Medical Devices (Amendment) (Great Britain) Regulations 2025

Baroness Merron Excerpts

Tuesday 6th May 2025 Grand Committee

Moved by

[Baroness Merron]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Baroness Finlay of Llandaff (CB)]

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

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

--- Later in debate ---

[Lord Kamall (Con)]

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

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

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

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

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

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

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

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

[Baroness Merron (Lab)]

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

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

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

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

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

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

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

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

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

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

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

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

Motion agreed.

Prosthetics for Amputees

Baroness Merron Excerpts

Thursday 1st May 2025 Grand Committee

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dementia and Alzheimer’s Treatments

Baroness Merron Excerpts

Thursday 1st May 2025 Lords Chamber

[Lord Evans of Rainow]

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

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

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

[Lord Evans of Rainow (Con)]

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

[Baroness Merron (Lab)]

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

[Baroness Ritchie of Downpatrick (Lab)]

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

[Baroness Merron (Lab)]

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

[Baroness Finlay of Llandaff (CB)]

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

[Baroness Merron (Lab)]

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

[Lord Scriven (LD)]

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

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Turnberg (Lab)]

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

[Baroness Merron (Lab)]

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

[Lord Markham (Con)]

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

[Baroness Merron (Lab)]

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

Self-harm: Young People

Baroness Merron Excerpts

Monday 28th April 2025 Lords Chamber

[Lord Lemos]

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

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

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

[Lord Lemos (Lab)]

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

[Baroness Merron (Lab)]

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

[Baroness Tyler of Enfield (LD)]

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

[Baroness Merron (Lab)]

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

[Baroness Owen of Alderley Edge (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Laming (CB)]

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

[Baroness Merron (Lab)]

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

[The Lord Bishop of Derby]

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

--- Later in debate ---

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

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

[Baroness Merron (Lab)]

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

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

[Baroness McIntosh of Hudnall (Lab)]

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

[Baroness Merron (Lab)]

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

[Baroness Kidron (CB)]

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

--- Later in debate ---

[Baroness Merron (Lab)]

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

Tobacco and Vapes Bill

Baroness Merron Excerpts

Wednesday 23rd April 2025 Lords Chamber

Moved by

[Baroness Merron]

That the Bill be committed to a Committee of the Whole House, and that it be an instruction to the Committee of the Whole House that they consider the Bill in the following order:

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

Motion agreed.

Mental Health Bill [HL]

Baroness Merron Excerpts

3rd reading
Wednesday 23rd April 2025 Lords Chamber

Relevant documents: 10th and 18th Reports from the Delegated Powers Committee. Welsh Legislative Consent sought.

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

My Lords, I will make a brief statement on the devolution status of the Bill. The majority of the Act that the Bill amends extends to England and Wales. An initial legislative consent memorandum was laid in the Senedd following the Bill’s introduction. Following further amendments to the Bill, supplementary legislative consent memorandums have been laid. I thank the Welsh Government for their constructive engagement, and I am pleased that they are recommending consent. The Senedd will hold a vote on legislative consent before the end of the Bill’s passage through Parliament.

Clause 30: Periods for tribunal applications

Amendment

Moved by

[Baroness Merron]

Clause 30, page 41, line 24, at end insert—
“(c) in paragraph (e), for “six months” substitute “three months”.”Member's explanatory statement
This amendment is consequential on clause 29(2) of the Bill and changes the period within which an application to the tribunal may be made where a patient is transferred from guardianship to a hospital to align that period with the initial detention period in relation to the patient.

[Baroness Merron (Lab)]

My Lords, this is a minor and technical amendment which would reduce from six months to three months the period within which an application to the tribunal may be made, where a patient is transferred from guardianship to a hospital under Section 19.

We are making this change to ensure that the relevant period within which transferred guardianship patients can make an application to the tribunal aligns with the relevant period for Section 3 patients. This is consequential to the changes that the Bill makes in Clause 29 to reduce from six months to three months the initial detention period for patients admitted for treatment, as part of our intention to provide patients with faster access to tribunals to review relevant decisions about their care. I beg to move.

Amendment agreed.

--- Later in debate ---

Moved by

[Baroness Merron]

That the Bill do now pass.

[Baroness Merron (Lab)]

My Lords, it has been an extraordinary honour and pleasure to take this Bill through the House with my noble friend Lord Timpson. As we are all aware, numerous aspects of the Mental Health Act 1983 are not serving us today. Over the decades, we have seen racial inequalities, inadequate care for individuals with learning disabilities and autism, and insufficient empowerment of patients who have not had an adequate voice.

Reform to the Mental Health Act is therefore long overdue. Many of the processes in the Act are out of step with a modern mental health system and with society at large. It has been a privilege to advance these reforms to deliver the Government’s manifesto commitment to modernise the Act to give patients greater choice, autonomy, enhanced rights and support, and to ensure that everyone is treated with dignity and respect throughout treatment, while ensuring that patient and public safety is paramount.

As noble Lords will be aware, this Bill is the product of the combined effort, over many years, by Members of both Houses and many outside Parliament who have worked for change and to whom thanks are due. I express my sincere gratitude to members of the former Joint Committee on the Draft Mental Health Bill: the noble Baroness, Lady Buscombe, as chair, as well as my noble friends Lord Bradley and Lady McIntosh of Hudnall, and the noble Baronesses, Lady Barker, Lady Berridge and Lady Hollins. The work and careful consideration that went into their rigorous scrutiny of the draft Bill, along with the constructive recommendations made, have undoubtedly strengthened it.

I pay tribute to the former Prime Minister, the noble Baroness, Lady May, who identified the need for modernisation and set up the independent review of the Act in 2017, chaired by Sir Simon Wessely and supported by the noble Baroness, Lady Neuberger, as one of the vice-chairs. Without this, we would not be here today.

I extend my heartfelt thanks to all Peers who have engaged with the Bill’s reforms. In addition to those previously mentioned, gratitude is due to both Front Benches—to the noble Lord, Lord Kamall, the noble Earl, Lord Howe, the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler. I am grateful to all noble Lords from across the House who have spoken during the various stages of the Bill and engaged with me and my officials over the past few months.

Because I would like to think that I am wise, I also thank my Whip, my noble friend Lady Blake, and my previous Whip, my noble friend Lord Cryer. I thank the Chief Whip and the whole of the Whips’ team and the team in the Leader’s office, including Ayeesha Bhutta and Michael Bleakley. My appreciation, as ever, goes to the clerks, doorkeepers and staff of the House.

