Medical Training (Prioritisation) Bill

Baroness Merron Excerpts

Committee stage
Thursday 12th February 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, the noble Lord, Lord Patel, deserves our thanks for opening our Committee debate in a cogent and powerful way. He is absolutely right: in this country, we train some of the very best doctors in the world—at great expense to them and to the taxpayer—but too many are choosing to leave the training process because in the now expanded competitive scrum they cannot access the training places they require. Each year many remain unemployed. That is a serious policy challenge, and Ministers are right to seek to address it. We need a long-term and fair solution.

The noble Lord, Lord Patel, is seeking to ensure that UK medical graduates are prioritised for training places first before those in the priority group are offered places. There would then be a third tier of prioritisation for any other eligible applicants. This would put UK medical graduates, as defined by Clause 4, ahead in the queue for training places. I do not think we can fault the noble Lord for his logic. If we believe there is currently a massive and disproportionate injustice being meted out to UK medical graduates, we owe them the best chance we can give them to enter further training pathways in this country.

However, I have two questions for the Minister. First, the Explanatory Notes confirm that those who have trained in Ireland, Iceland, Liechtenstein and Norway have been included in the priority group because

“existing agreements require us to recognise their qualifications and offer parity in access to the profession”.

Can the Minister please confirm whether the reordering of prioritisation, as proposed by the noble Lord, Lord Patel, would cut across the existing agreements that the UK Government are bound by?

Secondly, I think many of us agree that emergency legislation should be avoided as far as possible, but where it is necessary, it should be simple and straightforward. On the face of it, the amendments from the noble Lord, Lord Patel, would make the Bill a bit more complicated by adding a further tier of prioritisation. If that is so, I am sure he would argue that the extra complexity is well worth it. It would be helpful if the Minister could tell us whether such an additional tier of prioritisation would make the process more complex to manage.

Amendment 2 in the name of my noble friend Lady Coffey would prioritise UK medical graduates who are British citizens first, then those persons in the priority group and then UK medical graduates who are not British citizens. The category of other eligible applicants is not included. Perhaps it is an inadvertent omission; I do not know. Again, this would create a three-tier prioritisation process, where the Government are currently proposing two tiers, with the added dimension of drawing a distinction between different categories of UK medical graduates. Like the noble Lord, Lord Clement-Jones, I am uncomfortable with that as a matter of policy. On the face of it, the amendment presents a more complex set of arrangements than those proposed by the noble Lord, Lord Patel, so it would be helpful to hear from the Minister how the Government view my noble friend’s suggestions, including their ready workability.

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

My Lords, I am most grateful to all noble Lords for their helpful contributions to this debate. Amendments 1, 3, 6 to 8 and 12 to 14, tabled by the noble Lord, Lord Patel, seek to create tiered categories of prioritisation for the UK foundation programme and specialty programmes. Taken together, they would require places to be allocated to UK medical graduates in the first instance, and then to applicants in the other prioritised categories specified in the Bill. As noble Lords have observed, the Bill sets clear priority groups, but it does not make rankings within these groups, and that is what we are looking at.

I welcome my noble friend Lord Darzi, not least because the review that he undertook for the Government in 2024 recommended that we should prioritise medical training, for all the reasons given by the noble Lords who support it. I will return to this whole area when we debate a later group, but on the point made by the noble Lord, Lord Darzi—this will perhaps also be helpful to the noble Earl, Lord Howe—alongside UK graduates, we are prioritising in the Bill graduates from Ireland and the EFTA countries. This reflects the special nature of our relationship with Ireland—specifically, our reciprocal rights of movement and employment—and our obligations under international trade agreements with the EFTA countries, which the noble Earl, Lord Howe, referred to, that require consistent treatment of these graduates in access to medical training. The amendments that we are looking at would mean that we could not honour these agreements. That, by its nature and definition, would create huge difficulties.

On specialty training, these amendments would also mean that we could not effectively deliver on our policy intention to prioritise applicants with significant NHS experience who understand how the health service works and how to meet the needs of the UK population. It might be helpful if I summarise this by saying that the Bill sets out what I would regard as a binary system where applicants are either prioritised or not. Clearly, once that prioritisation has happened, the normal processes will apply to establish who the appointable applicants are, to fill the posts, and so on.

Amendment 2, tabled by the noble Baroness, Lady Coffey, seeks to create tiered categories of prioritisation for the UK foundation programme and to prioritise UK medical graduates who are British citizens above all other applicants. The Bill as drafted prioritises all UK medical graduates who meet the criteria, regardless of their citizenship status. It might be helpful to the noble Lords, Lord Mohammed and Lord Clement-Jones, to restate that what matters is where a doctor is trained, not where they are born. UK-trained medical graduates have undertaken curricula, clinical placements and assessment standards aligned to the NHS, and are therefore best prepared to move directly into NHS practice.

The Government are committed to prioritising those doctors who have already spent a significant part of their education within the NHS and understand how the health service works and how to meet the needs of the UK population, not least because—this is an issue that we have discussed many times—these doctors are more likely to remain in the NHS for longer, supporting the sustainable medical workforce for the future that we are all looking at.

As I set out in relation to the previous set of amendments tabled by the noble Lord, Lord Patel, this amendment would also mean that we would not be honouring the special nature of our relationship with Ireland and obligations under trade agreements with EFTA countries. I emphasise again in the Chamber today that prioritisation does not mean exclusion. All eligible applicants will still be able to apply and will be offered places if vacancies remain after prioritised applicants have received offers, which we expect to be the case particularly in certain areas.

My noble friend Lord Winston raised a question about the Bill in respect of highly skilled overseas doctors and particularly referenced clinical academics. As I have said, it is not exclusion from applying—it is prioritisation. It may be helpful more broadly for me to emphasise that there are likely to be opportunities in specialties such as general practice, core psychiatry and internal medicine, because historically they attract fewer applicants from the groups that we are prioritising for 2026. I understand the point that my noble friend is making, but we have to focus on the core purpose of the Bill. With that, I hope that noble Lords will feel able not to press their amendments.

[Lord Patel (CB)]

Obviously, the Minister is not accepting my amendment, but she makes the point that all the priority groups will be treated in the same way—whatever the definition is of people in the priority group, they will all be grouped together as a priority, and that would include UK medical graduates. What assessment have the Government made of the effect that it will have on UK medical school graduates to include all the others in the priority group? What disadvantage will that put UK medical graduates to? Will it be minimal, medium or a lot?

[Baroness Merron (Lab)]

We do not anticipate that that is going to cause a problem. The noble Lord did not specifically refer to the EFTA countries, but I should like to. Some of them will not produce any suitable people who are likely to be included, so in our modelling we do not anticipate that there will be a problem. What matters is patient care and getting people with the right training who understand what the NHS is about, understand the culture of the NHS and provide as best as they can. That is what the whole Bill is directed at doing and prioritising.

[Lord Jackson of Peterborough (Con)]

I accept that the Minister is not predisposed to accept the amendment from my noble friend Lady Coffey, and she has made a clear case for that, but is she in a position to reassure the House that the issues raised by my noble friend and others about the relative take-up of specialty training places in less popular disciplines, such as anaesthetics or paediatrics, will be looked at by the department? I did not get the opportunity to make this point, but one point was that prioritising British medical students—not excluding others—would have a positive impact on those particularly hard-to-fill disciplines. Is the department taking that into account generally in its workforce planning?

[Baroness Merron (Lab)]

Yes, we are.

[Lord Mohammed of Tinsley (LD)]

Can I ask about applications from overseas? I know from the paperwork that has been shared online that everybody has been grouped together as the rest of the world. With the applications that we have had this time and last year, it might be helpful to share the data of the breakdown by each country rather than just lumping it all together as the rest of the world. Then we could see how many applications there are from the nations that we have an international agreement with.

[Baroness Merron (Lab)]

I shall be very pleased to do that.

[Lord Patel (CB)]

My Lords, I thank all noble Lords who have spoken today, no matter which amendment they spoke to, and I am grateful to the noble Earl, Lord Howe, for his strong support for my amendment. More importantly, he said that UK medical graduates need to be prioritised and should not have to enter into competition with others whose graduation is not from this country. I know that the Minister was not able to say that UK graduates would be seen to be prioritised; I understand that. Of course, these debates help, because the outside world is interested in what is said here. I hope that particularly those who make decisions about interviewing or selecting for interview for training programmes will get the message, take note of this debate and bear in mind what it was all about. I beg leave to withdraw my amendment.

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[Lord Clement-Jones (LD)]

My Lords, I offer our strong support for Amendments 9, 11, 24 and 25 in the name of the noble Lord, Lord Stevens of Birmingham, and Amendments 5 and 10 in the name of my noble friend Lord Mohammed. I thank the noble Earl, Lord Howe, for his Amendment 4, because it, in essence, sets the theme of this group, which is the dashing of legitimate interests for this year, which a number of noble Lords explored.

Before I address the specific mechanics of these amendments, we need to thank the noble Lord, Lord Stevens, and other noble Lords who highlighted at Second Reading the whole question of the protracted failure in long-term workforce planning. For years, we have seen a disconnect between the number of medical school places and the number of specialty training posts. There is a bottleneck of our own making: 12 applications for one post is a disaster. My late wife trained in the 1970s and became a registrar at Barts. I have no recollection of it being anything like on this scale, and we risk dashing the expectations of many of those currently in training.

As the noble Lord, Lord Stevens, noted at Second Reading, the Bill does not widen the bottleneck; it simply reshuffles the queue. Although we on these Benches accept the principle that UK graduates should not face unemployment after taxpayer investment, we must ensure that, in correcting one failure, we do not commit a second failure of fairness against those have served our NHS in good faith.

These amendments address one of the greatest injustices in this Bill: the decision to implement major changes mid-cycle for 2026, using the blunt instrument of indefinite leave to remain as a proxy for experience. The Government claim that assessing actual NHS experience is “not operationally feasible” for the 2026 rounds. Since Second Reading, we have received compelling evidence to the contrary. As my noble friend says, we have heard from doctors currently using the system who confirm that the Oriel recruitment platform already captures data on “months of NHS experience”. The question is there; the data exists. The claim that this cannot be done is a choice, not an administrative necessity.

By refusing to use this data, Clause 2 creates a perverse experience gap. It excludes doctors who have served on our NHS front lines for two or three years but who have not yet reached the five-year threshold for settlement. We have received hundreds of emails detailing the human cost of this decision. We heard from a mother who lived apart from her one year-old child for seven months to study the MSRA exam, only to find the rules changing days after she sat it. We heard from a neurosurgery SHO with two years of NHS service, who notes that this mid-cycle change renders his sunk costs unrecoverable. We have heard from a British citizen whose wife, a doctor on a spousal visa, is deprioritised, despite being a permanent resident.

Amendments 9 and 11 offer the Government a lifeline. They are permissive—my noble friend’s amendments mandate the Government. The bottom line is that the Secretary of State should use the data we know Oriel possesses to prioritise those with significant NHS experience in 2026, just as they intend to do in 2027. To reject this is to choose administrative convenience over natural justice.

I see the amendments at this stage as a probing opportunity. We need the Minister to explain in specific, technical detail why the existing Oriel data fields regarding employment history cannot be used to filter applicants for this cycle. If the Minister cannot provide a satisfactory technical explanation today, and if the Government resist this flexible approach, we will be forced to conclude that this is a choice, not a necessity. In that event, we may well need to return to it on Report.

[Baroness Merron (Lab)]

This group of amendments relates to the implementation of prioritisation of posts starting in 2026. I thank all noble Lords for their consideration of this. It is a very important area, as noble Lords have said, and I have listened closely, as ever, to the points made.

Beginning with prioritisation for the UK foundation programme, Amendment 4, tabled by the noble Earl, Lord Howe, seeks to prevent prioritisation applying to offers for the foundation programme that were confirmed before 13 January. To clarify, the Bill will impact only offers for places made after the Bill is passed and becomes law. The Bill will therefore not have any impact on offers to the foundation programme made before it becomes law. In our view, the amendment is therefore not necessary. In any event, no such offers exist, other than for a very small and specific group.

The noble Lord, Lord Stevens, asked about those who have already been allocated. The only individuals who have already been allocated foundation programme places for 2026 are those who deferred last year for statutory reasons, such as maternity leave or sickness absence. These individuals have already been assigned to posts, and this year’s allocation process does not affect them in any way.

On a more general point, as I referred to in the earlier group, and as noble Lords will recall, the 10-year plan, which was published in July 2025, confirmed that it was the intention of the Government to come forward with the Bill we are speaking of today. The noble Lord, Lord Stevens, asked about the time it has taken since that date in July 2025. I can only say to the noble Lord that this is linked to our careful listening, which he will be aware of, to resident doctors and our understanding of the pressures that they are facing. The Bill is about action now. It is about acting decisively and introducing legislation for 2026, because, as noble Lords have kindly acknowledged, we need to start reshaping the workforce pipeline and show our commitment to easing the bottlenecks in training places.

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[Lord Clement-Jones (LD)]

I would be grateful if the Minister could say what proportion of those who wrote were disappointed with the Bill versus those who wrote supporting it.

[Baroness Merron (Lab)]

I cannot give an exact proportion, as the noble Lord is aware, but I have noticed that the proportion has changed as the Bill has progressed. As we have approached Committee, I have certainly seen more email traffic urging a non-amended Bill rather than an amended Bill. I would imagine that that is reflected in other emails. The noble Lord is indicating that it is not. I can see differing responses, but that has certainly been my impression.

The application of prioritisation to the 2026 intake is necessary and justified. If, as I referred to earlier, we waited until 2027, competition ratios are projected to rise even further, meaning that more UK graduates would be unable to progress their careers on time, with a greater risk to the long-term sustainability of the workforce. For these reasons, another year’s delay is not an option, and we cannot accept the noble Lord’s amendment.

Amendment 10, also tabled by the noble Lord, Lord Mohammed, also seeks to change categories of people who would be prioritised for specialty training places, starting in 2026, by virtue of having significant NHS experience or by reference to their immigration status. We cannot accept this amendment on the basis that the effect would be to prioritise every individual who applied for specialty training places in 2026 because all applicants are, by necessity, already registered on Oriel. This amendment would in practice nullify prioritisation for 2026 and render the legislation ineffective. It would not address the severe and growing bottlenecks in specialty training that the Bill aims and is designed to tackle.

The proposal to prioritise those who have demonstrated a professional commitment to the NHS also presents workability problems as there is no clear or objective definition of what such a commitment looks like, nor any reliable way to assess it for tens of thousands of applicants at this stage. Attempting to do so would be unmanageable in a practical sense and would introduce inconsistency, delay and uncertainty for applicants.

[Lord Stevens of Birmingham (CB)]

One objective proposition that has been suggested is two years of NHS experience, which, it is said, would be readily trackable on Oriel. Can the Minister confirm whether that would indeed be possible?

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[Baroness Merron (Lab)]

Although I cannot be specific about what is technically possible, I can say that, as the noble Lord is aware, the arrangements for 2026 in the Bill can change for 2027, and that will be the subject of consultation with a wide range of stakeholders to get the best definitions we can. We know that currently, because of the time pressure, we are going to have to use—I think the noble Lord used the word “proxy”, in my view correctly. So that is where we are.

[Lord Clement-Jones (LD)]

The Minister criticised Amendment 10 from my noble friend on the basis that, in a sense, it is technically not doing what it attempts to do. But she has not really addressed the key argument at the core of this, which is that the Oriel system is capable of assessing precisely the kinds of two-year experience that so many of these deprioritised doctors will have. Is the Minister saying that it is absolutely not possible to use the Oriel system for that purpose in this context?

[Baroness Merron (Lab)]

My recollection from my discussion with officials about this very point is that, with no criticism of the Oriel system, this is about what we are trying to do now and what we have available to us. It would require—I am looking for the right words—not just using that system but manual attention to thousands of applications. I am very happy to write to the noble Lord with further technical advice on the matter, but that is the situation of which I have been advised. The whole point about the way the Bill is designed is to make it workable. If we change it, we know we cannot deliver in the way the noble Lord might wish.

[Lord Clement-Jones (LD)]

I thank the Minister for that. I hope that, despite the recess, there will be time to get all the information we need. There is a real problem here with the credibility of the Government’s position. There are many of us who hope that it will be possible to do something different, particularly since, in a way, the boot is on the other foot. The Government have had since last July, as we keep being told, to get the Oriel system fit for purpose in order to supply the information for 2026.

[Baroness Merron (Lab)]

The noble Lord is ambitious on workability, beyond what I can honestly confirm is possible. Noble Lords would not wish me to stand at the Dispatch Box and suggest that, having looked at all we could do, the situation is anything other than that this Bill is a workable option. I can assure him that, as always, all noble Lords will get the information they are promised in a timely fashion. I also hope that the all-Peers letter and the letters I subsequently sent in respect of various areas of concern were helpful to noble Lords. I will of course ensure that anything further is there.

The issue with Amendment 10 is also that there is not that clear objective and definition of what a commitment looks like; it makes reference to it but does not explain it. By contrast, the Bill uses a set of carefully chosen, specified immigration statuses as a practical and proportionate proxy for identifying applicants who are most likely to have an established professional commitment to the NHS, which I believe is what all noble Lords are looking for. After careful consideration, we have concluded that for the 2026 recruitment round, that is the best approach. The amendment would remove any practical effect of prioritisation, which of course is at the heart of the Bill.

Amendments 9, 11, 24 and 25, tabled by the noble Lord, Lord Stevens, seek to create a regulation-making power to define additional persons with significant NHS experience to be prioritised for specialty training in 2026. We cannot accept these amendments. As already stated, the Bill sets out the most suitable criteria for prioritising specialty training places in this year. Under the existing Clause 2(2), for specialty training places starting in 2026, immigration status will be used as a practical proxy for NHS experience to allow prioritisation to begin swiftly. This proxy is being used because applications for posts starting in 2026 have already been made. Therefore, we need to prioritise based on the information already captured, and which can be assessed.

