Hospices: Funding

Baroness Merron Excerpts

Thursday 24th October 2024 Lords Chamber

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

My Lords, I am grateful for the thoughtful and constructive approach that noble Lords have taken to this important issue and for a number of considered proposals, which I will share with my colleague, Minister Stephen Kinnock, who is responsible as the Minister for Care. I know he will be interested.

I congratulate the noble Lord, Lord Farmer, not just on securing this debate but on the way he set out his thoughts, which enabled the debate to be so constructive and sensitive to the issues at hand. I share the thanks given by a number of noble Lords, and take this opportunity to thank all those working or volunteering—as my noble friend Lady Pitkeathley highlighted—in the palliative and end-of-life care sector, including in hospices, for the invaluable support, care and compassion that they provide to people and their loved ones when they need it most.

Like the noble Earl, Lord Effingham, and other noble Lords, I pay tribute to the contribution of Dame Cicely Saunders. She was indeed—and can be regarded very much as—a pioneer. Many people in this Chamber and outside have also played their part, and I thank them too.

Approximately 600,000 people die each year in the UK and that figure is set to increase as we have an ever-ageing population. That will mean an increase in the number of people who need palliative and end-of-life care. As we have heard today, palliative care can help in the hardest of times. It is care that makes a real difference. It can make something that seems quite unbearable a bit more bearable. It can give dignity. I was very interested to hear the noble Lord, Lord Farmer, state his definition of dignity. For me, dignity is crucial at all times and never more so than at the end of one’s life. It also makes it more manageable for not just the person being cared for but their loved ones too.

As a Government, we want a society where every person receives high-quality, compassionate care, from diagnosis through to the end of life. While the majority of palliative and end-of-life care is provided by NHS staff and services, we recognise the vital part played by voluntary sector organisations. Many noble Lords know that it is difficult to quantify how much palliative and end-of-life care is being provided at national or local integrated care board level, because care is provided across multiple settings, including in primary care, community care and hospitals, as well as in hospices. It is delivered by a wide range of specialist and generalist health and care workers, who provide care for a wide range of needs. These include, but are not always exclusive to, palliative care.

I recognise that there are more than 200 charitable hospices supporting more than 300,000 people in the UK with life-limiting conditions every year. As noble Lords have observed, most hospices are charitable, independent organisations that receive some statutory funding for providing NHS services. On the point about funding, in England integrated care boards are responsible for commissioning palliative and end-of-life care services to meet the reasonable needs of their local populations. On the point raised by the noble Lord, Lord Farmer, and other noble Lords, ICBs are responsible to NHS England, which has published statutory guidance on palliative and end-of-life care to support commissioners with this duty. It includes specific reference to ensuring that there is sufficient provision of specialist palliative care services and hospice beds, and future sustainability.

The noble and right reverend Lord, Lord Sentamu, the right reverend Prelate the Bishop of London and the noble Lord, Lord Farmer, raised the issue of variation by ICB area. It is important to note that this is in part—I emphasise “in part”—dependent on what is already available in terms of services, along with local needs. Noble Lords will recall the Health and Care Act 2022, which was a key moment. I remember the noble Baroness, Lady Finlay, being very involved in getting palliative care services added to the list of services an ICB must commission in response to the needs of its local population.

In addition to the guidance and service specifications, NHS England has commissioned the development of a care dashboard. The relevance of that is that it brings together all the relevant local data into one place and it will help commissioners to understand the needs of their local population and give them the ability to filter the available information—for example, by deprivation or ethnicity. That is meant to enable ICBs to put plans in place to track and address the improvement in health inequalities.

I will refer to the highly sensitive area of assisted dying, which was raised by the noble Lords, Lord Farmer and Lord McColl, and other noble Lords. I reconfirm to your Lordships’ House that, if the will of Parliament is that the law on assisting dying should change, this Government will work to ensure that it is implemented in the way that Parliament intended and is legally effective. I add that, irrespective of whether the law changes on this matter, we will and must continue to work towards providing high-quality, compassionate palliative and end-of-life care for every person who needs it.

I shall briefly look to the future and say to my noble friend Lady Pitkeathley, who raised the matter of research, that through the National Institute for Health and Care Research the department is investing £3 million in a new policy research unit in palliative and end-of-life care. The unit was launched at the beginning of this year and it will build evidence in this area. To respond to the right reverend Prelate the Bishop of London, it will have a specific focus on inequalities, which I very much welcome.

Noble Lords will be aware that this Government have committed to developing a 10-year plan to deliver an NHS that is fit for the future. We will be considering a whole range of policies, including those that impact people with palliative and end-of-life care needs. I say to the noble Lord, Lord Howard, that one of the three shifts that the plan will deliver is around the Government’s determination to shift more healthcare out of hospitals and into the community. The noble Lord referred to a plan by Hospice UK and said it was looking to update it. We will certainly be pleased to hear from Hospice UK on that matter. Palliative and end-of-life care services, including hospices, will play a very big part in that shift from hospitals to the community.

I turn to some of the additional points that noble Lords have made. I say to the noble Baroness, Lady Finlay, who has made such a big contribution in this area, and the noble Lord, Lord Balfe, who has been a strong advocate, particularly in respect of children’s hospices, that we will indeed be delighted to look at the Welsh experience. Just this week I had a meeting with the Welsh Minister, so I will be following up on that.

The noble Lord, Lord Farmer, asked whether there will be a move to implement the recommendations in the APPG report that would ensure that funding flows to hospices. As I have said, we are determined to move more towards community healthcare and we will certainly work with hospice providers to understand their views as part of this work.

I am sure that we were all very moved to hear my noble friend Lord Monks share his experience of the sad loss of his son Daniel; my sincere condolences to my noble friend and to his family and friends. I heard what he and so many other noble Lords had to say about the quality of care received in hospices, and I too will pay tribute.

I will of course take up the points made by the noble Baroness, Lady Berridge, on gift aid with my colleagues in the Treasury.

I say to the noble Lord, Lord Balfe, and to other noble Lords that my colleague the Minister of State for Care has recently had meetings with NHS England to look at a way forward in the whole area of providing services. I know that he also met the noble Lord, Lord Balfe. We are particularly anxious to reduce inequalities and the work going forward will look at that.

I will review the debate and if there are particular questions that I have not answered, I will of course do so. I will also address the comments and suggestions made by the noble Lord, Lord Scriven. I thank all noble Lords, and particularly the noble Lord, Lord Farmer, for leading us in this debate.

Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024

Baroness Merron Excerpts

Wednesday 23rd October 2024 Lords Chamber

Moved by

[Baroness Merron]

That the draft Regulations laid before the House on 29 July and 15 May be approved.

Relevant documents: 1st Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the first instrument by the Secondary Legislation Scrutiny Committee, 2nd Report). Considered in Grand Committee on 22 October.

Motions agreed.

Human Fertilisation and Embryology (Amendment) Regulations 2024

Baroness Merron Excerpts

Tuesday 22nd October 2024 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Human Fertilisation and Embryology (Amendment) Regulations 2024

Relevant document: 1st Report from the Secondary Legislation Scrutiny Committee

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

My Lords, these important regulations were laid before the House on 15 May 2024 by the previous Government, and one of my early tasks in post was to approve that this change in legislation be put before Parliament. I am pleased that we have secured this time today and grateful for stakeholders’ patience.

This legislation brings us one step closer to extending the chance to start a family. The Human Fertilisation and Embryology Act 1990 provides the legislative framework for regulating fertility treatments and the use of gametes and embryos in the UK. These draft regulations amend two aspects of Schedule 3A to the 1990 Act, which were inherited from the European Union’s tissues and cells directive 2006/17/EC.

The first issue we are seeking to address in these regulations is where “partner donation” is defined as being between a man and a woman who are in an intimate physical relationship, which excludes female same-sex couples. We are in an age where social attitudes to same-sex couples and family formation are very different and, alongside this advancement in attitudes, assisted reproduction techniques have developed that now allow both female partners to take part in the creation of a child. This is through reciprocal IVF where one partner donates her egg to make an embryo with donor sperm, forming a biological link to their child; then the other partner undergoes IVF, becomes pregnant and delivers their child.

Legislation has not kept pace at all with these advances. Currently, female same-sex couples who undergo reciprocal IVF as a non-partner donation are required to have additional screening for infectious and genetic diseases. This leads to an additional financial burden for female same-sex couples undergoing this treatment. It can cost more than £1,000 when compared to opposite-sex couples undergoing IVF using their own gametes, where there is no clinical reason for the screening.

The second issue we seek to address under the 1990 Act is where a person living with HIV cannot donate their gametes to create a family, unless it is with a partner in an opposite-sex couple. Thankfully, through the advances in the treatment of HIV, such as anti-retroviral therapy, the risk of transmission is now regarded as negligible through unprotected sexual intercourse and by extension, gamete donation.

The proposed regulations would allow people with HIV who meet certain conditions to donate their gametes to known recipients, where certain conditions are met. These are: that they have an undetectable HIV viral load of less than 200 copies per millilitre, shown by two tests prior to donation; that they have been receiving anti-retroviral treatment for at least six months prior to donation; and that the recipient knows of the donor’s HIV diagnosis and provides informed consent.

The proposed regulations will also modify the definition of partner donation to include female same-sex couples, allowing them to undergo the same testing requirements as opposite-sex couples. The regulations also create a new defined term of “partner donated egg” and exempt these donations from the requirement to comply with more stringent screening criteria. These policy changes have been adopted following advice from the Advisory Committee on the Safety of Blood, Tissues and Organs.