I extend my heartfelt gratitude to all the officials who have played a crucial role in the progression of this Bill, and hope your Lordships’ House will indulge me while I give them the honour of mentioning them by name, because I believe they deserve it. Special thanks go to Phillip Dunkley, our Bill manager, and his dedicated team, Callie Mulligan, Sam Monday, Emily Bouldero and Rhys Jose. I am deeply appreciative of the Bill’s senior responsible owners, Kathy Smethurst and Caroline Allnutt, as well as the DHSC officials, including Esther Horner, Hannah Coaker, Alice Devlin, Matt Siddons, Tabitha Mufti, David Nuttall, Jennifer Rhodes, Megan McIvor and Mihiri Seneviratne, and their teams.

Additionally, I want to acknowledge the invaluable contributions of the Government Legal Department officials, Matt Smith, Lizzie Rattee, Nicky Richardson and Tim Spencer Lane, and their wider team, along with my private office staff, including Carl Plane and Yetunde Agaga, as well as Diggory Bailey and Victoria Griggs from the Office of the Parliamentary Counsel.

While I cannot list every individual, I express my appreciation to all officials who have played a part, including officials from the Ministry of Justice. Their unwavering support and dedication have been instrumental in the successful advancement of the Bill, and their work with Peers—as noble Lords across the House will testify—has been exemplary. I am confident that this legislation will make the Mental Health Act fit for the 21st century and give greater and better support to people when they need it. I look forward to it receiving support in the other place. I beg to move.

[Lord Kamall (Con)]

My Lords, as the Minister has said, debating the passage of the Bill through your Lordships’ House has been a pleasure. We have seen a genuine spirit of constructive engagement with a Bill that we all acknowledge will help patients who encounter mental health services, as well as a cross-party desire to improve the Bill. This was not a particularly political Bill; we found alliances across political lines and did not play political games. We wanted to improve the Bill and make sure that patients receive the best possible care. That is a wonderful demonstration of the value of this House.

I extend my thanks to all Peers who took part. I also thank the members of the pre-legislative committee whom the Minister acknowledged. Like the Minister, I acknowledge my noble friend Lady May of Maidenhead, the former Prime Minister, who we have to thank for beginning the process that led to this Bill. My noble friend identified the issue of racial disparities in the use of community treatment orders and wanted to reduce the involvement of police where they are not needed. Even though my noble friend was unable to be in her place to speak to her amendments on Report, I am grateful to all noble Lords who supported them, and I am delighted that the House has decided that they should be inserted into the Bill. We look forward to how that will be debated in the other place.

It was also welcome to see the House rally behind my noble friend Lady Berridge’s amendment to ensure that the process for appointing nominated persons for patients under 16 aligns with the Children Act 1989. My noble friend was crystal clear that there has to be consistency between different Bills, and that we do not want people falling between Bills and into harm’s way. She highlighted this and gave some harrowing examples of what could happen if we do not align these Bills. We have to make sure that we align them as much as possible.

I also thank the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler, for their dedication to improving community treatment orders and addressing racial disparities. Noble Lords will remember that this is probably the issue that was closest to my heart, and we probed the Government heavily on it. There are still too many racial disparities. We understand that it is a complicated issue, but the Government assured the House that they are looking into the data around this. What do they know? What do they not know? How will they fill that gap and what will they do to address racial disparities? I hope that is something that all noble Lords can agree on.

Of course, I have to thank my noble friend Lord Howe for his stalwart support and advice on this Bill, and for his experience not only of parliamentary procedure but of previous iterations of this Bill. I appreciate his sagacity, and I am grateful whenever he agrees to work with me on Bills—sometimes to curb my schoolboy enthusiasm and keep me on the right path. I am grateful that he has agreed to work with me on the Tobacco and Vapes Bill, which your Lordships will debate later today.

I also thank the Minister—and of course her noble friend, the noble Lord, Lord Timpson—for taking time at the Dispatch Box, and for the fact that the Minister and her officials were always available to meet us to try to iron out some of the disagreements or find compromises. That is very much appreciated by all noble Lords in this House. I thank Ben, the special adviser in her office, for his input, and, in our office, our adviser Jamie Tucker, who was amazing in his understanding of the Bill.

I will end by mentioning a quote that was sent to me and my noble friend Lord Howe from the charity Blooming Change. On hearing that the House had voted in favour of my noble friend’s amendment on mandatory debriefing for mental health patients, a younger person told the charity:

“I genuinely for the longest time felt like I didn’t matter, to anyone or anything, that the universe didn’t need to hear my voice, that what I went through didn’t matter. It took so long to build my confidence and to find my voice … I’m glad I decided to use my experiences to fight for change and I’m so happy our words have made a difference. We will keep fighting for more changes, little by little”.


As the Bill now progresses to the other place, I hope all Members involved will heed those wise words.

Tobacco and Vapes Bill

Baroness Merron Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

Moved by

[Baroness Merron]

That the Bill be now read a second time.

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

My Lords, I beg to move that the Bill be now read a second time, and it is an honour to do so.

The evidence, despite perhaps some lingering myths and misperceptions, remains stark and compelling: smoking remains unequivocally the number one preventable cause of death, disability and ill health in our nation. Progress has been made, but this is not a problem of the past. Smoking continues to cast a long shadow over our society, remaining a significant public health challenge with persistent rates of prevalence. Every year we witness the loss of approximately 80,000 lives in the UK directly attributed to smoking.

The impact of smoking reverberates throughout lifetimes, increasing the risk of a whole range of conditions from stillbirth through to significantly higher rates of dementia, stroke, heart attacks, lung diseases and many cancers. Smoking also results in a significant loss of productivity in the wider economy and places a considerable burden on our healthcare system. In total it is estimated to cost society approximately £21.3 billion annually.

To correct this course, this Bill will create a smoke-free generation, making it an offence to sell tobacco products to anyone born on or after 1 January 2009, meaning those who turn 16 this year, and younger, will never legally be sold tobacco in the UK. This will gradually end the sale of tobacco products across the country, protecting future generations from the well-documented and evidenced harms of smoking.

In turning our attention to vaping, we face a nuanced challenge. Vapes are less harmful than smoking and absolutely have a strong role to play as a cessation aid for adult smokers seeking to quit. In fact, clients of stop smoking services who have used a vape to quit have had the highest success rate of any group. Nevertheless, a concerning increase in youth uptake should not be ignored. In 2023, one in four children aged 11 to 15 tried vaping, often drawn in through appealing sweet-like flavours and colourful packaging.

In response to this challenge, the Bill includes measures which address the rise in youth vaping and other nicotine products. We will ban advertising and sponsorship, and implement regulations concerning the flavours, descriptions, ingredients, packaging and point-of-sale displays of these products. The intention here is clear. We will ensure that the marketing of vapes can no longer target minors. However, it is imperative that the Bill strikes a necessary balance, ensuring that vapes remain an accessible option for adult smokers looking to transition away from dependence on tobacco, while clamping down on youth vaping.

The public understand the importance of this Bill and what it aims to achieve. Some 69% support a smoke-free generation policy, while 82% of adults support banning names of sweets, cartoons and bright colours on vape packaging, and 81% support banning the advertising and promotion of vapes at the point of sale.