To build on what I was referring to in the exchange with the noble Lord, Lord Clement-Jones—I know this is also of interest to the noble Baroness, Lady Finlay—while NHS experience is captured in the Oriel recruitment system, using it as an assessment criteria for the 2026 allocation round would require a manual review of tens of thousands of applications, “manual review” being the words I was looking for earlier. This is just not operationally feasible. There is no current agreed threshold for what constitutes a meaningful level of NHS experience. Stakeholders offer very different views on this, which is why we have committed to a proper engagement process, subject to the Bill’s passage, to ensure that any future definition is fair, evidence-based and deliverable.

The Bill already gives us flexibility to ensure that we take the best approach to prioritising those with NHS experience for specialty training posts in subsequent years. For posts starting in 2017 onwards, the immigration status category will not apply automatically. Instead, we will be able to make regulations to specify any additional groups who will be prioritised by reference to criteria indicating significant experience as a doctor in the health service, or by reference to immigration status.

For the reasons I have outlined, I ask noble Lords to withdraw or not press their amendments.

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[Earl Howe (Con)]

My Lords, I shall speak to my Amendments 20 and 21 and in support of the other amendments in this group.

My amendments are intended to work together and to return us to one of the salient themes of our debates at Second Reading, a theme which has been persuasively developed today by the noble Baroness, Lady Gerada, the noble Lord, Lord Forbes, and other speakers. At the heart of their concerns is why the Government have chosen to adopt a definition that threatens to undermine high-quality workforce capacity in the NHS, that jeopardises the sustainability of medical education delivered overseas by UK institutions, and that runs completely counter to the Government’s stated ambitions on promoting British standards of education internationally.

The Bill prioritises graduates based on strict geographic criteria, rather than on the provenance of their qualifications. UK academic institutions such as Queen Mary University of London and Newcastle University have campuses respectively on Malta and in Malaysia which train doctors to GMC-approved standards, using the same curriculum and the same assessments as those employed on their campuses in the UK.

The noble Baroness, Lady Gerada, has eloquently made the case for Maltese-trained students. I can add little to that. The noble Lords, Lord Clement-Jones, Lord Mendelsohn, and Lord Forbes have also spoken very powerfully on the same theme. The amendments of the noble Baroness, Lady Gerada, speak of the two qualifications—in other words that gained in Malta and that gained in London—as being identical in character. The amendment from the noble Lord, Lord Forbes, uses the word “equivalent”. I would go further by saying that the degree issued by the Queen Mary University of London Malta campus is not merely equivalent to a UK degree: it is a UK degree.

Not only that, but Queen Mary University is able to state that cohorts of its students trained in Malta frequently outperform their contemporaries who have studied and trained on the London campus. The intervention from the noble Lord, Lord Winston, has confirmed that that is not an isolated claim. The same claim could be made of many graduates of Newcastle University’s campus in Malaysia. These are excellent doctors, so there is not an issue of quality here.

Nor should there be an issue around numbers. In total, as we have heard, the number of these overseas-trained graduates is modest in comparison to the overall NHS training intake in a given year. The numbers really ought to be treated as de minimis. We have heard from Ministers that, if they were to flex the rules in the way that I and others are proposing, there would be no way for them in the future to control the total numbers of eligible applicants from these sources. My question is: why? It would seem perfectly possible to grant Ministers a power to cap total numbers at a figure corresponding to recent experience. It would then be up to the relevant universities concerned to collaborate year by year to ensure that the cap was not exceeded. That is what my Amendment 21 is intended to do.

Finally, we return to the issue of legitimate expectations. For all the reasons that I have given, students trained on overseas campuses of UK institutions have never dreamed of questioning whether the status of their qualification would differ in the slightest from the status of the qualification gained by their student colleagues in London. They are, in consequence, not to put too fine a point in it, appalled that, through this Bill, they are suddenly to be regarded as less deserving of a medical career in the NHS. I ask the Minister to think again.

[Baroness Merron (Lab)]

My Lords, I am grateful for this debate, as I have been grateful for the time that noble Lords have given to discussing their concerns about various aspects of the Bill in advance of today. I can say to both the noble Earl, Lord Howe, and the noble Lord, Lord Mohammed, that I always reflect on what they and other noble Lords say. Indeed, I reflect on what every noble Lord says—it is true that I may listen to some more than others, but that would be telling. I am genuinely grateful. In my view, it really does assist the passage of legislation and I take it very seriously. I will of course reflect, as I have before, not just on what is said in the Chamber but on what we have discussed outside.

The noble Earl, Lord Howe, said previously that people will be watching and reading this debate, and I absolutely agree and am glad that they do. So I must emphasise the point that this is not about excluding people from their applications; it is about prioritising. The reason we are in this position is the removal of the resident labour market test in 2020, which changed the whole landscape. In 2019, there were 12,000 applicants; now, there are nearly 40,000 applicants, which means four resident doctors for every specialist training post. I believe that noble Lords understand the scale. Internationally trained doctors make a huge contribution and will continue to do so. We are aiming to bring forward those internationally trained doctors who have significant NHS experience for training posts in the future, which I think is absolutely right.

Let me turn to the amendments in this group: Amendments 15 and 16, tabled by the noble Baroness, Lady Gerada; Amendment 17, tabled by my noble friend Lord Forbes; and Amendments 20 and 21, tabled by the noble Earl, Lord Howe. Each of these amendments seeks to ensure that graduates of overseas campuses of UK medical schools are prioritised for foundation and specialty training. I understand why this is being raised, and it is quite right to probe this whole area, in my view. While I appreciate the intention behind these amendments, and the manner in which they have come through, the Government are unable to accept them.

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[Lord Stevens of Birmingham (CB)]

I want to come in on the point about whether or not the UK Government would lack the ability to control the expansion of international places in the grandfathered campuses. Is it not the case that, in fact, the UK Government do have such a tool at their disposal, through the Office for Students? The OfS has to agree the number of undergraduate medical places that a university can operate here in the UK and can cap those, and could therefore introduce an off-setting mechanism so that any additional place created outside the UK would see a reduction in the UK authorisation. That would be incentive enough, I suspect, to ensure that universities did not behave in the way that the Minister is concerned about.

[Baroness Merron (Lab)]

The noble Lord kindly raised this with me before, and I did test it out. I am grateful that he has given thought to this, because it is an important point. However, I am advised that, unfortunately, the solution that he has come up with would not deal with all the concerns we have and would still give us difficulty. The noble Lord talked about the thin end of the wedge, and I fear that we are still in the same place. I am happy to write to the noble Lord, and to make that letter available, to explain further detail. I am grateful that he has given consideration to a solution for what is undoubtedly an issue.

[Baroness Finlay of Llandaff (CB)]

I understand the comments that the Minister has made to my noble friend Lord Stevens. Would she consider wording in the primary legislation that expands on the fact that the campus must be extant and includes that the number of students studying medicine for the UK degree must be the same as when the Bill passes? That would provide rigid guidelines in primary legislation and would not rely on another body, where a quota could possibly be negotiated.

[Baroness Merron (Lab)]

Again, I understand that the noble Baroness is coming forward with a solution and I appreciate her thoughts. I always reflect on what is said, but my initial reflection is that that does not deal with the fact that we already have a number of people. I asked this very question about continuing to prioritise them. It is significant even currently and that is part of the problem, although I understand what she is suggesting.

[Lord Clement-Jones (LD)]

My Lords—

[Baroness Merron (Lab)]

I will take one more intervention, but it might be helpful to hear all that I have to say.

[Lord Clement-Jones (LD)]

I am sure that it will, but I just wanted to follow up the Minister’s pledge to deliver a letter to us in which she will set out precisely what her concerns are. Will the timing of that letter be early next week so that there is time to table amendments for Report to meet some of those concerns?

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[Baroness Merron (Lab)]

As I always do, I will seek to engage in sufficient time before Report. I will not promise the beginning of next week, but we all know the deadlines that noble Lords are working to and I am very respectful of that.

Amendment 17 could create the loophole I have referred to and risks existing international overseas campuses expanding their intakes further. I am grateful that noble Lords acknowledge the concern and are considering how to deal with it. That would be outside any UK workforce planning.

Amendment 21 would provide a regulation-making power to limit the number of applicants who could be prioritised from these overseas campuses. Going back to my earlier comments, it is not clear how such a requirement would be implemented effectively and fairly in practice but, in any event, it would not provide an appropriate safeguard for UK workforce planning.

The Bill rightly prioritises those whose education and placements the UK taxpayer has supported, who are most likely to work in the NHS in the long term—I emphasise this point—and are better equipped to deliver healthcare tailored to the UK’s population because they understand the UK’s epidemiology. However, I hope my noble friend Lord Forbes and the noble Lord, Lord Mohammed, will take back to the university that graduates from international overseas campuses are not excluded and will continue to be able to apply to the foundation programme and specialty training.

Amendment 18 tabled by the noble Baroness, Lady Finlay, relates to the prioritisation of medical graduates from institutions in Ireland. The Government cannot accept this amendment, and I thought her own assessment of it was most honest and helpful. Throughout the development of this Bill, we have been clear that graduates from the Republic of Ireland are prioritised on the same basis as UK medical graduates. This reflects the long-standing and unique relationship between our countries, including the arrangements under the common travel area, which supports reciprocal rights of movement and employment. It also ensures coherence in workforce planning across both jurisdictions, where medical education and training pathways have been closely aligned for many years.

Introducing different criteria for graduates from the Republic of Ireland, as this amendment proposes, would risk disrupting those shared arrangements. It could also create an uncertainty in the provision of postgraduate training in Ireland.

Amendment 19, tabled by the noble Baroness, Lady Gerada, seeks to add Malta to the list of prioritised countries set out in Clause 4. This would require that those who hold a primary medical qualification from any institution in Malta, irrespective of their nationality, are prioritised for foundation and specialty training. I address this particularly to my noble friend Lord Mendelsohn, to whom I listened closely, as I did to the noble Baroness, but we cannot accept this amendment.

I refer particularly to the European Free Trade Association countries, as they have been mentioned a number of times, including by my noble friend Lord Mendelsohn, the noble Lord, Lord Clement-Jones, and others. Those countries listed in Clause 4 are those with which the UK has signed agreements that include offering parity of access to the workforce. I have looked back at when those agreements were made: for the EFTA countries of Iceland, Norway and Liechtenstein, the agreement was made in July 2021, and Switzerland was in 2019. I make these points because they certainly precede this Government. In practice, as I have said before, not all these countries will have eligible applicants in any case.

The 1975 UK-Malta reciprocal healthcare convention will continue and is not affected by the Bill. I emphasise that that agreement is wholly related to reciprocal access to healthcare, not access to training or employment related to medical training. I hope it is helpful to say that the Bill includes a power to amend the list of countries in Clause 4 to reflect any future international agreements that the UK may enter into. As I have also stated previously, the Government set UK medical school places based on future health system needs. I emphasise that there is no disrespect intended here and we very much value the long-standing partnership with Malta on healthcare, and that will continue to be valued. However, prioritising international graduates would undermine our ability to keep foundation training numbers aligned with the NHS workforce that we are planning for and manage those bottlenecks in specialty training, about which there is concern across the Committee. This is about focusing on patient care and ensuring that those whose education and experience best prepares them to practice safely and effectively in the NHS are the ones who are prioritised.

For specialty training, prioritising these individuals would not support our aim to prioritise doctors with significant NHS experience who understand how the health service works and how to meet the needs of the UK population. I reassure the Committee that this Bill will not affect existing fellowship arrangements with Malta, and the affiliation of the UK foundation programme and Malta foundation programme, to which the noble Baroness, Lady Gerada, referred, will still stand. Senior officials in my department have met with the high commissioner of Malta to the United Kingdom to assure him of this and last week I received a positive letter of acknowledgement from the Health Minister in Malta.

To be absolutely clear, individuals with a primary medical qualification from Malta will still be able to apply for foundation and specialty training places, and they will be considered for any places that are left after prioritisation. But it would still be the case that it would be at odds with the aim of the Bill for them to be prioritised for these places. For the reasons I have set out, I hope the noble Baroness will feel able to withdraw her amendment.

[Lord Winston (Lab)]

The NHS is a complex organisation which is going to be rapidly changing, with increasing issues regarding its employees and all sorts of new technologies that will develop in a way we have never seen before. In view of that, does the Minister think there might be some reason for the Government to consider looking at this situation in, say, five years’ time to see the effect of the Bill on the health service?

[Baroness Merron (Lab)]

My noble friend is right about the pace of change, and many of the changes we cannot even imagine as we discuss this today. We keep the impact of legislation under review, and the Bill will be no different to any other Bill in that regard.

[Baroness Finlay of Llandaff (CB)]

I do not want to put the Minister too much on the spot now, so could she clarify in her letter whether Clause 4(3)(b) means that the Bahrain campus is within the allocation for prioritised places, whether any other Irish campuses are, and how the limit would be held on other campuses developed from Ireland, given that the response we have had seems to exclude Malta and Newcastle?

[Baroness Merron (Lab)]

I am happy to set it out in a letter, but I can say immediately that graduates of the Royal College of Surgeons in Ireland’s Bahrain campus are not necessarily prioritised just because part of their programme takes place in Ireland. The Bill is clear that prioritisation applies to graduates of Irish medical schools who complete the majority of their medical education in Ireland, but I am happy to add to that in my letter.

[Baroness Gerada (CB)]

I am grateful to the Minister for the care with which she has addressed my amendments. I will be very brief. I must say I am disappointed, and I have a few points.

I will address Malta first. These are not international medical graduates; these are UK-trained doctors training in a UK university, albeit overseas. As I said, they are trained for the NHS. The Minister mentioned several times that it is not exclusion, it is prioritisation. I have already had emails from two doctors, one of whom is being excluded from applying for a postgraduate examination until the UK cohort has applied. I will not say their specialty, because it might identify them, but it means that the tiny island of Malta will not have this particular specialty because this doctor cannot finish his training until he does that. They are already being excluded from fellowship posts that have been long standing over decades—that is of last week.

Given the fact that the Bill is being taken through the House at such pace, as well as writing a letter—which I understand we will get in our post next week—would the Minister be willing to meet me and several Peers who have already raised some amendments so that we can explore this in more detail and work constructively towards a solution? I am sure these issues will be considered further on Report but, in the light of the Minister’s reply today, I beg leave to withdraw the amendment.

--- Later in debate ---

[Lord Clement-Jones (LD)]

My Lords, I support Amendment 22, standing in the name of the noble Lord, Lord Kamall. He absolutely made the case but, having heard what the Minister had to say on the previous group, I have a terrible certainty about what her response will be.

I assure the Minister that many of us want to find solutions, in the way that the noble Lord, Lord Stevens, mentions. The principles of the Bill are supported across the Committee; it is some of the detail that is in contention. We must be honest that the Bill deals with the symptom—competition ratios—not the cure, which is the bottleneck of insufficient specialty training places. I go back to the phrase that the noble Lord, Lord Stevens, used at Second Reading. We are simply reshuffling the queue.

This amendment places a necessary duty on the Secretary of State to review the adequacy of training places. We have received warnings from doctors in shortage specialties such as psychiatry and general practice, who fear that the Bill will drive away the international talent that we rely on. We need to know whether this legislation will succeed in retaining UK graduates or whether it will inadvertently exacerbate shortages by signalling to the global medical community that the NHS is closed for business. We cannot manage what we do not measure.

[Baroness Merron (Lab)]

My Lords, I welcome the debate that we have just had and I appreciate the support for what we are seeking to do, particularly from both Front Benches, as in the other place. I am most grateful for that.

The amendment tabled by the noble Lord, Lord Kamall, seeks to require the Secretary of State to review the impact of this Act within six months of Royal Assent and to require that that review is published and laid in Parliament. I understand the intent behind this amendment, but we do not feel that there is a need to accept it because the Government have already set out their impact-monitoring and evaluation plans within the published impact statement on 14 January.

The noble Lord’s amendment also specifies requirements that are not compatible with how recruitment cycles operate. He will understand that I want to report to your Lordships’ House only on the basis of proper information, as he would expect. However, data as specified in the amendment would not be available to allow us to meet those requirements or to allow sufficient time and flexibility for the investigation of impacts. However, I give the assurance that, should the Bill be passed, the Government will ensure that appropriate data is collected and investigated to facilitate the already proposed impact evaluation. I hope that this will be helpful.

--- Later in debate ---

[Earl Howe (Con)]

My Lords, I am grateful to the noble Lord, Lord Mohammed, for his amendment and his very helpful introduction. From these Benches, we have consistently raised our concerns about the downsides of emergency legislation. The Constitution Committee chairman, my noble friend Lord Strathclyde, wrote in his letter to the Minister that the Constitution Committee has

“repeatedly raised concerns about the fast-tracking of legislation, highlighting in particular the need to ensure that effective parliamentary scrutiny is maintained”.

We are all of us, I hope, doing our utmost in the short time available to scrutinise the Bill fully, but, with such a short period of time available, we cannot discount the possibility that this legislation will have unintended consequences. The noble Lord, Lord Clement-Jones, posited one particular example in his speech during the last debate.

It is true that the Delegated Powers and Regulatory Reform Committee has not brought anything in the Bill to the attention of the House. However, in the light of the fact that the Bill has been fast-tracked through Parliament, there is, I believe, a case for making all regulations under this Act subject to the affirmative procedure, allowing for additional future scrutiny. Like the noble Lord, Lord Mohammed, I look forward to hearing the Minister’s reply.

[Baroness Merron (Lab)]

My Lords, I am grateful not just for this brief debate but for the efforts of noble Lords to expedite this legislation. I acknowledge the short timeframe—it is not as short as in the other place but, nevertheless, noble Lords have been most co-operative, and I value that.

Amendment 23, tabled by the noble Lord, Lord Mohammed, seeks to require that all regulations made under the Act are subject to the affirmative procedure. This is an amendment we are not able to accept. To reiterate our intention, the Bill sets out the groups of people who are to be prioritised for specialty training from 2027 onwards. I reassure the noble Lord that the delegated power is limited to adding to this list by reference to significant experience working as a doctor in the health service or immigration status.

Similarly, we have set out in the Bill specialty training programmes excluded from the prioritisation scheme. The delegated power is limited to amend this list, and it gives necessary operational flexibility to respond to future changes in recruitment, training and workforce needs—something that I know noble Lords are very attuned to the need for.

