Social Care Reform

Baroness Merron Excerpts

Thursday 22nd May 2025 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what progress has been made in cross-party talks on the reform of social care.

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

My Lords, the Government are facing up to the challenges of adult social care reform. The Prime Minister has tasked the noble Baroness, Lady Casey of Blackstock, to lead an independent commission into social care, a once-in-a-generation opportunity to transcend party politics. The noble Baroness is tasked with building cross-party consensus on her recommendations and is starting a national conversation on what is expected from social care.

[Baroness Pitkeathley (Lab)]

My Lords, history shows us that reform of social care is a contentious issue and political consensus has been notable by its absence—indeed, parties have used proposals as sticks to beat each other with—but there is agreement on two things: first, the system badly needs reform; and, secondly, this is a long-term project that cannot be solved in one Parliament but across several. In view of that, does my noble friend agree that achieving political consensus is a vital part of any reform of social care? Can she tell the House that this will be specifically included in the terms of reference for the review that the noble Baroness, Lady Casey, is carrying out?

[Baroness Merron (Lab)]

My noble friend makes very strong points, which I absolutely concur with. This is an issue that needs to be able to stand the test of time and changes, whether they be in leadership or of Government. That is why we are taking the approach that we are. My noble friend will have seen the terms of reference that have been published. They are deliberately broad because we are tasking the noble Baroness, Lady Casey, to lead the work fully independently, which is particularly important in seeking cross-party consensus. Indeed, the noble Baroness’s review is very much about having the conversations cross-party and seeking to bring people together across parties and across sectors and the many individuals who have an interest in this.

[Lord Forsyth of Drumlean (Con)]

My Lords, is not the truth of the matter that there is a consensus between the parties? The Economic Affairs Committee of this House published a report some five years ago. There was unanimity across the House. There has since been another report. This setting up of commissions and so on is just to appease the Treasury, which refuses to provide the money that is needed for social care and is the key to cutting waiting lists and moving forward in the health service. Should not the Government just have the courage to commit to the resource that is necessary instead of kicking this into the long grass for another three years while elderly people and young people suffer from inadequate services and clog up beds in the health service?

[Baroness Merron (Lab)]

I understand the noble Lord’s impatience—I am sure we share it—and I hear what he says, but I have to remind your Lordships’ House that the previous Government did not commit funding to their plans, and I am glad the noble Lord agreed with that. I do not accept the characterisation of this. As my noble friend Lady Pitkeathley said, it has to stand the test of time. We are not waiting to take action; we have already put a number of pieces of work in place to lay the groundwork, including additional funding for social care authorities, increasing the carer’s allowance weekly earnings limit and an extra £172 million for home adaptations. We are not just waiting for this report. By the way, I do not recognise the three-year characterisation because the first phase will report in 2026 and then there will be a further report back by 2028. I feel this is the right way forward.

[Lord Forsyth of Drumlean (Con)]

Eight minus five is three.

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[Baroness Merron (Lab)]

I understand that, but the noble Lord said we were just waiting until 2028, and I am not aligning myself with that.

[Baroness Walmsley (LD)]

It is recognised that any meaningful social care reform must deliver for unpaid carers. Will the Minister say what role carer organisations are playing in shaping these talks?

[Baroness Merron (Lab)]

Unpaid carers are key because they provide care and support to those who require care. The needs of unpaid carers will be very much part of the commission. I know that the noble Baroness, Lady Casey, will be speaking to relevant organisations and those with lived experience.

[Lord Turnberg (Lab)]

My Lords, can my noble friend give us an estimate of the number of vacancies in the care workforce and tell us whether there has been an assessment of the impact on the workforce of the restrictions on overseas recruitment for care workers?

[Baroness Merron (Lab)]

I can say to my noble friend that the adult social care workforce is growing. Skills for Care data tells us that there has been an increase of 70,000 filled posts since 2022-23, that staff turnover is reducing and that the overall vacancy rate decreased to 8.3% in 2023-24 from 9.9% the previous year. While the direction is good, there is certainly more to do. As regards international care workers, it has indeed been factored in that we need a workforce, and that is one of the many reasons why the new measures that require care providers to prioritise recruiting international care workers are focused on those who are already in the UK, have visas and require new employment. I am sure we will talk about this as we discuss the Employment Rights Bill and all the directions it is taking to support professionalisation of the workforce and encourage those in the UK to take on adult social care roles.

[The Earl of Effingham (Con)]

My Lords, in July last year His Majesty’s Government scrapped the social care cap and curbed winter fuel payments. Sir Andrew Dilnot, author of the landmark Dilnot commission report on social care, said this was a “tragedy” and that

“we have failed another generation of families”.

With all due respect, the Government are doing a U-turn on the winter fuel payment; can the Minister rule out a U-turn on social care?

[Baroness Merron (Lab)]

Again, I do not recognise the characterisation of a U-turn on social care. The Prime Minister and the Secretary of State have been extremely clear, as I outlined earlier in response to the noble Lord, Lord Forsyth, about why this commission is in place. When it was brought to this House previously, I recall that many noble Lords, although not all, were positive about it because they saw the opportunity—which the previous Government did not, not least because they did not fund its suggestions. This Government are absolutely committed to having a lasting, practical answer that involves everybody concerned and will be supported in the right way. I would have hoped that the noble Earl would welcome that.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister explain how cross-party consensus will be constructed in relation to local mayors and local authorities? For example, the leadership in Cornwall Council has just changed, and there are huge care needs in Cornwall. How will we ensure that other parties—those underrepresented in this and the other House—are involved?

[Baroness Merron (Lab)]

As I mentioned, the terms of reference for the noble Baroness, Lady Casey, are deliberately broad. She will set out how she will involve all those who are affected and have a voice, because she wants to make sure that it is a thorough report.

[Baroness Buscombe (Con)]

My Lords—

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[Baroness Andrews (Lab)]

My Lords, can the Minister tell us what progress has been made on addressing the problem faced by many unpaid carers who have been penalised, through no fault of their own, for having been paid too much because of technical failures in DWP? Are we making progress on addressing those very serious issues?

[Baroness Merron (Lab)]

Yes, the relevant officials and Ministers are working on that. I realise the difficulty it has caused and they, too, are very sensitive to that point. I will reflect my noble friend’s comments to my ministerial colleagues.

NHS and Care Volunteer Responders Service

Baroness Merron Excerpts

Tuesday 20th May 2025 Lords Chamber

[The Earl of Effingham (Con)]

My Lords, the NHS and Care Volunteer Responders service has completed more than 2.7 million tasks and shifts, including more than 1.1 million telephone support calls, over the past five years. It provides volunteering support seven days a week, underpinned by wraparound support and assurance, as well as safeguarding, problem-solving teams and helplines running from 8 am to 8 pm. Volunteers are ID checked, have role guidance, hold DBS checks when required and have their expenses paid by the programme. How will the Government ensure that volunteering in the NHS and social care is encouraged and facilitated, given that the need for volunteers across the country remains acute? When will the new scheme begin operating and can the Government guarantee that existing patients will not be left in the lurch?

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

I start by saying, as I am sure the noble Earl agrees, how grateful we are for the generous contribution made by volunteers. They play a vital role in supporting patients, staff and services in many ways. The national NHS and Care Volunteer Responders programme was first established as part of the Covid response, and the noble Earl helpfully set out its contribution. The fact is that a model that worked well in a national crisis is no longer the most cost-effective option, so there will be a new recruitment portal for NHS volunteers to be fully launched this year. This is all about expanding voluntary opportunities and getting more volunteer hours to further support patients even better than volunteers do already.

[Baroness Walmsley (LD)]

Where will the current funding for this programme go? Will it go into the new scheme the Minister has mentioned, or into community services or support for vulnerable groups, or will this result in some kind of cut to services?

[Baroness Merron (Lab)]

I assure the noble Baroness that there is no intention that this will impact on services. As I mentioned, this is about getting value for money; the previous scheme did so during the Covid pandemic and just after, but we are in a totally different world now. All those who volunteered through the scheme that is being brought to an end will have been sent an email advising them how they can continue their volunteering—we do not want to lose people—and how it will be easier. The launch of the portal will provide a one-stop shop, overseen by NHS England. That is what will be funded. I hope that the noble Baroness and other noble Lords will find the website a much friendlier place through which they can volunteer.

