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.

Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

Committee stage
Friday 20th March 2026 Lords Chamber

[Lord Wolfson of Tredegar (Con)]

Causation is denied. My noble and learned friend can read it in Hansard, and I spoke to her outside. It is a testament to her dedication that she has been following this on TV. I do not know whether that shows how poor daytime TV normally is, though those of us who were here on Wednesday will remember that your Lordships’ House is very late night TV as well.

I spoke on the amendments when we first touched on this topic in Committee, right at the beginning. As my noble friend Lady Coffey said, those amendments interrelate with what has been discussed today. The Front Bench is focused on the question of making sure that we do not end up with a situation where different citizens and residents in the United Kingdom have substantially different rights in areas as important as this. I listened carefully to what the noble Baroness, Lady Smith of Llanfaes, said about what actually happened in the Senedd. The phrase “voting in the dark” was a stark one, which I think we ought to remember.

On the question of what the Bill actually does, I am reminded of when I studied private international law, where you have something called the characterisation question—something that lawyers often like. It basically goes like this: in order to get the answer you want, you rephrase the question to focus on the bit of the problem which you want to focus on. In this case, you ask the question, “What does this Bill do?” The noble Lords, Lord Pannick and Lord Carlile of Berriew, rightly say, as a matter of form, that the Bill amends the criminal law and therefore is a competence of Westminster. In reality, assisted dying will not be provided by the criminal justice system. In practice, it will be provided by the health service. That is why I listened carefully to what the noble Lord, Lord Stevens of Birmingham, and the noble and learned Lord, Lord Thomas of Cwmgiedd, said: in practice, this is a Bill which touches on health, which is a devolved competence.

That brings me to the wider and more important point. Earlier this week, the noble and learned Lord, Lord Falconer of Thoroton, raised Jersey, Guernsey and the Isle of Man—the Crown dependencies—in the debate on the Crime and Policing Bill. We also learned this week that the Scottish Parliament has chosen not to proceed with the version—and it was a different version —of this Bill proposed there. If this Bill were to receive Royal Assent, we would therefore end up in a position where substantially different rights would exist for different residents and citizens in the United Kingdom.

That raises an important point of principle, on which I would be interested to hear the noble and learned Lord’s view. Does he see it as a success of devolution that, on an issue as significant as this, people living in different parts of the United Kingdom—and for the purposes of this group of amendments, Wales—might have different rights in law, or does he have a potential solution to create a situation where, as close as possible, people have the same or substantially the same rights?

I respectfully ask the Minister to respond on this point as well. Frequently, we have heard from the Front Bench the phrase, “We are neutral”—that the Government are interested only in workability and will look at these issues as and when they arise. However, this is a deep constitutional issue. The Government cannot be neutral on the point of whether they are content in principle that people in England might have different rights on assisted dying from people in Wales. The Government ought to have a stance on that fundamental constitutional position. The Government also ought to have a position on the point raised by my noble friend Lord Deben as to whether, if this Bill were to go through, with palliative care being such an important part of the overall process, they would equalise funding to make sure that residents of Wales have the same access in practice to palliative care as those of us who live in England do.

For those reasons, I look forward to the responses of both the noble and learned Lord and the Minister.

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

My Lords, I am grateful for the views that have been expressed today. As usual, I will keep my remarks to those amendments that raise significant legal, technical or operational workability concerns. I very much associate myself from these Benches with the welcome to the noble and learned Baroness, Lady Prentis. We were delighted to see her return to your Lordships’ House and look forward to hearing from her.

I turn first to the amendments tabled by the noble Baroness, Lady Coffey. Taken together, they would restrict eligibility for assisted dying to England only and exclude people resident in Wales, registered with a Welsh GP or who have recently moved across the border. They would remove the powers of Welsh Ministers to issue regulations and guidance and limit the commissioner’s monitoring functions to England. Individually and as a group, the amendments could have complex effects, risk significant unintended consequences and lead to a lack of clarity about eligibility and the effect of the law across the England-Wales border.

Restricting the Bill to England, as we have heard, would also create a divergence in the criminal law of England and Wales. The protections in Clause 32 would not apply in Wales and the Suicide Act 1961 would continue to apply there as it does at present. It would therefore be an offence to take steps in Wales to assist access to an assisted death in England even where lawful under the Bill in England. That would represent a significant divergence in homicide- and suicide-related offences and run counter to the current devolution settlement.

Amendment 887 would remove Clause 57(2) and (3), preventing certain provisions from extending to Scotland and Northern Ireland, including those on approved substances, advertising, and employment protections. This would risk parallel and potentially conflicting regulatory regimes; may allow advertising of services in Scotland and Northern Ireland, contrary to restrictions in England and Wales; and could leave health professionals who, for example, live in Scotland but work in England and Wales without the same employment protections as someone in England.

There are a number of further amendments in this group concerning powers in the Bill relating to the provision of an assisted dying service in Wales; namely, Amendment 765, tabled by the noble Lord, Lord Goodman, Amendment 764, tabled by the noble Baroness, Lady Finlay, and Amendments 742, 743, 844, 903, 905 in the name of the noble Baroness, Lady Smith. I bring to the attention of noble Lords that these amendments may alter or impinge on the devolution settlement. Any such changes would usually be made following consultation across the UK Government and with the Welsh Government to explore the wider implications. Further, the Senedd would be expected to consider material changes that affect devolved competence.

Amendment 762, tabled by the noble Lord, Lord Goodman, would require the Secretary of State to specify which organisations will provide assisted dying services in Wales, within one month of the Act passing. This raises workability concerns as it requires clarity on who provides services before key implementation decisions have been made. This could be an interference with the ability of the Welsh Ministers in the devolution settlement to exercise their powers in a devolved area. As regulations under Clause 42 are made using the affirmative procedure, this amendment would also require parliamentary debates in both Houses within one month of the Bill being enacted.

Amendment 767A, tabled by the noble Baroness, Lady Coffey, appears to seek to limit the power of Welsh Ministers to make regulations related to private services only and would make Welsh Ministers unable to establish a publicly commissioned service. As currently drafted, the Bill leaves this as a decision for Welsh Ministers. This amendment would therefore have devolution impacts and, if passed, the Welsh Government would need to be reconsulted and the consent of the Senedd would need to be sought for this provision.

I make no comments on the other amendments in this group. As noble Lords are aware, those amendments have not had technical drafting support from officials. Therefore, any further revision and corresponding amendments may be provided to provide consistent and coherent terminology throughout the Bill.

[Baroness Finlay of Llandaff (CB)]

My Lords, may I question the Minister? The 49th report of the Delegated Powers and Regulatory Reform Committee drew attention to the very unusual nature of the clause in the Bill that allows the delegated powers to be used to do anything that an Act of Parliament can do and drew attention to the fact that this is extremely rare. Is the Minister saying that that is acceptable in this Private Member’s Bill and therefore potentially sets a major precedent in relation to other legislation? Can she clarify whether the Government, simply in relation to that, not to any other part, dispute the Delegated Powers and Regulatory Reform Committee’s conclusion?

[Baroness Merron (Lab)]

I am sure that all noble Lords welcome that report and its comments but, as the noble Baroness is aware, it is a matter for the sponsor to decide the response to that rather than the Government.

[Baroness Smith of Llanfaes (PC)]

What is His Majesty’s Government’s approach to the legislative consent Motion process and making sure that the Sewel convention is kept to? What intergovernmental discussions have this Government had with the Welsh Government on the constitutional implications of this Bill in particular?

[Baroness Merron (Lab)]

As noble Lords will be aware, engaging with the devolved Governments is a matter for the sponsor, not the Government.

[Lord Empey (UUP)]

My Lords, we have heard talk in this debate about respecting the devolution settlement. No, we do not. It is not that long ago, for instance, that the Northern Ireland Assembly voted against abortion but got abortion, and everybody on both Front Benches voted for it. So let us not fool ourselves that we have this great commitment to devolution and respect the views of the relevant assemblies. No, we do not.

[Baroness Merron (Lab)]

I note the comments that the noble Lord has made.

[Lord Falconer of Thoroton (Lab)]

I express my personal pleasure at seeing the noble and learned Baroness, Lady Prentis, back in the House. She was an extremely successful Attorney-General because she was wise and knew the law. I am very glad that she is back here to keep us in order.

On issues in relation to Wales, we have understood throughout the importance of complying scrupulously with the devolution settlement. The people of Wales have to be respected and the devolution settlement has to be respected. On two propositions here, there is no doubt.

First, this is about the criminal law. If a Bill were passed in the Senedd that sought to change the Suicide Act under the existing devolution settlement, it would have no effect because it would not be within the Senedd’s power to do it. That has to be dealt with by this Parliament.

