very good case as to why the offer which has been rejected would have been so helpful. On the issue of pay, our door has remained open to the BMA and to reasonable, realistic solutions to resolving the dispute, on which we have been repeatedly clear. I know the noble Baroness did not say this, but I say more broadly that there can be no suggestion that the BMA was not aware that we can go no further on pay this year. Resident doctors have already had a good deal on pay—an average 28.9% rise over the last three years—but pay expectations have to take account of the fiscal position and the impact across the whole of the NHS and beyond. I am glad to hear that noble Lords are in agreement with that approach.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the BMA pay claim has been ridiculous right from the start, and I share my noble friend the Minister’s outrage at the decision to carry out these strikes at a moment when the health service is on its knees, certainly in Birmingham. We are in a critical situation: the service is working under huge pressure, and ambulances are finding it very difficult to discharge patients at A&E because we cannot get the flow of patients through the system.

Listening to the noble Lord, Lord Kamall, I wondered if my noble friend the Minister shares my view. I remember the 2014 junior hospital doctors’ dispute. Although that was ostensibly about pay, what came through was frustration at the way training and working lives were organised, with inflexible placements and utterly insensitive rota allocations. It made junior doctors’ working lives increasingly difficult. This was 2014. Does my noble friend the Minister think that part of the reason we are here now is that nothing was done to respond to the substantive issues juniors raised at the time, and that at some point, there will be a constructive way forward? I am convinced that tackling the way junior and resident doctors are treated in the health service will have to be at the heart of what we do.

[Baroness Merron (Lab)]

I am grateful to my noble friend, and I share his view. I am sure he will be very familiar with this, but it is worth reminding ourselves that in the Statement we are debating, the Secretary of State said last week:

“On jobs, I have much more sympathy with the BMA’s demands. I have heard the very real fears that resident doctors across the country have about their futures; it is a legitimate grievance that I agree with”.


As the Secretary of State outlined and my noble friend referred to, we have inherited

“training bottlenecks that … leave huge numbers of resident doctors without a job … UK graduates”

used to compete

“among themselves for specialty roles; now, they are competing against”

the rest of the world.

“That is a direct result of the visa and immigration changes made by the previous … Government post-Brexit, and … compounded by the”


then Government’s

“decision to increase the number of medical students without also increasing the number of specialty training places”.—[Official Report, Commons, 10/12/25; col. 429.]

This has not just come about, and I am grateful to my noble friend for reminding us of the history of this.

[Baroness Browning (Con)]

My Lords, the Minister was asked what happens next. May I ask her to consider this? Notwithstanding what has already been discussed tonight in this Chamber, the general public out there are going to face a long period with a lot of bank holidays. If we think back to the Covid period, people, for different reasons, were reluctant to dial 999 or 111 to get medical advice or to seek assistance. I know from a personal point of view that I would really not want to be admitted into an emergency department unless I was literally dead. People have a fear of this: we see the trollies and hear now of the shortage of staff. I say that having worked in an operating theatre over a Christmas period.

Can the Minister say what plans the Government have already made to give accurate information to the general public about how they should proceed during this Christmas period if they have relatives who are showing cardiac symptoms or severe respiratory problems? There is a need for some practical guidance on what to do and to encourage people—if they are sitting at home and are genuinely that ill, they must seek help.

[Baroness Merron (Lab)]

I absolutely agree with a number of the points made by the noble Baroness, particularly her last one: people must seek the help they need. I assure your Lordships’ House that the entire focus of the department and the NHS will be on getting the health service through this double whammy of flu and strikes. Despite the huge extra numbers, there will still be people who are not vaccinated. Therefore, in addition to seeking help when needed, I also make a plea to those who have not yet been vaccinated please to do so; that will help immensely.

It is probably worth saying that the next round of strikes will bring the total number of days of strike action to 59, over 14 rounds of industrial action, since March 2023. So I remind your Lordships’ House that this did not start with this government but has preceded it for some time.