I am sympathetic to the desire for parliamentary scrutiny and I always try to ensure that it is provided but, because of the limited scope of these powers, we believe that the negative procedure is appropriate. As the noble Earl, Lord Howe, just referred to, the Bill has been assessed by the Delegated Powers and Regulatory Reform Committee, and no suggestion has been made that the negative procedure was inappropriate for this regulation.

I have spoken in a previous group to why we are dealing with emergency legislation. I hear what is said about the downsides, but we have to balance that with the scale of the problem and the urgency that it demands. That is why we decided to introduce emergency legislation.

The noble Earl spoke about the Constitutional Committee letter. We will be responding formally to the committee to address its concern. With that, I hope the noble Lord feels able to withdraw his amendment.

[Lord Mohammed of Tinsley (LD)]

I thank the Minister for that timely response. I particularly welcome the support of the noble Earl, Lord Howe, for the principle that I was trying to establish. However, on this occasion, I beg leave to withdraw the amendment.

--- Later in debate ---

[Lord Clement-Jones (LD)]

My Lords, I will speak to Amendments 26 and 27 on commencement, proposed by the noble Lord, Lord Kamall. I confess that we are conflicted on these. This brings us back to the tension at the heart of the Bill. We have UK graduates urging immediate implementation to resolve their uncertainty; conversely, we have international medical graduates asking for delay or transition because the rules are changing mid-cycle. If the Government eventually accept the amendments in group 2, providing a fair transitional arrangement for those with NHS experience, then immediate commencement becomes less punitive. However, if they persist with the blunt ILR proxy for 2026 then rushing to commencement simply accelerates an injustice.

I urge the Minister to clarify when precisely the regulations for the 2026 cycle will be laid if this Bill passes and whether they will include the transitional protections we have argued for. I am somewhat pessimistic on that. Certainty is needed, but it must not come at the expense of fairness.

In that context, as we are at the end of Committee, I must ask the Minister to confirm that she is going to meet the cross-party group of those of us who have spoken at Second Reading and in Committee before Report takes place. I have kept my diary free for the Monday before Report and I know that the noble Baroness, Lady Gerada, mentioned that earlier. We would all welcome a face-to-face meeting with the Minister. She talked about us being co-operative, and we all realise the Government’s desire for speed, particularly in the context of the industrial dispute, but, quite frankly, it takes two to tango.

[Baroness Merron (Lab)]

I am grateful for the noble Lord’s advice in his last comment.

I thank noble Lords for their contributions. The noble Lord, Lord Kamall, spoke about what I am going to call the tension between emergency legislation and the commencement clause. I will start on that point. I hope he is aware that our intent is, of course, to commence the Bill as soon as we possibly can, subject to its passage through Parliament. That is why I am so grateful to noble Lords and to Parliament more broadly—both Houses—that they have agreed to expedite the progress of this Bill.

I will come back on to this later in a bit more detail but, as I have already stated, there is a genuine question about operational feasibility, if strikes are ongoing, due to the strain that they put on the system. I am sure everybody in your Lordships’ Chamber would understand that. I will now refer to the amendments, and I have some other points to answer some of the questions that were raised.

Amendment 26, tabled by the noble Baroness, Lady Coffey, and spoken to by the noble Lord, Lord Kamall, and Amendment 23, tabled by the noble Lord, Lord Mohammed, and spoken to by the noble Lord, Lord Clement-Jones, relate to the date upon which the Act comes into force. Both would remove the provision that allows the Secretary of State to appoint the commencement date.

We cannot accept these amendments, as they remove an important element—and I emphasise this point—of operational flexibility, should it be needed. The commencement provision within the Bill is not a mechanism for delay. It is, we believe, a necessary safeguard to ensure that systems planning and operational capacity are in place before the Act is brought into force. Noble Lords will also appreciate that it is a material question, as referred to by the noble Lord, Lord Kamall, about how possible it is to proceed if industrial action continues, given the strain that strikes put on the system.

It is our intention to commence the Bill as soon as we are able, but it is essential that the Secretary of State is able to take all the circumstances, including operational readiness, into account when deciding when the Act should come into force. I think that it is honest to say this. Amendment 26 also seeks to require the Act to come into force one month after it is passed. Specialty training offers must be made from March. Delaying commencement by even one month would leave insufficient time to implement prioritisation for this year’s application round. In short, fixing a commencement date one month after Royal Assent, as Amendment 26 suggests, would create a situation where the Bill comes into force too late to tackle the bottleneck problem that we seek to resolve—the one that it is designed to remedy for the 2026 year—while also removing our ability to commence the Act only when systems are ready to deliver it effectively.

On the comments about industrial action made by the noble Lord, Lord Kamall, I reconfirm that the Government have been in intensive and constructive discussions with the BMA resident doctors committee since the start of the new year. The aim is to try to bring an end to the damaging cycle of strikes, and to avoid what is undoubtedly further, unnecessary disruption for patients and NHS staff. We continue to hope that those talks result in an agreement that works for everyone, so that there will be no more strike action by resident doctors in 2026.

With regard to the noble Lord’s request for more detail on operational readiness, I know he understands that introducing reforms to such a large-scale recruitment process is a big undertaking. We do not want the risk of creating errors that could lead to further uncertainty for organisations, for educators and, most importantly, for our trainees. An effective commencement demands clear processes for delivery across the health system. The reality is that industrial action will put this at risk because it is a diversion of resources, as it always is.

The noble Lord, Lord Clement-Jones, asked about further engagement. I have already had engagement with a number of noble Lords, including both Front Benches. If it is possible to do so before Report, I will write again. Time is extremely short, so while I am always glad to do so, if the noble Lord will allow me to look at that in a practical sense, I will be pleased to. With that, I hope that the noble Lord will withdraw the amendment.

[Lord Kamall (Con)]

I thank the noble Baroness for that considered response to the discussions. I thank all noble Lords who have spoken, not only to this group of amendments, but today. I also thank the staff for being here to look after us while we stay to this hour.

I should perhaps clarify for the noble Lord, Lord Clement-Jones, that when I laid the amendment it was with the amendment from my noble friend Lord Howe in mind. If we can address some of the perceived injustices or unfairness in the system, we should implement as soon as possible. I was not seeking to create a tension there.

I am grateful to the Minister for explaining that there are operational issues. I think that it would help the Government, and help this Bill to go forward, if the Minister were able to explain in a letter to noble Lords some of those operational issues, because sometimes it may be that we think that it is quite easy. I know, having been in government, that there are a number of issues. I can see that the Minister is looking forward to spending her Recess formulating that letter with her officials. The noble Lord, Lord Mohammed, talked earlier about a holiday, but I do not think that Ministers ever get a holiday. I am giving the Minister a challenge during the Recess to explain some of the operational challenges that lead to the Government not being able to accept this amendment to implement the Bill as soon as possible.

With that, I thank the Minister for her response. I thank all noble Lords who have spoken today and I beg leave to withdraw the amendment.

Tobacco and Vapes Bill [HL]

Baroness Merron Excerpts

Wednesday 11th February 2026 Lords Chamber

Moved by

[Baroness Merron]

That the amendments for the Report stage be marshalled and considered in the following order: Clauses 1 to 16, Schedule 1, Clauses 17 and 18, Schedule 2, Clause 19, Schedule 3, Clauses 20 and 21, Schedule 4, Clauses 22 to 40, Schedule 5, Clause 41, Schedules 6 and 7, Clauses 42 to 64, Schedule 8, Clause 65, Schedule 9, Clauses 66 to 83, Schedule 10, Clause 84, Schedules 11 to 13, Clauses 85 and 86, Schedules 14 and 15, Clauses 87 to 126, Schedule 16, Clauses 127 to 140, Schedule 17, Clauses 141 to 145, Schedule 18, Clauses 146 to 151, Schedule 19, Clauses 152 to 156, Schedule 20, Clauses 157 to 159, Schedule 21, Clauses 160 to 170, Title.

Motion agreed.

Better Start Longitudinal Programmes

Baroness Merron Excerpts

Tuesday 10th February 2026 Lords Chamber

[Baroness Thornton]

To ask His Majesty’s Government whether, and if so when and how, the learning from the results of the Better Start longitudinal programmes will become pregnancy and early years policy and be implemented.

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

My Lords, we welcome the valuable learning that is emerging from the five Better Start partnerships and we look forward to the national evaluation report in the spring. The programmes provide important insights into early-years support in highly disadvantaged areas. Best Start Family Hubs and Healthy Babies already deliver a place-based prevention focus model. We will consider Best Start evidence, alongside other evaluations, as we develop policy to deliver a new neighbourhood health service and raise the healthiest generation of children ever.

[Baroness Thornton (Lab)]

I thank the Minister for that and declare an interest: my sister, Gill Thornton, is the director of Better Start Bradford, which is part of the £250 million programme funded by the National Lottery, with local funding too, for the last 10 years. The model, which places children and family at the heart of service design, focuses on the first 1,001 days, which is critical because of the developmental window from conception to a child’s second birthday. I would like to hear how the Government will integrate this into their Best Start for Life programme.

[Baroness Merron (Lab)]

The work in Bradford is to be commended. I can assure my noble friend that, through Best Start Family Hubs and Healthy Babies, local authorities will be expected to do exactly what the noble Baroness says is happening in Bradford: that is, to establish very inclusive and diverse routes for parent and carer participation. We want families to shape how services are set out and I absolutely agree that the first 1,001 days of a child’s life is a crucial and critical developmental window.

[Lord Russell of Liverpool (CB)]

My Lords, the Minister may not have had the time that I have had to read the first report from this programme, which is called Exploring School Readiness. These projects have been going in five different areas, with 16 different programmes. In going through all 16 programmes, does she share with me the slight concern that there is only one mention of mobile phones and screen time? That was in Nottingham, where adults were asked to leave their mobile phones outside an area where their children were learning how to play, in order that the adults could concentrate and pay attention to their children, rather than pay attention to their phones. Given the rising concern generally in the country about the effect of screens and phones, not only on the very young but on the ability of parents to be parents, could that not be integrated and taken into account as this programme is taken forward?

[Baroness Merron (Lab)]

It is an important point that the noble Lord raises. This is being dealt with by the Government’s proposal to have a three-month consultation, so that we get it right in terms of acknowledging the concerns and challenges of screen time for children. So, I take the point that the noble Lord has made. This is of course a matter for DSIT. I will ensure that it is aware of the noble Lord’s comments, as well as the relevant departments—my department and the Department for Education—in respect of the programme that we are talking about.

[Baroness Walmsley (LD)]

My Lords, while I welcome today’s announcement about protecting special educational needs funding, I would like to ask about support for very young children with special needs and those with physical disabilities. Parents often find it difficult to find an early-years place or childcare suitable for these special children. Can the Minister point them towards any real, properly funded, properly resourced help from people with the right training looking after these special children?

[Baroness Merron (Lab)]

I hope I can be helpful to the noble Baroness. In the Best Start for Life strategy, we committed that each Best Start Family Hub will have a children and family services practitioner to support children and families who have additional needs. I feel that this new offer will help parents to understand their child’s development and identify emerging needs sooner. Importantly, it will also support vital join-up across the services, keeping children who have particular needs at the very centre.

[Baroness Rafferty (Lab)]

My Lords, would my noble friend the Minister confirm what the Department of Health and Social Care has taken from the Better Start work to inform its maternity and baby strategy?

[Baroness Merron (Lab)]

As my noble friend knows, we are absolutely focused on improving quality and consistency of care for women throughout pregnancy, birth and the critical months that follow. That is why we have appointed the noble Baroness, Lady Amos, to lead an independent investigation and why the Secretary of State will chair a maternity and neonatal taskforce to address the recommendations of the investigation. It is very much part of our work to give babies the very best start in life.

[Baroness Deech (CB)]

My Lords, the Minister has expressed the commendable ambition of raising the healthiest generation of young children ever. So why have the Government done nothing to condemn and educate about, if not prohibit, cousin marriage, the babies from which suffer twice the number of birth defects as those from non-cousin marriage?

[Baroness Merron (Lab)]

My recollection from debating that point previously is that we are looking at the evidence and the best way to tackle the issue that the noble Baroness raises: in other words, what best supports children to have that healthy and best start in life? We are looking at this in the round and I am sure that we will return to it, but I will also be pleased to follow up in writing to the noble Baroness.

[Lord Kamall (Con)]

My Lords, many noble Lords would support the objectives of the Better Start longitudinal programme, with its focus on improving children’s diet and nutrition, social and emotional development, and speech, language and communication skills. But can the Minister explain how, rather than with a top-down, Whitehall or Westminster-knows-best attitude, it is working with local civil society organisations, such as BRITE Box, which works with families and local communities to help them learn how to cook healthier meals on a budget to improve their nutrition and well-being?

[Baroness Merron (Lab)]

This will not be a top-down approach. We are ensuring that Best Start Family Hubs and Healthy Babies are in every local authority area. That is a major development, because from April it will reach more than 500,000 more children. It will also help us transition to neighbourhood health services. However, all of this will, as ever, be more successful by working together with other groups, including third-sector organisations such as BRITE Box.

[Lord Watts (Lab)]

My Lords, does the Minister agree with me that we would have had much healthier children if the previous Government had not shut down all the Sure Start centres and caused the poverty that they did?

--- Later in debate ---

[Noble Lords]

Oh!

[Baroness Merron (Lab)]

I think I heard what my noble friend said: I got the gist. What matters is not just that we are in a position where children’s health and well-being is not where it should be but that we are pulling together all the best examples of practice, including Sure Start and family hubs, and investing in provision, services and information. This will take us forward to a situation where we genuinely have the healthiest generation ever. That is not something we have now, particularly in the more disadvantaged areas.

[Baroness Manzoor (Con)]

My Lords, I am sorry if I sound like a broken record, but what are the Government doing to ensure that we retain the health visitors and midwives that we have? There are not sufficient midwives or health visitors in the service and they play a vital role in supporting young mothers and fathers in the care of their babies and children.

[Baroness Merron (Lab)]

They do: I completely agree. That is why they are very much part of our delivery plan. It is part of the move from hospital to community: part of the neighbourhood service model. We will be publishing the workforce plan in the spring; that will take account of it. This is a multidisciplinary approach. We are seeing more midwives. We are also seeing more consultants in obstetrics, for example, although I know that the noble Baroness was not referring particularly to that. We are also developing stronger health visitor teams. They all matter, because they bring the care closer to home in a way that will make the greatest impact.

Under-16s Energy Drinks Ban

Baroness Merron Excerpts

Tuesday 10th February 2026 Lords Chamber

[Baroness Walmsley]

To ask His Majesty’s Government when they expect to publish a timeline for legislation banning the sale of energy drinks to under-16s.

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

My Lords, we are taking decisive action on obesity, easing the strain on our NHS and creating the healthiest generation of children ever. As part of this, we will fulfil our commitment to ban the sale of high-caffeine energy drinks to children aged under 16, introducing the ban within this Parliament. Our consultation has closed. We are analysing the responses and will set out further information on our timelines in due course.

[Baroness Walmsley (LD)]

My Lords, the Government promised to ban the sale of energy drinks in this Session. The consultation has ended but we have not seen the results yet. When will the responses be published and when will the Government publish the regulations? Will the ban extend to all under-18s and all retailers, including vending machines and schools? There is still time to pass the regulations before Prorogation. Will the Government get on with it? Otherwise, it will be a promise made but a promise broken.

--- Later in debate ---

[Baroness Merron (Lab)]

I hear the noble Baroness’s counsel but, as I said, we have committed to introduce the ban within this Parliament, as the Secretary of State said. He also said ideally sooner, if possible. I can confirm that all sellers, retailers and businesses of all sizes in England, including in-store and online sales, should be in scope of the ban.

[Lord John of Southwark (Lab)]

My Lords, in addition to the harms of energy drinks, the 156 cans of fizzy drink that the average child consumes in the UK each year can and do contribute to higher rates of childhood obesity and dental problems. With that in mind, will my noble friend the Minister commend the work of —would you believe—Southwark Council, which introduced the Fizz Free February public health programme in 2018, which has now been taken up in 25 other areas and aims to significantly reduce the consumption of fizzy drinks among children and young adults? Will she also explore ways in which Fizz Free February can be supported and introduced more widely across the country?

[Baroness Merron (Lab)]

I am very pleased to commend this initiative by Southwark Council. It was developed by the council’s public health team and is a good example of what local action can do. My noble friend talked about the extension of this initiative across the country. I very much support that. What struck me, having looked online at Fizz Free February, was the importance of the information that reminded us that more five to nine year-olds are hospitalised due to issues with their teeth than anything else. That is a very sobering thought.

[Lord Ahmad of Wimbledon (Con)]

My Lords, I declare an interest: my wife and I have constant battles with our children over the downsides of energy drinks and caffeine. Energy drinks can lead to type 1 diabetes. What processes and programmes are being undertaken to ensure that schools, in particular high schools, are part of this process in educating students? Once they are out of the door it is very much a decision that they make themselves. I also support the noble Baroness, Lady Walmsley, in that every outlet should be part of this regulation.

[Baroness Merron (Lab)]

I agree on that last point, not least because that makes a level playing field, but it is also the right thing if we are to make that ban. The noble Lord describes a battle that I am sure goes on in many households. Schools are crucial. The incentive for schools is that children and young people will be much better placed to learn. One of the most disturbing things about this, and a message which we need to continue to get across, is that more headaches, difficulty with concentration and greater anxiety are all potential consequences of energy drinks. We work very closely with schools to ensure that the message gets through.

[Baroness Winterton of Doncaster (Lab)]

My Lords, one of the real successes of the previous Labour Government’s Sure Start programme was teaching families about healthy diet and how to prevent obesity. Can my noble friend the Minister assure me that the new family hubs will take an equally robust approach?

--- Later in debate ---

[Baroness Merron (Lab)]

I can certainly confirm that to my noble friend. The new Best Start in Life hubs will take the best from previous programmes, including Sure Start. We are providing information through an online service that has had 4.5 million hits so far, and we are working closely with the Department for Education on that. But yes, we will be taking the best of Sure Start.

[Lord Kamall (Con)]

My Lords, when a Government restrict the sale of products to some but not all customers for whatever reason, it is essential to pre-empt the effects on businesses that will be at the sharp end of enforcing this ban, especially corner shops and small retailers. What engagement have the Government had with small retailers, especially small corner shops, some of which do not always feel represented by the Association of Convenience Stores, to understand their concerns over violence or abuse when they ask for ID from customers who may appear to be underage?