--- Later in debate ---

[Lord Evans of Rainow (Con)]

My Lords, when I came here today, I did not think I would be hearing about Enoch Powell. I think that, if he were here today, he would be very interested in what we have been debating. Enoch Powell’s consistency was Wolverhampton South West. In the 2010 election, a colleague of mine of Asian background, a Sikh, won by the same majority as Enoch won it by in 1950. I am glad to say that Mrs Enoch said that Enoch would have been delighted by my Conservative colleague Paul Uppal winning that seat. It shows that people change over time. I wish he were here to hear what I am about to say.

I welcome these regulations laid before us by His Majesty’s Government. They bring forward the plans from May this year that were established by the Conservative Government. Now, as then, we believe that equality under the law is a long-established principle in this country and any improvement towards this end is to be lauded. I am sure that can receive support from all noble Lords.

These regulations mark a further step towards ensuring equal access to IVF services for people living with HIV and for female same-sex couples. It is another stage in the process of ensuring that as many people as possible can fulfil their dreams of parenthood, and it builds on the incredible work done to reduce the stigma associated with HIV, which has for so long prevented people getting tested and seeking treatment. With these changes, we will make it clear that people with HIV can live happy and fruitful lives.

The conditions in these regulations limit donation to those with an HIV viral load of no more than 200 copies per millilitre, meaning that the infection is undetectable and therefore non-transmittable. This requires the donor and recipient to have a personal relationship with one another and ensuring that safeguards are in place to minimise any risks associated with partner donation from people diagnosed with HIV. This will benefit hundreds of couples who have been trying in vain to become parents, and it will also reduce costs relating to IVF.

I hope that His Majesty’s Government will continue in the steps of the previous Conservative Government with efforts to help those living with HIV to have equal access to healthcare services.

[Baroness Merron (Lab)]

My Lords, I am glad to sense not just support for this draft statutory instrument but recognition in this debate. Following the comments of the noble Lord, Lord Evans, I acknowledge the contribution of my predecessor as Minister responsible for this area, who pressed on with the SI and ensured that it was laid. I am glad to be speaking to it today, as I know he is. I am also pleased to note that Adam Freedman from the National AIDS Trust is with us today. He is most welcome to the Committee. He has come to see the statutory instrument debated. He and his colleagues have patiently encouraged the previous Government and this Government in the right direction, and I thank him for that.

On the points raised by noble Lords, the noble Lord, Lord Wigley, asked whether the devolved Governments were content. I delighted to tell him that they are. He also asked about additional costs. A de minimis assessment was carried out, and it estimates £46,000 to £92,000 for the impact on the fertility sector. Obviously, as has been evidenced and described in this debate, there is a hugely positive impact from the measures within this draft statutory instrument.

I note what the noble Lord, Lord Wigley, said. I put down that he, along with the noble Lord, Lord Winston, and other parliamentary colleagues past and present, are veterans of change and of the Acts we are talking about. As the noble Lord, Lord Scriven, said, this is a journey—one that I suspect is not at its end, although I am pleased to take us further on that journey today. I also pay tribute to the contribution in this area of the noble Lord, Lord Winston, over many years, and to the contributions of other colleagues, who have given it their support and professionalism.

The noble Lord, Lord Winston, asked what the case would be if a recipient were HIV positive. The answer is that they will be able to get IVF. They are not actually affected by these regulations, which impact donors, not recipients. I assure the noble Lord that he was far from wasting the Committee’s time with his comments. I heard clearly his comments about counselling and the need for support. I will look closely at that with officials, following his remarks. I clarify that the £1,000 I referred to was not for IVF. It was an estimated cost for the additional screening required for female same-sex couples, which we are now seeking to correct.

On funding and the issue of availability on the National Health Service, as noble Lords will know, funding for IVF is devolved to ICBs. I am very well aware of the differential provision to different groups and individuals. I will consider future policy options, having picked up this part of the brief and spoken to a number of people about their concerns.

The noble Lord, Lord Scriven, also asked about access to IVF on the NHS. In addition to the point about consideration of advice that I will be getting about improving the service, I want to share his comment about this being just one more step in a positive direction. It is about supporting the fact that families come in all shapes and sizes. A family or a household is a family or a household, and parents are parents. They are there to support and bring up their child in a positive way, and we want to support that too.

I finish by thanking the noble Lord, Lord Evans, for reminding us that one thing that these regulations will do is take us a step on another journey—that of reducing the stigma for those who live with HIV. There have been so many medical advances, which is why we are able to bring this instrument forward today. But attitudes continue to be something to be challenged at times, and I am glad that noble Lords recognise the contribution of the legislative change we seek to make.

We want to ensure that those who want to start a family do not face barriers where there is no reason for those barriers. I place on record my thanks to the organisations who have pushed for and supported these reforms, particularly the National AIDS Trust, Stonewall, the Elton John AIDS Foundation and the Human Fertilisation and Embryology Authority. As I said earlier to the noble Lord, Lord Wigley, I thank all those parliamentarians and others along the way who have got us to this place today.

Motion agreed.

Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024

Baroness Merron Excerpts

Tuesday 22nd October 2024 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024.

Relevant document: 2nd Report by the Secondary Legislation Scrutiny Committee. Special attention drawn to the instrument.

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

My Lords, this draft statutory instrument proposes amendments to the Human Medicines Regulations 2012, which will expand access to naloxone, a life-saving medication that prevents death from opioid overdose. In addition, this draft statutory instrument makes amendments to keep the regulations current by updating references to Public Health England and the Health and Social Care Board, following the dissolution of those bodies.

We know the devastating impact that illicit drugs cause. Drugs destroy lives, tear families apart and make our streets less safe. Drug misuse deaths have doubled in number over the past 10 years, and we know that people who die from drug misuse often do so at a tragically young age, often in their 40s. Almost half of drug misuse deaths in 2022 involved opiates such as heroin. These deaths are avoidable. Dedicated drug treatment services provide the path to recovery and this Government are continuing to ensure that treatment is available and of high quality.

However, we also know that over half of people struggling with opiate addiction are not engaged in treatment. These are incredibly vulnerable people who often have multiple and complex needs; they are at increased risk of accidentally overdosing and dying. Tackling this issue supports the Government’s health mission. It will ensure that people can live longer, happier and healthier lives, and it chimes in with our collective efforts to break down barriers to opportunity and create a fairer society.

Naloxone is a highly effective antidote to opiate overdose. It can already be administered quickly and safely by anyone in an emergency, but current regulations specifically enable only drug and alcohol treatment services to supply it for future use without a prescription. That limits the reach of this life-saving medicine.

The draft instrument that we are debating today proposes two key UK-wide changes to existing regulations: first, to expand the list of services and professionals named in the regulations who can give out naloxone without a prescription. That means that professionals such as registered nurses and probation officers will be able to provide take-home supplies of naloxone where appropriate, should they wish to do so.

Secondly, it proposes to establish national registration services across the whole UK. This will enable other services and professionals who are not able to be named in the legislation but who come into contact with people at risk of overdose, including housing and homelessness services, to register and procure naloxone.

There is a positive background to these changes. The Department of Health and Social Care consulted on them at the beginning of this year and received over 300 responses spanning a range of organisations and professionals from across all four nations of the UK. Of these responses, approximately 95% agreed with the proposals that are set out. This demonstrates the level of interest in this important issue and the breadth of support for the changes we are seeking to achieve.

These changes have also been called for by experts in the sector such as the Advisory Council on the Misuse of Drugs in its review of naloxone in the UK. In addition, Dame Carol Black recommended naloxone provision as an important harm reduction measure in her two-part independent review of drugs.

Allowing more services and professionals to supply naloxone will mean easier access to it for people at risk, which in turn will mean lives saved. With the growing threat posed by synthetic opioids, which are often more potent and more deadly, the importance of this work only continues to increase as time goes on.

I want to provide reassurance that, with these changes, there is no compromise on safety. Naloxone is very safe and effective, even when administered by a layperson with no prior experience. It has an effect only if the person has been taking opioids and it is already widely used across the UK and internationally.

We are taking steps to mitigate against any very limited risks associated with wider access. We will provide updated guidance for services in scope, and we will set out robust requirements for training and safeguarding. I reassure the Committee that the intention of these changes is not to create additional burdens for services, particularly as we are aware that many of those in scope will already be facing pressures. These new powers are enabling, not mandatory. They provide an opportunity for increased provision, based on local need, but they do not make any requirements.

Finally, addiction is not a choice. It is often fuelled by wider issues, such as trauma and housing instability. This is a complex public health issue and must be tackled as such. We must change the narrative on addiction to one that is about the prevention of drug use, the reduction of harm and enabling recovery. The changes we are discussing here will save lives. On this basis, I beg to move.

[Lord Scriven (LD)]

I thank the Minister for setting out the rationale for this draft statutory instrument so well. I agree that this is a step forward in the ongoing battle against the devastating impacts of opioid overdoses. As she said, opioid overdoses have reached alarming levels, claiming thousands of lives every year. According to the latest statistics, opioid-related deaths have surged alarmingly in most regions. This is not merely a statistic. This is about the loss of lives, families shattered and far too many left to grieve, so it is important to take further action that is effective and wrapped in compassion. The temporary measures taken in Scotland show that the changes outlined in these regulations work and will save lives.

Naloxone, when used in the right place at the right time, is a life-saving medication. This draft statutory instrument will facilitate local supply networks, ensuring a broader distribution system and therefore more effective use of naloxone, empowering, among others, healthcare professionals, the police, prison and probation staff, and people in the youth justice system to facilitate the supply of this life-saving drug.

