Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

Friday 24th April 2026 Lords Chamber

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

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

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

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

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

[Baroness Coffey (Con)]

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

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

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

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

Women’s Health Strategy

Baroness Merron Excerpts

Thursday 23rd April 2026 Lords Chamber

[Baroness Walmsley (LD)]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Baroness Verma (Con)]

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

[Baroness Merron (Lab)]

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

[Baroness Blackstone (Lab)]

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

[Baroness Merron (Lab)]

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

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

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

[Lord Patel (CB)]

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

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

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

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

[Baroness Merron (Lab)]

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

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

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

[Baroness Sugg (Con)]

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

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


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

[Baroness Merron (Lab)]

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

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

[Baroness Bennett of Manor Castle (GP)]

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

[Baroness Merron (Lab)]

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

[Baroness Nargund (Lab)]

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

[Baroness Merron (Lab)]

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

[Baroness Altmann (Non-Afl)]

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

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

--- Later in debate ---

[Baroness Merron (Lab)]

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

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

[Baroness Hyde of Bemerton (Lab)]

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

[Baroness Merron (Lab)]

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

[Baroness Shawcross-Wolfson (Con)]

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

[Baroness Merron (Lab)]

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

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

Cancer Outcomes in the UK

Baroness Merron Excerpts

Tuesday 21st April 2026 Grand Committee

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Baroness Merron Excerpts

Tuesday 21st April 2026 Lords Chamber

Moved by

[Baroness Merron]

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

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

Motion agreed.

Midwives: Graduate Guarantee

Baroness Merron Excerpts

Tuesday 21st April 2026 Lords Chamber

[Baroness Walmsley]

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

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

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

[Baroness Walmsley (LD)]

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

[Baroness Merron (Lab)]

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

[Baroness Rafferty (Lab)]

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

--- Later in debate ---

[Baroness Merron (Lab)]

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

[Baroness Manzoor (Con)]

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

[Baroness Merron (Lab)]

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

[Baroness Burt of Solihull (LD)]

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

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Sahota (Lab)]

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

[Baroness Merron (Lab)]

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

[Baroness Prentis of Banbury (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Wigley (PC)]

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

[Baroness Merron (Lab)]

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

Tobacco and Vapes Bill

Baroness Merron Excerpts

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

Moved by

[Baroness Merron]

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

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

--- Later in debate ---

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

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

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

[Lord Naseby (Con)]

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

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

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

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

Motion A agreed.

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

Baroness Merron Excerpts

Wednesday 15th April 2026 Grand Committee

Moved by

[Baroness Merron]

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

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

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

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

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

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

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

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

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

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

“the treatment of disease, disorder or injury”.

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

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

[Lord Lansley (Con)]

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

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

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

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

--- Later in debate ---

[Lord Kamall (Con)]

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

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

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

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

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

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

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

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

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

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

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

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

[Baroness Merron (Lab)]

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

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

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

--- Later in debate ---

[Lord Markham (Con)]

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

[Baroness Merron (Lab)]

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

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

Motion agreed.

NHS Adult Gender Identity Clinics

Baroness Merron Excerpts

Wednesday 15th April 2026 Lords Chamber

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

My Lords, 5,624 patients under 25 were referred to adult gender dysphoria clinics in 2023-24, 6,355 were referred in 2024-25 and initial figures show that 6,167 were referred in 2025-26. There are strong safeguards within the existing service provision and specification that was agreed following public consultation, including with the medical royal colleges. These include specialist assessment, accounting for complex co-morbidities and care delivered by a multidisciplinary team with a wide range of expertise, including in neurodiversity and endocrinology.

[Baroness Maclean of Redditch (Con)]

I thank the Minister for that Answer, but I wonder if she has had a chance to review the landmark study from Finland recently, which suggests very strongly that gender medicine actually has a very negative impact on vulnerable young people with complex needs and, far from actually helping them, in fact is harming them. Can I urge her to expedite one of the most important recommendations from the Cass Review, which is to bring in a separate set of services for 17 to 25 year-old young people who are experiencing gender dysphoria? She will know that, currently, the adult clinics operate an affirmative model; that can be very worrying because young people can access life-altering and irreversible hormones after only two appointments. For young people with a whole set of complex needs, I do not think that is right.