This Bill is the product of the combined effort of Members of both Houses and many outside Parliament over the course of many years. A key manifesto commitment of this Government is to create a smoke-free generation, and this Bill has rightly received support from across the political parties. I express my thanks to many—over, as I said, many years—but I particularly thank the former Prime Minister, the right honourable Rishi Sunak MP, who committed to the original form of this Bill. I also thank my ministerial colleague, Ashley Dalton MP, and the members of the All-Party Parliamentary Group on Smoking and Health. Many others have also informed and motivated the action by this Government.

As we turn our attention to the substance of the Bill, I want to highlight its core aims. At its heart, the Bill is about safeguarding the health of our population. Its fundamental principle is to address the cycle of addiction and societal disadvantage. It is a key component of our broader health mission: a commitment to shift from treatment to prevention. Under our Plan for Change, the Government are committed to ensuring a sustainable health system that moves healthcare from hospital to the community, from analogue to digital and from sickness to prevention.

The Bill incorporates a UK-wide approach, reflecting the need for change across our four nations. Health is a devolved matter, so the Bill has been developed in close partnership and collaboration with the Scottish Government, the Welsh Government and the Northern Ireland Executive. This ensures not only greater consistency across the nations but a more enforceable regime across the UK.

In addition to creating a smoke-free generation, the Bill will amend the existing powers to designate certain outdoor settings as smoke free. This will offer greater protections to those at risk from the harms of second-hand smoke. Any such extension will be carefully considered and subject to consultation. In England, the Government will consult on banning smoking outside locations frequented by children and vulnerable people, such as schools, hospitals and playgrounds, but not outdoor hospitality or wider open spaces. Private outdoor spaces are out of scope of the powers in the Bill.

In addition, the Bill provides regulation-making powers to address the entire life cycle of tobacco, vaping and nicotine products, enabling the Government to set appropriate product standards to protect consumers. The introduction of a pre-market registration scheme will provide comprehensive oversight of manufacturers and the products they introduce to our stores. Retail licensing provisions then facilitate ongoing monitoring and modification of retailer practices, strengthening enforcement and ensuring adherence to the measures we put in place.

It is important to acknowledge, as I know many noble Lords do, the dynamic nature of the products we are discussing and the fact that our scientific understanding of their long-term impact continues to evolve. Therefore, the Bill allows for the highly technical details of the regulatory regime to be set out in subsequent regulations that are well placed to adapt to emerging evidence and market innovations.

This is not just about the Bill. The Bill is part of a wider effort across government to address the challenges of smoking and youth vaping. The Government are actively supporting current smokers who wish to quit. We are increasing funding for local stop smoking services by an additional £70 million in 2025-26 and delivering national action, such as the national smoke-free pregnancy incentives scheme and the vaping Swap to Stop scheme.

The Department for Environment, Food and Rural Affairs has laid legislation that will see the ban of single-use vapes from 1 June this year, addressing a key factor in youth vaping as well as environmental concerns. Moreover, to discourage non-smokers and young people from starting vaping, and to generate revenue for public services, the Government will introduce a vaping products duty, which will come into force from 1 October 2026. In order to continue to incentivise smokers to quit and keep the differential in price, duty rates on all tobacco products were increased by 2% above inflation in the Autumn Budget, with further additional increases for hand-rolling tobacco to reduce the gap with cigarettes.

We recognise the importance of robust enforcement of our new laws and regulations, so the Government have announced £10 million of new funding in 2025-26 for Trading Standards to tackle the illicit and underage sale of tobacco and vapes, and to support implementation of the measures in the Bill. In total, we will invest £30 million of new funding in 2025-26 for enforcement agencies, including Trading Standards, Border Force and HMRC.

I extend my gratitude to noble Lords on all sides of the House for their ongoing support for the Bill and for getting it to this stage. The time to act is now, which is why this is priority legislation for this Government and why we have gone further than the previous Government. I look forward to the collegiate and constructive debate that I know will follow from my engagement thus far, and I will seek to respond to the main questions and themes. I beg to move.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I am grateful to all Members of your Lordships’ House who have contributed to what has been a thoughtful and wide-ranging debate on a very important issue.

Today’s debate has been very well supported. I hope that noble Lords will understand that I will not be able to cover in my summary every issue that has been raised, but I will endeavour to respond to as many of the themes and questions as possible. Of course, I will be happy to have further discussions with noble Lords, and we will have the opportunity for these ahead of and during future stages of the Bill. I too look forward to Committee.

It seems many hours ago since my noble friend Lady Thornton spoke of the measures in this Bill being a further step along the way. I share that view, which has been expressed by a number of other noble Lords, particularly those in what I shall politely call the cohort of former Health Ministers. I do not know what the collective term is, but I am sure we will work on that. I am in that cohort, and I too worked towards the initial smoking ban in 2007. As a Public Health Minister, I introduced the display regulations we are now so used to. When we introduced the original ban in 2007, no one could have dreamed of the challenges we have today, including vaping; this was not something we had considered. It was also important to go with the public, which is why I was keen to outline the public’s support in my opening remarks.

I am grateful for the challenge. I have heard many concerns being expressed today, along with outright opposition to the Bill. I have also heard much support for the Bill, although there are rightly questions about the measures in it. Many noble Lords have been supportive, including the noble Lords, Lord Lansley and Lord Stevens, who assisted me by anticipating some of the arguments that will be deployed. The noble Baronesses, Lady Redfern and Lady Smith, and many others, were also very supportive.

I am grateful to my colleagues on both Front Benches for taking a line similar to the one I am about to take in respect of the Chief Medical Officer’s views. These include:

“If you smoke, vaping is safer; if you don’t smoke, don’t vape.”


I am also very grateful to noble Lords who were good enough to join me yesterday at a briefing with the Chief Medical Officer and officials, which I certainly found helpful. I know that others did too.

I understand that there are different perspectives on a number of issues, and I now turn to some of the points that were raised. I heard concerns about the smoke-free generation policy from a number of noble Lords, including the noble Lords, Lord Scriven, Lord Brady, Lord Naseby, Lord Sharpe, Lord Teverson and Lord Moylan. However, the reality is that smoking leads to significant harm. A clear majority of smokers regret ever having started. My noble friend Lord Browne spoke about this, as did the noble Lord, Lord Vaizey, who recounted his own personal experience. Many people struggle to give up due to the addictive nature of nicotine.

I am grateful to a number of noble Lords for sharing their personal experiences, which brought colour and a human touch to our debate. These included the noble Lords, Lord Jopling and Lord Rennard, my noble friends Lady Rafferty, Lady Ramsey and Lord Griffiths, and the noble Baroness, Lady Morgan.