In response to one of the issues that the noble Baroness raised, a question occurred to me. As this will not be a mandatory provision across the country, how will the Government monitor lives that could be saved but that may not be saved because of a lack of take-up of this in certain towns, cities or regions? It could end up that a life will be saved if one body decides to do this, while a life could be lost in a neighbouring county, city or town if that does not take place.

One of the key provisions in this draft statutory instrument is the move to enable the friends and family of those at risk to administer this drug. Allowing those closest to individuals at risk to carry and administer naloxone creates a lifeline that will, literally, make the difference between life and death.

I listened to what the Minister said about setting up local naloxone providers and supply co-ordinators, and I have read the draft statutory instrument and the explanation—but I am still not clear about what regulatory oversight of these bodies will be in place. Who will be the regulator and what powers will they have to deal with the improvement or, indeed, withdrawal of such a service if it is deemed that the local provider is not carrying out the rules laid down in the draft statutory instrument?

Clearly, the broader implications of these amendments are not merely about the use naloxone but about standing with those who struggle with addiction, and their families. These amendments are an essential evidence-based response to the dramatic increase in opioid use and overdoses. By enabling greater access to naloxone, they will help to save lives.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Lord, Lord Scriven, who I do not believe I have had the opportunity of welcoming formally to his new Front-Bench role. I am delighted to do that today; he is most welcome. I very much look forward to working with him and hope that he enjoys his role. I am also grateful to the noble Lord, Lord Evans, as ever, for his contribution.

I am pleased that both noble Lords, on behalf of their Front Benches, have been so positive in welcoming these regulations. I certainly agree with the closing words of the noble Lord, Lord Scriven: in doing this today, we are standing with those who struggle with drug use and with those around them—the communities, their families and their friends. It is with that motivation in mind that we are doing this.

I will of course write to noble Lords if there are any points that I do not manage to cover adequately. To pick up some of the points, however, the noble Lord, Lord Scriven, asked who will regulate. As part of the legislation, as I said in my introduction, there will be training and data-reporting requirements attached to both routes for new providers. Those new providers could be the emergency services, for example, and they will have to report on levels of prescribing so that effectiveness and safety can be monitored. That will absolutely be required of them.

[Lord Scriven (LD)]

The Minister might not still welcome me to my place now but although I understand that, my point was: what powers do those whom they report to have in ensuring compliance? That is the bit I did not get from reading the regulations.

--- Later in debate ---

[Baroness Merron (Lab)]

That is understood. I am sure that the noble Lord will be delighted to know that this is to be established, but he is certainly quite right to raise that point. I will ensure that, once that detail is established, it is made known.

On the point about a potential additional burden on services, which the noble Lord, Lord Evans, raised, we certainly recognise the fact that there are challenges in the scope of these regulations. Our intention—I stress intention—is not to create any additional burden. I think I was quite clear in mentioning that these are enabling, not compulsory, requirements. That is important, because it means that no service or individual professional will actually be required to give out take-home naloxone as a result of these regulations. That potentially allows a more gradual introduction of this.

For example, I know that the noble Lord, Lord Scriven, mentioned that there may be differences in the level of take-up across the country. I suspect that may well be the case. It will be our job not just to encourage it to be taken up but to work out why it is not being taken up. We will not just bring in this instrument; we will seek to actively promote it. As I said, we are confident that there is a high level of support for these changes and we will continue to work closely with services and professionals to support them with provision.

The noble Lord, Lord Evans, rightly said that the previous Government undertook the consultation. I am most grateful for that because it has informed where we are today. That consultation under the previous Government received significant positive support from the sector, with the overwhelming majority of respondents agreeing with the set-up of the changes.

The noble Lord, Lord Evans, raised a question about costs. There is no direct cost to the Government associated with these changes since, as the noble Lord will understand, this is only an enabling provision. It will be for services to determine whether they use this power and give out take-home naloxone. At the moment, local authorities provide funding for naloxone, which is supplied through drug treatment services based on their assessment of local need. Although local authority public health services will want to support the wider provision of naloxone, I recognise that their resources are limited; I am sure that many of them will tell me that. This will potentially mean that there is an additional call on their resources and they may need to pay for it through their own funding streams. However, we will monitor demand and engage with services and local areas to understand where any pressures may be.

Another point here is that this is not a neutral act. There will be benefits, in relation not just to personal health and saving lives but to costs associated with dealing with overdoses. I hope that will be seen.

The noble Lord, Lord Evans, also asked whether the methods of administration are permitted only by medical professionals. It is already the case under current regulations that naloxone can be administered by anyone. I emphasise the point about high levels of safety and that it can be administered by a lay person.

I think I have picked up most of the points raised, but as I said, if I have not I shall be very pleased to look further into any other points and to write.

To summarise, the changes we are proposing will allow more services and more professionals to give out take-home supplies of naloxone without a prescription. As I said, it can already be administered by anyone but having more services with the ability to supply it will mean easier access for the people who are at risk of overdose. It will support them and those around them, as has been generously welcomed and acknowledged by the noble Lords, Lord Scriven and Lord Evans.

In short, these changes will widen access to a life-saving medicine. I am sure we can all agree that any death from an illicit drug is tragic and preventable, and we should take every step we can to reduce drug-related deaths; that is what we are doing today. On this basis, I hope that noble Lords will join me in supporting these important regulatory changes. I commend these draft regulations to the Committee.

[Lord Evans of Rainow (Con)]

I thank the Minister for her responses. In Australia, Canada and some states in the United States the nasal spray is available over the counter. Does the Minister have any knowledge of any plans to administer it via our pharmacies?

[Baroness Merron (Lab)]

I am waiting for inspiration, as the noble Lord will realise. In fact, I would rather write to him, as he has made an important point and I want to be quite clear on it. I thank him for reiterating the point.

Motion agreed.

Food and Drink Industry: Processed Sugar

Baroness Merron Excerpts

Monday 14th October 2024 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask His Majesty’s Government what steps they are taking to engage the food and drink industry in reformulating their products to reduce processed sugar in favour of healthier natural alternatives.

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

My Lords, last month, as part of our health mission shift to prevention, we published the Government’s response to the consultation on banning junk-food advertising to children, putting the legislation on track and encouraging industry to reformulate and reduce sugar levels in products. There is continued engagement with industry to support action and understand the challenges that are faced in order to make the necessary changes and we continue to review the balance between mandatory and voluntary incentives to reduce sugar in everyday food and drink.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful to the Minister for her reply. I noted the reports about the shift; I wonder whether I can persuade her to shift the Government a little further. I endeavoured to persuade the previous Government that we should engage in further discussions in a round-table way with the food and drink industry to try to reduce the amount of processed sugar. I seek to persuade the Minister to convene a round-table meeting of those in the private sector interested in trying to effect reformulation in food and drink and to let us see something positive actually happening.

[Baroness Merron (Lab)]

We certainly want to reduce sugar intake, and I commend my noble friend for his campaigning on this issue. I know he will continue, rightly, to press me on this. We want to ensure that we learn from experts and will welcome further research in this area. We already have regular meetings with industry and monitor the progress being made. The ultimate prize is not just about looking at reducing sugar and replacing it with sweeteners but finding that our palates are encouraged to adapt to a rather less sweet taste, and that will be the best way forward.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister agree that there are far too many fake rumours going around that the obesity epidemic is inevitable and genetic, whereas the facts are that there is only one cause of the obesity epidemic and that is eating too much and it does not matter what your genetics are? Would the Minister agree that one way of helping the situation would be if the 40 million obese people in this country were to save themselves from a premature death and save the NHS billions of pounds every year by simply reducing the amount that they eat according to the recommendations?

[Baroness Merron (Lab)]

Taking on board the noble Lord’s point, I feel that it is important that we support people to make healthier choices. The noble Lord will be aware of—and I hope will welcome—the Government’s focus on moving from ill health to prevention. We want to make sure that people live well for longer. It is not only about making informed and heathier choices but about having the means to do so. That is why I particularly want to commend the fact that we will be introducing the restrictions on junk-food advertising to children on TV and online. That will make a major contribution.

[Baroness Brinton (LD)]

My Lords, the Food Foundation review in January this year noted that 41% of multibuys were still high in salt, sugar and fat, with only 3% on fruit, veg and staples. The Minister referred to working with the supermarkets and major manufacturers. Is this issue being raised with them as well? Particularly with the cost of living crisis, it would be extremely helpful if more multibuys were for foods that were good for people, such as fruit and veg, as well as basic staples and carbohydrates.

--- Later in debate ---

[Baroness Merron (Lab)]

I thank the noble Baroness for that point. It is one of a number of things that is discussed with industry. It is important to draw on the fact that the location restrictions—in other words, where things are located—that came into force in October 2022 have actually turned out to be extremely impactful. There is a whole range of measures that we need to look at, and we will continue to work with industry. As I said in response to my noble friend, we will look at the balance between what is mandatory and what is voluntary, because that will be our best way forward.

[Lord Kamall (Con)]

My Lords, I pay tribute to the noble Lord, Lord Brooke, for his persistence on this issue. As a Minister, I received many similar Questions. The noble Lord asked about natural sweeteners, but can I ask the Minister about artificial sweeteners? The world-renowned Mayo Clinic suggests that artificial sweeteners, while reducing sugar intake, might also have negative side-effects, and that food labelled as having no sugar or being low in sugar may give the impression of being healthy but actually contain high levels of saturated fat, trans-fat, sodium and other cholesterol-raising ingredients. Can the Minister tell the House, first, whether the Government are aware of any negative side-effects of natural sweeteners and, secondly, what the current thinking is on informing consumers on how reformulating food with less sugar does not necessarily make it healthy?