[Baroness Merron (Lab)]

My Lords, we are indeed committed to developing services for 17 to 25 year-olds, and I certainly recognise that this is a potentially very vulnerable time in a young person’s journey, as was clearly outlined in the report by the noble Baroness, Lady Cass. I can say to the noble Baroness that we recognise changing patient demographics, and therefore a holistic biopsychosocial assessment framework is being developed for use across all services, including a complexity measure to support understanding of the impact of any co-occurring conditions, as the noble Baroness refers to.

[Baroness Cass (CB)]

My Lords, we know that the 18 to 25 year-olds have many of the same complex problems as the under-18s and, as the Minister has said, they need similar holistic wraparound care, although that is not necessarily yet in place. However, Dr Levy’s review had a narrower remit than mine, focused on quality improvement rather than the model of care, so as a next step would the Minister agree to ask departmental and NHSE colleagues to convene a group, which should include independent experts, representatives of professional groups and representatives of the new children’s and young people’s services as well as service users, to consider how we best understand and, importantly, improve clinical outcomes for this group of young adults?

[Baroness Merron (Lab)]

My Lords, I remain grateful to the noble Baroness for her work and her expertise in this area, which I know has been acknowledged both by the previous Government and this Government. I will certainly take on board what she has said and ask my officials to discuss this further with NHS England.

[Baroness Thornton (Lab)]

My Lords, I would like to seek some clarification from my noble friend the Minister about this matter, because the Mental Capacity Act 2005 presumes adult capacity and the Care Act 2014 defines safeguarding thresholds, which my noble friend has outlined in some detail already. Can my noble friend the Minister confirm that adults aged 18 to 25 referred to gender identity clinics are treated as autonomous patients without additional safeguarding measures beyond those which she has already outlined and apply to any competent adult?

[Baroness Merron (Lab)]

Yes, I can assure my noble friend that patients are treated as individuals and their care is personalised. It is important, as my noble friend says, to recognise that the law presumes that patients aged 16 and over have capacity to consent to medical treatment. I can also give the reassurance, acknowledging as I have already that patients may have co-existing conditions that warrant additional safeguarding measures, that this will be determined on a case-by-case basis.

[Baroness Burt of Solihull (LD)]

My Lords, if the Government are concerned with safeguarding those aged 18 to 25, can the Minister set out what assessment has been made of the documented harms caused by multi-year waiting lists, including serious impacts on mental health, physical well-being and life outcomes? Given the evidence that regret or detransition among those accessing gender-affirming care is rare, can the Minister clarify what specific risk this proposed safeguarding framework is intended to address?

[Baroness Merron (Lab)]

It might be helpful if I speak in general terms. The Levy review highlighted multi-year waits for adult gender clinics. We recognise that waiting times are too long, and that is why we have increased the number of adult gender services from seven to 12 and we will be establishing a national waiting list. Dr Levy’s report did not make specific reference to concerns about safeguarding, and it is important to see it in that context. I emphasise once again that, where there are additional safeguarding matters, they will be dealt with on an individual basis as is right and proper.

[Lord Kamall (Con)]

My Lords, this is a highly sensitive topic, and I think we have to be very careful about how we talk about it. Evidence published in the BMJ shows a fiftyfold increase in recorded cases of gender dysphoria among children and young people between 2011 and 2021. While we should show compassion and not generalise about individuals presenting with gender dysphoria, what assessment has the Minister’s department made of the drivers for this rise in presentations? It is a sensitive issue, as I said, but are the Government assured that there are sufficient safeguards in place to ensure that the most vulnerable young adults are not irreversibly medicalised, only for some, even if just a small number, to regret it later?

[Baroness Merron (Lab)]

The noble Lord makes a number of points. Let me be quite clear that surgical interventions are only for adults—that is for those aged 18 and over. As I said in my answer to the noble Baroness, Lady Maclean, I also refer to the fact that the strong safeguards in place include, among a whole range of others, specialist assessment, access to a multidisciplinary team and assessment of capacity. These are strong safeguards, and it is right that this is the case in order to support patients to get the care that is appropriate to them and which they need.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, NHS England’s Levy review catalogued failings in relation to a lack of data and tracking outcomes from gender dysphoria clinics. Can the Minister explain how the NHS can offer any treatment without such evidence relating to efficacy, benefits, harms, regret and detransition? Can the Minister also comment on the criticism that clinicians are reluctant to correct patients’ unrealistic expectations, often those of young women, about medical transition. They believe that hormones and surgery can change biological sex; they cannot. That is a scientific fact and surely NHS doctors should explain that.