[Baroness Brown of Silvertown (Lab)]

My Lords, can the Minister assure me that we will not use volunteers to plug the gap in NHS services and that people will get an appropriate level of care when they arrive at an NHS facility?

[Baroness Merron (Lab)]

My noble friend makes an important point and I can give her that assurance. For me, volunteering provides a different type of resource. For example, Mid Yorks is advertising for trolley volunteers, ward befriending volunteers and café volunteers. It is about supporting the staff in their efforts, and supporting patients. Volunteers have always had a role, and long may that continue.

[Baroness Coffey (Con)]

My Lords, if the Minister is concerned about the use of volunteers, will she then consider the role of community first responders? Responses by volunteers are included in measuring the response times of ambulances to 999 calls. Based on her logic, she should now exclude that from response times so that we get the required transparency.

[Baroness Merron (Lab)]

This announcement does not affect transparency or services directly provided by the NHS. We are seeking to improve the volunteering offer to make it more cost-effective, and to retain, recruit and better utilise volunteers. I will look at the point the noble Baroness raises, but I emphasise my point to your Lordships’ House.

[Baroness Thornton (Lab)]

My Lords, I declare an interest as a non-executive director of the Whittington Hospital, which is my local hospital. It has a very strong volunteer scheme and is recruiting volunteers all the time. Can my noble friend the Minister assure me that this is about enhancing the work that is done locally, because most volunteers are recruited and most volunteering is done locally?

[Baroness Merron (Lab)]

My noble friend makes a very important point and I can certainly give her the assurance she seeks. Over 50,000 additional volunteers are recruited by NHS trusts, which they then support directly in the way my noble friend describes. Their roles are totally unaffected by the change to this programme. There are many thousands of volunteers who support the NHS directly or indirectly via other local and national voluntary sector organisations, and I pay tribute to them all.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare an interest as president of Attend. Can the Minister explain how, in the new system, the Government will work with an organisation such as Attend, which provides insurance, legal advice, financial services and networking to a whole series of agencies that provide volunteers across the country, to ensure that there are rigorously high standards and that those who volunteer are protected in their role, and that they benefit in addition to providing maximum benefit to the recipients?

[Baroness Merron (Lab)]

The noble Baroness raises an important point. I am sure there are many, like me, who have volunteered, or still volunteer, and gained as much as they gave, although they did not expect to. It is important to have standards, and to protect volunteers and everybody involved. That will be the case. A lot of local action builds relationships with local organisations, which is a very successful way of harnessing the benefits of volunteers and volunteering.

[Lord Balfe (Con)]

My Lords, I in no way denigrate volunteers, but can the Minister confirm that when a volunteer in a hospital comes across information about patients it has the same level of confidentiality as it would if it had been found by a member of staff, and that it is not acceptable for any information gathered by a volunteer to be used improperly?

[Baroness Merron (Lab)]

I share the noble Lord’s view. Various directions are given to volunteers about how to behave when they receive information that may be to do with safeguarding, and where it should go. It is important that volunteers and staff do not keep it to themselves and that action is taken, so I can give the assurance that he seeks.

[Lord Sikka (Lab)]

My Lords, the Air Ambulance Service is a vital part of emergency care. It is a matter of concern and shame that one of the richest countries has to rely primarily on charitable donations, which cannot provide a consistent and stable service. I urge the Minister to ensure that the Air Ambulance Service is properly funded from the public purse.

[Baroness Merron (Lab)]

There is a role for charitable organisations. One example is hospices. As I have been told many times in this Chamber, as well as outside it, many hospices and other charities, including air ambulances, welcome and relish the freedom they have as charities and do not want government funding or intervention. Of course, we very much respect and appreciate the role that the Air Ambulance Service plays. My own brother was saved some 10 years ago, so I feel very connected to this point. He is grateful, as am I.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I hear what the Minister says—that this is about a new scheme that will encourage volunteers within the NHS. However, sadly, data shows that instances of volunteering are declining across this country. Does the Minister know what measures will be put in place to ensure that all the volunteers who are currently on the scheme that is going to be closed are supported into whatever the requirements are in the new scheme? Having to go through DBS checks again, reapplying or anything like that might just put barriers in the way of supporting people who are already valued into the new scheme.

[Baroness Merron (Lab)]

I understand that point. It is important to retain and develop people’s interest and commitment. The new portal will be a one-stop shop and will be much better at achieving what the noble Baroness and I seek. I know, having heard about it already, that it has functionality that is not there now. I cannot currently put in my postcode and find out what volunteering opportunities there are, which seems ever so basic—we do that on many other fronts. The new portal will allow that. In other words, the potential volunteers will find it much more accessible and will be matched better. The standards of recruitment will be higher and we will retain people. The noble Baroness makes a very good point—it is why NHSE has written to everybody on the old functionality.

Healthy Life Expectancy

Baroness Merron Excerpts

Tuesday 20th May 2025 Lords Chamber

[Baroness Alexander of Cleveden]

To ask His Majesty’s Government what steps they are taking to reverse recent declines in healthy life expectancy, and to address poverty-related inequalities in life expectancy.

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

My Lords, it is unacceptable that who you are or where you live can impact healthy life expectancy. Reversing the decline in healthy life expectancy is a core part of this Government’s health mission. There is a long way to go but we are making good progress—exceeding our pledge to deliver an extra two million operations, scans and appointments by delivering well over three million, and addressing major health risks that particularly impact more deprived areas.

[Baroness Alexander of Cleveden (Lab)]

I thank my noble friend for her Answer. She may be aware that, this morning, the Health Foundation published a new international benchmarking report. It highlights that, in the 2010s, in all parts of the UK outside London, mortality rates increasingly lagged behind progress in the other 21 countries in the study and that, by 2021, mortality rates in the north-east and north-west of the UK were 20% higher than in the south-west. In light of this, will the Government heed the Health Foundation’s call for a new health inequality strategy that has a particular focus on those parts of the country that have faced long-term industrial decline?

[Baroness Merron (Lab)]

My noble friend raises an extremely important point about inequality. The Health Foundation report focusing on the 2010s shines a light on the need to drive action, which we are doing across government through our missions, with a very ambitious goal and the right approach of halving the gap in healthy life expectancy between the richest and poorest regions. Although I am certainly very interested in what the Health Foundation report says, further strategy is not needed at this time because of the approach we are taking. But I assure my noble friend that in addressing health inequalities, including in areas of past industrial decline, we will be driving economic growth and removing health-related barriers to health, wealth and prosperity.

[Lord McColl of Dulwich (Con)]

My Lords, people are not living as long as they were because of the obesity epidemic, which is killing people at an earlier age from a variety of very unpleasant diseases. Does the Minister agree that there are a lot of pseudoscientists around putting out propaganda that people cannot exercise personal responsibility and therefore government action must be taken? Could it be that those people do not want to see the end of the obesity epidemic because they are making so much money out of it?

[Baroness Merron (Lab)]

The noble Lord always has interesting observations that I listen closely to. I certainly agree that obesity is a major contributor to ill health. Some 64% of the adult population is overweight or living with obesity, and it does indeed, as he says, pose a major health inequality issue. The approach has to be on many levels, and there is government action. For example, we have laid secondary legislation on TV and online advertising restrictions on less healthy foods. We got on with that because we thought it extremely important. Equally, we support people not just through policy or medical intervention, but by encouraging them to adopt a healthier lifestyle. The reasons why people are obese are complex, and we approach it in that way.

[The Lord Bishop of St Albans]

My Lords, I welcome His Majesty’s Government’s commitment to bringing forward a child poverty strategy. The interaction between mental ill-health and poverty is well known. Will the strategy address access to vital mental health support services, especially for those in more remote rural areas where they are difficult to access?

[Baroness Merron (Lab)]

The right reverend Prelate is quite right to draw attention to mental health impacts and the inequality of their incidence. As I mentioned, there has to be a cross-government approach because if we address it through health alone, we will not succeed. Factors such as poor housing, low income, worklessness and disability, as well as ill health and many other factors, affect healthy life expectancy. That is why we are approaching it not by a separate strategy, but by a mission-led approach.