[Baroness Merron (Lab)]

The noble Lord makes some very good points. I can give the assurance that all sweeteners have undergone a rigorous safety assessment before being authorised for use. It is also worth drawing the attention of your Lordships’ House to the fact that the Scientific Advisory Committee on Nutrition is currently considering the recent World Health Organization guideline, Use of Non-sugar Sweeteners, which has particularly suggested that achieving weight control may not necessarily be about replacing sugar with sweeteners. It is about acknowledging that sweeteners are more difficult—to use a non-technical term—to use in the reformulation of food than they are in drinks. There has been success in drinks, which has not been exactly mirrored in food, but there are technical and practical reasons for that.

[Baroness Boycott (CB)]

My Lords, we all welcome the Government’s introduction of free breakfasts. However, at the moment, about 26% of kids are going into school obese and 46% are leaving school obese, so the question of what they eat in school is critical. At the moment, there seem to be no standards. Many of the breakfasts given are bagels and sugary cereals; they do not have fruit, porridge or vegetables. When is there going to be a standard, and what is it going to be?

[Baroness Merron (Lab)]

It is right that what children are given to eat in schools is absolutely crucial. The school food standards are in place, and they are meant to regulate and restrict food and drink that is provided in schools. It is important, and will be part of our move, following on from the Darzi review, towards the 10-year plan, to look at the quality of free school meals and ensure that they meet the requirements to support children and young people to eat healthily, not just for the immediate future but for forming good habits for the future.

[Baroness Jenkin of Kennington (Con)]

My Lords, the House’s special-inquiry Committee on Food, Diet and Obesity is due to report by the end of the month. The Government do not traditionally have a very good reputation for responding to many of the recommendations made by these committees, but may I urge the Minister to look very carefully at our recommendations? We spent a year on the report, I think it will be hard-hitting and I hope it will be helpful.

[Baroness Merron (Lab)]

I certainly expect that it will be hard-hitting and helpful. The committee was of course appointed to consider the role of foods, including ultra-processed foods—something which has been of great interest to noble Lords—foods that are high in fat, salt and sugar, and their impact on a healthy diet and tackling obesity. I certainly look forward to the recommendations of the report, and I hope that we can surprise the noble Baroness in a good way with our response.

[Lord Rooker (Lab)]

Can I remind my noble friend that, in 2010, when the World Health Organization held a major conference on reducing sugar, it held it in London for the very reason that the Food Standards Agency, on a voluntary basis with industry, had reduced the consumption of sugar by 50%? It was at that very time, of course, that the coalition Government removed nutrition from the Food Standards Agency and took it back behind closed doors into the Department of Health. It is time to go back to the attitude of openness and transparency on this.

[Baroness Merron (Lab)]

I certainly agree with my noble friend that openness and transparency will take us a long way, not only in this regard but in many others.

NHS Hospitals: Apheresis

Baroness Merron Excerpts

Wednesday 9th October 2024 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what steps they are taking to support increasing apheresis capacity in NHS hospitals in England.

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

The Government are aware of the issues around apheresis capacity within the National Health Service impacting patient services, including stem cell donations. A departmentally led working group met for the first time last month to examine existing apheresis capacity and to develop solutions, and it will report in the spring. This working group includes members of the UK stem cell register, health professionals and service providers, and it aims to develop an evidence base by which strategic decisions around capacity can be established.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank my noble friend Lady Merron for her very helpful reply. Only last month I chaired a round table in your Lordships’ House on apheresis capacity. Therefore, given the rapid developments in cell and gene therapies and related international regulation over the last few years, what plans do the Government have to update legislation governing the use of substance of human origin and the development of advanced therapeutical medicinal products to better utilise modern technologies such as apheresis platforms?

[Baroness Merron (Lab)]

I am grateful to my noble friend for her work in this regard. I certainly share the view that there have been very rapid developments in cell and gene therapies over the past few years, and there is tremendous potential for these therapies to address the root cause of diseases and to offer life-changing outcomes for patients. So, we are working with devolved Governments and with key stakeholders to review the EU standards and requirements, and to consider our approach in light of the changes introduced by the EU SoHO regulations, which will take account of innovation within the sector.

[Baroness Manzoor (Con)]

My Lords, can the Minister say what the waiting times are for patients and clinicians who wish to use the eight therapeutic centres we have in England? Are the Government committed to providing investment in addition to the £1.5 million that NHS England announced back in February?

--- Later in debate ---

[Baroness Merron (Lab)]

NHS Blood and Transplant provides the biggest apheresis service in Europe. It has been growing by 10% to 20% year on year, and that includes the workforce and increasing provision to patients. I will be pleased to write to the noble Baroness with the most up-to-date waiting list figures. However, in addition to the existing units, satellite services have been set up in Plymouth, Cardiff, Birmingham and London. I am glad to say that, over the next six months, NHS Blood and Transplant will also open new services in East Anglia and the south-west, and it is aiming to provide over 2,000 additional collection slots per year within the next 12 months. I hope the noble Baroness will welcome that development, which we want to continue to really harness the benefits of life sciences.

[Baroness Ludford (LD)]

My Lords, does the government review that the Minster mentioned encompass sickle cell patients? As a member of the All-Party Group on Sickle Cell and Thalassaemia, I am aware that apheresis is one of the few treatment options for sickle cell patients. It is crucial in reducing the chances of sickle cell patients suffering a sickle crisis whereby oxygen is prevented from travelling around the body, resulting in intense pain and potentially life-threatening complications. However, the lack of adequate apheresis capacity means that many sickle cell patients are unable to access this essential care. A number of APPG reports have shown that they often get under-prioritised and bounced out by other patients. Is the department factoring in sickle cell patients?

[Baroness Merron (Lab)]

I assure the noble Baroness that we are more than factoring it in. We are totally committed to working to support those with sickle cell, and thalassaemia. There is ongoing work to provide the very best possible care, including boosting the number of blood donors, which is vital in improving clinical pathways and delivering treatments. There is a treatment, as I am sure the noble Baroness is aware, called Casgevy, which requires apheresis as part of the process. It is being evaluated by NICE for the treatment of thalassaemia and it is also being evaluated for sickle cell. I hope all those things will bring great benefits.

[Baroness Finlay of Llandaff (CB)]

My Lords, I am grateful to the Minister for highlighting that we are a leader across Europe with our services, but only 50% of the country is covered. Can she assure us that in all reviews of the NHS, consideration will be given to centrally commissioned, highly specialised services such as this, rather than relying on local commissioning, that the workforce plan will recognise that highly skilled nurses are needed to undertake this treatment, and that that needs to be factored in? The numbers are small but the skills are enormous.

[Baroness Merron (Lab)]

What the noble Baroness says is very true and I certainly can give the assurances she seeks.

[Lord Winston (Lab)]

My Lords, I have scanned the literature because I looked at this Question on the Order Paper, and I noticed that there seem to be very few completed trials showing clear efficacy of stem cell transplantation, except in the case of blood dyscrasias such as cystic fibrosis. Would the Minister be kind enough to let me know how many trials are being conducted in this country? If she does not know, maybe she could tell me in due course.

[Baroness Merron (Lab)]

I thank my noble friend for raising that important point. I will be very pleased to look into this further, so I can answer him in full.

[Lord Evans of Rainow (Con)]

My Lords, I pay tribute to the noble Baroness, Lady Ritchie, for her work in this area. In England, leukapheresis can be performed only by the NHS Manchester apheresis unit, and the Birmingham unit can carry out only three of the apheresis services. Are His Majesty’s Government committed to expanding the range of apheresis services available at each unit?

[Baroness Merron (Lab)]

Further to my answer to the noble Baroness, NHS Blood and Transplant is seeking to expand capacity in the way I outlined. It is probably worth going back to the point about the apheresis working group. It met for the first time last month to determine the extent of the capacity issues which we know exist. It will also be looking at who delivers what, how and for what uses. It will identify the issues in respect of workforce, machinery, finance and efficiency, and seek to come up with a recommendation. It will report in spring of next year, so we have a route forward.

[Baroness Chisholm of Owlpen (Non-Afl)]

Have the NHS and the Department of Health and Social Care had any discussions with independent health providers to see whether they have any free capacity that therapeutic apheresis could perhaps utilise?

[Baroness Merron (Lab)]

I thank the noble Baroness for raising that issue. I am sure it will be part of the working group’s investigations as it seeks to expand capacity to meet existing demand.

[Lord Kakkar (CB)]

I draw noble Lords’ attention to my registered interests. The Minister has identified the importance of having a framework for the adoption and standard incorporation of innovative technologies into routine care. In this regard, the long-term plan for the NHS that His Majesty’s Government are preparing is a vital element of what will happen over the next five years. Can the Minister confirm that that plan will look specifically at commissioning these innovations in such a way that life sciences innovation in our country is protected, and they get to patients quickly?

[Baroness Merron (Lab)]

Yes, I can confirm that we will be drawing on the parts of the report of the noble Lord, Lord Darzi, that refer to that. He refers to the need for innovation, to expand the use we make of life sciences and to develop that still further. That will very much form part of not just our thinking, but our doing.

[Baroness Nicholson of Winterbourne (Con)]

Given the welcome switch of the National Health Service from being just restorative to preventive, might the Minister consider discussing the World Health Organization system of women health volunteers and visitors? Then, these discussions can start at a much lower level and people will be much less fearful of the treatment they may eventually have to have in hospital.

[Baroness Merron (Lab)]

Certainly, we want to look at all the ways we can support patients to get the services they need, and that includes providing reassurance and the information they need. I will look at the Baroness’s suggestion.