However, let us remember that the harms of smoking extend beyond the individual. They impact on non-smokers, especially children and pregnant women, through second-hand smoke. This policy will be the most significant public health measure in a generation. It will build on the previous steps I spoke of, such as the 2007 indoor smoking ban, with the goal of safe- guarding the health of future generations from preventable and serious harm. That is why we are bringing the Bill forward.

The noble Baroness, Lady Fox, decried the Bill on a number of levels, including—she must forgive me if I am wrong on this—that it is Tory legislation. Actually, this is a Bill on which we are agreed across the House and across parties. Of course there are questions, but a wise Government and wise Opposition Benches acknowledge good when they see it. That is where we are today.

A number of noble Lords suggested raising the age of sale to a particular age—for example, 21 or 25—as a potential way to address smoking. As the noble Lord, Lord Bourne, put so well, that would not stop young people starting to smoke. The whole point is that, once you have started to smoke, the challenge of giving up is tremendous, because it is an addiction. Introducing a particular age could have a positive impact but it will not fully achieve the ambition of a smoke-free UK. Our goal is to go further, to break the cycle of addiction. We want to drive smoking rates down to 0%. That is why we have suggested a smoke-free generation.

On the practicalities, implementation is absolutely key. On ID checks, the majority of retailers sell tobacco and vapes responsibly—I acknowledge that. They follow the recommended practice and regularly ask for ID from customers. The Bill provides powers to specify in regulations the steps that may be taken to verify a customer’s age, to provide clarity and to support retailers. The noble Baroness, Lady Walmsley, spoke to this point. We are exploring how we can enhance age verification with digital verification services, providing an opportunity to securely verify age, both in person and online.

With regard to the products in scope, the Bill captures all tobacco products, as tobacco is uniquely harmful. There are around five times more people smoking non-cigarette tobacco, such as cigars, than a decade ago, and the greatest increase is among young adults. To the noble Earl, Lord Howe, and the noble Lord, Lord Vaizey, I would say that this is why the Bill, importantly, captures all tobacco products and must not be watered down to exclude certain products.

The noble Earl, Lord Lindsay, and the noble Lords, Lord Strathcarron, Lord Scriven and Lord Brady, referred to other products outside of this range. I again call upon the words of the Chief Medical Officer: there is no safe level of tobacco consumption. That is what sets it apart from other products that we might feel are harmful. There is no safe level, not even a little bit; that is the key. Therefore, cigars, shisha and heated tobacco are all in scope. To the point raised earlier about heated tobacco, there is evidence from laboratory studies of its toxicity, and there are, as noble Lords have spoken of, less harmful tobacco-free products to support people to quit, rather than heated tobacco.

A number of noble Lords raised points about the growth in illicit sales. The noble Lords, Lord Dodds, Lord Blencathra, Lord Naseby, Lord Scriven, Lord Howard and Lord Murray, the noble Baroness, Lady Hoey, and the noble Earl, Lord Leicester, were concerned that the Bill’s ambitions could be undermined in this respect. As other noble Lords have said, history shows that when we have introduced targeted tobacco control measures, the size of the illicit market has not increased. As the noble Lord, Lord Bichard, told the House, it has in fact continued to fall. When the age of sale increased from 16 to 18, the number of illicit cigarettes consumed fell by 25%.

On the point raised by the noble Baroness, Lady Walmsley, the Government are cracking down on the demand for illicit trade, as well as the supply, with the joint strategy with HMRC and Border Force backed up by over £100 million of new funding over five years.

I am grateful to the noble Lord, Lord Bichard, for articulating support for those who work in trading standards as well as acknowledging their worth, and I share his views on that. As these were points raised by the noble Lords, Lord Moylan and Lord Udny-Lister, it might be helpful to reiterate that we have announced £10 million of new funding in 2025-26 for trading standards to boost the workforce and tackle the illicit and underage sale of tobacco and vapes.

A number of questions were raised about whether driving down the smoking of tobacco could lead to an increase in the smoking of cannabis. As the noble Lord, Lord Kamall, accurately said, the Bill is not banning the smoking of anything—it is in reference only to tobacco and vapes. I also ought to say that we are not aware of any link between the rates of smoking cannabis and the rates of smoking tobacco. I know that noble Lords are more than aware that cannabis is, of course, illegal.

On the matter of abuse against retail staff, raised by my noble friend Lady Carberry, we are working closely with retailers and will utilise the long lead-in time to best support them in preparing for and implementing these changes. That includes rolling out information campaigns for both the public and retail workers. We will not stand for violence and abuse against shop workers; everyone has the right to feel safe. To protect hard-working and dedicated staff who work in stores, this Government will introduce a new offence of assaulting a retail worker.

On the issue of smoke-free places, in England we intend to consult on extending smoke-free outdoor places to outside schools, children’s playgrounds and hospitals, but not—I say to my noble friend Lord Faulkner —to outdoor hospitality settings or wider open spaces such as beaches. This is because—and it might be helpful to the noble Baroness, Lady Bray, as an assurance—we judge that this adequately balances a range of priorities by protecting the most vulnerable while ensuring that businesses are not financially impacted.

There was a lot of discussion about the rationale for the broad powers, including within the Bill. Noble Lords are right to point to the high number of regulation-making powers that the Bill takes. I have no doubt that noble Lords have enjoyed or will enjoy scrutinising the 96-page delegated powers memorandum, which sets out in full the detail of the rationale for each and every one of the powers. I recommend it as good reading. Concerns were particularly raised by the noble Earl, Lord Howe, the noble Lord, Lord Blencathra, and the noble Baronesses, Lady Hoey and Lady Meyer. I assure noble Lords that each of these powers has been carefully considered and aims to ensure that the Bill establishes a clear regulatory regime for tobacco, vaping and nicotine products, and that we have worked very closely with the Attorney-General’s Office to get it in the right place.

As the noble Baroness, Lady Northover, spoke to, given the need to adapt to emerging scientific understanding and to market innovations, it is crucial that the details of the regime are set out in regulations, to ensure sufficient flexibility. In addition, most of the regulations require significant technical detail, which is more appropriate for secondary legislation.

As some noble Lords referred to, the Bill is UK-wide, so certain powers are being repeated for each part of the UK. Equally, the Bill restates or amends a number of existing powers from across tobacco control legislation, to bring it together in one place. That will help to make legislation more useful and accessible.

I can assure noble Lords that the Bill provides a statutory requirement to consult on regulations, and we are working constructively with retail associations and the Local Government Association to help shape the early design of the scheme. The noble Lord, Lord Mott, was right to say that we should support responsible retailers, who are the majority and who want to do the right thing. They do not want to be undermined by those who are not being responsible. I put that to the noble Lord, Lord Udny-Lister, who was concerned about impact.