[Baroness Barker (LD)]

Through the work of people such as Professor Michael Marmot, the Government know about the different incidences of ill health across the country. Retailers, particularly food retailers and high street pharmacies, know about the incidence of ill health way in advance of that because they have the data on consumption and purchasing behaviours. Will the Government work with them, particularly the large supermarkets, to increase the availability of data in advance, so that we can prevent some of the incidence of ill health rather than getting the NHS to pay for it when it has happened?

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[Baroness Merron (Lab)]

Prevention is certainly the best approach. As noble Lords will be aware, one of the three pillars of the published 10-year plan is moving from sickness to prevention, so that will feature very much in the plan. We work closely with industry to ensure that government can benefit from its information and its approach, and that we can bring industry along with us to ensure that, collectively, we are taking the best approach to making healthier foods available. We also have to make sure that people have the resource to have healthier foods, as well as information. It is, again, a many-pronged approach, but that is why it has to be a joined-up approach.

[Lord Patel (CB)]

My Lords, while accepting what the noble Baroness, Lady Alexander, and the Minister have said about social inequalities in health outcomes, there are other issues. For instance, period mortality affects life expectancy, so a male aged 65 will expect to live another 18.5 years and a female another 21 years. In turn, period life expectancy is affected by mortality rates so if you improve mortality rates, particularly for diseases where the rates are highest, you will improve life expectancy irrespective of social inequalities. That means that we need the health service to deliver high-quality care for those conditions which result in high mortality rates. Any forward plan or 10-year plan should address that issue. Does the Minister think that might be wise?

[Baroness Merron (Lab)]

I do feel that that would be wise, and we as a Government have already shown that trajectory. To give just one example, smoking remains the preventable killer in our country, and the landmark Tobacco and Vapes Bill will deliver the ambition of a smoke-free UK. We will have a smoke-free generation and will gradually end the sale of tobacco products across the country. We have to break that cycle of addiction and disadvantage which is particularly focused on areas of greater disadvantage. As ever, the noble Lord speaks wise words.

[Baroness Stedman-Scott (Con)]

My Lords, as somebody who has embraced the healthier lifestyle and healthy eating—far later than I should have done—I have looked at every strategy in the book and found one that works. I draw the Minister’s attention to the fact that Japan has the highest life expectancy in the world at birth. Multiple studies have put this down to both healthy eating habits and a strong culture of exercise, both of which are reinforced during school. With Committee of the Children’s Wellbeing and Schools Bill beginning today, what steps will His Majesty’s Government be taking to ensure that our children receive better health and exercise education to emulate the success of Japan?

[Baroness Merron (Lab)]

I congratulate the noble Baroness on being an example to us all. She referred to learning from international examples, including Japan, and indeed we do. We know that some 12 million adults and approximately 2 million children are not physically active enough, so we are developing targeted plans to help children build healthy eating habits and embed physical activity support into routines. We will continue to work closely with DfE on this.

Doncaster Royal Infirmary

Baroness Merron Excerpts

Monday 12th May 2025 Lords Chamber

[The Lord Bishop of Sheffield]

To ask His Majesty’s Government what assessment they have made of the impact of the conditions at Doncaster Royal Infirmary on patient care.

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

My Lords, Doncaster Royal Infirmary has a backlog maintenance bill of approximately £114 million, and serious infrastructure issues are indeed presenting challenges to delivering high-quality patient care. Repairing and rebuilding our healthcare estate is vital in creating an NHS fit for the future. South Yorkshire ICB has been provisionally allocated more than £150 million in capital investment for 2025-26 to begin to tackle estate challenges, including the condition of DRI.

[The Lord Bishop of Sheffield]

I thank the Minister for her Answer. She may be aware that one recent estimate of the costs involved in bringing the infrastructure of DRI into good repair came to an eye-watering £478 million. In 2021, a water ingress into the electrical circuits in the maternity ward caused the evacuation of premature babies in incubators and women in labour. In 2023, the collapse of a significant portion of plaster work in a hospital corridor ceiling resulted in no human injury only by the providence of God. How does the Minister intend to monitor the conditions at DRI to ensure that any future deterioration does not put the safety of patients and staff at risk?

[Baroness Merron (Lab)]

I am very aware of the unacceptable situation that the right reverend Prelate describes. I can confirm that, in terms of capital commitments, in 2025-26 the Government are backing NHS systems with over £4 billion in operational capital, £750 million of targeted estate-safety funding, which will be crucial to DRI, as well as £440 million to tackle crumbling RAAC. Why is this all so important? It is all about keeping staff, patients and their families safe, and it is also about providing the best possible care. I should say that the Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, which DRI comes under, is discussing—indeed, it absolutely should be discussing—options with the ICB to steer the programme allocations towards DRI.

[Lord Scriven (LD)]

My Lords, system allocation guidelines of January this year state that systems will receive at least 80% of their 2025-26 core operational capital in each year of this Parliament, relative to their 2024-25 allocation. With many hospital buildings in serious financial capital backlog, why have the Government put in a system that could see some areas’ day-to-day capital allocation cut by 20%?

[Baroness Merron (Lab)]

I can tell your Lordships’ House that we have inherited an undercapitalisation over the past few years, and it is essential—including to cut waiting lists and provide proper care—that we provide resources. However, the noble Lord is very aware of the extent of the backlog; it stands, according to the latest NHSE figures for 2022-23, at £13.8 billion. Even more worryingly, the critical infrastructure risk within that, which the highest-tier hospitals are wrestling with, is £7.6 billion. We have had to find the best route forward to be fair and efficient. Is it a major mountain to climb? Yes, it is. Are there various options for doing it? Yes, there are, but we believe that we have been as transparent and fair as we can be.

[Baroness Winterton of Doncaster (Lab)]

My Lords, I know that Secretary of State Wes Streeting is determined to increase NHS productivity. DRI’s bid for urgent work to the tower block would do just that; for example, by stroke services having a same-day emergency care centre linked to the in-patient ward with a knock-on effect on vascular services. That is all impossible with the current state of the hospital. Will my noble friend the Minister ensure that Ministers, officials and, crucially, the Treasury not only are aware of the patient safety concerns raised by the right reverend Prelate, but know that the DRI bid will increase productivity and efficiency, as well as improve patient care?

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[Baroness Merron (Lab)]

My noble friend is right about the effects of a poor estate. In addition to productivity, it very much affects safety, staff working conditions and capacity. The benefits are considerable, as she identifies—and indeed as the noble Lord, Lord Darzi, identified. I assure my noble friend that we are working across government—including with the Treasury and, to the right reverend Prelate’s point, with the local ICB and trust—to tackle this. My noble friend is aware that this Government committed nearly £20 million from the critical infrastructure risk fund to the hospital’s NHS foundation to move a section to the ground floor—not the part to which my noble friend referred, but it shows the seriousness with which we are taking this.

[Lord Kamall (Con)]

My Lords, the injection of capital to Doncaster Royal Infirmary is welcome. When the CQC inspected DRI in 2024, it found that the hospital

“did not have enough maternity staff with the right qualifications, skills, training, and experience to keep women safe from avoidable harm”.

While the Government develop their 10-year and workforce plans, what action are they taking in the meantime to address safety concerns from a lack of adequate staffing in maternity services? While we are on the subject, given the recently announced crackdowns on immigration and that many people who work in our health and care system are immigrants, how do the Government intend to encourage more British workers to fill vacancies in health and social care?

[Baroness Merron (Lab)]

On that point, I feel that the Government taking the backlog very seriously, against the background of what we have inherited, will make conditions far better for staff, which will make it a far more attractive place to work. That will be reflected when we report on the workforce plan. To the point about maternity, we are recruiting extra midwives and we are looking extremely closely at how we can better support best practice—as I saw just last week—how we can extend that and how we can bring better patient safety measures into the system. I am afraid that it is another area that we inherited in a difficult position, but noble Lords can be assured that we are working on it. I look forward to updating your Lordships’ House.

[Lord Scriven (LD)]

My Lords, I am going to come back at the Minister. I accept that the backlog is there. My question was: why have the Government put in a system that will reduce day-to-day capital expenditure, potentially by up to 20%, for some areas? That is this Government’s new plan. The Minister said at the Dispatch Box that the ICB in South Yorkshire has been allocated £150 million this year. It was allocated £161 million last year. How does this help Doncaster, Sheffield, Rotherham and Barnsley with their capital backlog?