[Baroness Merron (Lab)]

As we discussed on the Tobacco and Vapes Bill in this Chamber, the whole issue of age verification is crucial. I feel that businesses are used to seeking age verification. What matters is that they feel empowered to ask for it and that staff are trained. That is why we are indeed working with businesses in the way the noble Lord says. Many of them responded to the consultation and we are very pleased to have their voice in that.

[Lord Hampton (CB)]

My Lords, does the Minister agree with me—working, as I do, with children as a teacher—that there is a certain irony in banning sports drinks for sale to children yet allowing those drinks to sponsor sports teams?

[Baroness Merron (Lab)]

I understand the noble Lord’s point. We are focusing on those energy drinks that contain 150 milligrams of caffeine per litre as the way of making the greatest impact to children aged under 16. When I think that over 100,000 children aged 11 to 15 consume at least one high caffeine energy drink per day, I believe that that is the right thing to do, as some of those drinks are equivalent to four cans of Coke or two espresso shots. That is how seriously we need to take this. I hear his point about going further, but it is important that we focus on the absolute immediate.

[Baroness Manzoor (Con)]

The Government introduced voluntary guidelines for manufacturers to reduce salt and sugar in baby food and milk food products for ages up to 36 months. How has that gone? Will they introduce statutory guidelines after the first 18 months? Have companies complied with the guidelines?

[Baroness Merron (Lab)]

We were glad to introduce the voluntary measures. To be proportionate and evidence-based, they will in the first instance be voluntary. We will review along the way how we are getting on and whether there is a need for statutory action, as the noble Baroness asks.

[Baroness Bull (CB)]

My Lords, the noble Baroness’s Answer referred to obesity. There is a risk of obesity from these high-sugar drinks, but caffeine is perhaps the bigger danger, particularly for smaller bodies, which cannot deal with the excessive caffeine. Are the Government monitoring the use of caffeine pouches that are now available, which are inserted between the gum and the lip to give a hit of caffeine, which can be dangerous for young people?

[Baroness Merron (Lab)]

I actually do not know the answer to that, so I cannot confirm it is the case, but I will certainly look into it. I take the noble Baroness’s point about caffeine. That is the problem here, but it is also right that we consider sugar intake.

[Lord McColl of Dulwich (Con)]

My Lords, is the Minister aware that combating the obesity epidemic has been seriously impaired by a number of pseudo- scientists who have put forward the idea that obesity is inevitable and that we cannot do anything about it, so it must be government that does something about it? Does the Minister agree that there is only one cause of obesity and that is eating too much?

[Baroness Merron (Lab)]

The noble Lord always tempts me to agree with him. The causes of obesity are complex and include what people eat, how much they eat and who they are. It is the reason that the Government have taken on the responsibilities they can, such as restricting junk food advertising on TV and online, giving local councils stronger powers to block new fast food outlets, and announcing changes to the soft drinks industry levy. All these support people in making better choices.

National Cancer Plan

Baroness Merron Excerpts

Monday 9th February 2026 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, from these Benches, we very much welcome the national cancer plan and support its ambitions—and it is very ambitious. Many organisations and committees have called for an integrated, long-term plan, so it is very good that the Government have listened and, in particular, have taken note of the views of patients and their families—the people with lived experience of all these problems. However, may I reiterate Cancer Research UK’s response to the plan? It said:

“The key question that patients and their loved ones will ask, however, is how quickly will they see progress in cancer survival and outcomes? The improvements they are waiting for will depend on how this plan translates into delivery. Funding must match the ambition of what has been promised, or the NHS will struggle to expand its diagnostic capacity or introduce innovation at scale. And clear leadership and accountability are also crucial”.


Many of those points have also been mentioned by the noble Earl, Lord Howe, just now.

We know that outcomes in England have lagged behind comparable countries for decades, so it is positive to see improving cancer survival at the centre of the plan. However, it is going to be tough to achieve and will require much faster progress than what we have heard so far indicates. The key, of course, is improved diagnosis at an early stage, so I welcome the renewed commitment to earlier diagnosis and to meeting all cancer waiting time targets by 2029. It is outrageous that 92% of trusts do not reach the target for starting treatment. I welcome the full rollout of lung screening by 2030 and increasing the sensitivity of the tests used in bowel screening by 2028. However, what about breast screening? There have been problems in some parts of the country in getting that done. Can the Minister say whether these plans will be fully resourced? There is no point in doing the screening and tests unless an expert is there to interpret them. There are bold promises, but will they be matched with the resources and training required?

The plan talks about AI tools and liquid biopsy tests, which could certainly hold real potential for increasing productivity. However, before they are introduced, they must be robustly tested so that only safe and effective innovations reach patients and those that do not work can be dropped.

While there is a focus on diagnosis and treatment, I was pleased to see that the plan includes a commitment to increase action on lifestyle factors which we know cause cancer. Smoking tobacco, being overweight or obese, alcohol and UV exposure still cause many cancers that could be prevented. Fortunately, the Tobacco and Vapes Bill should certainly have a positive effect over the coming years in stopping people smoking in the first place. It is also positive to see action to strengthen protections on sunbed use and measures to drive HPV vaccination uptake, particularly in underserved groups. The new ad hoc committee on childhood vaccine rates is, I hope, going to contribute to that.

More action is needed to drive the shift from sickness to prevention, which is one of the Government’s core objectives in their 10-year health plan. There is still more to do to help millions of existing smokers quit smoking and to prevent someone becoming overweight or obese in the first place. Tightening regulation on alcohol through introducing minimum unit pricing, as implemented in Scotland and Wales, was a missed opportunity. Will the Government reconsider?

Rare cancers make up about 24% of cancers diagnosed in the UK and the EU every year. This includes cancers of children and young people, because they are less likely to suffer from the cancers caused by the lifestyle issues I have just mentioned. This is where research comes in, and the ability to implement research findings into the NHS. It is a sad fact that the NHS has been slow in the past to implement new cutting-edge treatments, so it is welcome that the plan has some important commitments in that respect. However, as with other aspects of the plan, the devil is in the detail.

The focus on ending delays in cancer treatment is a step forward, but funding 28 new radiotherapy machines is not enough when the treatment is so cost-effective and successful. We need to end the radiotherapy deserts. Will the Minister extend her ambition to the 200 extra radiotherapy machines that the Liberal Democrats have proposed? Another 28 will probably only replace the old machines that need to be replaced anyway—it will not take us forward. Can the Minister tell us about the plan to train the operatives for these new machines? Resources, training and accountability are at the heart of this. We have not had a lot of detail yet, so I look forward to getting more.

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

My Lords, I am grateful for the warm welcome from both Front Benches for the national cancer plan. This is a moment when we transform our cancer care and we make it personalised—we wrap it around the person instead of expecting it to be the other way around. The 62-day treatment standard has not been met since 2015, and outcomes, as we have talked about a lot in this Chamber, continue to lag behind those of comparable countries. That is what has driven us to this point to ensure that, by 2035, three in four people diagnosed with cancer will be alive five years later, whereas at present, the figure is three in five. That represents 320,000 more lives saved, with all the effects on their friends, families and communities, as well as themselves. That will be the fastest improvement in cancer survival this country has ever seen.

I will try to deal with some of the Front-Bench questions. I agree with much of what has been raised, including the recognition of all those, including those with lived experience, who contributed to what is, in my view and experience, a very bold 10-year strategy that actually sets out how we will do this. Both the noble Earl, Lord Howe, and the noble Baroness, Lady Walmsley, asked about clear milestones. I am glad to say that those are set out at the end of each chapter, with dates and the responsible organisations for all key actions and commitments.

The noble Earl raised the workforce plan. It will be published in the spring and will set out guidance—this goes to the point raised by the noble Baroness—not just on expanding numbers but on ensuring that staff are properly trained and supported. This will require a multidisciplinary team approach. We will use training directly as a lever to prioritise training places in trusts, often in the rural and coastal areas that the noble Earl asked about, as it is indeed the case that vacancy rates are higher and performance is lower. Training doctors of course takes time, but this is about long-term sustainable change and about turning around the whole of the cancer pathway. It is the exact opposite of us tinkering here and there. We are working with the royal colleges to boost the numbers of doctors specialising in clinical and medical oncology.

The noble Earl asked about bringing NHS England into the department. I see that as a great opportunity. Within the plan, we have set out a reformed national cancer board. It will be comprised of cancer experts, and it will be accountable—this is so important, as the noble Baroness said—for the overall delivery of the plan. Regionally, we will keep and strengthen the role of cancer alliances, which will work hand in glove with NHS regions to deliver cancer improvements.

The noble Earl asked how young people are being engaged. We worked with the Children and Young People Cancer Taskforce to ensure their voices were heard through its patient experience panel. Importantly, we will appoint a lead for children and young people with cancer to be part of the revamped national cancer board. We want their voices to continue to be heard. We definitely recognise the distinction between children and young people; they have different needs. For example, the plan highlights the importance of play for children, as well as the role of youth support co-ordinators in providing educational, emotional and fertility support for teenagers and young people. I agree with the noble Earl that cancer has a profound psychological impact on all patients and those supporting them. The plan sets out how that support must be standardised for children and young people, including the provision of longer-term support.

The noble Baroness asked about improving early diagnosis. We are providing £2.3 billion of investment in diagnostics to deliver 9.5 million additional tests by 2029 across screening and symptomatic diagnosis. The noble Baroness asked about seeing change; I say go to a community diagnostic centre. That epitomises where we are going with our National Health Service. We will also spend more than £650 million to complete the rollout of lung cancer screening by 2030, which is one of the things that can make the biggest difference in more disadvantaged areas, as well in prevention.

On radiotherapy machines, the responsibility lies at a local level. We expect local systems to continue to invest in new machines to meet the ambitious targets. Through the spending review, providers have been allocated with £15 billion in operational capital for local priorities and £5 billion to support a return to constitutional standards, including for radiotherapy machines.

[Baroness Finlay of Llandaff (CB)]

My Lords, I must declare my interests in palliative care over the years. I will not list them all now, but I had the pleasure of working on the palliative care commission under the chairmanship of Sir Mike Richards. From speaking to him, I am glad to learn that he will have a role in the modern service framework.

My concern about chapter 4 is that action 7 seems to compound palliative care with end-of-life care. It does not recognise the benefit of someone receiving interventions early. It has been shown that patients benefit maximally from having at least three months of involvement with palliative care, rather than it coming in too little too late. Therefore, when we have integrated services in a cancer centre, time is allowed for a recurrence—when there is a crisis—to be dealt with immediately, rather than patients going home and being told, “Oh, you will see somebody later”. You have to be on the spot and you have to be available 24/7. I hope that there will be recognition that palliative care services save money.

I was glad to see that that the RIPEL study in Oxford was referred to. I ask the Minister whether she recognises the figures that have come from Hull York which show that, where you have fully integrated specialist palliative care services, you can save about £800 million a year by avoiding wasted interventions. I should declare an interest in that I have a young family member with an extremely rare cancer.

I also hope that the Minister will be able to provide reassurance that the speedy processes for modern and semi-experimental treatments will be available much more rapidly because, at the moment, many patients are having to pay privately through fundraising schemes because there are treatments that are emerging but are not yet available on the NHS.

[Baroness Merron (Lab)]

I am sorry to hear about the member of the noble Baroness’s family.

To the point about treatment, by 2028, every cancer patient will have access to a personal cancer care plan via the NHS app. Tailoring treatment and support through the whole care journey is important, including before the care journey starts. It will be a complete innovation that we are not talking about rehabilitation but what we are now calling “prehabilitation”, to support people.

We are also investing £80 million in four new NHS aseptic medicine production hubs, which will be operational by next year, to increase the supply of chemotherapy and immunotherapy, using advanced automation.

To the points about hospices and palliative care, for some, treatment is not enough; it is about the timely and proactive availability of palliative and end-of-life care. That is what is going to make the difference to their quality of life. We are working with the royal colleges to deliver enhanced levels of care, known as acute and supportive oncology, to consistent standards, and that will integrate palliative and end-of-life care while supporting clinicians to provide the best treatment. We are delivering the biggest investment in hospices in a generation—some £100 million to upgrade buildings, facilities and digital systems.

[Lord Bethell (Con)]

My Lords, I echo the praise of other noble Lords for the report. Professor Peter Johnson has done an enormously worthwhile job, and there is so much richness and so many good things in the report.

I will put a spotlight on the unfortunate framing that catching cancer is, largely speaking and for the majority of people, simply a matter of bad luck. The report says quite clearly, under prevention:

“As much as a third of cancers are preventable”.


That is a very conservative estimation of the proportion of cancers that are preventable. Modern analysis would point to systemically preventable exposure to multiple risk factors, which are entirely clustered around class. This framing is incredibly important, because it leads to consequential decisions in the Treasury, among health colleagues and in the rest of government about what we should and could be doing as a society and as a Government to try to reduce the prevalence of cancer.

In Europe, the European Code Against Cancer puts prevention absolutely at the centre of the cancer plan. In countries such as Malta, Portugal and Spain, cancer reduction is not seen as something that is relegated to a paragraph in the introduction: it is absolutely front and centre of the whole cancer plan. It embraces all of health.

The noble Baroness, Lady Walmsley, mentioned screening and vaccines, but it is a shame that those are not much more front and centre and that the Government’s ambitions are not greater. Where are the targets on things such as obesity and clean air? These are the kinds of things that one would expect to see built into a cancer plan. In terms of the “all of government” approach, where is taxation and the planning system, mentioned in the plan as important levers for reducing cancer?

The bad-luck attitude to cancer is an old-fashioned clinicians’ bias that is no longer supported by the epidemiology. So, I ask the Minister, first, is it possible to perhaps review the research framework that has led to that kind of understatement of the preventability of cancer? Coming out of that, secondly, I ask the Minister whether she could perhaps consider looking at a cancer prevention plan, as they have in other countries?

[Baroness Merron (Lab)]

I am grateful for the noble Lord’s support for the cancer plan. I should have mentioned this. I will be honest: even as a Minister, I do not always pay full attention to the foreword, and I am sure that other former Ministers might share that, within a plan, but I commend this one to noble Lords, not least because the Secretary of State himself talked about his own experience of being told he had kidney cancer. He described his world being turned upside down. He talked about fear and foreboding, as does our Minister, Ashley Dalton MP. They both talked about fear and foreboding and the need to turn that round with action. That kind of drive, as well as the facts before us, drive this plan.

On the point about a cancer prevention plan and the question of where the strategy is for the reduction of obesity and so on, I say that this is a plan to be read alongside our other commitments. It builds on the 10-year health plan, which laid out the way we would be going forward with our shifts. This is about turning round the whole cancer pathway.

To the point specifically about prevention, I heard what the noble Lord said. We do not take the view that it is “just bad luck”. Where there is prevention, we should absolutely tackle that.

The plan tackles the causes head-on, not just by talking but with government action to cut smoking with the Tobacco and Vapes Bill, reduce obesity, act on alcohol harm and protect people from dangerous UV exposure, including through sunbeds. No one should lose someone to cancer that should have been prevented. We will not ignore the communities that are hit hardest. By having those preventions, we are supporting the communities that are hit hardest. Rolling out lung cancer screening more extensively will be one of the areas of importance.

I referred earlier to cancer alliances. They will promote, for example, new catch-up schemes to enable young people who have missed out on the HPV vaccination at school. They can have it administered at their local pharmacy. We are not leaving matters to chance. We are rolling out home testing kits for cervical cancer for those who do not go to appointments for a range of reasons, rather than offering only one opportunity.

In all these ways, the national cancer plan tackles the causes of cancer. We will continue to see that through. As the noble Lord knows, moving from sickness to prevention is a key factor in our 10-year plan.

[Lord Patel (CB)]

My Lords, I too support the national cancer plan, but I am not here to blow the Government’s trumpet. I will pick up on some of the points.

This is an ambitious plan, and that is good, because it might act as a catalyst for some progress. However, if that progress is to be achieved, the Government need to commit much more than what the cancer plan suggests. The plan suggests:

“Every patient will get a personalised assessment of their needs and a personal cancer plan—a complete support plan complementing their diagnosis and treatment”


and focusing on their wider needs. It goes on to say:

“Every patient will have a named neighbourhood care lead to coordinate their care and support after treatment”.


If that can be achieved, it will be fantastic. Apart from all the technological advances that we will have to fund in research terms, it is ambitious to suggest that liquid blood tests and cancer vaccines could be developed, be tested and be available tomorrow. It could be a long-term shot. Without investment, that will not happen. One of the key areas of deficiency is that there is nothing on what the manpower requirements would be and how this will fit into the manpower plan that the Government already have.

I heard what the Minister said about prevention. I heard nothing about developing cancer centres; we know from experience that outcomes are best when patients are treated in cancer centres, rather than in every hospital in the country. We have no targets to eliminate cancer. For example, it is possible to eliminate cervical cancer by a proper immunisation programme of HPV vaccines.

I am allowed only to ask questions, but it would be nice to have a longer debate. We never had one on the national health plan either. I hope that could be managed somehow.

[Baroness Merron (Lab)]

That last point will, of course, be drawn to the attention of the usual channels. I too would welcome a debate on this. Noble Lords might wish to note that when they have an opportunity to suggest or apply for debates.

The noble Lord’s last point was about elimination of cancer. That is possible in some cases. I am glad that he mentioned cervical cancer. I mentioned in my answer to the noble Lord, Lord Bethell, that we have committed to catch-up HPV vaccination campaigns from this year, to eliminate cervical cancer by 2040. That is absolutely the right thing to do, and to introduce the Tobacco and Vapes Bill, which I hope will become an Act, to phase out smoking and reduce youth vaping, which can be a gateway to smoking. That will also reduce risk factors.

The noble Lord, Lord Patel, is always right to press us to go further. I understand that. This is a plan for the long term but with staging posts along the way. We have already made progress. For example, I was very pleased when we announced a trial called EDITH for breast cancer screening, to harness the benefits of AI, working with operatives for sped up and more accurate diagnoses. This is one example and is to the point that the noble Baroness, Lady Walmsley, raised about AI.