Secondly, and separately, as a matter of practicality, how assisted dying is to be introduced in the health service and the provision of health in Wales is, in practice, a matter for Welsh Ministers. The approach that we have taken is that this Parliament must deal with the criminal law and Welsh Ministers must be left to deal with the decisions about how it is introduced. It may be that that requires an Act of the Senedd. Because of that possibility, we have included in the Bill the power for Welsh Ministers to give the National Health Service in Wales the power to take steps. That power would normally be given by the Senedd, but so that there could be no doubt about that, and so that it would not wait upon the Senedd, we have included it in the Bill.

Constitutionally, we are allowed to include it in this Bill. Even if there was no legislative consent Motion agreeing to it, we could go ahead without the consent Motion. I and the sponsor in the other place have made it clear, specifically and in writing, that we respect the devolution settlement and that if there is no legislative consent Motion in Wales that consents to this Parliament legislating in an area normally dealt with by the Welsh Senedd then we would withdraw those provisions, because we would not be respecting the devolution settlement. From our point of view, we have proceeded with these provisions only once the LCM has been given. That is our position in relation to it.

I shall now deal with the amendments in that context.

--- Later in debate ---

[The Earl of Effingham (Con)]

My Lords, before I speak to the substance of the amendments in this group, I pay tribute to the noble Baronesses, Lady Nicholson, Lady Berridge, Lady Fraser of Craigmaddie, Lady Grey-Thompson, Lady Hollins and Lady O’Loan, and the right reverend Prelate the Bishop of Newcastle. They have all stood up for a particularly vulnerable group of people, and they are absolutely right to do so. I am sure that the noble and learned Lord, Lord Falconer, is listening most carefully to their arguments.

Individuals with speech, language and hearing difficulties are particularly vulnerable, and it is imperative that they fully understand the process, their rights and the terms of the Bill before they can access the provisions made within it. My noble friend Lord Blencathra said that we really need to know that an individual understands what they are doing, and the noble Baroness, Lady O’Loan, used the phrase “crystal clear”. They are both absolutely right.

Surely how society cares for the most vulnerable of its citizens is an unmovable benchmark. Society must protect people with communication difficulties. The noble Baroness, Lady Berridge, specifically questioned the Government, and His Majesty’s Loyal Opposition believe that it is fair and reasonable to ask the Minister what specific work officials and Ministers have undertaken to establish the core risks posed by the Bill to those with hearing, speech and language impediments. In the view of His Majesty’s Government, how effective are the safeguards currently in place? Can the Bill be improved from a neutral perspective of workability to ensure that no one who faces the challenges we have discussed in this group ends their life without being given the obvious support that they need to fully understand the life-changing decision on which they are embarking?

As the noble Lord, Lord Winston, referenced in the previous group, during the course of the Bill, noble Lords have debated detailed provisions and addressed complex moral issues with a laser focus. However, the question at hand is not a complex one. Those who are not able to understand the situation without proper support must be provided that support if they are to take the decision to end their life. Surely that is non-negotiable.

The noble Lord, Lord Shinkwin, said that we have to think differently and challenged the noble and learned Lord, Lord Falconer, to lead by example. The right reverend Prelate the Bishop of Southwark took the words out of my mouth when he said that he remains hopeful that the noble and learned Lord will agree with this line of thought and commit to engaging collaboratively with all noble Lords whose amendments in this group aim to implement the right and appropriate protections for this vulnerable body of individuals.

[Baroness Merron (Lab)]

My Lords, I am most grateful for the debate that we have had today. In keeping my comments limited to amendments on which the Government have major legal, technical or operational workability concerns, I turn first to Amendments 171A and 174A, tabled by the noble Baroness, Lady Nicholson. The duty outlined within these amendments may prove difficult for doctors to discharge as they are ambiguously drafted and use undefined terms such as “religious, cultural or sex-based” barriers. It is also a mandatory duty that does not afford discretion to the doctor to refuse unreasonable requests.

The duty to appoint an advocate conflicts with Clause 22. It is unclear how these proposed advocates would be appointed or trained, or what their role or responsibilities would be. Furthermore, your Lordships’ Committee may note that where a person has religious, cultural or sex-based barriers, the amendment would also require such a person to be provided with an advocate who has training in and experience of relevant safeguarding issues and must be the same sex as the person seeking assistance. Introducing a more extensive mandatory duty for the provision of adjustments, including an advocate, may give rise to workability issues, as the cohort of advocates meeting these criteria could be very limited and may result in a person being delayed or unable to take part in a preliminary discussion.

--- Later in debate ---

[Lord Wolfson of Tredegar (Con)]

We all know what we are talking about here, but yes, absolutely.

This all goes back to the fundamental point of the Bill. I am addressing this point because the hypothesis is that the person has less than six months to live but, notwithstanding that, we are making sure that this particular group of people have an independent advocate. My point is simply that, if we are going to go down this road, there needs to be consistency: if they are not going to have an independent advocate, they really need to confirm it rather than merely indicate it. I apologise for my slightly loose language; the noble Baroness was quite right to pick me up on that. I hope the noble and learned Lord will consider my point as to whether “indicating” is actually the right test in subsection (2)(b)(ii) of his proposed new clause.

[Baroness Merron (Lab)]

I am most grateful to noble Lords for their contributions to this debate on independent advocates. I will limit my comments to those amendments on which the Government have major legal, technical or operational workability concerns.

I turn first to Amendments 168, 300 and 553, tabled by the noble Baroness, Lady Grey-Thompson. Without further consequential changes, Amendment 168 would result in an internal inconsistency with the framework currently set out in the Bill, which provides an independent advocate only for certain qualifying persons.

Similar concerns arise with Amendment 300, which seeks to establish a new system of advocates for disabled people. It is important to note—not just in reference to these amendments, which I heard the noble Baroness acknowledge are not quite as she might wish them to be, but in relation to the debate—that the Equality Act 2010 definition of disability is very broad. For example, it includes those with cancer. As a result, most people who are terminally ill for the purposes of the Bill would fall within that definition. That means that the amendment could apply to the majority of those seeking an assisted death.

Amendment 300 would require the independent advocate to confirm that the person has been offered

“all practicable social, medical, and palliative supports which are financially supported”.

However, there is no provision to ensure that the independent advocate would have access to the information needed to confirm this, which could make the amendment unworkable.

Amendment 553 relates to young adults aged 18 to 25. People in this cohort are legally adults, so the requirement for parental or guardian consent and to have an independent advocate may raise Article 8 ECHR issues relating to private and family life. To be lawful, these requirements would need to be objectively and reasonably justified and proportionate.

My noble and learned friend Lord Falconer, the sponsor, tabled Amendments 548A, 549A and 862A to address workability issues with the current drafting of the Bill by clarifying the regulation-making powers and parliamentary procedures in Clause 22. The amendments set out when a qualifying person must be informed about independent advocate support and the circumstances in which that support must be provided.

Amendment 544A, tabled by the noble Lord, Lord McCrea, would create a conflict with Clause 22(3), which sets out the role of the independent advocate in providing support and advocacy to a qualifying person. The amendment would remove the definition of “qualifying person”, which would result in confusion about who is a qualifying person and the role of an independent advocate appointed to assist a person who is not a qualifying person.

Amendment 553B, tabled by the noble Lord, Lord Weir, would place a duty on the commissioner to offer the support of an “independent disability advocate” to a disabled person as defined under Section 6 of the Equality Act 2010. As mentioned previously, given the breadth of the Equality Act definition, this duty would apply to most people seeking an assisted death. The amendment is unclear about the duties, training and qualifications that would be required of them.

Amendments 191 and 195 to 199, tabled by the noble Lord, Lord Frost, and spoken to by the noble Lord, Lord Gove, and the noble Baroness, Lady Lawlor, would require the Secretary of State to establish a scheme of neutral advisers to whom a person must be directed in the situation where a registered medical practitioner is unwilling or unable to conduct a preliminary discussion. The amendments are broad, ambiguously drafted and could give rise to significant workability issues.

Amendment 196 in particular would require neutral adviser organisations to make a number of very broad declarations. For example, under the amendment, a neutral adviser must declare that they do not and will not employ

“any person who has taken part in the provision of assistance for assisted dying”.

This could result in a potentially unworkable duty, as it would require the adviser to make a declaration about current and future conduct. These broad declarations could therefore be practically unworkable and create resourcing challenges by excluding significant parts of the workforce, if interpreted broadly.