[Baroness Merron (Lab)]

I am not quite clear about the questions I am being asked. However, I return to the point about safeguards and say to your Lordships’ House that I have already outlined the strong safeguards, the professionalism and the medically informed evidence. Contrary to what is being suggested, there is no casualisation at all about decision-making.

Learning Disabilities: Health and Social Care Access

Baroness Merron Excerpts

Thursday 26th March 2026 Grand Committee

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

My Lords, I am pleased to respond to this Question for Short Debate, and I congratulate the noble Lord, Lord Scriven, on securing what, as we have heard, is a very important debate. I also congratulate him on his commitment to improving outcomes for those who have a learning disability. Personally and publicly, I also want to acknowledge—I will use the noble Lord’s words—how raw this is for him. As well as giving my condolences on the death of his nephew Myles, I can only say that I genuinely believe that, as Myles’s uncle, he pays the greatest tribute to the memory of his nephew as he strives to improve services. It is a mission with which I fully associate myself and the Government.

I also want to acknowledge the other losses of the bereaved—not just those of noble Lords sitting here in the Room but those outside too. I have listened to the debate closely and if I am honest, what I am about to say can only in part meet some of the very real questions, and a number of the proposals too. I will do my best and I commit to raising the points made with my honourable friend Minister Zubir Ahmed, in whose portfolio this sits. I know he will welcome, as I have done, the contributions today.

I will pick up as many points as I can in the time that I have. All noble Lords, including the right reverend Prelate and the noble Lord, Lord Crisp, made the point that the health inequalities faced by people with a learning disability are totally unacceptable. I certainly align myself with that. We are committed to driving change. The 10-year health plan gives me hope in this regard because it outlines our ambitions to tackle health inequalities and speaks to the point the noble Lord, Lord Crisp—not exclusively but particularly—made about the need to see the whole person. That is what is missing generally, and it is what the 10-year health plan seeks to tackle, including driving that critical shift from treatment to prevention. The two issues that are presented by this debate are inseparable. I am grateful to the noble Lord for the way he has presented that.

I therefore say at the absolute outset to the noble Lords, Lord Scriven and Lord Addington, that a near 20-year life expectancy gap is not acceptable under any point. I also thank the noble Lord, Lord Addington, for saying that the shortcomings and concerns we are debating have been going on for many years, and what is important is that commitment to change. The noble Lord, Lord Crisp, who spoke of the experience of his brother-in-law Gareth, also spoke of good practice in Derbyshire. We should commend all those who do this and learn from it.

To the point about reasonable adjustments, there are clear legal requirements on health and care organisations and their staff. I hear what noble Lords say clearly: yes, that is all very well but it is not happening. But it is worth reminding ourselves that, under the Equality Act 2010, public sector organisations are required to adapt their approaches in a very practical sense, as the noble Lord, Lord Addington, called for, so that their services are accessible to disabled people as well as to everybody else.

I am grateful to my noble friend Lady Ramsey for bringing Patsy into the Room again. NHS England is rolling out a reasonable adjustment digital flag, as we have spoken about here. That will continue and it is to ensure that, in the way that she rightly demands, key information about a person and the reasonable adjustments needed for their care and treatment are to be recorded in care records. I say to my friend the noble Lord, Lord Addington, that a new information standard was published in December 2025, such that all publicly funded health and social care service providers must be able to share, read and write reasonable adjustment data by 30 September. Training on this digital flag is freely available.

Turning to the safety of people with a learning disability while accessing health and social care, the NHS learning disability improvement standards provide a framework to support NHS trusts and organisations in assessing the quality of their services, because we have to see consistency and improvement across the NHS. There is guidance available on the use of health and care passports to support personalised care for people with a learning disability, and for autistic people.