NHS: Independent Investigation

Baroness Merron Excerpts

Tuesday 8th October 2024 Lords Chamber

[Lord Scriven (LD)]

My Lords, I thank the Minister for bringing the Statement to the House. You do not have to be a mastermind to realise that the NHS is straining at its seams. It is only down to the great work of the many thousands of people who work in the NHS that millions of people get great care, even though some fall between the cracks.

The Darzi report is a very good medical history and it gives a diagnosis, but we all know that the treatment plan is going to be the important point if we are to deal with a reformed, new and productive NHS. There are some welcome themes in the report that are not new. Those who know the previous Darzi report will see have seen some of them before: prevention; moving resources from hospital care to primary and community care; dealing with the wider determinants of health; improvements in and parity for mental health; and a bigger role for public health.

I understand that the Minister will answer many questions by saying that we need to wait for the 10-year treatment plan, and probably the Budget, before such specific questions can be answered, but I have a few general questions for the Minister, to get at least a sense of the direction that the Government wish to take.

Is it the Government’s intention to restore the public health grant back its 2014 levels? Are there any general views about looking at changing the structure of public health, nationally or locally? On capital, what is the Government’s thinking about the general theme of allocation to hospital and non-hospital services, and how will this be managed and monitored? On data, what is the Government’s thinking on the workforce plan, particularly when there is a huge imbalance when it comes to digital and data between the private sector and skills within the NHS? That is not to say that there are not some good skills within the NHS, but there is clearly an imbalance.

Welcome as it is that the report talks about moving resources from hospital to non-hospital settings, I was a manager in the health service in the early 1990s and I know that this has been said since at least the 1970s. What are the Government going to do to be able to move resources from sunk costs in the acute sector into other sectors? What mechanisms will be put in place? How will this be monitored? More importantly, who will be held accountable for making sure that it actually happens? How will the new neighbourhood approach affect the existing workforce plan? If a new health service is anticipated, what will the effect be on the workforce plan and the implications for capital allocation?

We all want to see a productive and effective healthcare system that improves peoples’ health and independence, but that cannot be brought about if we do not have a strong, effective, well-funded social care system. I do not understand why social care has been kicked down to the next Parliament, or how we are going to solve the health and well-being of the population without that being done. If the major reforms of social care are in the next Parliament, what steps are the Government going to take in this Parliament to deal with the social care crisis?

I look forward to the Minister’s answers, but, more importantly, to the 10-year treatment plan’s arrival in the next few months.

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

My Lords, I thank the noble Earl, Lord Howe, and the noble Lord, Lord Scriven, for their opening observations. I will seek to deal with as many of them as I can; I am sure a number will be iterated in the course of the Back-Bench contributions.

I start by expressing gratitude to the noble Lord, Lord Darzi—my noble friend, if I can call him that—for what I regard as an open, honest and thorough review. He is known as a man of great service, not just to your Lordships’ House but to the National Health Service. He has served Labour and Conservative Governments with distinction. As noble Lords will be aware, he is an eminent cancer surgeon who has driven innovation and speaks up for staff and patients. It is not surprising to me that the Secretary of State asked him to conduct this review, tasking him to provide what we might refer to as hard truths, warts and all. I realise that when one asks for that it can be uncomfortable, but I hope that we in your Lordships’ House can sit with discomfort in order to find a way forward for the National Health Service.

The noble Earl, Lord Howe, referred to the terminology that the NHS is “broken”. I understand that that is uncomfortable to hear, but when I speak to NHS staff they recognise that terminology. We are at great pains to say that we are not being critical of NHS staff, but unless we start in an honest and open fashion we will not be able to—as the noble Lord, Lord Darzi, referred to—restore the trust that is necessary. As the Secretary of State said in the other place, this Government have resolved to be honest about the problems faced and serious about fixing them. That is why he commissioned this independent investigation. I very much hope that noble Lords can be of assistance in finding the way forward, because we now have a diagnosis on which we can consult and then move on to the necessary prescription to improve the health of our National Health Service.

The noble Lord, Lord Scriven, referred to the 10-year plan. I am glad that he looks forward to it—as do I—but how will we get there? We now have a very clear explanation of where we are. It is evidenced and has widely involved many people and organisations. It should therefore be regarded with great respect, and I think it largely has been. However, the next stage for the 10-year plan will be to have what will be the biggest consultation we have ever had in this country on the National Health Service. It will involve patients, staff, parliamentarians, stakeholders—all those who have a vested and informed interest in it. That will lead us to the 10-year plan. On the question about this being top-down, this is very much a bottom-up exercise, with the Government’s commitment underlying it.

It is important to say that the 10-year plan does not mean that we will wait 10 years for everything. We will identify those areas in which we can make swifter progress and we can then look beyond. The fact is —this came out many times in the report from the noble Lord, Lord Darzi—that this has been a long time in the making and to turn it around will not be quick.

The noble Earl, Lord Howe, acknowledged that there were problems in the NHS. I am grateful for that and for his reference to the need for change. I also listened closely to his reference to what had been done under the previous Government. Facts are facts, but what matters is output. As we are discussing today, whatever the previous investment and previous actions, some of which were very much to be commended, the output has not delivered the results we need. That is why we have the report by the noble Lord, Lord Darzi.

On the issue of dedicated staff, the staff team to whom I pay tribute goes way beyond clinical staff, important as they are, and includes the cleaners, porters and administrators. Noble Lords will recall that, when the workforce plan was published, we said that this was a useful step forward. Our job now, as a new Government, as the noble Lord, Lord Scriven, said, is to adapt the plan to ensure that it brings in one of the three pillars we will be going for: hospital to community. That will absolutely be our focus.

I note that the noble Earl, Lord Howe, does not accept the assessment by the noble Lord, Lord Darzi, of the Health and Social Care Act 2012. I see the noble Lord, Lord Lansley, in his place; I am sure he will have a contribution to make. I have to part company with the noble Earl on that point, as the evidence in the review is that the Act did not work in the direction we were seeking to take.

On capital expenditure, we find ourselves with a massive backlog of capital works, such that the ability of the NHS to deliver is being held back by the buildings and facilities. We have therefore instructed a review of this, which we will then look to.

Finally, the noble Lord, Lord Scriven, was generous enough to say that he does not expect me to respond to the detailed questions about funding. However, I can assure him that all these matters are being considered—in other words, how we can best deliver the output and the improvements in health that the report of the noble Lord, Lord Darzi, seeks to achieve.

[Lord Patel (CB)]

My Lords, if this were a Committee stage, I would have been delighted to engage in a debate with the noble Earl, Lord Howe, who is a class act at presenting a case even though he might not believe in it. He is a lovely man. I would have taken issue with him on the 2012 Act—maybe not all of it, but a significant part of it.

I congratulate my noble friend Lord Darzi on his report. It is an honest report about the state of the NHS currently, whatever the genesis of that might be. As this is a Statement, I can only ask a question. One of the areas the report refers to is the need for capital investment. This has been neglected for some time, and without it, we are unlikely to be able to deliver quality care in all the aspects the report seeks. So, what is the Government’s plan for capital investment in the NHS?

[Baroness Merron (Lab)]

I begin by agreeing with the noble Lord, Lord Patel, in his assessment of the noble Earl, Lord Howe, as I am sure your Lordships’ House does. On the issue of capital, the total maintenance backlog stands at £11.6 billion, an increase of nearly 14% on the previous year. As I mentioned in my opening comments, this is holding back the productivity, ability and capacity of the National Health Service. Our financial situation is well documented, but we have asked the department and NHS England to review the health service’s capital requirements, and that includes NHS England’s assessment of long-term estate needs across a range of areas. We will have to establish the position and where we are to go from there, but I assure the noble Lord of the importance of this matter.

[Baroness Thornton (Lab)]

My Lords, I should declare an interest as a non-executive member of Whittington Hospital, and indeed as its maternity safeguarding champion. I have huge admiration and regard for the noble Lord, Lord Darzi, with whom I worked when he graced these Benches as a very successful and effective Minister. I agree with his analysis of the Health and Social Care Act 2012; I was opposite the noble Earl, Lord Howe, when we were debating that legislation—for what felt like many years—before it reached the statute book, and I agree that despite the challenges to the NHS, the vital signs remain strong.

Page 38 of the report addresses the question of inequality in maternity and neo-natal mortality, which is described. Does the Minister agree that after East Kent, Morecambe Bay and Shrewsbury, we do not need further research into understanding the challenges in our maternity services? What we need is leadership, attention and focus, so that our maternity services can benefit from the proposals in this report and the 10-year plan.

[Baroness Merron (Lab)]

I agree with my noble friend. I am pleased to inform the House that just this week I announced a number of pilot programmes, through which maternity staff will be taught and supported to better identify the signs of a baby in distress in labour, so that action can be taken more quickly, and which will help staff deal with obstetric emergencies during caesarean sections. Such actions help to avoid preventable brain injuries and are right for the baby and the mother. We also need to tackle the issue of the more than £4 billion cost of the lawsuits that have been brought over a number of years.

I have seen good examples of teamwork in Bristol and Surrey, to name just two, and there are many things that can be learned. We know what strategies work—one of which is listening to women—but the challenge is, how do we roll out what is successful, including from the pilot programmes? Following the recent report, which showed a devastating situation in maternity and neo-natal care, that is a high priority for this Government.