--- Later in debate ---

[Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)]

My Lords, I have noticed that the time now is 5.18 pm. We have no intention of moving on to another group. When this group is finished, I will seek to adjourn the House. I say to any colleagues waiting for another debate that it will not be happening this week.

[Baroness Merron (Lab)]

My Lords, The Government do not have major workability concerns with Amendments 175 and 384, tabled by the noble Lord, Lord Moylan, whom we are very pleased to see in his place; long may he continue to be there.

I will say a few words about clinical practice, which may be helpful in addressing some of the points raised, including those just now by the noble Earl, Lord Effingham. Most of the questions were really about the Bill and are therefore matters for the sponsor, but I will make a couple of points about clinical practice. It is rare for a clinician to base prognosis on a median life expectancy. In addition, explaining the data used is not common clinical practice. I hope that is helpful to noble Lords.

The issues raised are rightly for noble Lords to consider and decide. Of course, that means that the way the amendments are currently drafted may require further consideration to be fully workable, effective or enforceable.

[Lord Falconer of Thoroton (Lab)]

My Lords, can I share everybody’s genuine pleasure that the noble Lord, Lord Moylan, is here? Can I not congratulate him on telling us about it? I would have done, but he told me he did not want it, so I respect his wishes. I thank my noble friend Lord Rooker for being willing to share his experience of the death of his first wife. I also associate myself with my noble friend Lady Royall; from personal experience, one should not feel that one has got some obligation or is in some way defective if one dies quickly of cancer or takes a particular attitude. We should not be censorious one way or the other as to what attitude people take when confronted with a terminal illness. How would we all react when confronted with it? We probably do not know.

First, we have had a debate about the six months, and I am incredibly unkeen to revisit the six months because I do not think that that was the frame within which the noble Lord, Lord Moylan, tabled his amendment. His amendment is about what is to be told to the patient rather than whether six months is right—I am gratified that the noble Lord, Lord Moylan, is nodding. I will focus on the issue: how should the patient be told? His amendment is in Clause 5, which is about the preliminary discussion. It requires the doctor conducting the preliminary discussion to discuss the person’s diagnosis and prognosis. It requires the doctor to refer to any treatment available to the patient, and the likely effect of the treatment, and it requires them to go through

“all appropriate palliative, hospice or other care”—

it is not just palliative and hospice care; it is other care as well—

“including symptom management and psychological support, and offer to refer them to a registered medical practitioner who specialises in such care for the purpose of further discussion”.

It is a detailed discussion about the prognosis, diagnosis and likely effect of treatment.

I was struck by the speech made by the noble Baroness, Lady Watkins. The idea that you are told you have six months to live, and that is it, is extraordinarily unusual. The idea that this happens is very unlikely; that it could happen in this context seems to me to be extraordinarily unlikely. Noble Lords will be aware that, in Clause 7, there must be a record kept of this conversation. The iniquity that one is trying to deal with seems to me to be unlikely to arise.

Should we be putting into the Bill the specific statistical material that has to be given? If you are relying on a median or an average, do you have to say that you are doing that and what the variations are? No, I am not in favour of that. There is a power for the Secretary of State, by codes of practice or guidance, to give indications as to how it should be dealt with. I trust doctors more than many people in this debate. It would be unhelpful to put in words such as those in the amendment into the Bill, so I am against the amendment.

On a completely separate issue, we have debated the question of the prognosis and the reason for the six months. I strongly adopt the words of the noble Baroness, Lady Noakes, that this is not the view of one person; this is the view of two doctors and a panel of three. This is not just a question of one prognosis and it is over. That is an issue that we dealt with previously. I am delighted that the noble Lord, Lord Moylan, was in a position to move the amendment. I am sorry to say that I do not agree with it.

Unpaid Carers: Patient Hospital Discharge

Baroness Merron Excerpts

Thursday 19th March 2026 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government what assessment they have made of the extent to which unpaid carers are consulted before a patient is discharged from hospital, and what plans they have to monitor this.

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

My Lords, the Health and Care Act 2022 requires NHS trusts to involve patients and unpaid carers in discharge planning, reinforced by 2024 discharge guidance. However, this is not always done consistently and carer involvement is not monitored nationally. We will support better implementation by commissioning work from the LGA’s better care fund support programme this year. Care transfer hub guidance also promotes best practice by encouraging early identification and involvement of carers in planning.

[Baroness Pitkeathley (Lab)]

I thank my noble friend for her Answer. It was important, though not easy, to win for carers the right to be consulted at the point of discharge. I am sorry that better statistics are not being kept, but I am glad to hear the plans for improvement. The survey from Carers UK shows that the number of carers being consulted is decreasing rapidly. Although I fully understand the pressure on the NHS at the point of discharge and the difficulties of securing proper social care support, does my noble friend agree that it is very short-sighted not to consult carers at this point? If they break down from lack of support, the patient is readmitted and there is further pressure on the NHS.

[Baroness Merron (Lab)]

I completely agree with my noble friend that the involvement of and support to unpaid carers is crucial when a patient is discharged because, as she says, it is vital not just for patient recovery but for the whole healthcare system. I welcome the recent Carers UK report that was published last year, which focused on how government legislation and guidance is or is not being implemented and monitored in practice. That has been and will be very useful work for us to continue with.

[Lord Young of Cookham (Con)]

My Lords, further to the question from the noble Baroness, Lady Pitkeathley, there are 120,000 young carers aged between seven and 18, many of whom are the principal carer for a parent or sibling, accompanying them when they go into hospital. Although many hospitals are good about identifying the young carers, not all of them are. What more can be done to make sure that these young carers are identified right at the beginning of the process and fully consulted about arrangements for discharge?

[Baroness Merron (Lab)]

The noble Lord is right to emphasise the role that many children and young people have as young carers. The Children’s Social Care National Framework is statutory guidance for local authorities, which have duties to identify young carers who may need support and to assess their needs. I am well aware that young carers may not be aware of this, but there is a right to request assessments. Improving joint working between adult and children’s social care services, as well as health services, is key. Lastly, I hope that the electronic patient record would identify where there was a carer, including a young carer.

[Lord Scriven (LD)]

My Lords, I declare my interest as a vice-president of the LGA. The model of unplanned discharge places an immediate burden on unpaid carers. What assessment have the Government made of the financial impact on unpaid carers during this period? Specifically, will they consider a discharge support grant to provide immediate short-term funding for carers for the first four weeks following an unplanned or non-thought-through discharge?

[Baroness Merron (Lab)]

I know the noble Lord will be aware of the better care fund, to which there is a commitment of some £9 billion. It can be used in various ways, including in the way that he described. I look forward to the work of the LGA’s better care fund support programme that we will commission this year so that we can work with NHS and social care partners, because we need to strengthen the approach of not just involving but supporting unpaid carers. Discharge should not take place if carers are not able to fulfil the duties that it is assumed they can fulfil.

[Baroness Andrews (Lab)]

My Lords, it is good to hear that there is real awareness of the issues caused by this. It is one of the most acute problems in the whole provision of social care, and it falls hard on unpaid carers when they do not even know how or who to ask for help. It has been diagnosed many times as a big issue. There used to be co-ordinator discharge people in hospitals who would help with this process. Are there still such posts? The news about the LGA work is welcome in relation to co-ordination when it counts and support for unpaid carers, who are the experts here. They are not passive arbitrators; they need to have their own knowledge and expertise recognised in this process. Is there provision at the hospital level for this?

[Baroness Merron (Lab)]

My noble friend makes exactly the right points. We certainly recognise the vital role that unpaid carers play in supporting those who are to be discharged. Decisions about staffing and the approach—I emphasise that a multidisciplinary approach is clearly needed here—are a matter for local areas, but I can say in addition that there is a regular cross-government meeting, which is really important when it comes to joining up the approach, that looks at providing unpaid carers with the recognition and support that they need, as my noble friend said. We are also working towards publishing a cross-government action plan later this year. So in this area, including the LGA work, the kind of approach that my noble friend talks about will certainly be considered.

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Pitkeathley, for being a tireless champion of unpaid carers over many years and successive Governments. She quite rightly pointed out that Carers UK found that only 14% of unpaid carers were asked about their ability and willingness to provide care before hospital discharge. I want to follow up on the previous question from the noble Baroness, Lady Andrews. One of the problems faced by successive Governments is that trusts and what were previously CCGs and are now ICBs are very bad at learning from other parts of the system that do things well. For example, Northumbria has been known to have a really good discharge system: it embeds co-ordinators and works out how to get that discharge going. How can the Minister’s department improve learning across the system where there is good practice, take that best practice and appropriately transplant it into other areas so that we can really tackle this problem once and for all?