To the noble Baroness’s point about performance, I pay huge tribute—as I am sure we all do—to the dedication of NHS staff at this time. During the November round of strike action, the NHS set an ambitious goal to maintain 95% of planned care. It succeeded in doing that, which is totally down to the NHS workforce pulling round. We also proved last time that we could maintain a near full programme of elective care. Our immediate plan, which the noble Baroness asked about, is to replicate this over the upcoming five days of industrial action in December. There is no reason for these strikes, and I know the effect they have and the concern they create for the general public. The noble Baroness allows me to remind us that these strikes are not supported by the general public.

[Lord Sentamu (CB)]

My Lords, one of the four priorities named in the Budget delivered by the Chancellor of the Exchequer was reducing waiting lists. If this strike goes ahead, what increase would there be in the waiting lists? Secondly, the Secretary of State in his Statement said that he is putting

“money back in … doctors’ pockets by”

funding

“royal college portfolio, membership and exam fees … backdated to April”,—[Official Report, Commons, 10/12/25; col. 430.]

and increasing the allowance for less-than-full-time doctors to £1,500. Where is the money coming from? Is this funded, or will this money be borrowed?

Finally, taxpayers spend £4 billion training medics every year. Are the Government persuading resident doctors to keep their social contract with taxpayers? It seems to me that calling this strike at this point in time is a bargain betrayed.

[Baroness Merron (Lab)]

I certainly understand the noble and right reverend Lord’s point. The offer we made—which covered a number of the areas that the noble and right reverend Lord referred to, plus more—is not applicable because it was not accepted. We put it forward, developed it further and did all we could that was realistic. The noble and right reverend Lord asked whether it is funded, but I will change the tense of his question: it would have been funded, but the offer was rejected and therefore is no longer on the table. That is why it is not going ahead.

On waiting lists, as I mentioned to the noble Baroness, Lady Browning, we have proved that we can maintain a near full programme of elective work, with 95% of planned care being maintained—and, again, let us pay tribute to the NHS staff who have done that. But let us not suggest that there are no effects. It affects the staff who step in to cover for their colleagues. We have an NHS in desperate need of reform. We are turning it around, but these strikes get in our way. As I mentioned, we cannot underestimate the amount of effort, finance, direction and morale—the list could go on—that these strikes take up. I am grateful to the noble and right reverend Lord for raising those points.

[Baroness Royall of Blaisdon (Lab)]

My Lords, I share the outrage, fury and frustration about this industrial action. My noble friend the Minister and others around the Chamber are absolutely right to pay tribute to the workforce, and I give a particular shout-out to nurses. We are always focused on doctors—I hope noble Lords present who are doctors will forgive me—but nurses do a splendid job, and too often we forget that they work for relatively little pay as well.

I was glad that when the Secretary of State was negotiating, he was talking about the training places, because the training bottleneck is absurd. I know many brilliant young resident doctors who are so frustrated and have a terrible deal, so I urge my noble friend to pass on to the Secretary of State my view that, when he is next around the negotiating table, training places should be there in the negotiations.

[Baroness Merron (Lab)]

My noble friend rightly refers, as I did earlier, to the training bottleneck. The Secretary of State was glad to acknowledge the need to tackle training. While he felt that there was no point on pay to be accepted, he certainly felt that the BMA resident doctors committee had a good point on jobs. To be honest, that is why it is so disappointing to be where we are today.

I will pass on my noble friend’s generous comments to the Secretary of State. He offered to introduce emergency legislation in the new year to prioritise UK medical graduates and other doctors with significant experience of working in the NHS in speciality training posts. That would have made a huge difference, but it has been rejected. He also offered to increase the number of training posts over the next three years, from the 1,000 that was originally announced to 4,000, bringing forward 1,000 of those training posts to start next year—that would have made a huge difference. I could go on, but I have made my point.