[Baroness Brinton (LD)]

My Lords, the excellent report of the noble Lord, Lord Darzi, refers to the stress our GPs are under and how patients are no longer flowing through the hospitals as they should. One issue is that hospitals are constantly referring patients back to their GPs when they are still on the same treatment pathway. Recently, a member of my family was at a post-op review following a pacemaker operation that had gone wrong. Her heart was still giving her problems, and she was told she had to go back to her GP to start the whole process again. Many patients in hospital clinics are being told to go back to their GP to get a scan or an MRI—which is one of the reasons why they were referred to the hospital. This is not fair on hard-pressed GPs and, above all, patients. Can this practice be stopped?

[Baroness Merron (Lab)]

I am sorry to hear of the circumstance that the noble Baroness raises. I agree with her about the pressure on GPs who, of course, are working harder than ever. We know, not just through the Darzi report but through much evidence, that discharge into the community has to take place at the right time and with the right support, and that is not the case at present. I will certainly take up the specific thing the noble Baroness asks for and look into it in far greater detail, because this is clearly a practice, as she described, that is not supporting patients or GPs but working against them.

[Lord Lansley (Con)]

A wholly different report could have been written based on the underpinning evidence. To that extent, the report may call itself independent but it was not objective. If the Minister subscribes to some of the hyperbolic criticisms of the 2012 Act, can she then explain how the NHS in Labour-run Wales—where the 2012 Act had no effect whatever—performed worse on almost every measure of performance? She said that output was what matters. Can she therefore confirm that productivity in the NHS rose after 2010, relative to the preceding period, up until the pandemic? Can she actually agree that it is outcomes that matter most? Will she say that the Government will maintain the progress that needs to be made in making the NHS accountable to the NHS outcomes framework that we established a decade ago?

Finally, to revert to what my noble friend and the noble Lord, Lord Scriven, rightly asked about, in the last decade the 10-year plan has been something that the NHS owned. There was the five-year forward view in 2014 and the 10-year plan in 2019, and now in 2024 the NHS should own the refresh of the 10-year plan, but I do not think that is going to be the case. Can the Minister explain why the Government are taking that earned autonomy away from the NHS?

[Baroness Merron (Lab)]

I do not recognise the description of taking autonomy away; I appreciate that that is the noble Lord’s opinion. The National Health Service is so key to not just our health and well-being but the economic health of this country. In my opinion, it is something of a backbone of the country. It is right that the Government have made this an absolute priority and have commissioned a very honest report—I hear his criticisms of the report; they are not ones that I share—and that the Government are held accountable. That does not mean taking away autonomy from the NHS. I accept the noble Lord’s point that it is outcomes that matter, and perhaps I should have put that better because by output I mean things not just being done but actually being effective. I thank him for that point.

On frameworks and meeting obligations, one of the points made not just in the Darzi report but elsewhere is on how many of the standards are not being met. We will return to a number of the standards to ensure that people can feel that they know what they are going to get and within what timeframe, and that that will be absolutely possible. We are interested only in what works. We are not interested in scoring points; we are interested in improving the health and well-being of the nation, and I hope noble Lords will want to join with that.

[Lord Fowler (CB)]

My Lords, I say straightaway that I entirely support the concept of an independent inquiry into the National Health Service. Indeed, it was something I advocated to the previous Government —not with notable success. I also pay tribute to the excellent National Health Service treatment and care I received when recovering from a recent heart attack. It was excellent in every way, from the ambulance service right through to the hospital treatment itself. In that context, does the Minister agree that the Government’s description of the National Health Service as “broken” is both unjust to the staff and an altogether false generalisation? It takes the language of the recent election into healthcare, and I would have thought that was one of the things we needed to avoid now.

[Baroness Merron (Lab)]

I am very pleased to see the noble Lord in the rudest of health and to hear of his positive experience. Of course, there are many positive experiences every single day, and the noble Lord is quite right to remind us of that and of the need to thank the whole NHS staff team who make that happen.

On the point about the NHS being broken, I understand the noble Lord’s view. However, I think it is important that we lay it bare and say what we have found. Having read the report by the noble Lord, Lord Darzi, I find it hard not to conclude that there are fundamental points within the National Health Service that are just not working. Of course there is good practice and there are brilliant outcomes in some areas, but it is not universal and that is what drives us to make that point. I hear what the noble Lord says. However, it is important to be honest, and that is what we have said we will be, uncomfortable though it might be at times.

[Baroness Pitkeathley (Lab)]

Does the Minister agree that integration between the different branches of the NHS, or rather a lack of it, is one of the problems? It is particularly a problem for patients. It works best when you cannot see the joins between various branches—when you cannot tell who the community nurse is working for, whether it is the hospital nurse and so on. Those are the things that puzzle patients. In thinking about the workforce, therefore, will the Government look at ways—for example, joint training—in which we can better integrate the staff, so that they work less in professional silos and much more across various branches of the NHS?

[Baroness Merron (Lab)]

Yes, I certainly agree with my noble friend about the need for better integration. Joint training is a very practical example and will be part of how we develop the workforce, because silo working clearly is not working, as we can see in the current state of affairs, particularly if we look at the relationship between the National Health Service and the social care service. It is not seamless, and individuals are suffering for that, so I very much agree with my noble friend.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests, in particular as chairman of King’s Health Partners and of the King’s Fund. In the report by the noble Lord, Lord Darzi, a picture is clearly painted of what now represents a very serious national challenge in securing the long-term sustainability of our health service and, as the Minister has recognised, the parallel need to consider questions of how we develop a long-term strategy for the provision of social care.

On 18 April this year, in a debate in your Lordships’ House initiated by my noble friend Lord Patel on the question of the long-term sustainability of the health and care systems, there was a discussion about how one might achieve consensus—consensus among the public, consensus among the professions and political consensus to ensure that a plan might be adopted which will require very difficult decisions and great courage and commitment over a sustained period of time to deliver the kind of objective about which we all agree. How will His Majesty’s Government go about developing that consensus in addition to developing the plan that must be applied?

--- Later in debate ---

[Baroness Merron (Lab)]

This will take us towards the 10-year plan. There will shortly—really shortly—be an announcement as to how the consultation will take place. It will be available to everybody with an interest in and a commitment to the National Health Service, and to those with lived experience, which is extremely important. It will be the biggest consultation that there has ever been on the National Health Service. I believe that is the way to achieve consensus, but you have to start by asking what the diagnosis is. Although I hear differing opinions in some areas of your Lordships’ House about the contribution of the report of the noble Lord, Lord Darzi, for me it makes a major contribution. If one does not know where one starts, one cannot end up in the right place. However, I absolutely agree with the noble Lord that consensus is key. We do not have the luxury of time for arguing the case, so this widespread consultation will get us to the right place.

[Baroness Tyler of Enfield (LD)]

My Lords, the forensic report of the noble Lord, Lord Darzi, shone a much-needed spotlight on the deteriorating state of children’s health services and worsening health outcomes for children, particularly the long waiting lists of over a year that some were facing before getting hospital treatment. What plans do the Government have to focus investment on children’s health services, which seem to have fallen behind adult health services, and to develop a children’s health workforce strategy as part of the overall NHS long-term workforce plan?

[Baroness Merron (Lab)]

I agree with the noble Baroness that that is unacceptable. There are just too many children and young people who are not receiving the care that they deserve. We know that waits for services are far too long and our determination is to change that—not least, as I am sure the noble Baroness has seen, given that children are at the heart of our opportunity and health missions, and rightly so. To ensure that every child has a happy and healthy start to life, among other measures we will train more health visitors and digitise the red book of children’s health records, so that parents and children can access the right support. We will be restricting vapes and junk food from being advertised to children, which will assist in the prevention of ill health, and we will ban the sale of high caffeine and energy drinks to under-16s. There will also be specialist mental health support in every school and walk-in mental health hubs in every community. I hope all of those will make a difference.

[Baroness Bloomfield of Hinton Waldrist (Con)]

My Lords, I draw attention to my entry in the register of interests as a trustee of the Royal Marsden Cancer Charity. The report of the noble Lord, Lord Darzi, discusses oncology services and life science research, both of which are at risk given NHS England’s planned closure of the paediatric oncology unit at the Royal Marsden in Sutton, cited alongside the Institute of Cancer Research as offering bench-to-bedside research and care. Does the Minister agree that such a closure would be devastating to the provision of paediatric cancer services, to research and to drug trials, and that it would undermine the recommendations of the report, which highlights the need to improve cancer survival rates and bolster our life sciences capability?

[Baroness Merron (Lab)]

I thank the noble Baroness for raising this important question, as she has done before with me. I know she is aware that I cannot comment on the individual case. What I can say is that research, diagnosis and treatment in all these areas, as we have heard from the noble Lord, Lord Darzi, are absolutely crucial to ensure that cancer patients are not being failed. We need to improve cancer survival rates, and we need to ensure that patients wait for no longer than they should. We have to research cancer, diagnose it on time and treat it faster.

Bread and Flour Regulations 1998

Baroness Merron Excerpts

Wednesday 11th September 2024 Lords Chamber

[Lord Rooker]

To ask His Majesty’s Government what plans they have to update the Bread and Flour Regulations 1998.

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

My Lords, although work on reviewing the Bread and Flour Regulations was paused due to the general election, I can assure my noble friend that I have picked this up as a personal priority. We have spoken to the devolved Governments about laying legislation later this year and I will update noble Lords on progress in the very near future.