[Baroness Merron (Lab)]

I understand that the noble Lord is, as I am, very keen to resolve this situation, but the fact is that DRI is in an extremely difficult place, which was the reason for the right reverend Prelate’s Question. To pursue the particular point he made, I will be very pleased to come back to him. However, I emphasise that the Autumn Budget made exceptional support for capitalisation, which is not just for the physical estate but also the digital estate. DRI has, for example, been updating patient records on paper. That is not the way forward and they will now be digitally brought up to date. On his particular point, I will be very pleased to look into it further and come back to him.

Medical Devices (Amendment) (Great Britain) Regulations 2025

Baroness Merron Excerpts

Thursday 8th May 2025 Lords Chamber

Moved by

[Baroness Merron]

That the draft Regulations laid before the House on 3 March be approved.

Considered in Grand Committee on 6 May.

Motion agreed.

Care Quality Commission: Mental Health Care Waiting Times

Baroness Merron Excerpts

Thursday 8th May 2025 Lords Chamber

[Lord Davies of Brixton]

To ask His Majesty’s Government how they intend to respond to the results of the survey undertaken by the Care Quality Commission, showing that people are waiting too long for mental health care.

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

My Lords, it is unacceptable that too many people are waiting too long for mental health care, as the Care Quality Commission survey makes clear. Mental health is a key priority for this Government. We are already transforming services, including through introducing new models of community-based care, recruiting 8,500 mental health workers and expanding mental health support teams so that we can provide access to specialist mental health professionals in every school.

[Lord Davies of Brixton (Lab)]

I thank my noble friend the Minister for her reply, and I welcome the progress that is being made. As she will be aware, yesterday the NHS Confederation published a report, based on research by the Centre for Mental Health, setting out urgent tasks that need to be undertaken. I know that she understands the need for parity of esteem; that could be marked by her giving the recommendations early consideration with a favourable turn of mind.

[Baroness Merron (Lab)]

I am aware of the very helpful report that my noble friend refers to. I acknowledge the challenges highlighted in that report and will certainly take into account the points it makes. I regularly meet with and listen to the sector on what we can do to improve outcomes and transform mental health services, and this report will of course feed into that.

[Baroness Tyler of Enfield (LD)]

My Lords, the NHS planning guidance for 2025-26 reduced the overall number of targets, including those for mental health, and the guidance given was of a fairly generalised and vague nature. In the absence of any such targets, what specific incentives are currently in the system for ICBs to prioritise improvements in mental health services?

[Baroness Merron (Lab)]

As the noble Baroness says, we reduced the number of targets on the basis of the recommendation by the noble Lord, Lord Darzi, that having so many targets was not delivering the results that we want. We have had to think boldly and innovatively. Since July 2023, NHS England has included waiting time metrics for referrals to urgent and community-based mental health services. I am looking at how we can drive improvements in quality and in the data to help services, particularly those with the most lengthy waits. I will also review the 2021-22 clinical review of standards to consider what else can be done to put mental health on a more equal footing, which it absolutely deserves.

[Baroness Wyld (Con)]

My Lords, what are the Government doing to improve access to perinatal mental health services? The Minister will appreciate the urgency, given that suicide remains a leading cause of maternal death.

[Baroness Merron (Lab)]

It is particularly appropriate that the noble Baroness raises this issue, as it is Maternal Mental Health Awareness Week. Yesterday I was very glad to attend an event organised by the Maternal Mental Health Alliance, where I spoke to women about their experience and what has made—or not made—a difference to them. I know we are looking forward to a debate on this later in the year, but 41 maternal mental health services have already been set up to provide care for women with moderate, severe or complex mental health difficulties, and more than 62,000 women are reported to have accessed a specialist community perinatal mental health service or a maternal mental health service. Additionally, 165 beds have now been commissioned across England in 20 mother and baby units, providing in-patient care to women. But yes, we need to do more.

[Baroness Gohir (CB)]

My Lords, in some NHS trusts, autistic patients with learning needs and poor mental health are automatically opted into video and phone appointments, despite their communication needs. It feels as if the needs of the NHS and doctors working from home are prioritised over patient care. I know this from experience, because my son was repeatedly given video and phone appointments, even though I kept saying I wanted him to be seen in person. What can the Government do to ensure that there is a uniform approach across trusts, that patient care is prioritised and that guidelines are adhered to?

[Baroness Merron (Lab)]

I thank the noble Baroness for raising her experience with her family. It is clear that patients are individual people and they need to be cared for and communicated with in the way that is appropriate to them. So I am sorry to hear what she reports; that is not what we expect. If she has not already provided the details, I will be pleased to look into the matter she raises, because it has repercussions across the whole system, as she rightly says.

[Baroness Berger (Lab)]

My Lords, the overwhelming majority of mental health conditions start in childhood and adolescence, and we need to do everything to give those children and young people the very best start in life. Yet, regrettably, we know that there are 35,000 children in this country who have been on a waiting list for two years or more. I listened closely to my noble friend on the excellent work that this Government are doing with the support teams in schools, but for those children and young people who have met the threshold for services, what more can be done to alleviate these unacceptable waits?

[Baroness Merron (Lab)]

I pay tribute to my noble friend for her contribution in supporting awareness and improved mental health, not just for young people but in maternity settings and across all mental health services. This morning I was at Alexandra Park School, where I saw what I regard as the exemplar for what my noble friend is talking about, because we need to prevent mental ill-health in young people. That is why we are extending the mental health support teams to ensure that every school has that available. While that is being developed, funding is available for mental health leads in schools. We are also working with local areas to ensure that they meet their obligations to the local community, which of course includes young people. I also feel that our Young Futures hubs will make a big difference. I agree with her: we have inherited a difficult position, but I assure your Lordships’ House that we are working to make progress, particularly for young people.

[Baroness Blackwood of North Oxford (Con)]

My Lords, what assessment has the department made of the benefits and risks of the growing trend that is being reported of those who are unable to access affordable mental health care therefore turning to AI platforms such as Grok and ChatGPT, which are of course unverified for this use?

[Baroness Merron (Lab)]

As the noble Baroness says, it is very important that people use the right support. Otherwise, there is immense danger in going for what is perhaps less suitable. To my knowledge, we have not made a particular assessment, but I will pick up the noble Baroness’s point, because it is very right. On a more positive note, we are—and I am particularly—looking at what support we can develop in a digital and online sense to support people, not just on waiting lists but to prevent ill health and assist in their recovery.

[Lord Kamall (Con)]

My Lords, given that there is a waiting list for mental health care, including community-based services, and given the many competing demands on public finances, what can the Minister tell the House about conversations that her department and local ICBs may well be having with local community non-state civil society organisations, including those that offer music, art, talking drama, dance and other therapies, to help those on the waiting list?

[Baroness Merron (Lab)]

As the noble Lord is aware, I regard the contribution of the community sector—the third sector—as absolutely crucial here. I personally work very closely, like the department more generally, both to improve our practice and to recognise the difference that the creative arts, for example, can add to people’s mental well-being, as the noble Lord says.

[The Lord Bishop of Leicester]

My Lords, in my own city of Leicester, some excellent work is being done with minority-ethnic communities in particular to help with access to mental health services. Nevertheless, significant inequalities remain. What more is being done to address those inequalities, particularly as they relate to people whose first language is not English?

--- Later in debate ---

[Baroness Merron (Lab)]

What the right reverend Prelate raises is absolutely key: tackling inequalities in mental ill-health is so important. We know that some groups are more excluded than others, and this is taken into account in the preparation of the 10-year plan, which will be published over the next few months. I hope the right reverend Prelate will, like me, find that the 10-year plan addresses how we will tackle inequalities over the coming years—it will do so—because that is a key point.

Medical Devices (Amendment) (Great Britain) Regulations 2025

Baroness Merron Excerpts

Tuesday 6th May 2025 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Medical Devices (Amendment) (Great Britain) Regulations 2025.

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

My Lords, this is a short—I hope—but technical SI, so it may be helpful to the Committee if I give some context. The Medicines and Healthcare Products Regulatory Agency regulates medical devices in the UK and helps to ensure that those products are safe and perform as intended. That includes ensuring that the legislation governing them is appropriate and keeps pace with advances in science and technology.