I hear what the noble Lord says about cancer centres. We are seeking to move treatment and diagnosis from hospitals to community. That is one model, but there are others, as the noble Lord would acknowledge. It is right to push us to go further, but what sets this plan apart is not just its level of ambition and its recognition that all is not right in the world but that it is setting out how we will get there. However, I welcome the transparency and leadership which is attached to this—which noble Lords have called for. This plan merits a lot of attention and support. I shall be pleased to discuss it in this Chamber further.

[Baroness Swinburne (Con)]

My Lords, I too recognise that this plan is a really good step forward in terms of the long-term plan for cancer sufferers. Many of our families have been touched by this awful disease, which is many and varied. However, I would like to focus on the innovation and research side of this, our speed of uptake within the NHS across the United Kingdom and how quickly, relative to other places in the world, we get some of the testing that is available out to our UK nationals.

A test called an Oncotype DX test, which is used to determine whether or not it is suitable for breast cancer sufferers to have chemotherapy, has recently been brought to my attention. In many cases, people can avoid chemotherapy if the test is actually telling the clinician that it is not necessary. In fact, the majority of patients with a particular type of breast cancer will not need chemotherapy, and that test will tell them and identify them.

The reality is that that test was available in the US from 2004. It was adopted by NICE in its guidelines in the UK in 2015. It is only now being widely adopted in the NHS across the whole country, rather than just in specialist teaching hospitals. That speed of adoption means that many people are actually having unfortunate treatment that they may not have required.

Therefore, I urge the Minister to look at how quickly we adopt these new genomic tests and how quickly we can actually improve that patient path for each and every patient. This was personalised medicine that was designed 20 years ago and we are only just starting to see it roll out nationally.

[Baroness Merron (Lab)]

The noble Baroness makes a very good point, particularly as we are in what I regard as a whole new area of scientific and technological advancement, and we have the chance to harness it.

In general terms, I can say to the noble Baroness that where, for example, there are regulatory problems with getting new treatments out there, we are working to remove all those blocks. That work is going on.

With regard to genomics, the plan does talk about routine genomic testing to match patients to targeted therapies and trials, and it also talks about investment in AI-guided radiotherapy, in cell therapy and in novel immunotherapies. There is also going to be the establishment of a cancer trial accelerator programme by next year, to increase trial access and speed.

My last point, which I hope will be helpful, is that six national research priorities are established, including early detection, mRNA vaccines, rare cancers and paediatric therapies. I take the point that the noble Baroness is making. The cancer plan addresses that, as well as seeking to remove blocks that should not be there.

Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[Lord Markham (Con)]

Building on from that, that is correct: there are two different approaches here. There are those among us who believe that choice should come first, and within that choice there should obviously be protections and safeguards. Then there are those people who have equally very firm beliefs that the restrictions should be in place first as protections. To summarise, a lot of the amendments in this group are about having certain illnesses and certain groups, such as disabled groups, that should be excluded from the Bill, and that you should be allowed to have this only if you have unbearable pain or suffering, or if there is no chance of treatments to extend life.

I will bring two points in here. Public opinion is overwhelmingly in favour of choice, at 70% in all the different opinion polls. I include disabled groups in that: they show that 70% of disabled people are in favour of it. Then, there are the personal experiences of people who are terminally ill: first, they do not want to die. They would be delighted if there were treatments that would extend their lives beyond six months, or for much longer. But, for them, getting the opportunity to have a death of their choosing is a great comfort and insurance. It does not mean that they are going to rush out and take it as soon as they have it. In a lot of cases—about 30% in other countries—they will not use it at all.

However, the fact is, those people want it to be there, like an insurance policy, so that if, towards the end of their life, they really do have unbearable suffering, however they define it—which might be pain, a loss of dignity, a feeling that they really do not want to go on—then they can have that choice and reason for wanting to do it, whatever their choice is. That is the important thing that we are trying to ensure. Yes, there will be protections, but giving people the ability and autonomy to have the comfort and the choice of being able to die in the way they wish is the most fundamental right of all.

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

My Lords, I am grateful for the contributions on eligibility and definition of terminal illness. Once again, I will keep detailed comments limited to amendments on which the Government have major legal, technical or operational workability concerns.

First, I will give a reassurance to your Lordships’ House in response to the observations of the noble Lord, Lord Harper, and the noble Baroness, Lady Grey-Thompson, about the modern service framework on palliative care and end-of-life care. We acknowledge that there has been a drafting error, which the noble Lord and the noble Baroness picked up on. The drafting error is in the national cancer plan. I reassure your Lordships’ House that, as has been stated previously, the interim update will be published this spring and the full modern service framework will follow in the autumn. That issue was purely down to a drafting error.

I turn now to the amendments. Amendments 71, 77 and 79 were tabled by the noble Lady, Baroness Finlay, and Amendments 83A, 104 and 105 were tabled by the noble Lord, Lord Polak, my noble friend Lord Hunt of Kings Heath and the noble Baroness, Lady Grey-Thompson. Noble Lords may wish to note the Government’s workability concern with this set of amendments. Key terms and concepts in the amendments are undefined, which may introduce uncertainty when determining who is eligible under the Bill and, particularly under Amendments 71, 77 and 79, what it means to slow a disease. There is a risk that unclear eligibility criteria could result in ambiguity for those applying the legislation, which may give rise to legal challenges to decisions made under it.

Amendment 105 could also give rise to legal challenge on the basis that excluding people with particular conditions from assisted dying may not be justified under Article 2 or Article 8 of the ECHR and may amount to unjustified discrimination under Article 14. Any differential treatment would need to be objectively and reasonably justified in order to comply with ECHR obligations.

Amendments 74 and 94, tabled by the noble Lord, Lord Taylor of Holbeach, would exclude from the definition of “terminal illness” any individual whose condition can be meaningfully halted or controlled by available treatment. Clinically, it may be difficult to determine whether an illness or disease can be “meaningfully halted, or controlled” by treatment, and it is possible that an illness or disease could have a short halt before deterioration starts again. This will make it difficult for clinicians to decide whether a person is “terminally ill” and eligible for assisted dying and is likely to lead to challenges to decisions. These amendments may result in a person becoming ineligible, irrespective of whether they choose to take the available treatment.

Amendment 75, tabled by the noble Baroness, Lady Finlay, would amend the definition of “terminally ill” by removing the test of death being reasonably expected in six months, and replacing it with a requirement that the rate of progress of the disease, with treatment in line with NICE guidelines, indicates that death can be expected within six months. Introducing the concept of treatment in accordance with NICE guidelines may create difficulties, as the amendment would require clinicians to assess the patient’s prognosis as if they were treated in accordance with NICE guidelines. This may result in a person becoming ineligible, irrespective of whether they chose to have treatment in accordance with NICE guidelines. This amendment therefore requires clinicians to make a judgment on a potentially hypothetical basis.

Amendment 80, tabled by the noble Baroness, Lady Lawlor, would provide that a person is “terminally ill” where their death has an 80% likelihood of occurring within six months, according to the written opinion of two specialist, consultant-level hospital doctors. These doctors must be knowledgeable about and have experience of treating patients with the progressive illness in question. This amendment would create significant operational workability concerns. It would require the clinician making a determination about the person’s prognosis to meet a high threshold of certainty. The criteria could be especially difficult to meet for a person who has a rare progressive illness or disease, about which there may not be widespread clinical knowledge or experience.

Amendment 82, tabled by the noble Lord, Lord Polak, would require two consultants to provide a view on an individual’s life expectancy, and for them to determine that their death can be “highly probable” within six months, rather than the current drafting of, can be “reasonably expected”. Several terms are not defined in the amendment and are likely to lead to ambiguity, including operational issues, around which doctors are to assess life expectancy and to what standard.

--- Later in debate ---

[Lord Moylan (Con)]

May I pursue a point the Minister made about my Amendment 85? My understanding of the Bill, as drafted, is that one has to have an inevitably progressive illness or disease, not that one has to have a six-month prognosis of one’s death. The two might be quite separate.

One might, as the noble Baroness said, have a combination of circumstances that means one is likely to die within six months without having a specific, identifiable disease. The Minister seems to be saying that the Government’s interpretation of this clause is that one does not need to have a specific, identifiable terminal illness; one simply needs to have a set of circumstances that together might result in a prognosis of death within six months.

If that is the case—and that is the Government’s view of the meaning of that clause, as the Minister seems to imply—that widens to an astonishing extent the conditions that might qualify for the Bill. I would like to hear the Minister say—and the noble and learned Lord, Lord Falconer, may possibly want to comment on this when he speaks—whether it really is their interpretation that it could be any set of circumstances that lead to a six-month diagnosis without there being an identifiable illness.

[Baroness Merron (Lab)]

I will briefly look at the actual amendment. As I said in my response, the workability concerns are about the specification of a list of illnesses or diseases. I have already outlined why that would be unworkable—because it is often a combination of illnesses, as well as the complications of those illnesses, that are interacting, rather than there being just one. I referred earlier to why it would be extremely difficult. I have been looking at the specifics of the amendment, but to do what it says would create more ambiguity than there is currently. In reality, my response is covering our concerns; where I do not make a comment, there are no workability concerns.

[Lord Taylor of Holbeach (Con)]

As the Minister will know, I have made it clear that I am concerned about suffering in the last days of life. One of the key elements of that is palliative care. When one talks about treatment, one of the incentives for death is suffering. Does the Minister have anything to say to the Committee about the status of palliative care within the National Health Service? Are there any plans afoot, and when will this particular course of treatment be available to people? Otherwise, many people faced with terminal illness will be tempted to seek assisted suicide, which I think should be discouraged.

[Baroness Merron (Lab)]

We are discussing a group of amendments about the definition of terminal illness. I have already placed a letter in the Library of the House outlining all the work in respect of palliative care. I have also made reference to the modern service framework.

[Lord Harper (Con)]

Having listened to my noble friend Lord Moylan respond to what the Minister said, I confess to being a little confused. The Minister seemed to be saying, in her comments about some of the amendments in this group, that the problem with having a list of conditions is that you could quite often have a terminal diagnosis as the result of a group of conditions, circumstances or illnesses. In my reading, the Bill does not say that. The Bill says:

“For the purposes of this Act, a person is terminally ill if … (a) the person has an inevitably progressive illness or disease”—


not lots of them; one—

“which cannot be reversed by treatment, and … (b) the person’s death in consequence of that illness or disease can reasonably be expected within six months”.

I carefully read the amendment, which talks about a specified list of conditions. Incidentally, coming back to the point made by the noble Lord, Lord Markham, twice as many members of the public support that approach than a terminal illness. The Minister’s answer to my noble friend Lord Moylan seemed to be disagreeing with what is actually in the Bill, so I am now more confused than I was before she got to her feet. Can she clear that up?

[Baroness Merron (Lab)]

I am sorry the noble Lord is confused. I know that my noble and learned friend Lord Falconer will be pleased to assist him with any confusion that there is in the case of this amendment.

[Lord Pannick (CB)]

I suggest to the Minister that the answer to the noble Lord, Lord Harper, is very simple. An unfortunate person may have more than one inevitably progressive illness or disease, each of which will lead to their death within six months. It is a standard principle of statutory interpretation that the singular includes the plural.

--- Later in debate ---

Debate on Amendment 87A (to Amendment 87) resumed.

[Baroness Merron (Lab)]

My Lords, I am grateful to noble Lords for their contributions to this debate. Amendment 87, tabled by my noble and learned friend Lord Falconer, the sponsor of the Bill, would clarify the intention of the current Clause 2(2), which is to prevent someone becoming eligible for an assisted death due to an eating disorder. Amendment 87 replaces Clause 2(2). The Bill’s sponsor in the other place indicated that they would look to improve the clarity on who is and who is not eligible in this clause. The noble Lord, Lord Harper, asked about interpretation. I hope those comments will be helpful, because the eligibility of people with eating disorders under the Bill is, of course, a policy decision, not one for government. I am sure that my noble and learned friend heard the noble Lord’s point.

This amendment, as is usual practice, has been drafted with the technical support of the Government, within the policy intent of the sponsor and of the other place. The amendment excludes from the definition of “terminally ill” any illness or disease caused by the person not eating or drinking, where not eating or drinking occurs as a result of a mental disorder. It also makes it clear that this expressly covers cases of limited eating or drinking. Given that Amendment 87 replaces Clause 2(2), if noble Lords accept it, a number of the other amendments in this group will, of course, fall away.

I turn to detailed comments on amendments that the Government consider have major legal, technical or operational workability concerns. Amendment 89, tabled by the noble Lord, Lord Polak, would lead to a person not being considered terminally ill under the Bill solely as a result of withdrawing medication, hydration or life-sustaining devices. Amendment 91, tabled by the noble Baroness, Lady Finlay, would mean that those whose refusal of nutrition is due to a mental illness would not be considered terminally ill under the Bill.

Amendment 92, tabled by my noble friend Lady Debbonaire, would exclude a person from eligibility if their terminal illness was

“solely as a result of standard medical treatment being refused or withheld”.

This amendment could have the potential undesirable impact of undermining a person’s autonomy and right to make informed choices about their own medical care. The definition of “standard medical treatment” is unclear here: the exclusion from eligibility could apply to a patient who refuses one standard medical treatment in favour of an alternative standard medical treatment. A refusal of standard medical treatment would mean that a person would become ineligible for ever, even where their refusal had no impact on their prognosis.

Amendment 101, tabled by the noble Baroness, Lady Parminter, would prevent people with physical effects or complications of a mental disorder being eligible for an assisted death. This may be difficult for clinicians to apply, as “physical effects” is an undefined term. The current drafting also layers a “for the avoidance of doubt” provision on top of another “for the avoidance of doubt” provision, which could lead to ambiguity about how the legislation should be interpreted. I heard the noble Baroness say that she was concerned about the drafting, so I hope those comments will be helpful to her.

Amendment 103, tabled by the noble Baroness, Lady Fox, would remove from eligibility people who, because of the effect of a mental disorder, refuse life-saving treatment and develop a terminal condition. Where amendments limit eligibility for specific groups, they could give rise to legal challenge under Articles 2 or 8, with Article 14, of the ECHR if such restrictions are not objectively and reasonably justified. As I have said, it is for noble Lords to consider the amendments in that light, should they wish to.

[Lord Falconer of Thoroton (Lab)]

First, I detect that the mood of the Committee is that I should put my Amendment 87 into the Bill, but subject to the amendment tabled by the noble and learned Baroness, Lady Scotland, and by the noble Baroness, Lady Berger, so I am minded, unless anybody indicates to the contrary, to let that process go ahead. I accept that, in putting it in, there are those who would like to build on it on Report, but I think we should put it in now.

I will deal very quickly with the other amendments in the group. Amendment 88, tabled by the noble Baroness, Lady Grey-Thompson, would leave out “solely”.

--- Later in debate ---

[Earl Howe (Con)]

My Lords, before the Minister rises to speak, I have a question for her about workability arising from one of the amendments included in this debate. In his Amendment 581A, my noble friend Lord Sandhurst posed a specific question on capacity at the moment when a person is given the substances with which they will take their own life. He is surely right that at that critical moment appropriate safeguards are needed where, for any reason at all, there is doubt about the person’s capacity—for example, where there is a history of fluctuating capacity. The doctor should clearly know how to respond to that situation. Can the Minister say whether she believes that the situation that my noble friend has described would require specific guidance to be issued by the Government over and above guidance already issued under the Mental Capacity Act?

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions on mental capacity and eligibility. As usual, I will keep my comments limited to those amendments on which the Government have major legal, technical or operational workability concerns. Indeed, if I do not refer to an amendment, clearly that is not the case, as was just suggested.

I wish to make a point to the noble Baroness, Lady O’Loan, who asked about consideration about compliance with ECHR. It is probably helpful for me to re-establish the consideration about that. It is the role of the Government—this is what I am doing—to highlight where there is a risk of issues in respect of the ECHR. However, it is for the House to decide whether policy choices might create a risk and whether that amount of risk is acceptable or not. The other thing, if it is helpful to the noble Baroness, is that, if it is found that primary legislation is incompatible, there could of course be a declaration of that incompatibility. It would not invalidate legislation. That is probably the main point that I want to emphasise, but this is ultimately a matter for decision by the House.

Amendments 117 and 892, in the name of the noble Baroness, Lady Hollins, would remove Clause 3 and insert a new clause requiring the Secretary of State to make regulations that establish an alternative framework for assessing and determining capacity, based on a psychological assessment, rather than reliance on the Mental Capacity Act. How to make that assessment on capacity—noble Lords have referred to this—is a policy choice and is therefore a matter for Parliament. However, as drafted, Amendment 117 uses a number of undefined terms such as “validated, standardised instruments” and “evidence-based methodology”, which, without further clarification or definition, are likely to create workability concerns. Amendment 892 would mean that the majority of provisions under the Bill could not come into force until the regulations under Clause 3 were made. This would make the backstop provision in Clause 58(4) ineffective.

I turn to Amendment 108, tabled by my noble friend Lord Hunt of Kings Heath. It would introduce a departure from the MCA framework by linking a lack of capacity in one area, to consent to care and treatment arrangements that amount to a confinement, to lack of capacity around another decision, the decision to end one’s life. This could create confusion and require additional guidance and training for practitioners.

It appears that Amendment 119 in the name of the noble Baroness, Lady Grey-Thomspon, would introduce a separate specialist capacity assessment process for adults with a learning disability. This departs from the MCA framework, which requires proportionate, decision-specific assessments, rather than separate processes for particular groups. Operationally, this could create significant training and resource demands, as specialist assessors would need to be identified. The Committee may wish to note that the amendment restricts any publicly funded provider from undertaking the mental capacity assessment, which would mean that individuals with learning disabilities would have to self-fund the assessment from a private sector provider. There are also technical drafting issues, including a lack of definition for “learning disability” and other terms such as “relevant professional regulator”, which could lead to uncertainty in how the legislation is applied.

Amendments 117, 892, 108 and 119 would all involve introducing differential treatment, by treating different groups of people differently. As such, they could give rise to legal challenge on the basis of ECHR obligations, specifically Article 14, which prohibits discrimination when read with Article 8. Any differential treatment, as I said more broadly earlier, would need to be objectively and reasonably justified in order to comply with ECHR obligations.