[Lord Rooker (Lab)]

I thank my noble friend the Minister for her Answer. On 16 May, the previous Government said that the regulations for England would come forward in July, on the basis of an agreement with the four nations and the four Chief Medical Officers. There really should be no delay; this could be picked up, like other Bills are being picked up, and be done quite quickly. Is my noble friend aware of the Written Answer I received on 23 July, when I asked about the reform of the Bread and Flour Regulations? It said that it “could include” folic fortification. I want my noble friend to be more specific now than in that Written Answer and give a specific commitment that this Government will do the folic fortification of flour, as agreed by all the consultations and the previous Governments.

[Baroness Merron (Lab)]

My noble friend has been a tremendous campaigner. Indeed, he reminded me that this is, I believe, his 22nd Question on this matter, so I do not wish to test his patience. I absolutely assure him that, as he said, the policy is being taken forward as a UK-wide measure and all the necessary preliminary legislative steps have been taken, including the public consultations he mentioned, which were reported on earlier this year. Subject to renewed collective agreement in England, Defra will lay legislation later in 2024.

[Baroness Walmsley (LD)]

My Lords, I am hearing that, unfortunately, the Government are not being very ambitious in the level of fortification that they will propose. They are considering a level that will reduce neural defects by only about 20%, whereas 1 milligram of folic acid in 100 grams of flour could reduce neural tube defects by 80%, which is a massive amount. Can the Minister at least reassure me that the appropriate committees will look at the level of fortification being proposed, so that it is appropriate and safe?

[Baroness Merron (Lab)]

I assure the noble Baroness that that has already happened. As I am sure your Lordships’ House is aware, the proposal is to add 250 micrograms of folic acid per 100 grams of non-wholemeal wheat flour. I emphasise that this fortification would be in addition to the foods that are already voluntarily fortified, such as a wide variety of breakfast cereals, so we are not talking about just bread. The feeling among the experts, to whom we listen, and the committees to which the noble Baroness referred is that this is the right level at which we can provide reassurance, and so this is where we are focusing our efforts.

[Lord Krebs (CB)]

My Lords, I am delighted to hear that the Minister has confirmed that folate fortification of bread flour will proceed. However, I want to ask her about members of our population who do not eat white bread flour because, for example, they are coeliacs or gluten intolerant, or because they come from ethnic groups who get their main carbohydrate intake from other sources such as rice. In the United States, rice, maize and flour are all fortified with folate and have been since 1998.

[Baroness Merron (Lab)]

The noble Lord raises an extremely good point. Before we speak about the groups to which the noble Lord referred, I want to point out that fortification will not be enough in any case. We need to continue our encouragement for women to take daily folic acid supplements before conception and in the first 12 weeks of pregnancy, because doing so can prevent up to seven out of 10 cases of neural tube defects—I want to emphasise that. I will take on board the noble Lord’s very important point and ensure that it is part of our considerations.

[Lord Kamall (Con)]

My Lords, I start by paying tribute to the noble Lord, Lord Rooker, for his persistence in this matter. When I was a Minister, I found it rather frustrating to be told that the consultation process could not be speeded up, so I pay tribute to the Minister for the progress she has made. However, I want to ask about a possible unintended consequence. The NHS website says that folic acid is not suitable for some people: those who are allergic to folic acid, obviously; those who have low vitamin B12 levels; those who have cancer, unless they have folate deficiency anaemia; and to those who are having a course of haemodialysis or who have a stent in their heart. Given these warnings on the NHS website, can the Minister assure the House that she is confident that those who suffer from those conditions will not be harmed unintentionally by increasing the volume of folic acid in our bread and flour?

[Baroness Merron (Lab)]

I thank the noble Lord for his support in this area; I know that he also worked hard to make progress in it. I can give the assurance he asked for, and I would say to people that if they are concerned, they should seek expert advice about their own personal circumstances. All of the expert advice and relevant committees are content that this is the right way forward.

[Lord Dodds of Duncairn (DUP)]

I thank the Minister for her personal commitment to this issue. Can she give a categorical assurance that the regulations will be amended across the entirety of the United Kingdom at the same time? She will know that in Northern Ireland we have a different regulatory regime for some of these matters due to the Windsor Framework. Can she also assure the House that there will be a common approach across the United Kingdom in both timing and content?

[Baroness Merron (Lab)]

I know that the noble Lord takes a great personal interest in these matters and has also campaigned very strongly. The area he refers to is being pursued because we want collective agreement on this across the whole of the UK, so that we can confirm that it is government policy with absolutely no qualifications, and that everyone is moving on the same timescale. I can confirm that we have notified the EU Commission and the WTO in order to fulfil international obligations and have thus far received no responses; that is why we are able to proceed with the next legislative steps.

[Lord Jackson of Peterborough (Con)]

My Lords, the Minister is a great asset to the Front Bench. This is a bipartisan issue, and I pay tribute to the noble Lord, Lord Rooker, for his excellent work over the years. When I was a Member of Parliament in the other place, Shine—formerly known as ASBAH—the charity for hydrocephalus and spina bifida, was located in my constituency. I say gently to the Minister that we have been campaigning on this issue for almost 20 years, and to my own Front Bench that there is no demonstrable, empirical scientific evidence of any substantial side-effects of putting folic acid into basic foodstuffs, and that it should happen. Finally, more than 30 countries have pursued this policy; they have tackled the enduring tragedy of spina bifida and hydrocephalus, and the impact they have on families. Therefore, can we please do this as soon as possible?

[Baroness Merron (Lab)]

I certainly hear the very welcome points that the noble Lord makes. As we progress, this will make us the first European country to mandate folic acid fortification of non-wholemeal flour. While some European countries, including Ireland, have voluntary fortification, mandatory fortification is not the case. I and my ministerial colleagues are keen to be in this position.

[Baroness Finlay of Llandaff (CB)]

I am grateful to and congratulate the Minister on her perseverance on this issue and on decreasing neural tube defects. Can she also ensure that products are appropriately labelled with warnings that they are not fortified and that any woman who might become pregnant should take additional folic acid supplementation? Without that, we will not tackle the ongoing problem of neural tube defects. I do have a concern that there is inappropriate fear over toxicity, given that in 1991 there was a very good randomised controlled study. People were divided into groups, given fairly high doses, including with multiple vitamins, and compared with those on a placebo. There were no adverse neurological or other effects.

[Baroness Merron (Lab)]

I am grateful for the noble Baroness’s contribution and can reassure your Lordships’ House, and anyone else who may be concerned, that, as noble Lords have said, this has been gone through over many decades. Safety is paramount. On products that are non-fortified, I will have to look into this, but for those that are fortified, there will be a transition period for industry because the equivalent of some 11 million loaves of bread are sold in the UK every day but only 65% of the flour used in their manufacture is produced in the UK. We have to look at this huge diversity of food products, including biscuits and cakes, and where it is a food ingredient in ready meals and soups. It is quite an undertaking, but your Lordships’ House can be assured that we are on it.

HIV Care: Access

Baroness Merron Excerpts

Wednesday 11th September 2024 Lords Chamber

[Lord Black of Brentwood (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare my interest as a patron of the Terrence Higgins Trust.

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

My Lords, in 2022 England exceeded the joint United Nations programme on HIV and AIDS targets, with 98% of people diagnosed with HIV receiving treatment. The UK Health Security Agency estimates that between 6% and 15% of people living with diagnosed HIV in England did not access HIV care that year. Re-engaging people into HIV care is a priority for the current HIV plan for England and for the new plan that is in development.

[Lord Black of Brentwood (Con)]

My Lords, we know from the opt-out testing programme in A&Es introduced by the last Government that up to 15,000 people in England who are aware that they have HIV are not accessing life-saving care, with devastating personal consequences for them and profound ramifications for public health, because if you are not on medication, you can pass on the virus. Is the Minister aware of the case of a 45 year-old man, out of care for several years, who went to hospital with a headache and was found to have a CD4 count of just four. He was diagnosed with cryptococcal meningitis, an AIDS-related illness. He went blind and died three months later, one of a growing number of tragic preventable deaths. Can the Minister ensure that we get an HIV action plan as soon as possible and that this issue—with funding, if necessary—will be a key part of it, to ensure that we get those lost to care back into it?

[Baroness Merron (Lab)]

My Lords, Ministers have already commissioned officials for advice on how to progress the development of a new HIV action plan. On the very tragic case that the noble Lord refers to, he will be aware that since April 2022, NHS England has funded emergency departments in London, and in areas of very high diagnosed HIV prevalence, to provide routine blood-borne virus testing for HIV as well as for hepatitis B and hepatitis C in everyone aged over 16. That attention at the point of contact is crucial in this area.

[Lord Fowler (CB)]

My Lords, I declare an interest as an ambassador for UNAIDS. Is it not a fact that we have been extremely successful in developing the means to combat HIV and AIDS, but we still face the obstacle of stigma around the whole subject, which is a serious deterrent for treatment and continuing treatment, as the noble Lord, Lord Black, suggested? Will the Government make the fighting of stigma around HIV a priority, so that we can become one of the first countries to be absolutely AIDS free?

[Baroness Merron (Lab)]

The noble Lord’s campaign in this area is very well regarded, and for good reason; I certainly agree with him. The fact is that engagement in care is strongly affected by a number of factors, including a person’s well-being and quality of life, discrimination and, as the noble Lord says, stigma. That, alongside accessibility of service, will define how successful we are. I am keen that our new plan will absolutely take account of stigma.

[Baroness Thornton (Lab)]

My Lords, the crisis of people lost to HIV care is of course underpinned by serious health inequalities. Are the Government taking account of the pilot work by the Elton John AIDS Foundation in south London, which has successfully returned people to care through case-finding, focus follow-up and wraparound support for people when they return to clinics, thus saving the local NHS millions in the care that would be necessary if they were not receiving it?