[Baroness Merron (Lab)]

The whole system needs to do better, as the noble Lord outlines. It will be helpful that we are also looking at commissioning research in this area to look at best practice, as well as barriers and solutions, regarding the involvement of unpaid carers—I think that has been somewhat overlooked, if I am to be honest with your Lordships’ House. We have regional teams that have issued very practical toolkits to help hospitals implement their legal duties; we should remember that there are legal duties in this response. In addition, that is why we are involving the LGA’s better care fund support programme, as I said, as well as seeking to publish a cross-government action plan. These will be steps in the right direction, but I very much acknowledge that we do not start in a good place.

[Lord Patel (CB)]

My Lords, although the better care fund is a help, its success depends on how hospitals and the LGA work together. Would the Minister agree that the fund is still used to fund short-term gaps, particularly winter pressures, and that the yearly funding cycle does not help for longer-term planning? Could that be improved?

[Baroness Merron (Lab)]

I can see the pressure and difficulties that can bring. There is a range of reasons why discharges do not take place in a timely fashion—not just processes but the interface between health and social care, and capacity. As we look at how we involve carers and improve discharge rates, matters of funding will be key.

[Lord Kirkhope of Harrogate (Con)]

My Lords, we live in a world where we have constant criticism, both of government—rightly, quite often—and of many individuals for their behaviour. But here we have a situation where the health service and, indeed, society are being saved many billions of pounds as a result of the work of people who volunteer to care for their relatives and others—those in the voluntary sector, in our hospice movement and all over the health service. Without these people, we would be in real trouble. Is it not marvellous, and can we perhaps commend them and approve of what they are doing both to save us resources and to show that people are basically good?

[Baroness Merron (Lab)]

I am very grateful to the noble Lord. I and the Government are certainly cognisant of the role that unpaid carers play. That is why, last year, we increased the carer’s allowance weekly earnings limit. This was the largest cash increase ever and means that 60,000 additional carers will qualify. That is part of our recognition, but I share the views the noble Lord has given and the comments about my noble friend Lady Pitkeathley and Carers UK—I am grateful to all.

GP Contract

Baroness Merron Excerpts

Tuesday 17th March 2026 Lords Chamber

[Lord Kamall (Con)]

My Lords, I am grateful to the Government for this repeat. The Minister in the other place pointed to 1.3 million referrals being diverted through something called “advice and guidance”. This means that GPs must seek input from a specialist before making a referral, but some professional bodies have warned that this mandatory approach will risk creating barriers to patients accessing specialist care and may compromise patients’ safety if they are not referred in a timely manner. To address these concerns, can the Minister set out what clinical safeguards are in place where a GP believes a patient needs to be referred directly to a specialist but is instead referred to go through this advice and guidance process? If a patient comes to harm as a result of any delay due to not being referred directly to a specialist, who will bear responsibility for that decision and how will accountability be determined?

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

As the noble Lord said, we have seen 1.3 million people diverted since April 2025. Otherwise, they would have been added to the electives waiting list, in clinical terms, unnecessarily. The main thing I can say to the noble Lord on advice and guidance is that I think the figures speak for themselves. That is why we are embedding it into the core contract. We are recognising it as routine practice. It provides more predictable funding and removes annual sign-ups. More generally, I must emphasise to the noble Lord that it does not take away a GP’s right to refer. That remains a matter of clinical judgment and, as in all things, clinical judgment will rule the day.

[Lord Scriven (LD)]

My Lords, the Government have now mandated a cast-iron guarantee that GP practices’ online portals must remain open in core hours, but a portal is merely a digital letterbox, it is not a clinician. Has the department conducted a full clinical risk assessment of the danger of red-flag symptoms being buried in high volumes of routine digital traffic? If so, will the Minister publish those findings today? If not, how can the Minister guarantee that this always-on requirement is clinically safe for patients?

[Baroness Merron (Lab)]

When we develop digital approaches, I have to say again that the figures speak for themselves on, for example, patient satisfaction with general practice: people believe it is finally moving in the right direction. According to the Office for National Statistics, some 77% of people described contacting their GP as easy. That was in January this year, and it was up from just 60% in 2024. I think the public are giving their own view. On development of online access, we always ensure that patient safety is at its heart. I cannot give the commitment to publish that the noble Lord seeks, but I will be very happy to write to him and place a copy of the letter in the Library of the House, giving all the detail about how patient safety is assured. That is core to all our work and developments.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, it is evident all over the country that there is an epidemic of sick notes. Is there anything that the Government are doing to strengthen the arm of GPs who try to resist giving a sick note on simple request?

[Baroness Merron (Lab)]

If I have understood the noble Baroness correctly—forgive me if I have not—the GP contract does not address that directly. That is obviously a more general but important point about GPs’ practices and how they deal with matters. GPs are given advice in their updated training on how to manage those situations, and I expect them to follow it.

[Baroness Gerada (CB)]

My Lords, the new GP contract appears to be baking in access over continuity: my GP, when I want to see him. How will the Government protect continuity of care, which is after all what keeps the NHS safe and provides value for money, and which patients welcome?

[Baroness Merron (Lab)]

We have already said that through our 10-year plan, and this contract very much ties into the main pillars of the plan. We found GP services in a very difficult and challenging state, as I know the noble Baroness will be more than aware. We regard GP services as the front door. We want to see that continuity of care and we expect GPs to organise it accordingly. We all understand that it is not always possible, but clearly the best form of care, whether in the community or in hospital, is on a continuous basis and wrapped around the patient’s needs, not the other way around.

[The Lord Bishop of Manchester]

My Lords, the Statement made in the other place refers explicitly to coastal areas and deprived places, and I welcome that. Will the Minister say something about how we can ensure that there is good access to GP services in rural areas?

[Baroness Merron (Lab)]

The right reverend Prelate is right to raise this. We have been very concerned for some time about the inequalities in coastal areas and areas of greatest need, where healthy life expectancy is the lowest. That includes communities with higher deprivation levels. That is why we began our reforms last year with an independent review of the outdated Carr-Hill formula. That is about the distribution of GP funding, which is fundamental to the point the right reverend Prelate makes. It is based on data that is around 25 years old in some cases, and clearly our population has changed. I look forward to updating the House when that review is concluded.

[Baroness Manzoor (Con)]

I welcome some of the criteria that are going to be used, particularly for deprived communities, in relation to access, but there remains a postcode lottery in terms of access to GPs, particularly in deprived communities. My concern is that, with some of the algorithms and IT being used as a postbox, patients are being referred directly to A&E departments. Will the Government assess in A&E departments which people are being referred that way so, that we can ensure that that loophole is addressed?

[Baroness Merron (Lab)]

It is important to say that online access does not sit alone. There is also in-person access, including telephone access if people prefer that. The intention is not—and it is not the practice—that they are just postboxes. They are dealt with. We constantly keep those approaches under review. Our expansion is about access to GPs. That includes, for example, in answer to some of the points that have been raised today, including by the noble Baroness, repurposing £292 million from primary care network incentive scheme moneys to fund additional GP sessions to create more capacity, because that is necessary whatever way people make contact. That was based on feedback from the BMA, which said this would be a more effective use of funding.

[Baroness Browning (Con)]

Is there any monitoring of when GPs insist on a telephone call rather than a face-to-face meeting, or when things are sent by email to the surgery and they are then triaged by others rather than their normal GP? Is there any identifying of just how many cases they miss of those very serious conditions that subsequently end in serious illness or even death? I am particularly thinking of such things as sepsis, where the symptoms are not always so overt to begin with as they are as the disease progresses. Is there any monitoring of how successful these new systems are in picking up those types of diseases?

[Baroness Merron (Lab)]

All the systems are under constant review. It might be helpful if I point out to the noble Baroness that one of the key things in the GP contract for 2026-27 is the requirement for all clinically urgent patients to be dealt with on the same day. That is not required currently; I think that will make a huge difference. Again, I emphasise that we will not be defining “clinically urgent”: it will be down to practices to use their clinical judgment, and that is the right place.

NHS: In-house Software Capabilities

Baroness Merron Excerpts

Monday 16th March 2026 Lords Chamber

[Viscount Hanworth]

To ask His Majesty’s Government what plans they have for sustaining and enhancing the in-house software capabilities of the NHS.

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

My Lords, NHS Digital services are built and run to rigorous Government Digital Service standards. They are secure, user-centred, interoperable and continually improving. National Health Service England has significantly expanded its in-house engineering and data capability, and it is reducing its reliance on outsourced systems and strengthening operational resilience. These measures ensure that health and care data is available in all clinical settings to improve outcomes for patients, while delivering value for money to the taxpayer.