The 2002 regulations transposed relevant EU directives into domestic law and is now therefore considered to be assimilated EU law. The regulations contain references to several specific pieces of assimilated EU law that will form part of the regulatory framework for Great Britain. This is an important step towards delivering the Government’s 10-year health plan, in terms of the development of legislation apart from this SI. We need safe and effective medical technologies to achieve the shifts that will help build an NHS fit for the future, to take us from hospital to community-based care, from analogue to digital solutions and from treatment to prevention.

As we know, since the 2002 regulations were introduced, technology has advanced significantly. The MHRA has therefore set out plans to make a number of updates to the regulations—separate to the SI we are debating today, of course—to further improve patient safety and access to medical devices, as well as to keep the UK as an attractive market for medtech innovators. I assure noble Lords that, as part of this, there continues to be considerable engagement with the sector, not least because life sciences manufacturing is vital to the UK’s economic growth. In 2021-22, there were almost 119,000 people employed at life sciences manufacturing sites across the country. We will support the sector to flourish, in line with our growth agenda.

The MHRA is taking a phased approach to the implementation of the future medical devices regulatory framework in order to support system readiness and to minimise the risk of supply disruption for UK patients. A key piece of secondary legislation was made in 2024 to ensure that there is appropriate oversight of a device once it is in use. The further secondary legislation, to which I have referred, is expected to come into force in 2026. That legislation will update the regulatory requirements for devices before they are put on the market and will introduce key measures such as implant cards, unique device identifiers and an international reliance scheme for medical devices; in other words, it will take us forward to the place where we need to be.

In the meantime, the statutory instrument that we are here to debate will help provide continuity for the regulation of medical devices until the subsequent statutory instruments to which I have referred are put in place. I assure noble Lords that this instrument does not make changes to the current regulatory requirements. Instead, by maintaining the regulatory status quo, it will help ensure a smooth transition to a future regulatory framework that protects patient safety, improves access to transformative technologies and supports innovation.

This statutory instrument amends the Medical Devices Regulations 2002 to remove the revocation date of four pieces of assimilated EU law, so that they can continue to apply in Great Britain until such time as they are replaced with the updated law to which I have referred. The measure was consulted on from November last year to January this year. Of the 287 responses to the consultation, 83% were in favour, while a further 12% had no opinion. If this statutory instrument were not agreed to and the provisions expired in May—in other words, this month—there would be a significant gap in the regulatory framework, as well as risks to patient safety.

I will now give the Committee an overview of the four pieces of assimilated EU law for completeness; I know that noble Lords will be interested in this. First, the decision on common specifications for in vitro diagnostic medical devices sets out specifications that certain IVD devices must meet in order to demonstrate compliance with essential requirements.

Secondly, the regulation on electronic instructions for the use of medical devices establishes the conditions under which instructions for the use of medical devices may be provided in electronic form, instead of in paper form.

Thirdly, the regulation on devices manufactured utilising animal tissue, as well as their derivatives, sets out requirements to be met before those devices can be placed on the market.

Finally, the regulation on the designation and the supervision of approved bodies sets out further requirements relating to those bodies, which assess applicable medical devices for conformity with the regulations.

Although we are revoking the sunset dates instead of replacing them—not least because we do not wish to use up any more parliamentary time with debates on short, technical SIs such as this—the Government do not intend for this assimilated EU law to be kept in place indefinitely. I hope that will be a helpful and welcome reassurance. This SI serves as a temporary measure to maintain the status quo until more permanent measures are in place. In the meantime, this is important assimilated EU law that must continue to be complied with.

That will also ensure that unnecessary EU divergence is minimised, which is particularly important in this instance because, as noble Lords will be aware, Northern Ireland continues to operate under the EU framework for medical devices under the terms of the Windsor agreement. More broadly, I reassure the Committee that the regulations for Great Britain do, where appropriate, align with global best practice. As noble Lords will, I hope, be aware, the Government’s aim is to ensure patient safety while minimising unnecessary regulatory burden.

In conclusion, I am glad to say that the UK is a prime location to research, develop and manufacture pharmaceutical and medtech products. We want to continue to attract medtech manufacturing investments that deploy the latest innovations, are highly productive and are consistently high-quality. Key to achieving this objective is proportionate regulation, and implementing regulatory changes must be done in a sensible and measured manner.

As I have set out, the continuation of this assimilated law is necessary to prevent significant disruption to the current regulatory framework and, consequently, negative impacts on patient safety. I beg to move.

[Baroness Finlay of Llandaff (CB)]

I thank the Minister very much for her introduction to this tide-over regulation, which is as it has been portrayed to us. I should declare that my son is involved in medical technology, in cardiology; you could say that our family has a bit of skin in the game, although I do not understand the technology that he is developing— it is so complicated.

I have just a couple of questions. As the new regulations are eventually developed, can the Minister confirm that there will be no more regulatory burden on those trying to innovate and that we might lessen the bureaucratic burden on them? Will there be compatibility reading across to the FDA regulations? The American market, which is subject to a lot of debate at the moment, is a potential market for devices developed in this country overall. In that process, can there be the assurance that we also do not jeopardise our European market, or the Far East on the global scale? We will need to export the technology that we develop.

--- Later in debate ---

[Lord Kamall (Con)]

My Lords, I thank the Minister for introducing this statutory instrument. I want to be clear that we on these Benches recognise the need for this measure, since, without it, key regulatory provisions would expire at the end of this month, as the Minister explained. That would create uncertainty and risk disruption to the oversight of medical devices in Great Britain.

We understand that this instrument is, in essence, a stopgap, as the Minister said, and that the MHRA’s consultation, particularly with small and medium-sized enterprises and clinicians, demonstrated strong support for continuity. But while the measure preserves the status quo for now, it has provoked some questions about the Government’s long-term strategy. I am grateful to the Minister for reassuring us that this is definitely a temporary stopgap and that they are looking for a longer-term and more pro-innovation solution than when we were in the EU.

As the Minister said, this revokes the sunset clauses in four areas in particular: performance standards for diagnostic devices, electronic instructions for use, the regulation of devices containing animal tissue and the designation and oversight of approved bodies. These are not mere technical footnotes; they are essential to ensuring safety, clarity and public confidence in the medical device sector, so we understand that revoking their expiry is necessary to avoid disruption.

Can the Minister add any more detail at this stage to what she has already said? This first phase, focusing on pre-market regulation, is expected in 2026. What further reforms are expected to follow? I know that she explained some of that in brief—I suspect that she did not elaborate as much as she could have for reasons of time—but can she say a bit more about the future plans for this regulation? If she cannot now, perhaps she will write to me, because that was a very welcome move. I was going to ask lots of questions about whether the short-term fix will remain in place for the long term, but the Minister has reassured us. Nevertheless, perhaps she could set out some more details either today or in writing.

I do not believe in regulatory divergence for divergence’s sake, but let us be clear that neither should we agree with regulatory alignment for the sake of regulatory alignment. I understand the concerns of the noble Lord, Lord Rennard, but I recall that, when I was a Health Minister, many a supplier—regardless of whether they supported the UK leaving or remaining in the EU —asked me, “Now that we’ve left, can we take advantage of our independence and develop a more pro-innovation approach than the EU?” In technology—I spent 14 years in the European Parliament—the EU was known as an area for regulation; if you wanted innovation, that was in the US. We have to get a better balance between the two. Whereas the EU focuses more on the precautionary principle and less on innovation, perhaps we can get a better balance in this country, so that we do not align for alignment’s sake.

The Minister also mentioned Northern Ireland. As we know, as a result of what noble Lords, said there are some concerns in Northern Ireland but, given that the EU is seen as an area generating regulation, should the EU impose additional regulatory burdens on businesses in Northern Ireland? What steps will the Government take to support them to protect their competitiveness? That is one of the concerns I know from the most pro-innovation businesses in Northern Ireland.

Finally, on international trade, not strictly within the remit of these regulations, so I hope the Minister and her officials will forgive me—this does not have to be answered straight away—has the Minister or the department assessed the impact of recent US tariffs on medical device imports? Does the UK import a substantial number of medical devices from the US? I know that we talked about the importance of the US as an export market. Will these tariffs have an impact on medical devices from the US, particularly those that have been made with components imported from outside the US into the US before being re-exported? Does that have a price implication? Have the Government made any assessment of the implications for availability, cost and affordability, particularly for NHS procurement? Clearly, as the noble Lord, Lord Rennard, and others said, there is the impact on medical device suppliers exporting to the USA. Has any assessment been made of that market? Across the House, we all want a thriving life sciences sector in this country, but we should be assessing the impact of the proposed tariffs. I know some of them have been in abeyance.