[Baroness Merron (Lab)]

I can confirm to my noble friend that we are, and say how grateful we are to a number of charities, including the Terrence Higgins Trust and the Elton John AIDS Foundation. As she says, there have been pilots for emergency department HIV opt-out testing since 2018. A pilot that began in April has expanded that to 47 additional sites, and we will be looking closely at the impact of that.

[Baroness Barker (LD)]

My Lords, if that pilot in the 47 areas shows, as it did in London with the Elton John work, that such testing finds people who not only do not know their status but are lost to care, will that form a basis of the national plan the Government are working on? Will there be a particular emphasis on extending services to people in rural areas, who do not have the access to clinics that people in metropolitan areas do?

[Baroness Merron (Lab)]

Yes, and I thank the noble Baroness for making those points, which I certainly agree with. The challenge for us now is to reduce the number of people who live with undiagnosed HIV, but also to reduce the number not seeking care and treatment. For the first time, the latter has exceeded the former, which suggests that we have a challenge we must focus on in the new plan, and we will do so.

[Lord Kamall (Con)]

My Lords, I pay tribute to my noble friend Lord Black for his consistent campaigning on this issue, and especially for helping those with HIV. What has been learned from previous initiatives? We know that in recent years, the NHS and the previous Government looked at ways to address issues such as vaccine hesitancy, and the reluctance of some to seek tests and treatment at any time. What lessons have been learned from these previous initiatives for the HIV action plan—for example, by working with local communities and the charities that a number of noble Lords have mentioned to encourage more patients with HIV to seek treatment, especially in communities such as black and Asian communities, where there may also be a stigma, as the noble Lord, Lord Fowler, mentioned, around admitting that they have HIV?

[Baroness Merron (Lab)]

There is what I call a three-pronged approach to interventions to reduce the number of people not being seen for care, which is so important, as I know the noble Lord is aware: identifying people who have not been seen for care; contacting them and re-engaging them; and addressing the barriers to engagement, which a number of noble Lords have referred to. This means sustaining engagement with care in the long term and supporting people with HIV.

We will review what lessons we are learning from the HIV action plan for England, which runs to 2025, and that means we will be able properly to inform the development of the new plan. I look forward to updating your Lordships’ House on this.

[Lord Cashman (Non-Afl)]

My Lords, we have come a long way since the dark days of the 1980s and 1990s, when many lives were lost. Progress has been made primarily through the work of activists, NGOs, the commitment of Governments and, indeed, the commitment and leadership shown by the noble Lord, Lord Fowler, to whom I pay tribute. But we are seeing greater numbers of people disengaging from HIV care for many reasons, including stigma, mental health issues, poverty, discrimination, and the terrifying fear of isolation within families and communities. Will the Government therefore look at the projects carried out across the country, including in Greater Manchester, and, indeed, as has been mentioned, the NHS South East London Integrated Care Board project, which focused primarily on these issues and groups and successfully reintegrated people back into HIV care? Arguably, this approach must be in any national HIV action plan.

[Baroness Merron (Lab)]

Yes, we will be looking at all the work currently going on and at the successes—and there are many. I believe that my noble friend is referring to Fast-Track Cities, an international initiative involving cities tackling HIV through a multidisciplinary, multi- sectoral approach. There are 13 signatory cities in the UK, and all are beacons of good practice that we must learn from, including in order to find out what is not working. I also want to emphasise peer support, which has been shown to reduce self-stigma, but also to improve engagement in care and the taking of treatment, and to having low levels of virus. This area will obviously very much feature in the new strategy.

[Baroness Sugg (Con)]

My Lords, looking at HIV internationally, the UK has long been a proud supporter of the Global Fund. In 2022 alone the Global Fund reached over 15 million people with HIV prevention services, including 710,000 HIV-positive mothers, who received medication to keep themselves alive and to prevent transmission of HIV to their babies. Will the Government commit to continuing to support the Global Fund?

--- Later in debate ---

[Baroness Merron (Lab)]

Certainly, as the noble Baroness says, the Global Fund is crucial in HIV care. The UK remains a world leader in efforts to end the global AIDS pandemic and funds all the key partners in the global AIDS response. I confirm to your Lordships’ House that some £1 billion was recently pledged to the Global Fund. That will save more than 1 million lives, including by providing antiretrovirals for 1.8 million people, and provide HIV counselling and testing for 48 million people. It will also reach 3 million members of key affected populations with prevention programmes. We will continue to have discussions with the FCDO about the support this Government give.

Government Policy on Health

Baroness Merron Excerpts

Tuesday 10th September 2024 Lords Chamber

[Lord Kennedy of Southwark (Lab Co-op)]

Before the Minister responds, I make it clear that these should be questions, not speeches.

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

My Lords, to set out some key points in respect of the right honourable Alan Milburn, he has no formal role in the department. Therefore, the conflicts of interest the noble Lord referred to do not even arise. The main thing I would like to set out is that it is very important to make a distinction between the areas of business and meetings in the department about generating ideas and policy discussion—it is those in which Mr Milburn has been involved, at the request of the Secretary of State—and the very different meetings about taking government decisions. If I might summarise it for your Lordships’ House: Ministers decide, advisers advise.

[Lord Wallace of Saltaire (LD)]

My Lords, I declare a certain puzzlement at this Question. I recall, when the Conservatives were in office, reading regularly on the front page of the Times that donors had been talking to the Prime Minister or various Cabinet Ministers about government policy and expressing strong views on which direction they should take in various areas. As an academic, I am also well aware of the extent to which expertise comes into government through informal channels.

On one now famous occasion, which was not reported at the time, a number of experts on the Soviet Union whom I knew well were invited by Margaret Thatcher to an informal seminar in No. 10 to advise on whether the Foreign Office or Margaret Thatcher’s advisers were correct in their attitude to the Soviet Union. A number of the academics suggested that the Third Secretary of the Communist Party, then a man called Gorbachev, was a good person to get to know. Mrs Thatcher took their advice rather than that of her advisers and it had a remarkably positive impact on British foreign policy. Do the Government accept that all informal contact with outside experts is desirable and that it is a good thing, where possible, that it should be reported?

[Baroness Merron (Lab)]

It is right that people from outside government come into departments to lend their expertise and share their views and that Ministers make decisions without those people involved. That was the line I was trying to draw. The Secretary of State for Health is very fortunate to be able to turn to every living former Labour Health Secretary, from the right honourable Alan Milburn through to my noble friend Lord Reid, Andy Burnham and many others, because all of them have offered to roll their sleeves up and assist us. Perhaps I could remind your Lordships’ House that, between them, they delivered the shortest waiting times and highest patient satisfaction in the history of the National Health Service. I hope that we will be able to do justice to their experience.

[Lord Foulkes of Cumnock (Lab Co-op)]

My Lords, does the Minister agree that this is very different, because the Minister is taking advice from people with huge experience, and it is open and above board? This is unlike when Boris Johnson was Prime Minister, and his wife Carrie Johnson apparently made a number of decisions, including the appointment of Ministers. Was that not something we ought to be worried about, rather than this open and sensible arrangement we have now?

[Baroness Merron (Lab)]

My noble friend makes an important distinction, and I would certainly share that view. It is worth reminding your Lordships’ House that ministerial meetings that are attended by third parties are declared in a quarterly transparency publication in the established way. Of course, this will be done. I can tell your Lordships’ House that I had a meeting with the right honourable Alan Milburn, and it was very useful.

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare an interest because I was on the Times Health Commission. We took evidence from a wide range of people, including the person mentioned. Can the Minister provide assurances that, whenever people are consulted, they are routinely asked to declare their interests; that any declaration of interest is repeated not only at the first meeting but whenever other people are present so that it is well known; that the consultation goes widely; and that there is no overreliance on a small number of people? We at the Times Health Commission found that, by consulting widely, we were able to hear very conflicting views, which was helpful and formative.

[Baroness Merron (Lab)]

I thank the noble Baroness for sharing her experience of consulting widely. It is certainly entirely legitimate for government departments to do just that. However, those who do not have a formal role are not required to declare interests; it is different for those who have a formal role. Requiring them to do so would mean, for example, us sending forms in advance to Cancer Research UK before it comes in to talk to us about cancer and to assist us. Would we want that? We would not. Of course, where there is a formal role, we absolutely do that.

It is probably worth saying that a particularly high-profile invitation went from the Secretary of State to the noble Lord, Lord Darzi. He will report shortly on the true state of the National Health Service. He does not have a specific role in the department but he has been invited by the Secretary of State to assist; I believe that he will assist both your Lordships’ House and the other place.

[Baroness Bennett of Manor Castle (GP)]

My Lords, when the Green Party consults on health policy, among the organisations it consults are the Socialist Health Association, Keep Our NHS Public and 999 Call for the NHS—all organisations that are greatly concerned about the continuing privatisation of the NHS. Can the Minister tell me whether the Secretary of State or she herself have had meetings with any of those three organisations since coming into government?

[Baroness Merron (Lab)]

I cannot answer that, I am afraid. I would be very happy to look at it for the noble Baroness.

[Lord Markham (Con)]

Although I understand completely the role of advisers—obviously Alan Milburn is a very reputable adviser—where is the line? My concern is that, when an adviser has a pass, has been in meetings without Ministers present and has perhaps directed civil servants in those meetings, a line has perhaps been crossed. I would welcome assurances from the Minister that this has not occurred and that there have not been any meetings where Alan Milburn has been there without Ministers—in effect, directing policy with no formal role.

[Baroness Merron (Lab)]

The right honourable Alan Milburn has not been directing policy; he also has no pass. I hope that is helpful to the noble Lord.