I agree with my noble friend’s point about acknowledging the role of nurses. In fact, if my noble friend will allow me, I will go further: we are talking about the whole healthcare team. That is another point to the issue on pay: while the BMA doctors committee continues to press for a pay deal far in excess of anything that anyone else is getting, the impact across the NHS, both on staff and on services, continues to be under threat—and we cannot allow that.

[Lord Patel (CB)]

My Lords, as a doctor, I feel that a doctor withdrawing or withholding services from a patient is dishonourable and unethical—full stop. I find no reason that I can support for a doctor to withdraw their services, because their patients are trusting them with their lives. As far as I am concerned, junior and senior doctors should never go on strike, whether or not the issue with pay is justified—that is a separate issue; there are other ways to discuss and handle that. In response to the question from the noble Lord, Lord Kamall, about what should happen now, junior doctors or resident doctors, or whatever they call themselves, should go back to work and not go on strike—not now and not ever.

There is a separate and long-standing issue with training, which has been referred to. Some years ago I reviewed medical training and was chairman of the Specialist Training Authority. There is a need now to review doctors’ training completely, particularly postgraduate training. It is not sufficient to allow for more training posts—that does not solve the issue. What is required is a complete review of the training of speciality doctors. I hope that the Secretary of State, in his discussions, can make that offer and set up a review. I have no reason whatever to support the junior doctors’ strike.

[Baroness Merron (Lab)]

The noble Lord is an honourable man, as we all know in your Lordships’ House. I heard his comments on how he sees withdrawing labour in this regard, and I hope they are heard more widely. He makes a good point about reviewing training. Unfortunately, we are currently in the position of having made an offer that was rejected. The offer we made is not going ahead, so I cannot give the commitments that the noble Lord might like. We will deal with the strikes in the first instance, as I know noble Lords would expect. I am sure that if we ever get back to a constructive discussion, the issue of a review could be put forward, as the noble Lord suggested.

[Baroness Neville-Rolfe (Con)]

I agree with the noble Lord, Lord Patel, on strikes. Why are we still allowing in overseas doctors, when domestically trained doctors cannot secure the speciality jobs that they are applying for? When will the legislation that the Government have talked about come in? It really would make a difference.

[Baroness Merron (Lab)]

I can only agree wholeheartedly with the noble Baroness about what a difference it would make. It was actually included in the comprehensive offer that we made to the BMA on 8 December. Our first point was about introducing emergency legislation, which would—exactly as the noble Baroness asks for—prioritise UK medical graduates and other doctors who have significant experience of working in the NHS for speciality training posts. At the risk of repeating myself, I can do no more than to say that the BMA has rejected that, as part of the offer, and so it will not go ahead. Had the BMA accepted it, we would have been absolutely willing and able to introduce that emergency legislation. Our job will be to consider the next steps, now that we have had confirmation of the rejection of the very point that the noble Baroness rightly emphasised.

[Baroness Wheatcroft (CB)]

My Lords, has not the time come for the BMA to reject the way the resident doctors committee is behaving? I do not believe that the NHS I know would be supportive of its actions.

[Baroness Merron (Lab)]

I am sure that the BMA will hear what your Lordships’ House has said today and, in particular, the point made by the noble Baroness. Perhaps I could conclude this important debate by referring to a YouGov poll which was conducted on 12 December. It found that only 33% of the public support strikes in this area and that 58% of the public oppose strikes. The public have made their voice clear, as has your Lordships’ House, for which I am grateful.

Breast Cancer

Baroness Merron Excerpts

Monday 15th December 2025 Lords Chamber

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

My Lords, too many women are dying of breast cancer. Even with a national screening programme, tragically, 11,500 die from breast cancer each year in the UK. AgeX, a large and important research study, is investigating the effects of routine screening of women over 70. Results are expected in 2027. The UK National Screening Committee has been closely involved throughout, and we will use the findings as soon as they are available.