I recognise that I have asked many questions, and I do not expect the Minister to have all the answers straight away, despite the advances of iPad technology and wireless communication. Maybe one day that will extend to telepathy. Perhaps the Minister can write to me on the questions that she is unable to answer today. In drawing my remarks to a close, I will be clear that noble Lords on these Benches support this measure as a necessary step to prevent regulatory disruption, but the real test follows. I hope the Minister, in answering the questions, is able to share a clear timeline for the programme for reform as we hopefully move towards a more pro-innovation approach.

[Baroness Merron (Lab)]

I am grateful to noble Lords for their valuable contributions and the way in which they have raised issues relating not just to the statutory instrument before us but this whole area of important work. I am also grateful for the support more broadly on the need to get the legislation right in order to protect patients, get the best medical technology within our grasp and support innovation. I am sure we will return to this subject. I will respond to a number of the points, and I will come back to noble Lords on anything significant that I have not responded to.

I reiterate that this SI is essential if we are going to prevent what I would call significant disruption. The words used were “a stopgap”. I think that is a fair legal term in this setting. It will preserve the status quo as we progress to more comprehensive regulation, which I know is what noble Lords are interested in.

The noble Baroness, Lady Finlay, asked for an assurance that we would not jeopardise not just the European market but other markets because we need to export technology. That is a fair point. I can say in response that over recent years we have learned important lessons from the implementation of new medical devices regulations in the EU as well as the global approach to regulation. How has this informed our approach to regulatory reform? It is why the Government are taking a phased approach to the delivery of these regulations to support the sector and adapt to the changes. It is also the reason why we are in continued discussion and are working closely with the sector.

We recognise the benefit of international harmonisation of medical device regulations in order to reduce, as we would all like, unnecessary regulatory burden or duplication of assessment for manufacturers, which is something that has been raised many times with me and I am sympathetic to. This means that, where sensible, we will align with the regulations of other jurisdictions, including those in the EU. Any reform to assimilated law will be to support domestic priorities and the Government’s national health and economic growth missions.

The noble Lord, Lord Rennard, raised a number of points. He raised the issue of products being subject to EU and UK regulations and whether this would make tech companies less likely to innovate. I believe the noble Lord also argued that we should be in line with the EU, and he raised the important issue of Northern Ireland. On these points, we will seek to align with international best practice and EU regulations where they are sensible, support manufacturers and support where we want to get to on patient safety and the contribution of medical technology.

On Northern Ireland, the MHRA is the competent authority for devices placed on the Northern Ireland market. It continues to have oversight of medical devices across the whole of the UK. We will continue to monitor any risks to the supply of devices to the whole of the UK market. I can give the assurance that, at present, the supply is stable and processes are in place to identify alternatives if needed. My final reassurance is that the SI before us today will not have any impact on the supply of devices to Great Britain or Northern Ireland.

The noble Lord, Lord Kamall, also raised a number of key points and requested more detail on what further reforms are expected to follow. He also raised regulatory alignment, making the point that, in his opinion, the EU can be more cautious and asking how we as a country can be more innovative. The noble Lord also asked about Northern Ireland and about the impacts that US tariffs have in respect of medical devices.

On plans for regulatory reform, the MHRA has published plans to introduce several SIs to amend the framework for medical devices. The post-market surveillance SI, which will come into force in June as noble Lords may recall, represented the first significant step in this reform. That legislation will put in place strengthened legal requirements for how manufacturers monitor and report on their devices once they are being used.

In November last year, the MHRA launched a consultation on further aspects of regulatory reform which will inform a subsequent pre-market SI that introduces, among other things, a new international reliance scheme, measures to improve traceability of implantable medical devices, more risk-proportionate changes to the classification of certain devices and the prohibition of misleading claims. We expect that legislation to come into force in 2026. I think that all those will put us in a much better place than we are currently, because they will allow us to keep pace with changes in the market.

The MHRA also continually monitors the UK’s medtech landscape for developments that could affect patient safety and the implementation of regulations. Details of further regulatory proposals will be communicated when available, and I look forward to bringing those before your Lordships’ House.

On US tariffs, there are ongoing discussions, and I will not seek to pre-empt them. The MHRA will monitor any impacts once they become clearer. That is very much under a watching brief.

I hope I have demonstrated the need for these regulations, not just for the public currently but as being key to the forthcoming 10-year plan. I hope that the Committee will agree that we are continuing with this assimilated law to prevent significant disruption to the current framework and to ensure that patients, device users and the economy are all protected.

Motion agreed.

Prosthetics for Amputees

Baroness Merron Excerpts

Thursday 1st May 2025 Grand Committee

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

My Lords, I thank the noble Lord, Lord Mackinlay, for securing this debate and for giving your Lordships a tremendous opportunity for a very informed and meaningful debate. Having listened as the Minister, which I did very closely—I assure noble Lords that I will also review the points that were raised—my summary is that the case is well made. The current service is not where it needs to be and we have some way to go. That has been the theme throughout.

I associate myself with the comments of the noble Lord, Lord Kamall. The noble Lord, Lord Shinkwin, also spoke about those who rely on prosthetics as well as orthotics. The fact is that they cannot play a full part, reach their potential and lead a reasonable live without the right services and support. I wanted to set out those general points.

We have heard a lot of powerful and personal testimonies today. I particularly thank the noble Baroness, Lady Ludford, who spoke of her dear late husband, and the noble Lords, Lord Mackinlay and Lord Shinkwin, for bringing colour to this very important debate. I absolutely agree that all those living with limb loss deserve the right care, as do those with disabilities, because everybody should lead independent fulfilled lives.

I was interested when the noble Lord, Lord Mackinlay, started by outlining the various reasons for limb loss—running from war to diabetes to cancer to, of course, sepsis. I have heard and understand the call, particularly from the noble Baroness, Lady Ludford, for greater attention to be given to sepsis, as it is a killer of so many.

I will make some general points, which I hope will be helpful. First, we are committed to improving access for patients to the right prosthetics at the right time. That is why the Secretary of State for Health and Social Care, Wes Streeting, was delighted to meet with the noble Lord, Lord Mackinlay, and those affected by limb loss a few months ago to hear their first-hand experiences of the services that are and are not being provided. During the meeting, the Secretary of State also heard about variation in practice across the country and the need to improve personalised care. I will come back to this point later, but the noble Lord, Lord McColl, spoke about the importance of fit, which is so obvious, but this is about getting the right thing for people’s needs. People are individuals and it is important to recall that.

The noble Lord, Lord Shinkwin, talked about the isolation for those with disability and I absolutely take that on board. The NHS in England cares for around 60,000 patients with amputation or limb difference, around 25,000 of whom are seen annually. I highlight that care is delivered in 35 centres that provide specialist prosthetic services across England with multidisciplinary teams. On the point about isolation and practicality, a multidisciplinary approach is absolutely right.

We need to consistently and fairly account for varied clinical circumstances and patient preferences. To state the obvious—I think it is worth doing so—the needs of an adult who has lost a limb caused by diabetes will be very different from the needs of a child with sudden limb loss caused by a traumatic and tragic event. It is hard, and the literal point from the noble Lord, Lord McColl, was that one size does not fit all. We need the engagement of those with lived experience so that healthcare services can meet those varying needs.

On the matter of taking action—because I think we can see that we are not where we want to be, and I freely acknowledge that—we have committed to reforming elective care equitably and inclusively for all adults, children and young people. I know that noble Lords appreciate and have identified that prosthetics are complex and intricate devices, and they have also rightly spoken about cost—and, might I add, value for money. For example, a multi-grip device can cost more than £20,000, while at the same time some 70% of patients may decide—and by that I do not mean that they decide freely but that they may be in a position whereby they have to decide—to abandon their upper limb prosthesis. Our health service has to ensure that the right prosthesis is available for the patient, not just because of value for money but because of the trauma associated with being offered a solution that just does not work. The noble Lord, Lord Mackinlay, spoke powerfully about that.