[Viscount Hanworth (Lab)]

I thank the Minister for that reassuring Answer. The NHS has had a disastrous history of outsourcing its IT technology, which has wasted millions of pounds. A requirement of outsourcing is that there must be sufficient in-house expertise to properly assess the need for outside assistance and the quality of whatever assistance is on offer. In the absence of such expertise, outsourcing can be perilous. Moreover, given the requisite in-house expertise, outsourcing may become unnecessary. At a time when a host of novel IT solutions are becoming available, the IT staff of NHS England are seeing their numbers radically reduced. At the same time, the NHS is becoming increasingly dependent on the services of large American IT corporations. Can we be assured—genuinely assured—that history will not be repeating itself?

[Baroness Merron (Lab)]

My noble friend is right to point out the history. The NHS previously relied very heavily on large, outsourced IT systems that, in some cases, led to inflexibility, high long-term costs and limited NHS control over core platforms and data. I was glad to arrange for my noble friend to meet the chief data and analytics officer at NHS England last Wednesday. I hope that, like me, he was reassured that NHS England has very much shifted its model towards building and operating critical digital services in-house, in line with the standards that I referred to in my initial Answer.

[Baroness Watkins of Tavistock (CB)]

My Lords, cyber security is an essential element in any system, but nowhere more so than when people’s health records are being maintained. Many security breaches are attributed, at least in part, to human error. What investment are His Majesty’s Government making to train front-line staff in the new systems and provide continuous professional development to achieve the 10-year digital healthcare plan?

[Baroness Merron (Lab)]

The straightforward answer is that we are doing exactly that. It is important to say that our front-line digitisation—our move from analogue to digital—is not something for the sake of it; we are doing it because it is improving efficiency and outcomes. For example, a 94% coverage of electronic patient records is expected by the end of this month, and the digitally mature trusts show a 13% lower cost per admission. That is a prize worth having, but we can do it only through the systems and training that the noble Baroness seeks.

[Lord Kirkhope of Harrogate (Con)]

My Lords, I support what the noble Viscount said. The history of software in the National Health Service is nothing less than a disaster. Coupled with that is a very unfortunate situation where some of the companies that have been responsible for these messes in the NHS are still on the Government’s procurement lists and are still getting contracts from the Government. Surely more attention should be paid to that, and we should curb that as soon as possible.

[Baroness Merron (Lab)]

If the noble Lord has particular companies in mind, he is most welcome to raise them with me. It is important that we look at what NHS teams have done: they have designed, built and maintained national platforms. The NHS app is an example; I am sure that many noble Lords will be familiar with it. That is going to be our digital front door to the NHS. In addition, there is the NHS login and core national infrastructure. All these mean full NHS ownership, governance and control. Supported by £2.5 billion of investment in 2025-26, we are, as the noble Lord seeks, expanding NHS in-house digital capability to reduce the reliance on large suppliers.

[Lord Scriven (LD)]

My Lords, last week’s catastrophic attack on Stryker by Iranian-linked actors paralysed supply of some critical surgical equipment across the NHS. Does the Minister agree that our total reliance on vulnerable third-party global medtech platforms is a serious security risk? How will the Government ensure in-house expertise and procurement software so that the NHS can bypass compromised commercial networks during such crises?

[Baroness Merron (Lab)]

Cyber attacks across our whole government are extremely concerning, and that is why we have built resilience. On health and social care specifically, I can assure the noble Lord that, in 2025-26, we invested £75 million across health and social care; that built on the £375 million invested since 2017. When I had responsibility for the blood transfusion service, my own experience was that, where there was a cyber attack, we had the systems in place.

[Lord Kamall (Con)]

My Lords, there is always a very difficult balance between keeping something in-house or outsourcing it, and we should not forget the national programme for IT in the NHS in the early 2000s, which ended up costing between £10 billion and £20 billion. My question is on the company Palantir. The Minister will be aware that there are a range of views on Palantir. Some say that it is the best software available and that no one can match it; others say that they are worried that it will lock the NHS in long-term and scrape data for other uses. What specific measures have NHS England and the department put in place so that, in the event that the Palantir contract is not renewed, the healthcare system will be able to move seamlessly to another supplier?

[Baroness Merron (Lab)]

That seamless movement is an important point generally, but the federated data platform does not centralise or sell patient data. Data remains firmly under NHS control, and access is strictly governed. It is fully auditable and used only for approved patient benefit and NHS benefit. Palantir operates strictly under the instruction of NHS England and it does not, as I said, own or control NHS data. That access is tightly governed. In response to the earlier question, I note that the federated data platform to which the noble Lord refers is cyber resilient and subject to rigorous contractual, legal and information governance controls.

[Baroness Bennett of Manor Castle (GP)]

My Lords, my question also relates to the federated data platform. I am sure the noble Baroness is aware that more than 50,000 patients have written to their local trust boards asking not to have their data placed on it. The Greater Manchester ICB, serving 2.8 million patients, has said that this does not present value for money and is a big public trust issue. Palantir is of course owned by Peter Thiel and Alex Karp, who are closely associated with the Trump regime and have very right-wing and anti-democratic views. Does the Minister acknowledge that this association with Palantir is damaging our NHS?

[Baroness Merron (Lab)]

I would first look at delivery: the federated data platform has enabled nearly 100,000 extra operations, removed over 600,000 patients from waiting lists and reduced unnecessary bed days by 15%, as well as driving a 10% improvement in cancer diagnosis—so people are being diagnosed sooner because the system is working more efficiently, and that is important. This is a three-year contract given in 2023. I refer the noble Baroness to the comments I made to the noble Lord, Lord Kamall, about the rigorous contract due diligence for all commercial agreements, including with Palantir.

[Lord Patel (CB)]

My Lords, it is historically true that the NHS wasted a lot of money, but this was partly because the development of digital services was in-house. Currently, things are looking much better, and the classic example is the development of the NHS app. However, I will ask the Minister about the health research data service that will be established. Patients should have confidence in data that is used and collected for research, partly because of the recent report on UK Biobank, where the researchers published the codes they were using to access data for research. It has to be made absolutely certain that the public have the confidence in the data that is used.

[Baroness Merron (Lab)]

Absolutely—public confidence is really important, and the debate around this today perhaps emphasises the need to communicate the realities of what is going on. But giving the NHS greater control and long-term value for money, as well as protecting privacy and improving public trust while improving outcomes, is the way forward. But the noble Lord is quite right, and we will ensure that we seek to build that confidence still further.

NHS: Heart Valve Disease

Baroness Merron Excerpts

Thursday 12th March 2026 Lords Chamber

[Lord McCabe]

To ask His Majesty’s Government what assessment they have made of whether NHS services for heart valve disease support healthy ageing and ensure older adults receive equitable access to timely treatment.

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

My Lords, to accelerate the 10-year health plan ambition to reduce premature mortality from heart disease and stroke by 25% and to tackle unwarranted variation across the country, this year we will publish a new cardiovascular disease modern service framework. It will support consistent, high-quality and equitable care while fostering innovation across the cardiovascular disease pathway.

[Lord McCabe (Lab)]

I thank my noble friend the Minister for her response. The guidelines of the European Society of Cardiology and the European Association for Cardio-Thoracic Surgery suggest that the UK is falling behind in terms of diagnosis and treatment for heart valve disease. Can she give an assurance that the new framework will take full account of these guidelines and pay particular attention to the diagnosis and treatment of older people?

--- Later in debate ---

[Baroness Merron (Lab)]

I am most grateful to my noble friend for his work in promoting the improvement of services for those with heart valve disease. I can say—it might be helpful—that we are driving down cardiology waiting lists. The number of people waiting over 52 weeks from referral to treatment was down 9% between the end of December 2025 and the end of January 2026. Yes, the modern service framework will accelerate this progress to reduce premature mortality and will set standards for the best evidence-based interventions.

[Lord Patel (CB)]

My Lords, management of people with heart valve disease is truly a low-hanging fruit in reducing deaths due to cardiovascular disease. Some 400 people a year die on waiting lists for transcatheter aortic valve implantation. It is simple for people who have breathlessness or suffer from decreased exercise tolerance or chest pain. Even I, within five minutes, could diagnose whether they were at risk of heart valve disease or not—line them up and I will tell you.

[Baroness Merron (Lab)]

I am reassured that the noble Lord can assist within five minutes—we might consider engaging him. The serious point is that early diagnosis is important, and the modern service framework will build on the work that has already been done. I know that the noble Lord is aware of this, but just the use of a stethoscope is the way to make an early and initial diagnosis. We are upping our game here by bringing in AI-assisted stethoscopes, which will be a massive assistance for diagnosis.