I turn to Amendment 235 in the name of the noble Lord, Lord Moylan. The effect of this amendment is that certain groups of people would not be able to make a valid first declaration, as the noble Lord said. This could exclude people with learning disabilities, mental disorders, as per Section 1 of the Mental Health Act 1983, and autism from accessing assisted dying. An individual who may experience substantial difficulty in understanding processes or communicating their views, wishes or feelings would also be excluded under this amendment from accessing assisted dying. The definition of “mental disorder” in the Mental Health Act is extremely broad and will include those with conditions such as ADHD, dyslexia, anxiety and sleep disorders. The Committee may wish to note that these groups would be excluded, even if their condition had no impact on their ability to fully understand the relevant information.

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[Baroness Merron (Lab)]

I am sure that both I and my noble friend will be very pleased, together or separately, to reply to the noble Baroness.

[Lord Falconer of Thoroton (Lab)]

I shall deal with the issues raised in this debate under the following heads. First, what is the correct test and legal framework to apply in relation to mental capacity? Secondly, how do we deal with the question of particular conditions that people have? Does it make it inappropriate, or should there be exceptional protection? Thirdly, what about Clause 22, which is the independent advocate provision?

First, on capacity, as noble Lords know, the Bill provides that the tests under the Mental Capacity Act 2005 shall be applied to determine whether or not the person seeking an assisted death has the capacity to make such a request. Remember as well, for what it is worth, that, in addition to having the capacity to make that request, the person, in order to get an assisted death, also has to have a clear, settled and informed wish to end their own life, and has made that decision to end their own life voluntarily and has not been coerced or pressured by any other person into making it. Those last two protections—a clear, settled and informed wish, voluntary and no coercion—are separate from the question of capacity.

The question of capacity is: is that person capable of making the decision? The Mental Capacity Act, which has been in force for approximately 20 years, starts from the assumption that a person does have capacity to make a particular decision, and only if it is shown that the person does not have that ability are they not able to make that decision themselves.

Should we change that assumption? There are two big proposals in front of us. First, there is Amendment 115 in the name of the noble Baroness, Lady Findlay of Llandaff, and supported in particular by the noble Viscount, Lord Colville of Culross, who made a speech in favour of it. Subsection (1) of that proposal says:

“In this Act, a person has capacity to make a decision to end their own life if they do not lack capacity to make that decision, and references to “capacity” are to be read accordingly”.


I shall read that again for those who did not get it first time round. In this Act, the proposal is that

“a person has capacity to make a decision to end their own life if they do not lack capacity to make that decision, and references to “capacity” are to be read accordingly”.

That looks almost identical to the existing provisions, and I am quite unable to see what the difference is that is being proposed.

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[Lord Wolfson of Tredegar (Con)]

My Lords, I am grateful to my noble friend Lord Blencathra for opening the debate on this group. He is right that we should consider carefully how the most vulnerable will be protected under this legislation. Having a multidisciplinary specialist review before a person in a care home is certified to have capacity seems an interesting and a sensible safeguard. It was not clear to me whether the five working days is from the date of the review or from the date of the findings of the review, but no doubt that could be looked at and clarified.

Of course, generally, social care is a policy area that needs attention. We know that too many older people receive inadequate care in old age, and I must say that it seemed to me that the personal experience of the noble Baroness, Lady Hayter, and that of my noble friend Lord Deben can both be right. It is likely that there are excellent care homes and care homes that need improvement. I am afraid that that is probably the society we live in.

Effective communication is a challenge that older people face. This is an obstacle for the process under the Bill for assessing capacity. It therefore seems sensible for specialists to be involved when the person requesting assistance is in a care home. We also have to consider the risks of institutionalisation, which I know from experience can certainly be a factor for people in care homes. I would be grateful if the Minister could confirm what the Government’s conclusions are on this proposal and its workability. Would it be prohibitively costly or could it be delivered?

On the amendment from my noble friend Lady Eaton, this additional process and heightened evidential standard for persons in care homes is a constructive and interesting suggestion. I invite the Minister to update the Committee on whether the Government have considered the two separate proposals in this group and come to a view on which would be the more workable and effective if implemented. That assessment would not only be helpful to the Committee but might enable the House in due course to make a more informed decision on the best way to improve this part of the Bill on Report. If that assessment has not yet been made, perhaps the most appropriate way forward would be for Ministers to write to the Committee to update it, at some point between now and Report.

[Baroness Merron (Lab)]

My Lords, I am most grateful to all noble Lords who have contributed to this debate on assessing capacity in care homes. As noble Lords will be aware, my remarks will be limited to areas where the Government have assessed that there may be major technical or operational workability concerns.

I say to the noble Lord, Lord Blencathra, that that will include matters relating to the ECHR. The noble Lord, Lord Carlile, already picked that up in his own characteristic way, but I gently say to the noble Lord, Lord Blencathra—I know he is aware of this because of his experience—that Government Ministers have a duty to advise your Lordships’ House of implications. As I explained in the last group, decisions on the ECHR are ultimately for Parliament. I am sorry to frustrate him with repetition, but it is appropriate to the relevant considerations. I will just ask him not to listen if he feels it is very irritating.

This may be helpful to the noble Lord, Lord Wolfson, as well. Amendments 112 and 111, in the name of the noble Baroness, Lady Eaton, spoken to by the noble Baroness, Lady O’Loan, aim to strengthen safeguards for care and nursing home residents by ensuring that capacity in these cases is established through specialist clinical assessment and that capacity assessments seek to rule out reversible medical causes of impaired or fluctuating capacity. The Government consider that Amendment 111 may be inconsistent with the Mental Capacity Act’s assessment framework, which does not require enhanced assessment for certain groups. I dealt with this in more detail in the last group. By requiring expert psychiatric input before capacity is confirmed, Amendment 112 could create inconsistency with the MCA’s presumption of capacity and the principle of proportionate, decision-specific assessments.

Amendment 110A, tabled by the noble Lord, Lord Blencathra, would affect care home and nursing home residents’ capacity assessments and require expert psychiatric input before capacity is confirmed. Again, this could create inconsistency with the MCA’s presumption of capacity and the principle of proportionate, decision-specific assessments.

If passed, each of these amendments would lead to a difference in treatment between care home and nursing home residents and all other citizens in assessments for assisted dying. That difference in treatment—the noble Lord, Lord Blencathra, may wish to close his ears at this point—could give rise to challenge under the ECHR, particularly Article 8, which refers to respect for private and family life, and Article 14, which concerns the prohibition of discrimination. The differences in treatment would need to be justified, necessary and proportionate.

[Lord Deben (Con)]

If the Committee decided that the conditions in a care home were such that it would be better to have a system there that was slightly different from the one for those who were not in a care home, surely that is justification enough. As the Minister knows, I am entirely in favour of the ECHR and disagree very strongly with my noble friend, but this seems a bit of a red herring, frankly. The fact of the matter is that, if this was the policy that was put forward, I think it very unlikely that anyone would find it possible to stop it under the ECHR.

[Baroness Merron (Lab)]

It would not be possible in any case to stop it in that way, because it would not invalidate legislation. I am just drawing the Committee’s attention to the fact that it would require further work. As the noble Lord will know, if a court finds that primary legislation is incompatible, it may make a declaration of incompatibility. As I said, although it does not invalidate legislation, it is usual practice for the Government to consider and address these matters.

[Lord Carlile of Berriew (CB)]

I am afraid that the Minister is between a rock and a hard place here. If these amendments are not passed, she might find that the Government are in breach of Articles 9, 10 and 11. I would be grateful if she could consult her lawyers in relation to that matter.

[Baroness Merron (Lab)]

I will consult my lawyers with pleasure.

Lastly, all the amendments in this group address complex issues and, if they were passed, considerable further policy and drafting work would likely be required.

[Lord Falconer of Thoroton (Lab)]

I thank the noble Baronesses, Lady Smith of Newnham and Lady Hayter of Kentish Town, for sharing their significant and painful experiences. I thank the noble Baroness, Lady Fox, for doing the same in relation to the last months of her mother’s life.

This group deals with the question of whether there should be special provision for people in care homes. Two routes are suggested: first, in the amendment from the noble Baroness, Lady Eaton, which was spoken to by the noble Baroness, Lady O’Loan, that there be a higher evidential standard; and, secondly, that a series of additional tests should be raised.

I think that everybody in the Chamber is agreed that care homes vary across the country; there are those of the highest possible standards and those that do not have the same high standards. It is also the case—a point made forcibly and effectively by the noble Baroness, Lady Watkins—that one should not confuse the fact that there are people in long-term care and people in high-tech nursing homes who are being rather elided here. People become institutionalised and may suffer long-term cognitive problems from being in care homes for a long time. The question raised is whether additional steps beyond those provided for in the Bill should be put in place to check that such people, particularly those who have been in care homes for the long term, have capacity.

The current arrangements require that the co-ordinating doctor is satisfied, after discussion with the patient and anybody else, that they have capacity, and similarly in relation to the independent doctor. Then, the panel has to be satisfied, and then the co-ordinating doctor has to witness the second declaration of the patient. The co-ordinating doctor can witness that second declaration only if he or she is satisfied that, among other things, the patient has capacity. Fifthly, the doctor providing the assistance also has to be satisfied that the patient has capacity. The question posed is whether, despite the fact that there are five separate occasions on which a doctor or a panel have to be satisfied of capacity, for somebody in a long-term care home, one should make additional provision for separate assessments or have a higher evidential standard.

Medical Training (Prioritisation) Bill

Baroness Merron Excerpts

2nd reading & Committee stage
Wednesday 4th February 2026 Lords Chamber

Moved by

[Baroness Merron]

That the Bill be now read a second time.

Northern Ireland, Scottish and Welsh legislative consent sought.

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

My Lords, it is essential that the changes we hope to make in this Bill resolve some of the existing workforce issues within our NHS. I say at the outset that the Bill will not be a silver bullet, and I do not wish to present it as such, but the changes it introduces for foundation and specialty training will lead to a more sustainable medical workforce that can better meet the health needs of our population.

I am most grateful to all those who have engaged with us, including the devolved Governments, to recognise the shared challenges that we face across the United Kingdom. My thanks are also due to noble Lords from across the House for their constructive contributions, time and interest in meeting me and officials. I am also most grateful for the cross-party support that has been demonstrated, both in the other place and in my discussions with the Front Benches in this House. A number of organisations have also expressed their support, including: the BMA, the Academy of Medical Royal Colleges, the Royal College of Physicians, and the Royal College of Surgeons of Edinburgh.

The NHS is beginning to show signs of recovery, following a period of unprecedented strain. Nothing in the NHS functions without its workforce and I am grateful for the dedication and professionalism of our workforce. Supporting, valuing and planning for that workforce is fundamental and, I know, something that your Lordships’ House takes a great interest in—and rightly so. Because the NHS depends on its workforce, we are developing a long-term approach to workforce planning, aligned with the ambitions set out in the 10-year health plan published in July, which set out the intent of this Bill.

That work will culminate in the publication of a 10-year workforce plan in the spring, setting out how we intend to ensure that the NHS has the right people in the right places with the right skills. Staff have been clear for some time that they want change, not only in absolute numbers but in how they are trained, supported and treated at work. We have heard from many who have been exceptionally frustrated by the current application process. There are challenges within medical training that cannot be addressed without legislative change, and that is why we are taking action with this Bill. I am absolutely delighted that my noble friends Lord Duvall and Lord Roe have chosen to make their maiden speeches in this important debate. I, like all noble Lords, very much look forward to hearing from them.

One of the most pressing of those challenges is the severe bottleneck in postgraduate medical training. For several years now, the number of applicants for foundation and specialty training places has grown far more rapidly than the number of available posts. In 2019, there were around 12,000 applicants for 9,000 specialty training places. In 2020, visa restrictions were lifted, and we find this year that this has soared to nearly 40,000 applicants for 10,000 places, with significantly more overseas-trained applicants than UK-trained ones.

This has created intense competition, uncertainty and frustration for many at the start of their careers. At the same time our NHS has become increasingly reliant on international recruitment. This Government deeply value the contribution made by doctors from all around the world, many of whom have played and continue to play a vital role in patient care, and nothing in in this Bill diminishes that contribution. However, it is neither sustainable nor ethically comfortable for the UK to depend so heavily on recruiting doctors from countries that themselves face serious workforce challenges while a growing number of UK-trained doctors struggle to access training posts. Competition for medical staff has never been fiercer. The World Health Organization estimates a shortfall of 11 million health workers by 2030. Shoring up our own workforce will limit our exposure to such global pressures without depriving other countries of their homegrown talent, and this Bill seeks to address that imbalance.

Let me turn to the Bill itself. The Medical Training (Prioritisation) Bill gives effect to the Government’s commitment to place UK-trained doctors and other defined priority groups at the front of the queue for medical training posts. It does so while continuing to allow internationally trained doctors to apply for and contribute to the NHS. Let me emphasise that the Bill is about prioritisation. It is not about excluding people, but it is unashamedly about prioritisation. For the UK foundation programme, the Bill requires that places are allocated to UK medical graduates and those in priority groups before being offered to other eligible applicants. For specialty training, it introduces prioritisation initially at the offer stage for 2026 and from 2027 at both the short-listing and offer stages. That will significantly reduce the level of competition being faced by UK-trained applicants, and it will provide greater certainty at a critical point in their career.

Internationally trained doctors with significant NHS experience will continue to be prioritised for specialty training, recognising the service that they have given. This year, immigration status will be used as a practical proxy for NHS experience in order to allow prioritisation to begin swiftly. For following years, we have taken powers in regulations to enable us to refine this approach in consultation with key partners. I have been asked by noble Lords what this means for those with refugee status. This status is not a stand-alone priority group, although refugees will be prioritised for specialty training in 2026 if they fall within another priority category, such as holding indefinite leave to remain or having completed the foundation programme. Refugees who do not fall within a prioritised group may still apply for specialty training posts and the Bill will not change their eligibility to apply for locally employed doctors’ roles.

I am seeking to address up front some of the concerns that will quite rightly be raised in the course of the debate. One of those is a concern I have heard about why British citizens who have graduated from medical schools outside the UK will not be in the priority group, including some doctors who would be eligible only for provisional GMC registration. I understand the reasons why this is being raised, and I have heard how some would prefer all British citizens, in a blanket sense, to be prioritised. The problem with that is that it would undermine the very intent of the legislation, which is to enable effective workforce planning and the development of our future medical workforce.

The principle is to create a sustainable domestic workforce. It is not about where a student is born; it is about where they are trained, and the fact is that UK-trained doctors are more likely to work in the NHS for longer. In addition, the Government set UK medical school places based on future health system needs. Student intakes and graduate outputs of overseas medical schools are not included in our domestic workforce planning. If we prioritised British citizens in a blanket sense for foundation training places regardless of where they studied, that would undermine our key aim to build UK-trained capacity while ensuring that we do not provide more foundation programme places than we need. I reiterate that this Bill is about prioritisation and not exclusion. All eligible applicants will still be able to apply and will be offered places if vacancies remain after prioritised applicants have received offers, which we expect to be the case on the basis of our long experience.

I have also listened to colleagues expressing concerns around the treatment of applicants graduating in Malta. The UK’s long-standing partnership with Malta on healthcare is valued and will continue. Doctors training in Malta will still be able to come to the UK to gain NHS experience to support their training, for example through fellowship schemes. These arrangements are not affected by the Bill. However, as I stated earlier, for recruitment to specialty training places in the UK, the Government assess that it is important to prioritise to ensure a sustainable workforce that meets health needs.

I turn to the matter of public health specialists, who are particularly identified in the Bill. Public health is a unique medical specialty that draws applicants from medicine and other professional backgrounds who all undergo the same rigorous training. All public health specialists, regardless of professional background, complete the same rigorous medical specialty training programme and are subject to the same high professional standards. The Bill excludes from prioritisation any specialty programmes wholly in the field of public health, as it would undermine the multidisciplinary public health specialist workforce. The Government will monitor the impact on the public health specialist training programme, which currently accepts very small numbers of international medical graduates.

I am aware that there are concerns relating to terms and conditions and mobility for some specialists. We have set out the actions we will take to make the NHS a better and great employer. However, a focus on the NHS alone will not support the whole health workforce, as many public health specialists work outside the NHS with differing employment arrangements. But we are committed to working with the BMA, employers and professional bodies to make public health careers more attractive.

On timing, the Bill includes provisions to allow prioritisation to apply to the current application cycle, with posts commencing this August. That requires Royal Assent by 5 March. It is therefore important to seek timely passage for this Bill to avoid disruption for trainees who need sufficient time to find somewhere to live, sort out childcare and arrange any other aspects of their lives before their posts start, and for NHS trusts that are planning the front-line services. I hear the concerns of some noble Lords about the impact on those applying in the current application cycle, particularly where applicants report that they did not know how prioritisation might affect them. As I said earlier, these concerns are understandable, and they have been carefully considered. However, delaying action would only prolong the current problem by further entrenching the existing imbalance in training competition and it would weaken our ability to plan a sustainable workforce.

The commencement provisions provide necessary flexibility, ensuring that implementation can be carried out in an orderly and workable way, taking account of operational realities. On that point, there is a material consideration, which I am sure will be raised and understandably so, about whether it is possible to proceed if strike action is ongoing. The disruption strikes cause, and the pressure they put on resources, would undoubtedly make it a lot harder operationally to deliver the important measures in this Bill. It is our intention to commence as soon as we can, subject to the Bill’s passage through Parliament, but it is vital to have a safeguard to ensure that the systems planning and operational capacity required for successful implementation are firmly in place.

I conclude by saying that the Bill will not solve every workforce challenge, but it is a very important step towards a more coherent, ethical and sustainable approach to medical training and workforce planning: something that has been called for for many years.

It is estimated that four resident doctors will be competing for every specialty training post in 2026. With the delivery of this Bill, this number can reduce to two resident doctors per place. British taxpayers spend £4 billion training medics every single year. It will be by better aligning public investment, training capacity and long-term service needs that the Bill will give UK-trained doctors a fair chance to serve in the health service they train to support, and to do so in a way that benefits us, the public, across the country. I beg to move.