On the matter of balance in respect of vapes, there was a useful debate, both in the Chamber and at a meeting I held with the Opposition Front Bench, about the matter of flavours. To avoid unintended consequences on adult smoking rates, the scope of restrictions will be carefully considered and consulted on. The noble Earl, Lord Howe, raised the issue of exemptions from the advertising ban for public health purposes. We are clear that healthcare providers can continue to provide advice about vaping as a smoking cessation tool. For example, pharmacists could display public health campaign messaging or provide advice to customers about vaping as a smoking cessation tool. I wish to say to my noble friends Lady Mattinson and Lord Hanworth, as well as the noble Earl, Lord Russell, that we will keep emerging evidence under review, and have already commissioned a 10-year study to investigate the long-term effects of vaping on the health of 100,000 young people, which I hope will be helpful.

On the matter of filters and the environment, I understand and am sympathetic to the concerns raised by noble Lords, including the noble Baronesses, Lady Grey-Thompson and Lady Bennett. The environmental harm of items with tobacco butts is evident, as it is the most littered item in the UK. Ultimately, the best way to tackle this littering is through reducing smoking rates, but we are where we are. Local authorities already have powers to tackle littering, including through the ability to issue fixed penalty notices of up to £500. We are working closely with Defra to take a systematic approach to what is indeed something of a blight.

On the matter of age and the concerns, including twins born either side of midnight, should such a thing ever happen, I remind noble Lords that other policies already do this, such as universal credit increases, NHS screening programmes and access to vaccines.

On the “polluter pays” levy, raised by the noble Lords, Lord Crisp and Lord Young of Cookham, my noble friend Lord Faulkner and the noble Baroness, Lady Walmsley, the Government’s present preference is, as I think noble Lords are aware, to continue with a proven and effective method of dealing with tobacco products through increases in tobacco duties, to incentivise those who currently smoke to quit, and to generate finances that can be put back into public services.

I am most grateful to the noble Lord, Lord Bethell, for his support for the Bill and appreciate the intentions behind his suggestion to be smoke-free by 2040.

On the points about the Windsor Framework, I have heard the concerns about the application of smoke-free generation policy in Northern Ireland from the noble Lords, Lord Dodds and Lord Weir, the noble Baroness, Lady Hoey, and my noble friend Lady Ritchie. I have met the Northern Ireland Health Minister, and we continue to work well with his office. I assure noble Lords that we are content that the measures intended to apply to Northern Ireland are consistent with the obligations in the Windsor Framework.

In closing, I am most grateful to all noble Lords who have contributed to this debate. This is a landmark Bill, and it will be the most significant public health intervention in a generation, so I beg to move.

Bill read a second time.

Funerals: Death Certificate Delays

Baroness Merron Excerpts

Thursday 3rd April 2025 Lords Chamber

[Viscount Stansgate]

To ask His Majesty’s Government what steps they are taking to reduce reported delays in holding funerals because of changes in the provision of death certificates.

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

My Lords, the death certification reforms are increasing scrutiny of deaths and patient safety, and supporting the bereaved. We are taking steps to reduce the time to register a death, through active monitoring of the reforms, using weekly data from the ONS to target the challenges and the necessary support. We are also working with faith groups and the funeral sector to identify and reduce any obstacles, and sharing any concerns we receive with NHS England so that they can be swiftly resolved.

[Viscount Stansgate (Lab)]

I thank my noble friend for that Answer. When my dad died—incidentally, he was born 100 years ago today—it was possible to arrange his funeral in two weeks. That is not now possible. I have talked to the National Association of Funeral Directors, and I understand that there is a lot of confusion around the country about the new procedures, although everyone understands why they are there. Is there more that could be done in hospitals or by GPs to help families who are having to cope with the unfamiliarity of the new procedures at the time of their own grief? More widely, might it be possible for the Government to start considering regulating the funeral profession, as has happened in Scotland?

[Baroness Merron (Lab)]

I am sure that we all wish to pay tribute to the memory of my noble friend’s late father. I appreciate the points that he has made. It is not the case that delays to funerals can be identified and formally linked with the changes in death certification. My noble friend raised a lot of points, many of which are valid. In a bereavement, it is more important than ever that any official processes—as well as the funeral sector itself—work as seamlessly and sensitively as possible. I assure my noble friend that not only are we driving improvement by implementing the death registration reforms but we are very focused on supporting the bereaved. On my noble friend’s point about regulation, I am not aware of any plans at present.

[Lord Scriven (LD)]

My Lords, to solve a problem, first you have to accept that it exists. Everyone involved in funerals, from the GPs doing the certification to the funeral directors, say that there is a direct link between the extra time to deal with funerals and the reforms. The reforms were needed, but can the Minister clarify the number of medical examiners required in each region—because regional variation exists—to prevent lengthy delays in funeral arrangements? What assessment have the Government made to ensure that the current number of medical examiners is sufficient to meet regional demand?

--- Later in debate ---

[Baroness Merron (Lab)]

I do not have the figures to hand, but I would be very pleased to write to the noble Lord. As I said, this is a complex area. The reforms were introduced in September, and it is very difficult to make before and after comparisons. Since 2001, a long-term trend has shown an increase in the median time between death and registration, and that cannot be attributed to death certification reforms. In addition, the reforms are about the introduction of statutory medical examiners as opposed to the non-statutory arrangements that existed before—and there was even more regional variation before September than we are finding now. I assure your Lordships’ House that I am working very closely with officials to understand the reasons for this so that we can take more action.

[Lord Kamall (Con)]

My Lords, I thank the noble Viscount, Lord Stansgate, for the conversation we had about this Question. As we all know, when a loved one passes away, it is a distressing time, and surely delays can only add to that distress. I am sure that noble Lords understand why these reforms were brought about in the first place: they were introduced after a qualified doctor, Harold Shipman, murdered his patients and signed the death certificates himself. In a recent Written Answer on these delays, the Minister for Public Health in the other place said:

“The expectation on doctors and medical examiners is clear … they should complete certification as quickly and efficiently as possible, and the Government is working with all stakeholders to make sure this is the case”.


Can the Minister explain to your Lordships what that means? Is the department simply asking them to complete the certificates, or is it identifying blockages or misunderstandings in the system to help unblock them in order to speed up the process?

[Baroness Merron (Lab)]

The noble Lord’s observations are correct. As I said, it is so important to be timely and sensitive at a time of bereavement. Governments and Ministers have been working to bring in the system over the last 50 years—in fact, it has been overdue for reform for that long, so I am very glad to have taken this action. Introducing this robust system means working with medical examiners as well as the bereaved, so that we hear from them about what has happened. We also work very closely across government, including with the MoJ and the Home Office. As the noble Lord will know, the medical examiner system is led by NHS England through the office of the National Medical Examiner. I reiterate that delays are not due solely to this introduction; it is very important to unpick this issue. We now have better data and get weekly reports, which is helping greatly.