[The Lord Speaker (Lord Forsyth of Drumlean)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely. I invite her to ask her supplementary question.

[Baroness Brinton (LD) [V]]

My Lords, the Resuscitation Council UK, the British Cardiovascular Society and the National Council for Palliative Care have excellent and sensitive joint guidance on the use of cardiovascular implants towards the end of life. My family’s experience in different parts of the country shows that not all cardiac surgeons take account of end-of-life care in patients. In one case, a patient was told that she would not be allowed to leave the hospital until she had a pacemaker, despite the fact that, at 88 years old, she did not want one and, two years on, bitterly regrets finally agreeing. Can the Minister say whether the review that she just mentioned will ensure that surgeons follow the guidance and work not only with patients but with their other clinicians?

[Baroness Merron (Lab)]

I am sorry to hear the experience that the noble Baroness describes. We are indeed seeking to have a whole-team approach to the whole patient. I absolutely agree with her that it should indeed consider where somebody is in their life stage.

[Baroness Browning (Con)]

The noble Lord, Lord McCabe, referenced older people in particular in his Question—he did not say where he drew the line at old, but perhaps I will declare an interest. What happens, for example, when really older people need heart surgery but are considered to be an anaesthetic risk? With new developments in heart surgery, I wonder whether the Minister can tell us what progress there has been in carrying out procedures without necessarily needing to have invasive surgery.

[Baroness Merron (Lab)]

I can privately share with the noble Baroness that I suspect that “older people” covers both of us: it is over 65. The point that she makes is important. The option of what is called a TAVI intervention is far less invasive than a surgical intervention, as she referred to. That activity has grown significantly year on year, with something like a 16% increase on 2024-25. That is a very welcome step forward as we move towards minimally invasive procedures.

[Baroness Andrews (Lab)]

My Lords, it is obvious that early testing for heart valve disease is an exemplary form of preventive medicine, which is where we all need to get to. The House owes my noble friend gratitude for organising heart valve testing through the Heart Valve Voice, which was extremely successful. Does my noble friend agree with me that, because of the absence of routine testing, we should look for opportunities to link heart valve testing with the other sorts of routine testing where there is a captive audience? These could include, for example, occasions when people go for cholesterol testing or possibly even flu vaccination, which are becoming more routine? If we could get that in operation at an early stage, it could make a significant difference.

[Baroness Merron (Lab)]

My noble friend is right and, certainly, as we move through our 10-year health plan, the opportunity to make every contact count is very important. I refer my noble friend to the advances that we have made in services available in community pharmacies, because measuring blood pressure is hugely important. Our pharmacies, I am glad to say, have delivered nearly 4.2 million blood pressure monitoring checks since October 2021. We have more than 7,500 pharmacies now available in our high streets delivering this service. That is the kind of thing that my noble friend is looking for.

[Lord Kakkar (CB)]

My Lords, I declare my interest as chairman of King’s Health Partners. The Minister made reference to AI stethoscopes aiding in the diagnosis of patients with heart conditions. The evidence for this was established in a very large trial—the TRICORDER trial—involving some 1.5 million patients and more than 200 general practices in our country. What it demonstrated was, compared to the use of the ordinary standard of care, a doubling of the rate of diagnosis for heart failure and a tripling of the rate of diagnosis for heart arrhythmias. The problem was that, subsequent to the trial, the diagnostic rate did not increase, suggesting that it is necessary to invest in training and the establishment of new working pathways to ensure that innovation can be properly established in routine clinical practice. Is His Majesty’s Government funding such activity?

[Baroness Merron (Lab)]

The noble Lord is right to make the point that innovation research is one part of it, but it is actually its implementation that matters. However, the faster and more frequent detection of cardiovascular conditions is the key thing and training is certainly a part of that.

[Lord Kamall (Con)]

My Lords, I am grateful to the Minister for giving me time for this question. She will be aware that studies analysed in around 155,000 diagnoses of aortic stenosis in England have found that women were significantly less likely to be referred to specialists and far less likely to receive valve replacement. This also applies to patients from deprived areas and in some ethnic minority groups. What assessment have the Government made of these disparities and what action are the noble Baroness’s department and NHS England taking to ensure that patients have access to heart valve treatment regardless of their gender, ethnicity or where they live?

[Baroness Merron (Lab)]

The noble Lord is quite right: women are underdiagnosed, they are undertreated and some ethnic minority groups face poorer access. That is why I very much welcome the fact that, in the framework to which I referred, dealing with inequalities will be absolutely key. Research, in which we are partnering with the British Heart Foundation, will focus on tackling inequalities in higher-risk groups as well as unequal cardiovascular disease outcomes. Inequalities and tackling them will be at the heart of all our acceleration of progress as well as our research.

Human Medicines (Amendment) Regulations 2026

Baroness Merron Excerpts

Wednesday 11th March 2026 Lords Chamber

Moved by

[Baroness Merron]

That the draft Regulations laid before the House on 29 January be approved.

Relevant document: 51st Report from the Secondary Legislation Scrutiny Committee. Considered in Grand Committee on 9 March.

Motion agreed.

Tobacco and Vapes Bill

Baroness Merron Excerpts

3rd reading
Monday 9th March 2026 Lords Chamber

Moved by

[Baroness Merron]

That the Bill be now read a third time.

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

My Lords, I will make a short statement on the position regarding legislative consent on this Bill. The Bill is UK-wide, and it has been developed in partnership with the Scottish Government, the Welsh Government and the Northern Ireland Executive. A legislative consent Motion was received from the Northern Ireland Assembly on 10 February 2025, from the Scottish Parliament on 29 May 2025 and the Senedd on 9 December 2025.

Following further amendments to the Bill on Report, supplementary legislative consent Motions have been sought from the Scottish Parliament and the Senedd. It has not been possible to complete this process before Third Reading. However, noting the strong support of the Scottish and Welsh Governments, we are hopeful that this process will conclude shortly. The Northern Ireland Executive has confirmed that their current legislative consent Motion is sufficient. I beg to move.

Schedule 16: Advertising etc: audiovisual and radio broadcasting

Amendment 1

Moved by

[Baroness Merron]

1: Schedule 16, page 169, line 39, leave out “(a) and (b),” and insert “—
(a) in paragraph (a),”Member’s explanatory statement
This makes a structural change to facilitate my amendment to Schedule 16, page 169, line 40.

[Baroness Merron (Lab)]

My Lords, Amendments 1 to 5 are minor and technical, and stem from the amendments that the Government made on Report on advertising. The amendments ensure consistency across the advertising-related restrictions in the Communications Act 2003. In particular, they will ensure that a business which manufactures or sells more than one type of product, such as vaping products and nicotine products, is in scope of the restrictions on sponsorship of prohibited products. It was always the Government’s intention to capture any business which manufactures or sells prohibited products, no matter how many different types of product they sold or manufactured. The amendments therefore provide consistency across the advertising-related restrictions and prevent the creation of a potential loophole. I beg to move.

Amendment 1 agreed.

Moved by

[Baroness Merron]

2: Schedule 16, page 169, line 40, at end insert—
“(b) in paragraph (b), after “other tobacco products” insert “, herbal smoking products or cigarette papers (or of two or more of those products)”.”Member’s explanatory statement
Section 368G(1)(b) of the Communications Act 2003, as amended, will refer to an undertaking whose principal activity is the manufacture etc of cigarettes or certain other products. The amendment spells out that this covers an undertaking whose principal activity is the manufacture etc of two or more of those products (for consistency with other amendments).

--- Later in debate ---

Moved by

[Baroness Merron]

That the Bill do now pass.

[Baroness Merron (Lab)]

My Lords, it has been a privilege to take this landmark Bill through your Lordships’ House. Smoking is the number one preventable cause of death, disability and ill health and tobacco claims around 80,000 lives every year. While tobacco remains the greatest threat, this legislation is about protecting future generations from the harms of not only tobacco but nicotine addiction.

I extend my thanks to noble Lords who have contributed from right across the House: in particular, on the Front Benches, the noble Lord, Lord Kamall, the noble Earls, Lord Howe and Lord Russell, and the noble Baroness, Lady Walmsley. My thanks go also to the Secretary of State for his leadership and support and to former Minister Ashley Dalton MP, who advanced this Bill to your Lordships’ House.

I also want to pay tribute, as many of us do, to former Prime Minister the right honourable Rishi Sunak for his ambition for a smoke-free generation. I also thank the Chief Medical Officer, Sir Chris Whitty, for his expertise and unwavering focus, and all the officials who have played a crucial role, including the Bill team, policy teams, analysts, the Bill’s senior responsible owners, my private office and the Government Legal Department and the Office of the Parliamentary Counsel for their invaluable contributions.