[Baroness Hodge of Barking (Lab)]

I thank my noble friend the Minister for her Answer. She is right that a common cause of death in women is breast cancer, but age is a primary risk. One in three breast cancers occurs in women aged over 70 but, shockingly, nearly half of breast cancer deaths occur in women over 70. Yet the NHS stops inviting and encouraging women to have a mammogram at 70. Given the evidence, can the Minister bring the review of the age limit to a close more urgently than 2027, stop the discrimination against older women and ensure that women continue to be invited to have a mammogram after the age of 70?

[Baroness Merron (Lab)]

My noble friend makes a very powerful case; I am grateful to her for doing so. The UK National Screening Committee continuously monitors emerging evidence through horizon scanning and maintains active engagement with international peers. Should robust evidence regarding the extension of breast screening age thresholds become available, the committee will look at it right away. In the meantime, a suite of public-facing information communicates to women aged 71 and over that they can have screening every three years if they wish. I realise that does not quite meet my noble friend’s request, but I hope it indicates movement to support women aged 71 and over.

[The Earl of Effingham (Con)]

My Lords, women over the age of 70 are entitled to receive free breast screening every three years. However, for those who are digitally excluded, both awareness of this and the practical process of making an appointment can present real barriers. What steps is the NHS taking to ensure that women over 70 are aware of this right, and how is access to screening being made easier for those who struggle with digital access?

[Baroness Merron (Lab)]

Part of the 10-year plan, as we move from analogue to digital, will be ensuring that digital exclusion will not be a barrier. As I mentioned in response to my noble friend, it is indeed the case that women aged 71 and over can have screening every three years, and that can happen by women calling their local breast screening service to ask for an appointment. In other words, analogue is still possible, not just digital.

[Lord Kakkar (CB)]

My Lords, I draw the House’s attention to my registered interest as chairman of King’s Health Partners. Is the Minister content that sufficient resources are applied to the molecular characterisation of screen-detected breast cancer in such a way that those over the age of 70 who have breast cancer detected are appropriately treated?

--- Later in debate ---

[Baroness Merron (Lab)]

I should be able to answer, I admit, but I would rather be honest with the noble Lord: I would prefer to write to him because of the specific nature of his question. I am content with the role of the research trial and that we are now harnessing AI tools through the EDITH trial backed by some £11 million of government support. Using cross-cutting AI tools in respect of the breast cancer screening pathway will be of great assistance.

[Baroness Burt of Solihull (LD)]

My Lords, I feel quite shocked after the question from the noble Baroness, Lady Hodge. I recently went for my final invited mammogram, so I did a little research. I did not come up with that figure, and I wish I had because it changes everything I was going to say; it is very important. People who do not necessarily enjoy the wonders of the world of AI and all these other things do not know all this. They are told, “Right, you’re over 70, you’re pretty much all right now”. Some people do not get any advice and, given what the noble Baroness, Lady Hodge, said, we should review this as a matter of urgency.

[Baroness Merron (Lab)]

I hope I have outlined to your Lordships’ House how the AgeX trial will greatly assist. Clinical evidence, as and when it is available—it is sought actively—is acted on by the National Screening Committee. I emphasise to the noble Baroness and the noble Earl who raised it previously that, as I said to my noble friend, NHS England is producing public-facing information to communicate to women aged 71 and over that they can have screening every three years if they so wish, and I hope that women will take that up if they so wish.

[Baroness Symons of Vernham Dean (Lab)]

My Lords, I was unaware that women over the age of 70 can have screening every three years, and I am very grateful to have heard that today. Given the ages in the House of Lords, might it not be possible to do some screening of women here for breast cancer? What are the statistics for death from breast cancer in women over 70? How serious is the issue in terms of the number of fatalities?