[Baroness Finlay of Llandaff (CB)]

My Lords, at the Commission on Palliative and End-of-Life Care, chaired by Professor Sir Mike Richards, we have heard from medical examiners and the bereaved. It is clear that the ability for the bereaved to speak to a medical examiner and go through things in detail is very supportive. However, the delays in notifying the cause of death and transferring the case notes seem to be from the doctor who had seen the patient. The medical examiner cannot start until both those events have happened, and at that point their work begins. So the increasing digitalisation of the health service and of notifications could speed up these processes. Does the Minister agree that the digitalisation proposals from the noble Lord, Lord Darzi, will bring about those changes and simplify the process?

[Baroness Merron (Lab)]

I agree that those changes—the move from analogue to digital, which will be outlined in the 10-year plan—will indeed help in this area, as well as many others.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, clearly, this is a complex and difficult issue, and there does not seem to be any one reason why these delays have started to extend. Can the Minister tell the House whether there are any financial implications for people who have to wait much longer for a funeral to be arranged, given that they are not cheap to begin with?

[Baroness Merron (Lab)]

I am not aware of the specifics around that point, but we will be very pleased to look into that because we do not want people to be inconvenienced and distressed even further.

[Lord Polak (Con)]

My Lords, the Minister will know that, in the Jewish community, we bury our deceased within 24 hours. I have not noticed any change in that since September—so perhaps that fact will help her.

[Baroness Merron (Lab)]

I am grateful to the noble Lord. He is of course aware that, as the former chief executive of the Board of Deputies of British Jews before coming to this place, I worked on this very area to ensure that there were swift responses and burials for the faith communities that require them. That continues to be a great focus of our work.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, in Northern Ireland, the practice is that funerals are held three days after death. Does the Minister think that anything can be learned from that?

[Baroness Merron (Lab)]

We are always happy to learn from the practices of other Governments, and we will continue to work on speed and, as I said, to keep distress and delay at a minimum.

[Lord Rook (Lab)]

My Lords, I point to my entry in the register of interests as an Anglican priest. I am particularly glad that my noble friend the Minister mentioned the challenges for faith communities and the important role that ministers of religion have not only in conducting funerals but in supporting families with grief and loss. Obviously, a delay to those things can cause family stress and tension. What are the Government doing to engage Muslim communities, which particularly feel the stress and pressure of this issue given their obligation to have swift funerals?

[Baroness Merron (Lab)]

I pay great attention to this area, as I mentioned in my response to the noble Lord, Lord Polak. I met faith group leaders in December, and we have worked very closely with faith groups to develop the medical examiner system. The faith groups are very supportive of the reforms, have broadly welcomed the implementation and continue to work with us to identify any issues, for which I am very grateful. Data from regional medical examiner offices in England, although unpublished, indicate that 88% of requests for urgent scrutiny—the group we are talking about in the faith communities—were met. Indeed, in Wales the corresponding figure has been assessed to be 99%. I assure all noble Lords that we are working extremely hard to make sure that the system reduces any unnecessary delays, and we will continue to do so.

NHS Pensions

Baroness Merron Excerpts

Thursday 3rd April 2025 Lords Chamber

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

It may be helpful if I respond to the noble Lord by saying that a compensation scheme is already in place to cover direct financial losses, certain HMRC interest charges and the costs of financial and accountancy advice. On the specific point that the noble Lord raises, I will be very pleased to answer further on the response of my honourable friend in the other place.

It is also important to remember that this arises from a reform to public service pension schemes in 2014 and 2015 under the coalition Government. As part of those reforms, older pension scheme members were given protections enabling them to stay in legacy schemes, but younger members were moved on to reformed schemes. Therefore, legal cases were brought, and the Court of Appeal found against the then Government. We are dealing with an inherited situation, and we are working at pace to get the right things to people, but also in order that people do not lose out.

[Lord Scriven (LD)]

First, I have to declare an interest as a member of the NHS pension scheme. To be helpful, will the Government look at taking two urgent measures to help alleviate some of the problems that the late delivery of these statements has caused? The first is to extend the carry-forward rules from three to five years, and the second is to provide an immediate remedial service statement for those needing transitional tax-free amount certificates. If the noble Baroness cannot answer in full, a written response would be welcome.

[Baroness Merron (Lab)]

I am very glad that the noble Lord has given me that option, which I will gladly take. Perhaps it would be helpful to your Lordships’ House for me to say that the deadline to issue remedial service statements was 1 April or later. That was not achievable because of the level of technical complexity, capacity, and delays in HMT and HMRC setting out lower-level policy requirements under the previous Government, so Minister Karin Smyth extended this deadline last week and published a new timetable. Separately, 137,000 higher-earning members of the NHS pension scheme require remedial pension savings statements as part of their remedy. The deadline for that was 6 October. HMRC did not allow this to be amended. The current position is that, to date, 94,012 statements of the 137,000 have been issued. These delays are due fundamentally to the annual allowance element of the remedy being poorly designed and, again, late requirements provided by HMT and HMRC. To say that this is a knotty problem would be underestimating it.

[Baroness Watkins of Tavistock (CB)]

I thank the Minister for the assurance in the Statement that no individual member will in the long term suffer financial detriment. However, is she able to explain how the NHS Business Services Authority issued 23,000 inaccurate statements against 57,000, which is over 30%, and what are we doing to get efficiency and effectiveness from this authority?

[Baroness Merron (Lab)]

I appreciate the point that the noble Baroness refers to. The priority is to get this matter resolved, as she will appreciate. With respect to the NHSBSA, we will also be working closely with it to ensure that the correct service is given in future. Obviously, I want to see this put right to assure people as soon as possible.

[Lord Davies of Brixton (Lab)]

I thank my noble friend for her further clarification of the issues here. This is an extremely complex issue, and I know that better than most because I was involved in the original negotiations, going back to 2011.

What was disappointing about the discussion in the House of Commons on this issue was that there was overemphasis on working out who was to blame rather than on achieving a solution at pace. I thank the Minister here for focusing. Can she give an assurance, first, that everything is being done to resolve this situation? There is also the issue of the way in which the Statement is worded, referring specifically to financial loss. Those people have had to suffer high levels of uncertainty and delay in making their arrangements, which is not easily captured in the term “direct financial losses”. They will be significantly concerned about that lack.

Finally—I feel some sympathy for my noble friend—this is an issue that runs across all the public service schemes. Similar problems are arising in other schemes, not quite to the same extent, but there is failure there. Does my noble friend agree that this illustrates that any changes to public service pensions need to be considered extremely carefully, before we end up with similar problems down the line?

[Baroness Merron (Lab)]

I certainly agree with my noble friend. This runs across all public service pensions. Indeed, it is not just the issue of pensions but the administration and support given. To the point raised by both my noble friend and the noble Baroness, Lady Watkins, I should add that the NHS Business Services Authority and the department are in regular contact with the Pensions Regulator on delivery.