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[Baroness Merron (Lab)]

My Lords, I am most grateful to all noble Lords who contributed to this debate for the support given, including just now by the noble Earl, Lord Effingham, to working with us, because I think there is general recognition that we have a problem that needs to be dealt with. I am very glad, as I said at the outset, to have been the Minister at the Dispatch Box when my noble friends Lord Duvall and Lord Roe made their moving maiden speeches. They both have many years of distinction in public service, and I know that that will continue as they bring their own unique experiences and views on the world to your Lordships’ House, which will be much enriched by their presence.

A strong and consistent theme has come through today’s debate: a shared concern for the well-being of NHS staff, recognition of the importance of workforce planning and the need for a sustainable health service. I am grateful for the thoughtful questions, and I will endeavour to answer as many as possible—I have already referred to some in my opening remarks. I will of course review the debate, as always, and I will be pleased to write to noble Lords on those matters I was not able to get to.

This legislation is about giving future generations of doctors trained in the UK a clearer and more secure pathway into NHS careers. It is about sustainable workforce planning and, as the noble Earl, Lord Howe, referred to, about fairness—to those who train here, to taxpayers who fund that training and to patients. As many noble Lords acknowledged, significant public investment goes into medical education every year, so it is right that we ask ourselves how that investment can be best aligned to what we need.

I have listened closely to the concerns raised today, particularly about the Bill’s impact on those who will not be prioritised. To reiterate, the way I look at this is that the Bill is about prioritisation, not exclusion. I assure your Lordships’ House that all eligible applicants will still be able to apply, and they will be offered places if vacancies remain after prioritised applicants have received theirs. We absolutely expect that to be the case; that is our experience. To be more specific, there are likely to be opportunities in specialties such as general practice, core psychiatry and internal medicine, which historically attract fewer applicants than the groups we are prioritising for 2026. We still need those people.

The noble Baroness, Lady Hollins, asked about possible unintended consequences for the UK’s international reputation. I believe our proud history of welcoming colleagues from across the world will continue and, as I have just said, international colleagues can, of course, continue to apply after prioritisation has taken place and there are vacancies.

On new specialty training posts, we have committed to creating 1,000 of these new posts over the next three years, focusing on specialties where there is greatest need. This is on top of creating 250 additional GP training places each year. The noble Earl, Lord Howe, raised questions about the availability of training places. Expansion will be matched with training capacity. We have not yet confirmed which specialties will receive the new posts, but we will ensure that expansion is targeted where patient demand and workforce pressures are the most acute.

I am glad that the noble Lord, Lord Stevens, made reference to the cancer plan. It was a bright spot in today’s news—I am sure all noble Lords will understand —and has not had the airtime it ought to have had, so I am most grateful to him. What I can tell the noble Lord about the creation of new specialty training posts is that there will be a focus on those with greatest need. We will set out steps in due course and I look forward to keeping the noble Lord informed. Non-prioritised graduates will also continue to have routes into NHS careers through locally employed doctor roles, gaining experience that can support future progression and prioritisation.

Let me turn to some of the specific points that were raised by noble Lords. The noble Lord, Lord Patel, asked about British citizens who have graduated from medical schools outside the UK and will not be in the priority group. I understand why these concerns are being raised but, going back to the core of the Bill, to prioritise them would undermine our aim to build UK-trained capacity while ensuring we do not provide any more foundation programme places than we need. To reiterate, UK-trained doctors are more likely to work in the NHS for longer, and retention is an issue that is much discussed in your Lordships’ House. They will be better equipped to deliver tailored healthcare that suits the UK’s population because of what they understand. Reference was made to the provision extending also to the Republic of Ireland graduates. Their inclusion ensures consistency in workforce planning across both jurisdictions, which reflects the long-standing protocol rights for movement and employment. That was something in which the noble Lord, Lord Clement-Jones, was particularly interested.

On specialty training places starting in 2026, British citizens will be prioritised, because that is one of the prioritised immigration statuses being used as a proxy to indicate someone who is likely to have significant experience of the NHS. Why? Because applications for posts starting in 2026 have already been made. Prioritisation is only at offer stage because shortlisting is under way, so it is a timing matter about implementation. From 2027, immigration status will no longer automatically determine priority, but we have the ability to set out in regulations the persons who will be prioritised based on criteria which indicate they are likely to have significant NHS experience, or based on their immigration status. As I said earlier, we will be engaging with our partners to work out how best to define that.

On the point made by a number of noble Lords, including the noble Earl, Lord Howe, and the noble Lords, Lord Clement-Jones and Lord Stevens, about graduates of overseas campuses, including Malta, which I will turn to presently, having heard the noble Baroness, Lady Gerada, the UK foundation programme applications for 2026 show that there are almost 300 applicants from these overseas campuses, of whom 152 are UK nationals. This is a substantial number and, if we were to do what is being asked—to prioritise graduates of UK overseas campuses—our estimation is that this could encourage universities to establish further international partnerships which would simply increase pressure still further. It also risks creating a loophole that would encourage new overseas partnerships to seek preferential access to the foundation programme across the UK. The noble Lord, Lord Clement-Jones, picked out Liechtenstein in particular, but, as the noble Baroness, Lady Coffey, referred to, we are talking about the EFTA countries, which include Liechtenstein, and they are prioritised simply because of existing international agreements that we are obliged to honour. However, in practice, not all these countries are going to have eligible applicants.

[Lord Clement-Jones (LD)]

I hope the Minister does not mind. Does the Minister think that the agreement with Malta should be honoured as well?

[Baroness Merron (Lab)]

I am coming on to this, but the agreement in respect of Malta that I would refer to is a reciprocal health agreement. It does not apply in this area. It is about the reciprocal provision of healthcare. I will turn to Malta, however, after saying a brief word about overseas campuses generally.

Just to re-emphasise, overseas campus students are not part of the numbers that the Government are setting. We do not have that control. If we prioritised those graduates as well, that would eat away at the very core of the Bill and the things people actually want us to do.

The noble Baroness, Lady Finlay, and the noble Lord, Lord Clement-Jones, wanted an indication of how this would all align with the international education strategy. The Bill does not conflict with this, because the international education strategy supports universities expanding internationally. It does not prevent UK universities delivering medical degrees overseas. That strategy stays in place.

I turn to Malta for the noble Baroness, Lady Gerada—

[Baroness Hollins (CB)]

Can I just a question? The Minister has suggested that these students could come and work in non-training posts. But the problem, as I understand it—do correct me if I am wrong—is that, for example, St George’s students must complete their foundation year in the UK to be eligible to apply for full registration. Therefore, it means that they cannot complete their medical education without being eligible to apply for the foundation training. While a different contract could potentially be negotiated for future students at an overseas campus, the current students who have this contract and expectation in place need to have that honoured. I do not feel that the Minister has responded to the concerns that have been raised eloquently around the House.

[Baroness Merron (Lab)]

As I said at the outset, I will endeavour to answer all questions, but where I do not have an answer, particularly where I want to look at them in closer detail, I will be very pleased to write, of course, as always.

Still turning to Malta—which is a pleasure—let me say straight away that we do have a long-standing partnership with Malta on healthcare. It is valued and it will continue. Doctors who are training in Malta will still come to the UK, as they do now, to gain NHS experience to support their training, for example through fellowship schemes. This is not affected by the Bill.

As I discussed with the noble Baroness just yesterday, senior officials in my department have met with the High Commissioner of Malta to the United Kingdom in order to assure him of this. But it is important to prioritise in order to ensure a sustainable workforce that meets its health needs. Again, that is at the core of the Bill. Malta has its own foundation school. This is not part of the UK foundation programme: it is affiliated with the UK foundation programme office which administers the UK programme. That means—this point has been made to me—the Malta Foundation School delivers the same curriculum and offers the same education and training as the UK foundation programme. The Bill will not impact this affiliation or the other ways in which work carries on closely with the Government of Malta when it comes to health.

The noble Earl, Lord Howe, also made the point that he believed small numbers of students were impacted. I have referred to the 300 applicants from overseas campuses. I hope it is understood that that is why there is a significance there.

If there are other matters that I have not addressed to the satisfaction of the noble Baroness, Lady Gerada, I will be very pleased to review this, because I suspect there were some more points to address. I will be very pleased to write to her to give her comfort in this regard.

I move on now to the impact on doctors who were part way through the application process—a point spoken to by noble Lords, Lord Patel, Lord Mohammed, Lord Clement-Jones, and other noble Lords. As I stated earlier, delaying implementation of the Bill until next year, which would be required if we were to respond as requested, would mean another full year where we are not tackling the issue of bottlenecks in medical training. It seemed to me that the feeling in the House was that we did need to do that.

I understand the discomfort of noble Lords around this. It is important that I recognise that, but it is also important to recognise when introducing legislation that sometimes it will not work perfectly for everybody. This is about prioritisation, not about exclusion.

Following that point, the noble Lord, Lord Stevens, the noble Baroness, Lady Coffey, and the noble Earl, Lord Effingham, asked about emergency legislation. They asked: why now? As the Health Secretary set out in the other place, he has listened to resident doctors and their concerns about a system that does not work for them. He agreed to bring forward that emergency legislation as quickly as possible, rather than wait—this is key for a number of the points raised—another year to do so.

The noble Earl, Lord Howe, and the noble Baroness, Lady Coffey, asked about the Bill’s commencement and why it will not commence at Royal Assent—that is a very fair question. We are introducing reforms for a large-scale recruitment process. I know that noble Lords will understand what a major undertaking this is. We do not want to create errors or more uncertainty. To make sure that it is effective in commencement, we must have clear processes for delivery across the health system, and I am sure that all noble Lords appreciate that these elements cannot be switched on overnight. As the Secretary of State said in the other place, there is a material consideration about whether it is even possible to proceed if the strikes are ongoing. He is concerned—I share this concern, as I am sure all noble Lords do—about the disruption that strikes cause and the pressure they put on resources, which would make it so much harder operationally to deliver the measures in the Bill.

[Lord Mohammed of Tinsley (LD)]

I will press the point I made earlier about uncertainty. Not having a commencement date creates a lot of uncertainty for the current batch of students, who are really worried about whether they will they gain a place and, more importantly, where. I want to impress this issue on the Minister; it was raised by the Russell group medical school admissions head with me personally.

[Baroness Merron (Lab)]

I completely understand the point about uncertainty. Uncertainty exists in the current system, and uncertainty may transfer for different reasons. We are keen to get on with this. I am just indicating some of the circumstances—strike action—that would cause difficulty for us in terms of commencement. I hope we can proceed. I think the noble Lord will understand exactly what I am saying.

The noble Baroness, Lady Coffey, asked about the release of more granular detail. I draw noble Lords’ attention to the fact that NHS England already publishes a wide range of recruitment data, including data on country of qualification and nationality groups. It will publish further granular data when possible and monitor the implementation of the Bill, should it pass—that, for me, is the most important point. If the noble Baroness is referring to other information, she is very welcome to raise that with me.

I am of course very happy to meet with my noble friend Lord Stevenson. In general, the 10-year health plan commits to working with professional regulators and educational institutions over the next three years to overhaul education and training curricula.

To answer the question from the noble Baroness, Lady Coffey, on prioritisation, if I can put it in my language: you either are or are not prioritised. There are no tiers of priorities within priorities; it is as it is written in the Bill.

The noble Lord, Lord Mohammed, asked about the impact of prioritisation on harder-to-fill specialties. This approach will not negatively impact recruitment. In fact, it will ensure that priority groups are considered first, while keeping the door open for when we need people. I think it will help get people into the areas in which we need them, because it will direct people to where we do not have sufficient applicants.

At its heart, the Bill is about the UK-trained medical graduates on whom the NHS heavily relies. We are grateful for their skill, commitment and professionalism. It is our responsibility to ensure they are trained, supported and treated well at work. This is a more sustainable and considered approach to the allocation of medical training places. A number of noble Lords said that this is a problem that has been around for years. We are grasping the proverbial nettle. The Bill is a measured step towards the goals of clarity, fairness and opportunity. It will not, on its own, resolve everything—I am fully aware of that—but it will help us with a pressing problem. With that, I beg to move.

Bill read a second time and committed to a Committee of the Whole House.

NHS: Corridor Care

Baroness Merron Excerpts

Wednesday 4th February 2026 Lords Chamber

[Baroness Watkins of Tavistock]

To ask His Majesty’s Government what assessment they have made of the provision of corridor care in the NHS; and what plans they have to mitigate any issues arising.

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

My Lords, we have introduced new data collection on corridor care, which will be published shortly for the first time. We are taking sustained action to reduce the use of corridor care, ensuring that there are safeguards for patients in the interim to still receive high-quality and safe care with dignity and privacy. We are investing £450 million to expand same-day and urgent care services, and to improve hospital flow, as well as introducing new clinical operational standards.

[Baroness Watkins of Tavistock (CB)]

I thank the Minister for her reply, but I want to understand when a credible long-term delivery plan will be published—rather than “in the near future”—to restore year-round resilience, making whole-system patient flow a core performance priority. Unnecessary stays in hospital are linked to worse patient outcomes, and it should be possible to reduce the nearly 13,000 beds occupied on average each day in 2025 by people medically fit for discharge, in turn reducing the need for corridor care.

[Baroness Merron (Lab)]

Let me say at the outset that corridor care should not be normalised; it is not what we want to see as routine. The reality is that we cannot eliminate it entirely—I think that is understood—but the current situation is not as we would want it to be. In addition to the Urgent and Emergency Care Plan 2025/26, which sets out clear actions to deliver improvements, the most challenged trusts are receiving targeted support. Looking to the future, as the noble Baroness asked about, the medium-term planning framework clearly sets out a trajectory to improve the situation. The introduction of clinical guidelines for the first 72 hours will also increase the proportion of people discharged within 72 hours. I very much recognise the situation the noble Baroness describes.

[Baroness Kingsmill (Lab)]

My Lords, as a former chair of an NHS community trust, I say that the situation often arises because of the shortage of social and community care. What are the Government doing to address those issues?

[Baroness Merron (Lab)]

On social care, we are making progress on building a national care service. Around £4.6 billion of additional funding has been made available for adult social care by 2028-29. Along with other matters, including funds to improve and provide adaptation so that people can return home when they would not have been able to otherwise, we are providing funding of over £1 billion for adult social care with local authorities. This can be used to expand capacity. Of course, we have an independent commission chaired by the noble Baroness, Lady Casey.

[Baroness Manzoor (Con)]

My Lords, in a recent survey 78% of physicians reported undertaking corridor care. It is becoming almost the norm all the year round. It affects patients’ dignity, health and safety, and patient outcomes, because there are greater infection rates. I welcome the Minister’s points on the action that the Government are taking, but it is rather long-sighted and there is a real urgency to do something now.

[Baroness Merron (Lab)]

I agree with the noble Baroness. Corridor care is perhaps one of the most visible and distressing symptoms of an NHS that the noble Lord, Lord Darzi, described as broken. We have to fix a number of the processes. I welcome that we are expanding urgent care access, for example, in primary, community and mental health settings, which will reduce demand on services. However, without publicly available data and the clinical operational standards that we are setting, the change will not be made as quickly as we would all like. There are immediate actions, as well as medium and long-term actions.

[Lord Rennard (LD)]

My Lords, my mother-in-law, Molly, is 110.

--- Later in debate ---

[Baroness Merron (Lab)]

I agree with the need for more adult social care, but there is a whole range of factors that affect discharge delays, including the number of people who present. What the noble Lord outlined was not right and not the way in which his mother-in-law should have been dealt with. I know he would not expect me to comment further on individual circumstances, but if somebody is being considered for corridor care, that should be appropriately risk-assessed by clinical teams. The exact point he made is something that I have asked about. There should be a named nurse, and the provisions he talked about, such as food and drink, should have been there.

[Baroness Gerada (CB)]

My Lords—

--- Later in debate ---

[Baroness Gerada (CB)]

We know from evidence that you can avoid hospital admission by improving continuity of care by general practitioners. When will the Minister redress the imbalance whereby GPs are funded from only 8% of the NHS budget yet deliver 70% to 80% of its care?

[Baroness Merron (Lab)]

We very much appreciate the role that GPs play. Corridor care is related to a whole range of factors, not only the position of GPs. I have heard what the noble Baroness has said and will gladly relate it to my ministerial colleague.

[The Earl of Effingham (Con)]

My Lords, the Minister referenced data collection in her previous responses. In November, hospitals carried out 10% fewer operations than in October, but the Government claim the waiting list went down. Is that because the Government are paying hospitals £3 million per month in a process known as “validation”, and so it appears that the health service is treating more patients than it actually is? Is that the real reason that corridor care numbers are up?

[Baroness Merron (Lab)]

No. I hope that the noble Lord would welcome a greater level of activity in this area. The waiting lists are going down. We have delivered, for example, 5.2 million extra appointments since we came into government, when we had promised just 2 million. Waiting lists are going down, and I am very happy to provide the data again to the noble Lord so that he can investigate that.

[Lord Brooke of Alverthorpe (Lab)]

My Lords—

--- Later in debate ---

[Lord Brooke of Alverthorpe (Lab)]

My Lords, my recent experience in care homes is that there are vacancies—unfilled beds—in private care homes. When are we going to do something about the mismatch of people in corridors, when beds are available? There needs to be some system introduced to get people into them.

[Baroness Merron (Lab)]

The first thing that needs to happen is that people need to be cared for in the hospital. As I said in answer to an earlier question, everybody should be assessed according to their need. If there is a shortage of beds, it is for that hospital to manage. There will always be a difference of demand. However, where there are problems in hospitals that are not responding as they should, we are putting in improvement teams to ensure that change can be made. Of course, it is only when people are well enough, and it is suitable and safe to discharge them, that they will be discharged. It is important to match up availability of social care beds to needs.

Baby Milk Powder: Cereulide

Baroness Merron Excerpts

Wednesday 4th February 2026 Lords Chamber

[Baroness Bennett of Manor Castle]

To ask His Majesty’s Government whether they have identified any systemic issues following the discovery of the toxin cereulide in baby milk powder sold in the UK; and if so, what steps they plan to take as a result.

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

My Lords, Nestlé and Danone launched product recalls of certain infant formula products because of the possible presence of cereulide toxin. This is a live incidence and it is too early to identify any systemic issues.