Currently, patients often wait 12 months or more to access advanced prosthetics. On the practical side, that is to ensure that they have recovered from surgery and are able to use them. However, I have to acknowledge that there are a number of cases where earlier access to advanced prosthetics is clinically suitable yet is not happening.

When it comes to action, I am therefore pleased to say that, because of the Secretary of State’s meeting with the noble Lord, Lord Mackinlay, in November, there is a review of the clinical commissioning policy relating to multi-grip hand and upper limb prosthesis. The aim of the review is to reduce timelines as far as possible and shift to a much-improved patient-focused service. NHS England is starting that work with an audit of the latest clinical data on uptake and patient outcomes. We can expect to see the result of that this summer. To the noble Lord, Lord McColl, that will of course include the matter of literal fit, which he rightly spoke of.

Furthermore, this month NHS England will issue updated standards and expectations for prosthesis care across the 35 regional rehabilitation centres. There will be a greater emphasis on services for children and young people and prenatal consultations for congenital limb loss as well.

The point about workforce came up; I think all noble Lords spoke of it, and rightly so. I smiled at the noble Lord, Lord Kamall, only because he is more than aware as a former Health Minister of the challenge that we have and the absolute need to address that issue. To improve access times to prosthetic services and get the right services in place, it is clear that we have to increase the capacity and retention of the prosthesis workforce.

I was very interested that the noble Lord, Lord Mackinlay, referred to craft industries and the fact that they are reducing and have done over many years—because of course they provided the possibility of skills and no longer do so in great numbers. But I thought that it was a very important reflection, as is the fact that prosthetists and orthotists are the smallest group, I am afraid to say, among the 14 allied health professionals in the NHS, and there are very significant staff retention issues. A report by the Health and Care Professions Council found that 12.8% leave within four years of registration.

We are faced with a small number of people entering the profession and limited places that offer the relevant degree. To put that in context, only 43 students graduate each year from a joint prosthetics and orthotics degree, of which approximately 25% follow a career in prosthetics and 75% in orthotics. I think that lays out the reality.

To address this capacity challenge, a new degree course in prosthetics and orthotics has been established at Keele University, complementing the three existing courses at Derby, Strathclyde and Salford universities. As I hope noble Lords are aware, we are working at pace to publish a refreshed long-term workforce plan to deliver the health service fit for the future on which the 10-year plan is focused. As part of that, we have a national retention programme. I say none of these things because everything is all right; I say all these things to show the direction we are taking.

The question was raised by the noble Lord, Lord Kamall, about how we attract the best engineering students to input into this field, and I thought that that was a very strong point. In addition to expanding routes and apprenticeships, and the new workforce plan, those who are eligible students can get a non-repayable grant of a minimum of £5,000 a year, and prosthetists and orthotists can get a grant of an extra £1,000 a year.

Noble Lords have spoken much about the need to harness modern-day technology and how the current techniques that are used may be out of date. I very much share the need to continue to embrace technology, including by making research grants available, and I hope we will see more activity in that.

I thank noble Lords not just for their time today but their insight and experiences. It has been a very moving and very practical debate, in my view, and one that I look forward to taking forward to get the right steps in place.

Dementia and Alzheimer’s Treatments

Baroness Merron Excerpts

Thursday 1st May 2025 Lords Chamber

[Lord Evans of Rainow]

To ask His Majesty’s Government what steps they are taking to advance the development of dementia and Alzheimer’s treatments.

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

My Lords, the Government are committed to advancing the development of dementia treatments having invested £496.4 million over the past five years through the National Institute for Health and Care Research and UK Research and Innovation. Additionally, the Dame Barbara Windsor Dementia Goals programme, with up to £150 million of associated funding, aims to speed up the development of new treatments for dementia by accelerating innovation in biomarkers, clinical trials and implementation.

[Lord Evans of Rainow (Con)]

I thank the Minister for that helpful response. Finding a cure for dementia is the challenge of our time. Some drugs now available delay the onset of dementia. They are available privately, but not on the NHS. The NHS says that the assumed costs of administering the drugs are too high. Can the Minister look into this matter to see whether she can clear any barriers to making the new drug lecanemab accessible to everybody on the NHS?

[Baroness Merron (Lab)]

I understand the point the noble Lord is making; I was glad to have the chance of a discussion with him yesterday. I also thank him for his campaigning on such an important matter. I share his view about the need to ensure speed and efficacy. To that point, I say to him that since March this year, as part of the regulation action plan, NICE and the MHRA have been building on the systems we already have in place to make sure that there is rapid access. To prepare for a new generation of dementia treatments, NHS England is working closely with regulators to ensure that arrangements are in place to support the adoption of any new licensed and NICE-recommended treatments as soon as possible. As the noble Lord will understand, it is important that we have the right treatments that do the job and are available. On some of the more recent ones, I understand the disappointment, but the fact is that no disease-modifying treatments are currently available. However, science is developing, and I am sure we will discuss this further.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, more than 150 treatments are in the Alzheimer’s medicine pipeline. Can I encourage the Minister, along with her ministerial colleagues in the Department of Health and Social Care, to take all steps to ensure that the UK remains globally competitive as a centre for dementia clinical trials?

[Baroness Merron (Lab)]

My noble friend raises a very important point. In terms of trials, I will certainly be signing up—and I encourage noble Lords and their friends and families to do likewise—to Join Dementia Research, which is a collaboration between NIHR and a number of excellent charities, including the Alzheimer’s Society and Alzheimer’s Scotland, to take part in trials. There is no need to be a particular age or to have a diagnosis of dementia. I hope that noble Lords will join me in supporting this endeavour.

[Baroness Finlay of Llandaff (CB)]

My Lords, the commission on palliative care that I am currently involved in has found that by integrating services for patients with dementia, such as in the York Frailty Hub, the number of admissions to hospital can be decreased. People can stay at home with families supported and they can carry on living well within limited capabilities while we wait for new treatments and, hopefully, prevention to come along. Will the Minister meet me and Professor Mike Richards to go through some of the details of our findings? They have huge implications in saving finances for the NHS and improving care of patients.

[Baroness Merron (Lab)]

That is a very helpful offer which I will be pleased to accept. I compliment York on its initiatives, which set a very high standard. I will also discuss the points that the noble Baroness has raised with Minister Kinnock, who is the responsible Minister in this area.

[Lord Scriven (LD)]

The previous question shows how the rollout and co-ordination of good practice are really important. Therefore, in light of the 50% staffing cuts to NHS England, can the Minister clarify the plan for the national dementia team which sits within NHS England? Will its core funding and capacity be protected or cut?

[Baroness Merron (Lab)]

We are abolishing NHSE. It is the biggest quango, and we are finding immense duplication. At this stage, I cannot comment on the exact matter to do with the team, but I can say that dementia work continues to be a very high priority, as I hope the noble Lord heard from my commitment to the noble Lord, Lord Evans. Indeed, we are keen to support not just those at risk of dementia but those who care for them. This is an expanding area of work. We have much good practice to draw on and we are extremely active, as the noble Lord has heard, in developing research to move further forwards more quickly.

[Lord Kamall (Con)]

My Lords, I thank my noble friend Lord Evans for raising this issue. We know that, often when a new drug is developed, even though some patients may benefit, it may initially be too expensive for NICE to recommend, based partly on a cost-benefit analysis. We know that eventually the price falls to a level which the NHS can afford and which can then be seen as good value for taxpayers. Given that this happens with many new drugs, have the Government considered convening a group of philanthropists, foundations, charities and other civil society organisations that might be willing to fund treatment for some, if not all, patients when new but expensive breakthrough drugs such as those my noble friend Lord Evans referred to are available but are considered too expensive initially?

[Baroness Merron (Lab)]

We are very open to all sorts of creative ways of dealing with the matter, but it is important to say on the drugs that we are discussing that lecanemab and donanemab can only slow the progression of the disease by between four and six months. The challenge is not just whether it is available on the NHS but how helpful it is. We have a lot of progress to make, and that is why we are committed to ensuring that new treatments can quickly become available and that prevention is key.

[Lord Turnberg (Lab)]

My Lords, I have of course signed up for the dementia survey and I recommend it. One of the commonest forms of dementia is vascular dementia and we can do quite a lot to prevent it and treat it when it is caused by high blood pressure and diabetes. It requires quite a bit of surveying the population. How far have we got with that?