[Baroness Merron (Lab)]

Breast cancer is one of the most common cancers, and more than 50,000 were diagnosed with it in 2023. My noble friend Lady Hodge gave further information. On the point about offering screening here, my strong suspicion is that it will not be practical and it is better for people to go to their community. I will speak to my ministerial colleague, Ashley Dalton MP, in whose portfolio this falls. My recollection is that it is in letters or advice, but I want to check. It should be in there but, if it is not, perhaps it could be, so I will put forward my noble friend’s suggestion.

[Baroness Butler-Sloss (CB)]

My Lords, up to what age will it be possible?

[Baroness Merron (Lab)]

I do not know if I dare comment about vested interest, but why not? I am not aware that there is a final limit. It is on request.

[Baroness Manzoor (Con)]

My Lords—

--- Later in debate ---

[Baroness Manzoor (Con)]

My Lords, I welcome the Government’s strategy to have a dedicated cancer plan, but can the Minister say when this plan will be published, particularly in relation to breast screening? Will she give an indication of the uptake rate by women from disadvantaged backgrounds and women from ethnic minorities? The uptake rates are very low. Will these also be considered in this national plan?

[Baroness Merron (Lab)]

The answer to that latter question is yes, and the noble Baroness will not have to wait too long to see the national cancer plan.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, as a breast cancer survivor, I cannot estimate enough the benefit of breast screening leading to early diagnosis. In that respect, I urge my noble friend the Minister to talk not only to her ministerial colleagues in the devolved Administrations but to oncologists within the Department of Health to ensure that we get an earlier date for publication than 2027. Women, particularly those over 70, want reassurance about the prevalence or non-prevalence of cancer within their body.

[Baroness Merron (Lab)]

We certainly do speak with the devolved Governments, as my noble friend highlights. As I have said, this whole area is guided by the scientific and independent advice of the UK National Screening Committee, which is closely involved in the AgeX trial to which I have referred. I assure my noble friend that action will be taken as quickly as possible.

Emergency Adrenaline

Baroness Merron Excerpts

Monday 15th December 2025 Lords Chamber

[Baroness Ramsey of Wall Heath]

To ask His Majesty’s Government what assessment they have made of community access to emergency adrenaline following the authorisation of needle-free delivery methods.

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

My Lords, the Government welcome the approval of needle-free adrenaline delivery methods. In July, the medicines regulator, the MHRA, recommended consideration of changes to legislation to allow the supply of and access to such methods of emergency adrenaline delivery, particularly in schools. The Government are currently considering that recommendation, as well as any changes to regulations that may be required. The Government may assess community access to emergency adrenaline as part of any legislative changes.

[Baroness Ramsey of Wall Heath (Lab)]

My Lords, as the mother of a severely allergic needle-phobic 17 year-old, the authorisation of needle-free adrenaline devices such as Neffy is a potentially transformative development. These products offer families vital peace of mind by enabling life-saving treatment without needles. The Natasha Allergy Research Foundation, for which I am a parliamentary ambassador, is urging better access to such treatments, but Neffy is currently available only privately. Could my noble friend the Minister confirm when it will be accessible on the NHS and whether wider rollout could improve adrenaline availability in public settings?

[Baroness Merron (Lab)]

I very much understand my noble friend’s personal involvement in this area. I congratulate her on her work in promoting the availability of needle-free delivery of adrenaline, and I too welcome its approval. It is down to local area prescribing committees to provide advice to integrated care systems on whether to include new products such as nasal adrenaline and whether they should be included in local formularies. This takes into account available evidence, as well as any relevant guidance. Following this Question from my noble friend, I will seek a view from NICE as to whether it is considering developing guidance in this area, as I know she would find that helpful.

[The Earl of Effingham (Con)]

My Lords, it has been four years since the Commission on Human Medicines first examined widening public access to adrenaline auto-injectors. It is an excellent initiative, but it requires national co-ordination. What progress have the Government made in establishing a national lead for allergy—which some refer to as an allergy tsar—given their previous support for the idea?