The Food Standards Agency is working across agencies and with the Department of Health and Social Care to manage the incident response. The FSA has published information on the product recalls on its website, including advice for consumers.

[Baroness Bennett of Manor Castle (GP)]

I thank the Minister for her Answer, but I would posit that there is very clearly a well-identified systemic problem that non-mandatory ingredients such as arachidonic acid, which is the source of the current contamination in Nestlé and Danone products, place a burden on infant metabolism and create multiple potential points of microbial and other contamination in the manufacturing process by the four companies that supply the vast bulk of infant formula in this country through complex, for-profit global supply chains. Are the Government going to look into further action on this?

[Baroness Merron (Lab)]

Obviously, we are very concerned about toxins and ensuring that there is no damage done to people: that is the reason for the product recall. The effect of this is that it creates bacteria, so it is like food poisoning in that respect.

With regard to what the noble Baroness has said about ARA oil, the concern of the FSA is very much about safety. What has happened here, as I understand, is that ARA oil is a very common ingredient, but this one appears to have had some contamination, which has affected certain batches, and it is those that are being recalled.

[Lord Patel (CB)]

My Lords, what the Minister said is correct, but only partially. Arachidonic acid is the key component that may contain bacillus cereus, which is the product that produces the toxin cereulide, which causes problems for babies including vomiting and diarrhoea. It is the same as any bacteria or virus that causes the gut rot that we often experience. It is a supply chain problem and the current regulatory mechanism relies on self-regulation. That is what needs to be addressed. We had a similar problem in 2008 with another chemical called melamine, which was in milk products and caused kidney damage to babies. Does the Minister agree that it is the regulation of the supply chain and production that needs to be addressed?

[Baroness Merron (Lab)]

As ever, the noble Lord has put things better than I did. I understand the point he is making. The FSA’s role, certainly in the incident response, includes chasing supply chains to identify any additional potential products and businesses. I certainly agree that it is very important to stem any difficulty. But, as it is a live incident, the only point I would make, as I said to the noble Baroness, is that the focus is very much on managing the situation. Therefore, there has not been the opportunity to look into the detail that I agree it needs. That will happen, as it always does, in an incident such as this.

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that it took Nestlé four weeks from its first notification of contamination to the Dutch Government to initiate the first product recall on 5 January, following further tests? Does she agree that there should be independent testing, rather than relying on in-house testing by the formula producers? Does she agree that that independent testing should be triggered, at the very least, at the first whiff of any possible contamination?

[Baroness Merron (Lab)]

In my preparation for this Question, which is an important one, I asked a similar question to officials, particularly those from the FSA, and they assured me that testing shows we are meeting the right standards. They also made the point that this is all covered by the Food Safety Act. In their opinion, they have the tools to do the job. I am not aware that there has been something wrong in the management of this live incident, but I am aware that the FSA and the UK Health Security Agency are liaising very closely with the manufacturers to establish the root cause of the possible presence of this toxin. But I can also reassure your Lordships’ House that it is confined to certain batches. That is the information that is going out.

[The Earl of Effingham (Con)]

My Lords, providing the best nutrition for children of all ages is surely a “must have”. So, why do the Government allow ultra-processed foods to constitute between two-thirds and three-quarters of calories in UK school meals? They are high in fat, sugar and salt. That is not a good combination.

[Baroness Merron (Lab)]

The noble Earl has moved from food safety to what is in food. Food standards applicable to school meals are both monitored and in place. As he knows, the general advice from the NHS on processed foods is that we would all benefit from eating less of the foods that are high-fat, high-salt and high-sugar. But those foods are not presenting the immediate safety concerns. I make that distinction as we are looking here at toxins in products.

[Baroness Manzoor (Con)]

My Lords, of course the best food for babies comes from breastfeeding. May I advocate that we should not lose sight of the fact that many mothers do breastfeed? But I understand the anguish and fear that mothers who cannot breastfeed have had in relation to this incident, and the department needs to do more to make young new mothers aware of the issue, because, as the Minister and I know, there is a shortage of community midwives and health visitors.

[Baroness Merron (Lab)]

That last point is something that will be looked at as part of workforce planning. I totally agree with the noble Baroness about the importance of the multidisciplinary team in supporting new mothers to find the right ways that are suitable for them and best for their baby—and I am glad the noble Baroness accepted that breastfeeding is not possible for everybody.

[Baroness Neville-Rolfe (Con)]

My Lords, as the grandmother of a baby who was born pre-term, I was very interested in this incident. As far as I could make out, it seems to have been well publicised, and those who might be affected got to know of it very quickly. Is there any evidence that harm has been caused, or did the Food Standards Agency, which was set up to deal with these sorts of things, do a decent job on this occasion?

[Baroness Merron (Lab)]

I am certainly convinced that more than a decent job has been done on this occasion. I know that the FSA, along with the department and the UK Health Security Agency, have, as was said to me, been working non-stop since the incident was notified, and I am genuinely reassured by that. What I would say is that alternatives are available, there is no problem with the supply of alternatives and if anybody—grandmothers, mothers, parents, friends, or whoever—has concerns, they should check the NHS website and the FSA website and, if they remain concerned, they should seek guidance from a medical professional. There are people who are potentially affected, but, as I said, this is a live incident and it is being monitored.

[Lord Winston (Lab)]

My Lords, I have in the past given notice to the Minister about this, with regard not to milk but to other issues: for example, where small humans, such as embryos or babies, come in contact with fluids or chemicals that might be dangerous. It is not only milk that may need better observation. Does she agree that we should look rather carefully at how we regulate the fluids used for culture of human tissues, in particular embryos, where there may be some risks of not getting better results, or possibly even of danger to the embryo?

[Baroness Merron (Lab)]

Safety is paramount, whether we are talking about embryos, adults or children. I would be pleased to hear from my noble friend if there are particular areas on which he would like to be reassured, or at least responded to. But I hope that, in respect of food safety, in this situation, your Lordships’ House will see that all actions have been taken by the relevant authorities, with speed and in line with the laws available.

Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, in the interests of time I do not propose to summarise the many points and questions that have been raised in this debate. However, I wish to speak briefly to Amendment 320A in the name of my noble friend Lord Wolfson. The amendment seeks to set the presumption that the first assessment by the co-ordinating doctor

“must be undertaken in person, except in circumstances where this is not reasonably practicable”.

It is plain from everything that we have heard in the debate that the first assessment is a pivotal moment in the process set out in the Bill. It is the point at which a co-ordinating doctor must satisfy themselves not only of the diagnosis and prognosis but of the patient’s capacity and will and, crucially, the absence of coercion or pressure, as set out in Clause 10. These are human judgments that depend not simply on what a patient says but on the way that they say it, on physical cues and on the broader context in which the conversation takes place.

I listened carefully to the noble Baroness, Lady Finlay, in particular, as I did to other noble Lords, and an in-person assessment undoubtedly allows a clinician to observe matters that may not be apparent on a screen—for example, who else is present in the room, whether the individual appears comfortable speaking freely or whether there are signs, however subtle, of hesitation or external influence. At the same time, I suggest that we need to be patient-focused as well as doctor-focused, which is why my noble friend’s amendment seeks to recognise practical realities. There will surely, from time to time, be circumstances, perhaps in late-stage illness when a person may be in acute distress, where an in-person assessment is genuinely not possible. The reasons for that could be several, but in those cases we need to ask ourselves whether a live video and audio link would be preferable to a delay, or even a complete exclusion from the process.

I emphasise that the amendment is a probing one. If we decide that provision should be made for certain cases then that would surely be a classic area for guidance or codes of practice, but the key test in every instance would be what is reasonable in the circumstances. My noble friend wants to be clear that this amendment is about setting the right default for arguably the most consequential clinical judgment in the entire scheme of the Bill, while preserving professional discretion in response to the needs of the patient where circumstances require flexibility.

I have deliberately spoken in general terms when talking about what might not be reasonably practicable. The question is really the one posed by the noble Baroness, Lady Hayman: how rigid do we wish the Bill to be in prescribing how the system should work? I hope the noble and learned Lord, Lord Falconer, could set out his vision of how this mechanism will work in practice and how he will ensure that the safeguards that we all want to see can still be maintained if an in-person assessment is not possible.

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

My Lords, I am grateful to all noble Lords for their contributions to this debate. As ever, I will limit my comments to amendments on which the Government have major legal, technical or operational workability concerns.

First, I draw the attention of the Committee to operational workability concerns about Amendments 60 and 65. Under Amendment 60, professionals delivering the service would be responsible for checking whether the person was in England or Wales on multiple occasions before carrying out their duties, even if it had been confirmed that the person was ordinarily resident in England or Wales. That would place a significant burden on professionals delivering an assisted dying service.

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[Baroness Merron (Lab)]

I understand the point, but it is about verifying that.

[Lord Falconer of Thoroton (Lab)]

My Lords, I express my gratitude to everyone who has taken part in the debate. I make special mention of the noble Baroness, Lady Smith of Newnham, and the noble Lord, Lord Polak, who spoke about the death of their father and mother. Like everyone else, I am grateful for what may have been something that was quite difficult to contribute to the debate. I hope I have not left out anyone else out who has done that.

These amendments fall effectively into two categories. The first is the England and Wales category—what do you have to be in England and Wales to do?—and, secondly, and separately, in what circumstances is a face-to-face meeting between either the patient and the doctors or the patient and the panel required?

I will deal first with the position of England and Wales, raised by Amendment 60, from the noble Baroness, Lady Coffey. Currently, under the provisions of the Bill, the first declaration made by the patient, the second declaration made by the patient, the first assessment of the patient, the second assessment of the patient and assistance being given to the patient all have to take place in England and Wales. There was a range of other things that the noble Baroness wished to take place while the patient was in England and Wales—for example, switching from one doctor to another, which is a process. For my part, I think the Bill has broadly got right when you have to be in England and Wales. Having listened carefully to what the noble Baroness has said, I am not minded to suggest an amendment in relation to that, and I note that it was not picked up as an issue by other people.

The face-to-face issues were much more what the Committee, if I may say so, was interested in through the course of this debate. The effect of the debate has been, in effect, to identify four possibilities. First, Amendment 65 wants each of the occasions, namely the two doctors and the panel, to always involve a face-to-face meeting. Secondly, there should be a face-to-face meeting unless there are—I use this phrase without intending to pick up all the amendments—exceptional circumstances or practicability issues. Thirdly, the third amendment from the noble Lord, Lord Blencathra, which he referred to, is that there should be, to use his language, a “statutory protocol” defining where there can be remote meetings, accepting that the norm is face to face. Fourthly, we could simply rely on the existing provisions of the Bill, which is that codes of practice can be issued by the Minister under the various provisions of the Bill saying when face to face is appropriate and when it is not.

The testimony—that is what it felt like—given of cases where remote has gone wrong have enormous power and I think we are all aware of circumstances where face to face will lead to much greater and better communication. The other side of the coin, which was referred to by the noble Baronesses, Lady Pidgeon and Lady Hayman, my noble friends Lady Jay and Lady Blackstone and the noble Earl, Lord Howe, is that there will be circumstances where, if you insist on face to face, you are, in effect, excluding some people from this right when they should have it. There are arguments on both sides.

I come away with the strongest possible feeling that the Committee thinks that face to face where possible is best but that there will be circumstances where it is not appropriate. That brings me to my third and fourth possibilities. It is wrong and dangerous to try to use a phrase such as “reasonably practicable” or “exceptional”; more is required and guidance should be given. This is not a criticism—it is a congratulation—but I do not think the words “statutory protocol” are right, but I get from what the noble Lord, Lord Blencathra, is saying that he wants something that has the force of regulations or something similar that says, “This is what we have in mind”. Whether that is a code of practice or a statutory protocol, I am not sure. I am sure it is not what is called a protocol, but it might be something quite like that. I think the right course for me is to go away and bring back something that satisfies the Committee that there will be something—a statutory protocol or a code of guidance—that indicates when face to face is appropriate or should be the norm, but gives the circumstances where it would not be, because I get the sense of anxiety about that. I hope, in the light of that approach, noble Lords will feel able to withdraw or not to press their amendments.

--- Later in debate ---

I would also be grateful to hear from the Minister on what consideration Ministers have given to the possible use of AI to establish the workability of the Bill, as I am conscious that that is the focus of the Minister’s work on this. If they are thinking about how the Bill will work, they must have reached at least a provisional view on whether AI will or will not be part of those processes and, if so, whether that is appropriate. For those reasons, I look forward to the contributions of those noble Lords.

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their contributions on this debate on artificial intelligence. It follows the debate yesterday, as referred to by the noble Lord, Lord Deben. The purpose of Amendment 66, tabled by the noble Baroness, Lady Coffey, is to prohibit artificial intelligence from being used to carry out functions under any section of or schedule to the Bill. This amendment is likely to have major workability impacts that could render the Bill unworkable and/or undeliverable.

While this is a policy matter, I will pick up points and considerations that have been made on the use of AI in practice. Broadly, artificial intelligence is absolutely in use in a number of pathways. It was indeed referred to in the 10-year health plan, and the ways it is being used include imaging and diagnosis. As this amendment stands, it would preclude an improvement in speed and in quality of care for patients.

Following my comments on workability, the amendment would incur an administrative burden that is likely to increase over time. AI is increasingly used across the economy and public services, including in the NHS, as set out in the 10-year health plan. The effect of the amendment as drafted is very broad in prohibiting this use of AI from carrying out any functions under the Bill. In the future, when AI is integrated into NHS systems across the board, it may well be difficult or even impossible to quarantine systems that are used for functions under the Bill. Additionally, this may risk creating a parallel system where voluntary assisted dying services are left behind and are potentially less safe for patients.

[Lord Falconer of Thoroton (Lab)]

I am grateful to the noble Baroness, Lady Coffey, for raising artificial intelligence. There was, broadly, a consensus around the Committee, which the noble Baroness supported, that the amendment is much too blunt, but as she said, fairly, it gives us an opportunity to talk about AI. I will also pick up the right reverend Prelate the Bishop of Hereford’s contribution; he rightly said, as has been echoed around the Committee, that there have been huge benefits for patients from AI.

I think four concerns were raised during the debate. The first was: will AI affect decision-making? I think the underlying point there is that we do not want machines to make the decisions that are referred to in the Bill; we want human beings to make them. In particular, the decisions I have in mind are the decision of the first doctor, the decision of the second doctor, the decision of the panel, and the decision of the doctor, at the point that the assistance is being given, that the conditions are still satisfied. Everybody around the Chamber wants that to be decided by a doctor or a panel, depending on which it is, and I completely and unreservedly endorse and accept that.

Does that need to be made even clearer in the Bill? I will consider it, but I do not think that it does. The acid test for me is that if you fail to comply with your obligations as a doctor or as a panel, you can go to prison for up to five years. It is very difficult to imagine how you could put a machine in prison, so it is pretty clear that these decisions must be made by a human being. For my part and for everybody who supports the Bill, that must remain the position.

The second concern is advertising, which the noble Baroness, Lady Berridge, referred to. She is absolutely right. I have made it clear that I will bring forward amendments. Those amendments, which are almost finally drafted, make provision specifically in relation to digital advertising—they do not specifically refer to AI, but we need to address that in the advertising provision. I will lay those amendments so that the House can consider them.

The third concern is slightly generalised, which is that AI is very persuasive, particularly in persuading people to do things that they do not necessarily want to do. The first thing on that is that there is a wider societal requirement to address the pervasive impacts of AI in a whole range of things. We should all try to contribute to that. More focused on this is the question of the safeguards in the Bill, because they then become incredibly important. In particular, the safeguards require that there is doctor-to-patient discussion in relation to the decision for that patient, and they are specifically required in the preliminary conversation, the first conversation and the second conversation. It is those safeguards that one must see as the antidote to the persuasive aspect of AI, but I completely accept what people said on that.

The fourth issue, which was touched on very briefly, was the operation of devices. That, I think, referred to the fact that quite a number of medical devices can be operated by, for example, the blink of an eye or something quite minor. Again, that needs to be properly safeguarded. Those may not necessarily be AI problems but problems with other sorts of developments in technology.

I thank the noble Baroness, Lady Coffey, for raising this. We need to consider all the points she made. At the moment, apart from the advertising amendment, which I will bring forward, I am not sure that it requires amendment to the Bill.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I will be very brief. The Government do not have any major technical or operational workability concerns on the amendments tabled by the noble Lord, Lord Sandhurst, and the noble Lord, Lord Harper, which were originally tabled, as we heard, by my noble friend Lord Hendy. To make the usual point, as noble Lords will be aware, these amendments have not had technical drafting support from officials, so further revision and corresponding amendments would be needed to provide consistent and coherent terminology throughout the Bill.

[Lord Empey (UUP)]

My Lords, I raised the point that the state could be liable in cases where the companies people worked for were nationalised or owned by the state. It seems not unreasonable that in due course the Minister could express a view on behalf of the Government, because the Government could be directly—and financially—affected by the consequences of the Bill.

[Baroness Merron (Lab)]

I appreciate the point the noble Lord is making—and indeed the points that the noble Earl, Lord Howe, made. However, as your Lordships’ House knows, I correctly restrict myself to commentary on what is before us. Should the Bill include this amendment, we will then respond at the appropriate time.

[Lord Falconer of Thoroton (Lab)]

My Lords, there are effectively two entirely separate issues raised by this group of amendments. The first is whether we should extend the current eligibility to people who have an inevitably progressive illness or disease to somebody who is terminally ill because they have injuries—for example, from a car accident—that might make them die within a specified period.

I was not sure whether the noble Lord, Lord Harper, was pressing that as an amendment, because the thrust of his remarks was much more focused on the effect on the Fatal Accidents Act. Whatever his position, I am afraid that I am not in favour of that amendment because the whole Bill has been put together and the argument for it has been based on people who are terminally ill. That is very different, for a whole variety of reasons mentioned by people, from somebody who is the victim of an injury.

I can see that people might say there was considerable moral equivalence, and the noble Lord, Lord Hendy, was right to say how persuasive he was when I spoke to him in relation to it. However, my clear view is that we should not extend the Bill beyond its current eligibility. I should also make absolutely clear that the wording of the Bill is clear; there is no prospect whatever that a court could construe the words “illness” or “disease” as meaning “injury”. What we send from Parliament will be the way it is read.