[Baroness Merron (Lab)]

I am glad that I will be joining my noble friend in signing up as a volunteer. Certainly, the Lancet commission of last year said that some 45% of dementia cases are estimated to be preventable or delayable. That report is going to inform our actions as we look to the future. Perhaps it is helpful to clarify to your Lordships’ House—I am sure that many of us have experience of this—that the NHS health check for adults in England aged 45 to 74 is designed to do exactly as my noble friend says and identify early signs of various conditions which are contributory factors.

[Lord Markham (Con)]

A lot of the challenges in testing the efficacy of some medicines lie in measuring the progression of the disease. That is mainly done verbally and, as we all know, people have good days and other not-so-good days, so measuring the progression and impact of the treatment is hard. As the Minister will be aware, things such as retina scans are showing quite promising measurements in terms of the onset and progression. What are we doing in research in that area?

[Baroness Merron (Lab)]

I will be pleased to write to the noble Lord on that specific point, but it might be helpful if I say on the point raised earlier by the noble Lord, Lord Kamall, that investment in discovery science by the UK Dementia Research Institute, for example, included the recently announced Shingrix study in partnership with GSK and Health Data Research UK, and we are also working via the Dementia Translational Research Collaboration. I am sure that the noble Lord will be aware of the NIHR dementia trials network, which offers people with dementia the opportunity to take part in early clinical trials irrespective of where they live. The summary of all this is that we have some way to go, but we have made considerable progress in investment and plans for the future. I will take into account the noble Lord’s point.

Self-harm: Young People

Baroness Merron Excerpts

Monday 28th April 2025 Lords Chamber

[Lord Lemos]

To ask His Majesty’s Government what up-to-date information they have on the level of self-harm among young people under the age of 18; and what plans they have to address the problem.

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

My Lords, published data from NHS England shows that in 2023, 9.4% of 8 to 16 year-olds and 36.8% of 17 to 24 year-olds had tried to harm themselves at some point in their lives. We are committed to identifying children and young people, and adults, who have self-harmed or who are at risk, for tailored or targeted action, which also forms part of delivering the suicide prevention strategy for England.

[Lord Lemos (Lab)]

I thank the Minister for her helpful response, but is she aware of recent research for the WHO? More than a third of 15 year-olds said that they had deliberately self-harmed—one in two girls and one in five boys—but the gender gap is closing. Almost one in four of both girls and boys self-harmed in the last week, and nearly 90% of self-harm incidents involving12 to 17 year-olds are unreported. Perhaps the Minister could outline the Government’s plans for turning around this worrying and worsening trend.

[Baroness Merron (Lab)]

I definitely share my noble friend’s concern about what is a worrying trend, and I can confirm that I am aware of the research to which he refers. In addition to the suicide prevention strategy, we are providing access to a specialist mental health professional in every school in England. We are rolling out Young Futures hubs and recruiting 8,500 mental health workers, and we continue to fund and benefit from the multi-centre study of self-harm to inform the development of policy and clinical practice, in order to tackle the very real and serious problem that my noble friend describes.

[Baroness Tyler of Enfield (LD)]

My Lords, we know that self-harm is most common amongst 15 to 24 year-olds, particularly young women. As we have already heard, there are so many challenges in accessing the mental health support that young people need that often, they cannot get it before their mental health problems get worse. The Minister already referred to the rollout of Young Futures hubs. Can she tell the House when there will be such a hub in every local area, to ensure that young people can access the support they need at the earliest signs of emerging mental health problems?

[Baroness Merron (Lab)]

The noble Baroness is quite right that it is unacceptable that too many children and young people are not receiving the mental health care they need. Our determination to change that, as she says, is about rolling out Young Futures hubs in communities. We are at an early stage of developing the plans, and I very much look forward to continuing to work across government to deliver this and to updating your Lordships’ House.

[Baroness Owen of Alderley Edge (Con)]

My Lords, there has been an alarming number of so-called sextortion cases targeting teenagers who, tragically, have gone on to take their own lives. Are the Government working with schools to tackle the stigma that children sadly feel, and to give them the confidence to report this abuse?

[Baroness Merron (Lab)]

The noble Baroness makes a very strong observation. The statutory guidance on relationships, sex and health education is under review, and we are working closely with the Department for Education on that review. I emphasise again the funding of the multi-centre study of self-harm, whose work is vital in getting to the core of the issues the noble Baroness raises.

[Lord Laming (CB)]

My Lords, the Minister will, I know, agree that self-harm needs to be taken very seriously indeed. Access to child and adolescent mental health services has got worse. I am told—I hope that it is wrong—that in some parts of the country access is delayed for more than a year. Can the Minister assure the House that this is being addressed?

[Baroness Merron (Lab)]

I can indeed assure the noble Lord and your Lordships’ House that this is being addressed, and I recognise the situation that he refers to. Early intervention on mental health is vital if we want to stop young people needing to reach for crisis support. Following on from my previous answer, there is no doubt that schools and colleges play an extremely important part, and that is why we have made the commitments on action that I previously outlined.

[The Lord Bishop of Derby]

My Lords, last month, Susannah Hancock, a member of the Youth Justice Board, published her independent review into placement for girls in custody. Many of the professionals that she consulted through that review identified self-harm by girls in secure settings as one of the biggest areas of concern. In the 12 months to September 2024, 55% of all self-harm incidents in the youth custody service involved girls, although they make up only 1.6% of the total average population in these settings. Can the Minister assure me that her department intends to collaborate with the MoJ to act on the report’s partnership recommendation to ensure greater consistency of good practice in responding to girls in custody who self-harm, including developing clear and consistent protocols on whether and how restraint is used, in order to prevent further traumatisation?

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[Baroness Merron (Lab)]

The right reverend Prelate makes some key points. I can certainly assure her that I am working with the MoJ on the area she describes, where risk is indeed high, despite the numbers. We must be very alert to that.

[Lord Kamall (Con)]

My Lords, we all know the importance of evidence in driving and developing better policy. Regarding the data, what do we know, what gaps in knowledge are the Government aware of and what are they doing to fill those gaps to drive better policy?

As an aside, how is the department working with, say, local community civil society projects, which may well be working in local communities with people who have self-harmed and survived or who are in danger of self-harming?

[Baroness Merron (Lab)]

The role of civil society is crucial. I have had a number of very helpful meetings and visits, including most recently with the Samaritans. We very much believe that that sector supports the delivery of not just the national suicide prevention strategy, of which tackling self-harm is part, but tackling self-harm where it is not linked directly with suicide.

I refer the noble Lord to the work being undertaken by the multi-centre study of self-harm, which I know will be of interest. It has a long-standing research programme to keep an eye on—more than keep an eye on—and examine self-harm trends, and the findings also inform NICE clinical guidance. Recent research has looked at different ethnic minority groups, the characteristics and outcomes for children under 13 who self-harm, and patterns and risk factors for self-harm among university students—and that is just a snapshot.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, those of us who are not experts but have some direct experience of this problem know that self-harm is not just one thing; it can come in a number of forms. One of the problems for families is that it is not always easy to spot, at least not initially. Can my noble friend say in what way families are being supported to identify and then help young people who are beginning to exhibit signs of self-harm?

[Baroness Merron (Lab)]

My noble friend is right: it is crucial that, where they are able to, friends, family and communities assist those at risk and those who are actually self-harming. The recommendation is that people should not hesitate to speak to a GP or access the free listening services that are available through not just the NHS but the Samaritans, for example.

[Baroness Kidron (CB)]

The publication of the online safety children’s code by Ofcom last week received mixed reviews from many and a howl of fury from both Ian Russell and the Children’s Commissioner. Can the Minister say what the Government make of the fact that the children’s code makes no provision whatsoever for live streaming, nor for deliberately extending its use, both of which increase harm and were identified in the evidence of Ofcom itself?

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[Baroness Merron (Lab)]

That is a matter, as the noble Baroness knows, for my ministerial colleagues in DSIT, and I will gladly raise her comments with them. Obviously, the Online Safety Act requires all sites in scope to rapidly remove illegal suicide and self-harm content and proactively protect users from illegal content. I am aware of the differences of opinion that the noble Baroness refers to, and I will gladly take that up with my colleagues.