[Baroness Merron (Lab)]

We have been focusing our efforts, as I said, on whether changes to the law are required to allow wider access to, for example, adrenaline nasal sprays, which are a welcome development. Our focus is on that, rather than on the appointment of a tsar, to which the noble Earl referred. We will be establishing national clinical directors, and I am sure that this will be considered in that regard.

[Baroness Finlay of Llandaff (CB)]

My Lords, with the disaster of poorly managed allergy, only 24 ICBs have been able to state the extent to which they have services, and none are able to state whether they have a specialist nurse and dietician. Will the Government use the opportunity of the single patient record to provide guidance to ICBs for commissioning, to make sure that those who have serious allergies, such as we have heard about, can get the advice and support they need and be guided to the most appropriate way to manage their allergy in the immediate emergency and in the long term?

[Baroness Merron (Lab)]

I certainly agree with the noble Baroness that the single patient record gives us all sorts of absolutely key opportunities, including in this regard. It is important that we note how common allergies are—they affect nearly one-third of the UK population. Although in most people allergic reactions can be mild to moderate, in some cases they are severe. We need to cut that risk and, in particular, tackle the approximately 50 suspected cases of deaths each year that we currently have. I agree with her contention.

[Lord Scriven (LD)]

My Lords, following on from the previous question, new delivery methods are welcome but we need a workforce to implement them. As the noble Baroness said, it is concerning that not a single integrated care board currently holds the information on whether it has specialist allergy nurses employed in its area. How can the Government ensure that patients have access to these new treatments when local commissioners are failing to track, co-ordinate or prioritise the specialist skills needed to deliver them?

[Baroness Merron (Lab)]

This is an important part of the availability, as the noble Lord has highlighted. The kind of issues under consideration when we look at the availability of these welcome products include, in addition to their ease of use without specialist training in community settings and their use through proper training, suitability for different age groups and the temperature sensitivity of the products. Training will be part of how we look at developing the workforce plan, but I take the point about assessing what training is needed when we think about where they will be available. That is very much part of our consideration.

[Lord Patel (CB)]

My Lords, based on the statistics the Minister just cited about the number of lives that would be saved if emergency adrenaline was easily available in the community, can she say what training would be required? If the drug is given inadvertently to a person who is not in anaphylactic shock, what will happen?

[Baroness Merron (Lab)]

The noble Lord raises a point on the practical and safety concerns that we would need to consider in widening access to adrenaline in the community. I should add that that would be regardless of the administration method. On his point, and following on from the question from the noble Lord, Lord Scriven, it is essential that training ensures safe administration, whatever the formulation, because we do not want to create an unsafe environment. The training will be appropriate to what is needed. However, I must emphasise that we are in the process of considering this, but with a positive outlook and an intent to provide.

[Lord Scriven (LD)]

My Lords, to be helpful to the Minister, I know she will not be able to give an absolute commitment at the Dispatch Box, but with the Government’s 10-year health plan focusing on digital integration, will she commit to embedding a national allergy register within the single patient record, which would deal with many of the issues noble Lords have raised on this Question?

[Baroness Merron (Lab)]

I know that the noble Lord always seeks to be helpful. That is indeed a helpful suggestion, which I will gladly take away, but I will not be able to give a commitment, as the noble Lord is aware.

[Lord Winston (Lab)]

My Lords, I was a little unhappy with the answer to the question from the noble Lord, Lord Patel. My understanding, having seen medical students being given injections of adrenaline during a physiology class to see what would happen—in larger doses than you would probably need in this case—is that they might feel a bit faint. I would have thought that giving a non-injection method is even safer and that the likelihood of side-effects is much lower. Is that not fair?

[Baroness Merron (Lab)]

I am sure that is fair and I certainly bow to my noble friend’s expertise in this regard. I thank him for that, and I thank the noble Lord, Lord Patel, for his question. However, I feel a little inadequate on the medical front here.