I can certainly give the assurance to my noble friend that we are working cross-government to ensure that these difficulties are corrected as soon as possible. I absolutely recognise the inconvenience, uncertainty and potential distress that have been caused to individuals. As I say, this has a root in it being discriminatory from 2014-15. That said, it falls to us to put that right.

[Baroness Altmann (Non-Afl)]

My Lords, does the noble Baroness agree that at the heart of this problem is the complexity of our pension system and the tax rules, which have undermined the generosity of public sector pensions, which are meant to be a really generous benefit but have turned into a hugely unwelcome cost for our most senior medical staff and nursing staff, as well as others in the public sector? Is she looking, at the same time as trying to correct some of these errors, at finding other ways of improving the problems in the scheme, which will remain even after the statements are issued, such as doctors and nurses themselves having to go on to an HMRC tool to retrospectively adjust their annual allowances for the various tax years going back all those years? Will there be consideration of addressing the cost of scheme pays? Has consideration been given to providing independent financial advice for senior members of the scheme, who would then have some comfort that what they are frightened of—and is driving early retirement or stopping overtime—is either unnecessary to worry about or can be dealt with in another way?

[Baroness Merron (Lab)]

I very much value the noble Baroness’s expertise in this area, so I particularly value her acknowledgement of the complexity of the scheme. Certainly, in our efforts to support the workforce, we consider all matters to make working for the NHS better and simpler. There has been talk—the noble Baroness did not quite say this—that pension issues are impacting NHS activity. There is no evidence of that. Nor is there any clear evidence from NHS payroll data that pension tax rules limit the activity of, for example, the consultant workforce overall. All that said, I, as ever, will be pleased to take away the suggestions that the noble Baroness makes and to have them looked into.

Mental Health Bill [HL]

Baroness Merron Excerpts

Report stage
Wednesday 2nd April 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Tyler, for, as others have said, the eloquent way in which she introduced her amendment.

I know this is a topic that noble Lords across the House feel strongly about, and I appreciate the arguments in favour of the creation of a commissioner. Indeed, as other noble Lords have said, it was a recommendation of the pre-legislative Joint Committee.

Having listened keenly to what the noble Baroness has said, and having discussed this issue with her and her noble friends, I have to say that I agree with the noble Lord, Lord Bradley, when he says that the landscape has changed. We are now at a time when the Government are looking to reduce duplication and arm’s-length bodies—something that I believe a responsible Opposition should support. We believe it should not be necessary to have a new, separate, independent mental health commissioner.

We were going to group this amendment with the ideas about strengthening the CQC, but that has been ungrouped and we will talk more to it in the next group. When I had some conversations with those who supported the independent mental health commissioner, they said I should look to Children’s Commissioner as an example. I looked at the Children’s Commissioner; it does a great job, but it has a staff of 25, a temporary staff of 31, and expenditure of £3 million. That may not sound a lot of money but I wonder whether that amount of money could be better invested in strengthening the CQC. One of the things about any bureaucracy is that they grow and have more non-essential roles as other bits of legislation bring them in. I worry about the cost and duplication of functions.

I completely understand the argument from those who say that the CQC has not been doing its job and those who have criticised it for being ill-equipped. That is why we tabled our amendment, which will be discussed in the next group, about strengthening CQC functions. However, rather than saying all that now and repeat it in the next group, I do not wish to detain the House any longer. I believe there should be a comprehensive review of the CQC and proper accountability, and I hope we can achieve that without an independent commissioner.

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

My Lords, I thank all noble Lords for their contributions on this fiercely and keenly debated proposal. Amendment 47, in the name of the noble Baroness, Lady Tyler, leads me to say that we continue to be of the strong view that the functions of the proposed commissioner, as set out in the amendment, would clearly overlap with the existing responsibilities of other organisations, most notably the CQC. I must respectfully disagree with the noble Baroness: the CQC has a statutory role in monitoring the Mental Health Act. It publishes an annual report that serves to drive policy improvements in this area.

--- Later in debate ---

[Lord Scriven (LD)]

Can I just ask the noble Baroness a very quick question? Will the newly appointed person have a statutory right to call for papers and witnesses from other departments to deal with mental health issues, as a commissioner would?

[Baroness Merron (Lab)]

I cannot draw a comparison with a commissioner but I will be very pleased to answer the noble Lord definitively in writing.

Secondly, as announced by the Secretary of State, we are abolishing NHS England as part of the radical reforms we are making to the national health system to rid it of duplication, inefficiency and waste, so that vital resources can be redirected to the front line. On this, we very much look forward to the much-anticipated report from Dr Penny Dash on the wider patient safety and oversight landscape. Of course, as noble Lords will be aware, the 10-year plan for the NHS is being co-developed with staff, patients and the public. I believe these changes only confirm that creating a new mental health commissioner would be not only duplicative but completely at odds with the important and very live reforms that the Government and the CQC are making.

During the course of the Bill, including today, I have heard noble Lords speak passionately about introducing a mental health commissioner role akin to that of the Children’s Commissioner. I very much value the work of the Children’s Commissioner and, as I have said before, I do not accept that it is a valid comparison. More pressingly, following a constructive meeting last week with the Children’s Commissioner, which the noble Baroness, Lady Tyler, referred to, I can report that she is concerned about the establishment of a mental health commissioner. In her view, covering all aspects of children and childhood is a critical part of her role. This is because children see their mental health as indistinguishable from their wider health and experience of childhood. We discussed this at some length. The Children’s Commissioner’s view is that the proposed establishment of a mental health commissioner risks taking a siloed approach to the barriers and challenges that children face, and I feel it is incumbent on us to listen to that view.

I also reiterate that I am deeply concerned about the level of resource needed to take this forward, as required in the amendment, as was understood by the noble Lord, Lord Kamall. This would be on top of the resources needed to remodel the healthcare quality and regulatory landscape to avoid the risk of duplication and waste. I can honestly say that I do not feel that this can be justified, particularly in the current climate.

The noble Baroness, Lady Bennett, made comparisons with the Government’s plan to introduce an Armed Forces commissioner. This is a manifesto commitment that we are certain addresses an important and specific gap: the strengthening of support for Armed Forces communities to improve service life. Furthermore, we are talking about an entirely different set of responsibilities, aimed at different set of needs in an entirely different environment. So I have to say once again that I do not believe that it is a useful comparison with respect to Amendment 47. For these reasons, I ask the noble Baroness to withdraw the amendment.

[Baroness Tyler of Enfield (LD)]

My Lords, I thank the Minister for her response and particularly thank other noble Lords who have contributed. I apologise to the noble Baroness, Lady Bennett, for forgetting to thank her for adding her name.

The short answer is that we disagree quite fundamentally on this. I do not accept the argument that the Minister has just put forward that the comparisons that I and the noble Baroness, Lady Bennett, have drawn are not good; I think they are very good. Of course, I understand that the landscape has changed. I understand that arm’s-length bodies, particularly large ones, have gone out of fashion and I understand the reason for that. I am talking about a very small body that acts as an advocate. I think that is different. I do not think it is something that the CQC can or will do.