I say to the noble Baroness, Lady Hollins, that I am deeply saddened by the tragic circumstances of the death of David Lodge. I send my condolences to David’s friends and family. In response to the noble Baroness, who called for a way forward, and the noble Lord, Lord Scriven, who raised whether this can all be a tool for change, because it is not currently—I heard him say that—I know that the noble Lord recently met the Minister for Health Innovation and Safety, Zubir Ahmed MP, as I mentioned. I understand that my colleague the Minister has agreed to work with the noble Lord, Lord Scriven, to continue to hear insights from those with lived experience and wider stakeholders. The Minister is currently working with officials to explore options to improve the process, because we know there is a lot further to go to get ICBs to meet the expectations they have upon them. All these points have rightly been raised on ensuring accountability, reducing inequalities and preventing avoidable deaths. That work will absolutely continue, and I look forward to noble Lords taking part in it.

The noble Baroness, Lady Hollins, asked whether there are any plans to establish a specific inquiry or committee. Currently, there are no plans to do this; however, as I have said, the Minister is very much on the case. On wider action to improve health outcomes, I absolutely hear the points made by the noble Baroness not only in your Lordships’ House but to me personally before this debate, for which I am grateful. If we are talking about those with learning disabilities, we are talking about not just episodes of care but building relationships to enable the correct care for that person; I use the word “person” very definitely in this regard.

Reference was made to the Health and Care Act 2022 and the requirements that it contains. The Government have published a code of practice setting out their expectations on training delivery, and we continue to roll out the recommended Oliver McGowan mandatory training package. I can tell the noble Earl, Lord Effingham, that more than 3 million people have completed the first part of the training, and funding has been provided to support greater uptake this year.

On the point about health checks, the Secretary of State recently wrote to all GPs to emphasise the importance of identification, recording and the quality of the checks themselves.

A number of very pertinent points have been made. I assure noble Lords that they will all fed into the move towards improving the situation for those who have learning disabilities. We owe them nothing less.

Migraine Care: 10-year Health Plan

Baroness Merron Excerpts

Monday 23rd March 2026 Lords Chamber

[Lord Londesborough (CB)]

My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I declare my interest as a migraine sufferer.

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

My Lords, the Government are committed to improving migraine care through the 10-year health plan. We are strengthening neurological services by expanding community-based care and community diagnostics for earlier identification, widening the availability of effective treatments, such as calcitonin gene-related peptide inhibitors, and enhancing the NHS app. NHS England’s neurology programmes are also expanding specialist capacity, reducing avoidable A&E attendances and helping people with migraine to remain in work and maintain their well-being.

[Lord Londesborough (CB)]

I thank the Minister for engaging on a subject that has been raised just once in this House since 1961—which is extraordinary, as we have 10 million migraine sufferers in the UK, more than half of whom have no diagnosis or access to preventive medication. Migraines cost the wider economy more than £10 billion per annum in lost productivity and tax revenues, with hundreds of thousands of capable people unable to work due to lack of treatment, so does the Minister agree that there is a compelling economic as well as compassionate argument for better GP training, more neurologists and including migraine in the NHS Pharmacy First scheme?

[Baroness Merron (Lab)]

I agree with the noble Lord. I appreciate the conversations we have had prior to this Question and acknowledge that he is one of the millions of people suffering from this condition. There is certainly a substantial economic and NHS impact from migraine. I am glad my department is working with the Department for Work and Pensions on a number of initiatives, including the WorkWell programme and the individual placement and support in primary care initiative, which are all focused on supporting those with migraine to stay in work and get back to work.

[Baroness Winterton of Doncaster (Lab)]

My Lords, the approach that my noble friend the Minister has outlined regarding migraine care is very welcome. The 10-year plan also talks about cholesterol management due to its links to cardiovascular disease, but the plan can quite often be confusing for the patient in terms of the care that is provided. A simple example would be suggesting that cheese is bad for cholesterol but good for osteoporosis. HEART UK has therefore raised the fact that there should be a holistic approach to the patient. Can my noble friend make sure this happens in the 10-year plan and the delivery of it?

[Baroness Merron (Lab)]

I can indeed say to my noble friend that a holistic approach is exactly at the core of the 10-year plan, as is the enhancement of care through expanded community diagnostics, better prevention and the use of personalised digital tools, including the NHS app. All these will be helpful in the way my noble friend seeks. The workforce plan, which we will see shortly to support the 10-year health plan, will also acknowledge the need to see people holistically and to staff up accordingly.

[Lord Scriven (LD)]

My Lords, there has been a more than 20% increase in the number of emergency hospital admissions since 2021 due to this condition. Will the Government include and fund migraine in the Pharmacy First scheme and empower pharmacists to prescribe for this high-volume condition?