Finally, I pay tribute to Ministers and officials from the devolved Governments for their collaborative approach. This is genuinely a four-nations Bill which will ensure that we create a smoke-free generation and tackle youth vaping in every corner of our country. I beg to move.

[Lord Kamall (Con)]

My Lords, we have now reached the conclusion of what many will see as a landmark Bill. I thank all noble Lords who have contributed throughout the various stages of its journey through your Lordships’ House, which began with its introduction as long ago as March last year. From these and other Benches, we heard a range of views on its various proposals and on the Bill itself. For some, it goes too far. For others, it does not go far enough. However, among all the disagreements, there were three points that I think noble Lords can agree on. First, smoking is bad for your health. Secondly, current evidence shows that vaping is less harmful than smoking tobacco. Thirdly, not vaping is healthier than vaping.

Beyond that, our debates covered a number of issues, from the evidence base to how to make vapes an attractive alternative to adults who wish to quit smoking while not appealing to children, as well as matters of individual liberty. We also debated the illicit sale of tobacco, the treatment of specialist retailers, cigarette filters, the compatibility of the Bill with the Windsor Framework and the enforcement of a regulatory regime of considerable complexity. We also probed the Government on the evidence behind some of the proposals, for example on the relative harm of heated tobacco compared with combustible tobacco for smokers who have tried vapes but did not like them, so reverted to cigarettes.

While we did not always agree, I thank the Minister and her officials for meeting my noble friend Lord Howe and me throughout the passage of the Bill. I particularly thank her for the concessions made: we particularly welcome the amendment permitting vape vending machines in secure mental health settings. These are vulnerable people in restricted environments for whom access to cessation aids is not a luxury but a genuine health need and it was right that the Bill was amended accordingly.

Independent Commission on Adult Social Care

Baroness Merron Excerpts

Monday 9th March 2026 Lords Chamber

[Lord Young of Cookham]

To ask His Majesty’s Government what progress has been made by the Independent Commission on Adult Social Care.

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

My Lords, the independent commission is making strong progress, and its work is on track. Just last week, the noble Baroness, Lady Casey, set out early recommendations for the Government to consider and take forward. This was informed by the commission’s extensive work, which included engaging with people and their families and across political parties. Later this year, the noble Baroness, Lady Casey, will launch the national conversation and publish the phase 1 report.

[Lord Young of Cookham (Con)]

I am grateful for that. Last week, the noble Baroness, Lady Casey, said that the adult social care system was held together by “sticking plasters and glue” and said on the “Today” programme that the system was “horrendous”. She is due to complete the first part of her review this year—basically, looking at getting better value from the existing system—but the second part, which will look at the long-overdue reform of the adult social care system, will not be completed until 2028. That will be too late for this Government to pass the necessary legislation, making this Parliament the fifth to have ducked this issue. The noble Baroness, Lady Casey, completed her review of grooming gangs in four and a half months. If asked, she could complete the second part of this review by September 2027, which would give us adequate time for this to be done in this Parliament. Will the Minister ask her to do just that?

[Baroness Merron (Lab)]

I understand why the noble Lord pushes this point, and I am sure that we all share his view. It has also been said that there is not a lack of good ideas, but there has been a lack of good politics. That observation has been made. The noble Baroness, Lady Casey, is chairing an independent commission and she has made it clear how complex and deep-seated these challenges are, as the noble Lord described. The 2028 date is a “by” date; the noble Baroness may report sooner, but that is a matter for her.

[Baroness Pitkeathley (Lab)]

My Lords, the noble Baroness, Lady Casey, concentrates on workforce issues. I am sure that she and my noble friend agree that patients, families and carers do not care who is employing the social care worker, as long as they are getting support. Should we concentrate on a flexible workforce that works across both agencies without boundaries to meet the changing needs of the population?

[Baroness Merron (Lab)]

That is key in the mind of the noble Baroness, Lady Casey. We need to better join up the NHS and social care workforces. We will have a workforce plan for the NHS in spring this year and we are also investing in developing our social care workforce to professionalise and respect it.

[Baroness Barker (LD)]

My Lords, last summer, local authorities came under pressure from the Department of Health to make people and their families go through assessments for continuing healthcare. From the speech by the noble Baroness, Lady Casey, on 4 March, we now know that ICBs were at the same time employing private companies to make sure that their CHC payments went down. Will the Minister undertake to review all the applications for continuing healthcare to each ICB throughout this financial year and publish the results, showing how many were accepted, how many were accepted on appeal and how many families were sent on a runaround between the different agencies?

[Baroness Merron (Lab)]

What the noble Baroness describes—people getting the runaround—is, of course, unacceptable, and we have discussed this a number of times. I would be pleased to take back her suggestion to the Minister for Care, Stephen Kinnock.

[Lord Laming (CB)]

My Lords, for what it is worth, I congratulate the noble Baroness, Lady Casey, on her initial findings, which illustrate all too well how serious the situation is. The problem will be made worse by things such as, as the Minister just reported, the NHS workforce plan that will be produced in the near future. That is welcome as far as it goes, but it illustrates the separation between NHS services and local authority services. The reality is that there are very few people using adult social care services who are not simultaneously looking to the health service for their continuous needs. Will we continue to do everything possible to bridge the gap between the two services?

[Baroness Merron (Lab)]

Yes, indeed. We have three core foundations in place in our government objectives for adult social care, one of which is—to the point made by the noble Lord—strengthening the join-up between health services and social care services, because people need to experience more integrated, person-centred care. I am glad that the noble Lord welcomes the immediate actions, set out by the noble Baroness, Lady Casey, that the Government must take on adult safeguarding, dementia and motor neurone disease. We are not wasting any time in taking those recommendations forward.

[Lord Kamall (Con)]

My Lords, picking up on the points made by the noble Baroness, Lady Pitkeathley, and the noble Lords, Lord Young and Lord Laming, when we were in government, we published a White Paper on an integrated national health and care service, to be available for patients from birth to their later years. When the new Government were elected, as was their prerogative, the Secretary of State talked about creating a separate national care service, but we have heard little since. Can the Minister tell your Lordships’ House whether we will have to wait until the next stage of the Casey commission, in 2028, to get any further details at all, especially on how it will work in tandem with our healthcare system, or can we expect any clues or hints before then?

[Baroness Merron (Lab)]

The noble Lord does not have to wait because, in addition to the work by the noble Baroness, Lady Casey, which, as I have said, is independent, she has set out immediate recommendations, which we are working on. We have already made commitments on the disabled facilities grant for housing, so that people can stay in their own homes. We have announced a £500 million investment in the first ever fair pay agreement, and we are uplifting social care allowances to support disabled people more than they ever have been. Those are just some examples, and I would be very happy to direct the noble Lord to other ways in which we are already taking action.

[The Lord Bishop of Norwich]

My Lords, in 2023, the Archbishops’ Commission on Reimagining Care encouraged a conversation not only between provider and recipient but with all those involved in care and support, to create rounded and fulfilled lives. That includes the voluntary sector, community groups and faith groups, which provide befriending and bereavement support and acts of worship in care homes. What plans does the Casey commission have to ensure that all parties participate in the national conversation mandated in its terms of reference?

[Baroness Merron (Lab)]

As I said earlier, that will be a matter for the noble Baroness, Lady Casey. But I have every confidence that all the groups the right reverend Prelate referred to will be included, not least because the noble Baroness and the secretariat have already met, travelled widely and had many conversations, including with some 400 groups and individuals, focusing particularly on those with lived experience.

[Lord Sikka (Lab)]

My Lords, 83% of adult social care is controlled by private equity. Its business model includes high prices, profiteering, low wages, asset stripping and tax abuse. It has profit margins of between 20% and 40% from adult social care. When are the Government going to end profiteering in this sector and ensure that social care is provided by not-for-profit entities only?

[Baroness Merron (Lab)]

Various sectors have their role to play, and that includes the private sector, the voluntary sector and the public sector. As I have mentioned, we are building a national care service. It will focus on a high quality of care, greater choice and control for individuals and joined-up neighbourhood services, exactly as noble Lords request.

[Baroness Butler-Sloss (CB)]

What can the Government do about bed blockers before the final report?

[Baroness Merron (Lab)]

I assume that the noble and learned Baroness is referring to people who are staying in unsuitable settings, such as hospitals, for too long because an alternative is not available. We are looking at reforming the better care fund, which assists a greater joined-up approach, and we are bringing in neighbourhood services so that people can be cared for nearer home. We are also harnessing technology—I have witnessed many good examples of that—whereby people do not have to be in hospital but can be at home, and the money we are investing so that people can improve accessibility within their own homes will also assist people to get back home.

Human Medicines (Amendment) Regulations 2026

Baroness Merron Excerpts

Monday 9th March 2026 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Human Medicines (Amendment) Regulations 2026.

Relevant document: 51st Report from the Secondary Legislation Scrutiny Committee

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

My Lords, I am glad to introduce these regulations, which will take effect from 31 March 2026. This statutory instrument is technical, relating to the preparation and administration of vaccines.

In autumn 2020, in response to the Covid-19 pandemic, multiple temporary amendments were made to the Human Medicines Regulations 2012 to support the rollout of the Covid-19 and influenza vaccination programmes. Three of these amendments were extended in 2022 and 2024 following public consultation, and are due to lapse on 1 April 2026.

These regulations look to retain several provisions within those amendments—which have been utilised in the Covid-19 and influenza programmes for five years—as permanent legislation and expand them to other vaccines. They are designed to build on the benefits that the amendments have provided to date, as well as on the wider lessons learned during the pandemic and in recent polio and MMR vaccine catch-up programmes. I will briefly set out what each of these regulations does, and what amendments this instrument will make to them.

Regulation 3A(1) and (2) of the 2012 regulations enable trained healthcare professionals, or staff under the supervision of trained healthcare professionals, to conduct the final stage of assembly and preparation of Covid-19 vaccines without additional marketing authorisations or a manufacturer’s licence being required. This enabled bulk assembly of Covid-19 vaccines during the pandemic. Given that we are no longer in a pandemic and have taken a more targeted approach to recent Covid-19 vaccination campaigns, this instrument allows these provisions to lapse from 1 April 2026.

Regulation 3A(3) and (4) permit holders of a wholesale dealer’s licence who do not hold a manufacturer’s licence to relabel Covid-19 vaccines to reflect changes in shelf life resulting from product thawing. This instrument retains these provisions as permanent legislation and expands them to include any vaccine against an infectious disease, which will helpfully support flexibilities in the supply chain now and in the future.

Regulation 19 allows Covid-19 and influenza vaccines to be moved between different NHS service providers at the end of the supply chain, without the need for a wholesale dealer’s licence. This instrument retains these provisions as permanent legislation and expands them to include any vaccine against an infectious disease, with relevant safeguards in place to regulate its use.

--- Later in debate ---

[The Earl of Effingham (Con)]

My Lords, I thank the Minister for introducing these regulations. Vaccination remains one of the most effective public health interventions available to us all. The flexibilities introduced during the pandemic enabled the rapid deployment of both Covid-19 and influenza vaccines at scale. It is understandable that the Government now seek to make certain arrangements permanent and extend them to other infectious diseases.

His Majesty’s loyal Opposition support a vaccination system that is resilient, agile and capable of responding to future public health requirements. Expanding the role of community pharmacies and broadening the vaccinator workforce may well assist in that aim, provided that safeguards are robust. However, it would be wrong to wave this past without scrutiny, as temporary powers become permanent.

The introduction of a permanent vaccine group direction mechanism is a significant change. Flexibility must be matched by clarity. If a patient experiences a serious adverse reaction following vaccination under a vaccine group direction, where does the ultimate legal and clinical responsibility lie? Is it with the authorising body, the supervising clinician, the employer or the individual vaccinator? It would be helpful to have that clearly set out by the Government.

On workforce scope, the regulations expand the occupational health vaccinator provisions and align them with professions able to operate under a patient group direction. Can the Minister clarify the criteria used to determine inclusion? Were decisions based on professional registration, competence in administrating injectable medicines, workforce capacity or other considerations? I am sure all noble Lords agree that consistency and safety are paramount.

On public confidence and uptake, greater flexibility does not automatically mean higher vaccination rates, so how will the Government ensure that these changes actually translate into improved uptake among eligible and vulnerable groups? What benchmark will the Government use to evaluate the success of the measures?

A full impact assessment has not been produced. Although the stated impact may be minimal, these are system-wide changes. Reporting under the Medicines and Medical Devices Act occurs on a two-year cycle. Does the Minister consider that sufficient, or will interim data on safety, workforce, deployment and uptake be made available?

These are important questions to answer, and His Majesty’s loyal Opposition do indeed support a framework that is safe, proportionate and future-proofed, but one which has been properly stress-tested.

[Baroness Merron (Lab)]

My Lords, I am most grateful to noble Lords for participating in this debate. I appreciate the welcome for these measures and the acknowledgement of their importance from the Opposition Front Bench and the noble Baroness, Lady Bennett. I will turn to some of the questions. I will, of course, be very pleased to write to noble Lords on anything I am unable to answer.

The noble Baroness, Lady Bennett, raised the issue of provision of Covid-19 vaccinations and remarked that Covid is still very much with us; I am not quoting her directly but that is what I took from what she said. In answer to that, this is a big change, but it is now a relatively mild disease—I stress relatively—for, I stress again, most people. It can still be unpleasant, but I am glad to say that the rates of hospitalisation and death have reduced significantly since the pandemic. These proposals, as I mentioned in my opening remarks, are very much about building on the successes that we saw in the Covid-19 and the flu vaccination programmes. As I mentioned, they are about taking that best practice and ensuring that we have a vaccination system in the future.

The noble Baroness also asked about private vaccination services. It is still the case, of course, that the NHS offer of vaccination is there for all those who are at higher risk of serious outcomes; there are a number of such people and we want to ensure they are properly looked after. Private provision is also available, as the noble Baroness said, as with some other vaccines. The availability and price of any vaccines provided through the private market is a matter for the private sector and not something that we seek to regulate.

On travel vaccines, as I am sure the noble Baroness is aware, a number of such vaccines are available free on the NHS through GP surgeries. These are against polio, typhoid, hepatitis A and cholera. These vaccines are free because they protect the public against those diseases that are thought to carry the greatest risk if they were to be brought into this country.

[Baroness Bennett of Manor Castle (GP)]

One of the vaccines on the list of those that are only available privately is against typhoid. There was a publication last week, I believe, looking at the spread of antimicrobial resistance to typhoid and the fact that antibiotics that we have been using against typhoid for decades are now increasingly not working. Can the noble Baroness assure me—again, I will understand if she wants to write—that the Government keep this constantly under review? Drug-resistant typhoid would be very serious; 10 or 20 years ago we might have thought that we could just treat people, but that may no longer be the case.

[Baroness Merron (Lab)]

I can certainly assure the noble Baroness that effectiveness is kept under review. I know that she was not questioning this, but I also re-emphasise that typhoid vaccinations are available free on the NHS from GP surgeries. It is important to give that reassurance.

The noble Earl, Lord Effingham, asked where ultimate legal and clinical responsibility lies. An appropriate person has to be responsible for ensuring that only fully competent qualified and trained health professionals are individually authorised to use the most recently approved version of the VGD. That authoriser is usually a clinical manager or service lead. Authorised health professionals working under VGDs must understand their legal and professional responsibilities before they use VGDs. This follows the same principles set out in the NICE guidance. In that respect, I say to the noble Earl that this is not a new situation, but I accept it is quite right to ask about that.

The noble Earl also asked how we will ensure that changes translate into improved uptake. He will know our commitment to stabilising and improving uptake across the vaccination system, including, importantly, among those in underserved communities and groups that have historically lower vaccination rates. We have set out actions to improve uptake in our 10-year plan, as well as in our strategy Giving Every Child the Best Start in Life. We are also taking a multipronged approach, if I can put it that way, to improving vaccination uptake. That includes exploring whether there are other settings, such as community pharmacies and health visitors, who can assist in this. We also seek to continue to deliver clear messaging on the risks of disease and the benefits of vaccination. Importantly, we are investing in better digital services and data so that we know where we can target our efforts.

With regard to the question about community pharmacies having the necessary training and equipment if there are, unfortunately, adverse reactions, all providers and trainers have to ensure that those who are involved in vaccination have the right, high-quality training that enables them to deal with such reactions. I should say—I hope that this is a reassurance—that the amendment does not change the training expectations of those staff. Also, they are consistent: it does not matter where the service is being delivered.

A full impact assessment covering these amendments was carried out in 2023. It considered that making the relevant parts of the regulations permanent and expanding them is unlikely to create any significant additional impact. The amendments delivered by this SI are not controversial and do not reach the cost to business threshold; as such, a de minimis assessment was carried out and published on GOV.UK.

I hope that noble Lords will accept that, in amending these regulations, the Government are seeking to maintain important safety measures while increasing the effectiveness of the system’s supply chain and workforce. With that, I thank noble Lords for their contributions and questions.

Motion agreed.