[Baroness Merron (Lab)]

We constantly review and discuss with pharmacists the range of conditions they cover. It has been one of the highly successful ways of making community-based care available, and we certainly want to continue to work with pharmacists. It is also important to note that more modern treatments are available now on prescription, which will all also support people to manage their condition and will reduce unnecessary A&E admissions.

[Baroness Manzoor (Con)]

My Lords, as has already been mentioned, over 10 million people in the UK suffer from migraine, and it is highly prevalent in women. It is also linked to anxiety and depression. I welcome what the Government are doing in extending women’s health hubs and emphasising mental health in the 10-year plan but, unfortunately, there are no systematic gateways for migraine care in the 10-year plan. How can the Government address this in the light of the significant problem that there is? I am also sorry to hear that the noble Lord, Lord Londesborough, suffers from migraine.

[Baroness Merron (Lab)]

It is important that we acknowledge that this is a debilitating condition. The noble Baroness is right that it is one of the most common neurological conditions, affecting one in five women and one in 15 men. Indeed, it is a major cause of disability. The 10-year plan sets out the main pillars. For example, there will be an updated adult neurology service specification, which will come into being just next month. It was published in August, and I believe it will take account of the points the noble Baroness rightly raises.

[Lord Hunt of Kings Heath (Lab)]

My Lords, my noble friend the Minister, very welcomely talked in her first response about widening access to treatment. My understanding is that NICE guidelines can be very tight for some of those treatments. As part of the work she has put forward, can my noble friend ask NICE to review its guidelines to make sure they are absolutely up to speed?

[Baroness Merron (Lab)]

As I know my noble friend is well aware, the eligibility criteria are set independently by NICE. They are based on clinical evidence and cost-effectiveness, rather than being set by Ministers. However, it is worth saying that the introduction of oral CGRPs, which do not require specialist initiation, will significantly widen access through primary care and reduce the bottlenecks in the system. We are very keen that people can access effective drugs, and I take on board the point my noble friend made.

[Lord Kamall (Con)]

My Lords, I thank the noble Lord for the Question, because although many people think that migraines are just bad headaches, they are in fact a distinct, complex neurological condition. They are responsible for 43 million lost working days each year and are estimated to cost the UK economy up to £4.4 billion. The Minister rightly talked about calcitonin gene-related peptide therapies, but apparently only about 29% of trusts allow access to CGRPs. I welcome what the Minister said about increased access via primary care, but I note that these drugs prevent migraines by targeting a molecule involved in pain transmission. What specific steps is the Minister’s department taking to increase access to these treatments in addition to the primary care initiatives?

[Baroness Merron (Lab)]

We very much recognise the concerns that people may face unnecessary hurdles when trying to access CGRP treatments. NHS England is working with integrated care boards to ensure that the pathways being followed are consistent and timely. It would perhaps be helpful for me to mention some of the national tools, such as NHS RightCare’s headache and migraine toolkit and the Getting It Right First Time recommendations; they also speak to the clearer referral rates that the noble Lord called for and reduce variation. We want people to receive appropriate treatments; we do not want them to be delayed.

[Lord Patel (CB)]

My Lords, migraine as a symptom is a manifestation of a whole spectrum of different diseases, both neurological and vascular, and some are based on allergies. The important aspect of treating migraines is correct diagnosis, and advances in diagnostic techniques, including some of the treatments that the Minister mentioned, are now making that easier. Does she agree that, in addition to having a community-based service, it is important to train the right people to make the right diagnoses, so that patients can get the right treatment at the right time, no matter who dispenses or prescribes it?

[Baroness Merron (Lab)]

I certainly agree. NICE’s headache guidelines and the Royal College of GPs’ training modules support that better recognition and management.

[Baroness Blower (Lab)]

My Lords, speaking as a person who was identified as possibly prediabetic and having a significant heart and cholesterol problem, I can tell the House that, when I looked at the charts of what I might be able to eat from both of those sources, it seemed I was left with kale and cucumber. A holistic approach for this is very important, and I am pleased to say that I am very healthy and do not eat only kale and cucumber.

[Baroness Merron (Lab)]

I am sure your Lordships’ House is, like me, delighted to hear that about my noble friend.