I am pondering on what the Children’s Commissioner has said. I understand the point about children and their mental health being part of their wider experience, but we have to remember that a lot of the work of the mental health commissioner would be about adults who are being detained and whatever. We are not going to agree, so I suspect the best thing to do is to test the opinion of the House.

--- Later in debate ---

[Lord Kamall (Con)]

My Lords, as I said on the previous group, I will start by speaking to the amendment in my name and that of my noble friend Lord Howe. It would require the Secretary of State to conduct a review into the ability of the CQC to effectively fulfil its role

“in carrying out its duties under the Mental Health Act 1983, and … in regulating the provision of mental health services”.

We have also included proposed new subsection (3), which would ensure that the review of the CQC’s functions will also include an assessment of whether it will be able to “effectively carry out” its new duties under the Bill.

As the Minister will know, in May 2024, Dr Penny Dash was commissioned to conduct the independent review of the operational effectiveness of the CQC. The full report, published in October, found

“significant failings in the internal workings of CQC which have led to a substantial loss of credibility within the health and social care sectors, a deterioration in the ability of CQC to identify poor performance and support a drive to improved quality—and a direct impact on the capacity and capability of both the social care and the healthcare sectors to deliver much needed improvements in care”.

In addition, my noble friend Lord Howe raised the issues arising from his meetings with the charity Blooming Change on a number of occasions. It has raised serious concerns about the CQC’s monitoring activity. We also know that the Secretary of State himself has claimed that the CQC is not fit for purpose, and that there are some fundamental issues with how the CQC oversees the mental health care system.

As we have heard from other noble Lords, one solution would be to have an independent mental health commissioner. Our solution is to call for a review of the CQC that specifically focuses on its mental health functions, to make sure that it does its job properly. The review conducted by Dr Dash comprehensively assessed the CQC’s ability to regulate primary, secondary and community care, but it did not focus on the sufficiency of mental health care regulation. I thank the Minister for the brief meeting with my noble friend and me earlier this week, in which she indicated that she would be able to give greater assurances on this particular issue. I look forward to what the Minister has to say on it, because this is part of our justification for not supporting the mental health commissioner: we want to see a strengthened CQC. We do not want duplication, but, in avoiding duplication, we want to make sure that the CQC does the job it is supposed to do. I hope I can get that assurance from the Minister when she speaks.

I have some sympathy with Amendment 61, in the name of the noble Baroness, Lady Fox, in line with the comments of the former Prime Minister, Tony Blair, but I also have some sympathy with what the Secretary of State said. We thought about whether we could find an appropriate amendment to table on this. We have to be very careful and sensitive about this issue: we in Parliament or officials in Whitehall cannot hope to pronounce on the issues individuals face in their homes or communities. It is about getting the balance right.

The noble Lord, Lord Alderdice, also spoke about the concerns about overdiagnosis, but we cannot just make a generalisation. We have to make sure that the mental health professionals are doing their job, with the right guidance, to ensure that we understand the needs of each individual. For that reason, I thought it was far too difficult—and it would have been insensitive —for me to lay an amendment on this topic. I did not want to go there for that reason. This is an issue that has to be discussed, but we have to do it in the most appropriate way—in a sensitive way that understands those who suffer seriously from mental health conditions.

Let me turn to the amendments tabled by the noble Baroness, Lady Tyler. She and I have both raised the issue of racial disparities. In Committee, I went in very strongly on it—this is the issue that matters to me personally very much, and I shared some of my own experience of racial discrimination. I am as frustrated as everyone else that we still have not resolved the problem to this day; we still do not understand why, disproportionately, black men in particular are subject to detentions and community treatment orders. I asked questions at the time. What do we know? What do we not know? What are we doing to fill that knowledge gap? Once we have filled that knowledge gap, what are we going to do about it? Once again, I thank the Minister and her officials for the detailed meetings that they had with us when they laid out some of the things that they are doing. Could I tempt her to share with noble Lords some of that discussion and her letter, to assure us all that the Government really are on top of that issue, know what they are doing and are going to address these problems?

I was unsure about how effective the provision in Amendment 49 would be. I know that it is not very fashionable for politicians to say, “I don’t know”; we are supposed to make a firm decision one way or the other and agree or strongly disagree. But I wanted to reflect on whether that amendment would represent an additional burden on the healthcare professional, additional cost or additional bureaucracy. Given that we cannot, at this stage, say for sure how this will turn out, I support the suggestion of the noble Baroness, Lady Tyler, to pilot a scheme of a senior responsible person to address racial disparities. If we could pilot it in some places, it would give us the data to understand whether a responsible person would be effective in addressing those disparities. We all know that more needs to be done. We have had successive Governments of all political colours, and we still have not solved this problem. Let us be determined, as a House, whichever party we are, to tackle this problem of racial disparities, and let us make sure that we do it in the most effective way.

I am grateful for what the Minister said on Monday, but I hope that she will give some consideration to what the noble Baroness, Lady Tyler, said about piloting a responsible person to see whether that works. Maybe it will not work, but at least we would have the data and evidence. I would appreciate the Minister giving a more detailed explanation of some of the research that is being conducted to fill that gap, so we can understand why there are still racial disparities and what Governments of any political colour would have to do to address them.

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions on this important and somewhat wide-ranging group of amendments.

I turn first to Amendment 48, tabled by the noble Baroness, Lady Tyler. We very much recognise that there are inequalities in the use of the Act between different demographic groups, and particularly that there are significant racial disparities. The noble Lord, Lord Kamall, has rightly expressed some frustration with the fact that we all find ourselves where we are today.

To those points, I would say that these inequalities are explored in the impact assessment published alongside the Bill. I reiterate how grateful I am to Peers who recently attended our round table to examine research findings and ongoing work to address racial disparities under the Act. I am glad to hear that the noble Baroness, Lady Tyler, found it helpful—as indeed I did.

I offer the assurance that NHS England already publishes the Mental Health Act Statistics annual reports, broken down by ethnicity and other demographic information, including gender, age and index of multiple deprivation decile. We are improving the data through the patient and carer race equality framework, and we will monitor these inequalities as part of the overall monitoring and evaluation of the reforms.

Furthermore, as I announced on day one of Report, I commit to update Parliament annually on our progress with implementation, including racial disparities. I also committed to undertake further investigation into racial inequalities under the Act. As far as possible, we want to better understand where disparities are most significant across the patient journey, what drives those disparities and, most importantly, where we can most effectively intervene to reduce those inequalities. I very much look forward to keeping Peers updated on those findings, as the noble Lord, Lord Kamall, has rightly requested.

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[Lord Kamall (Con)]

I am sorry to interrupt. Just to go back to my amendment on the CQC, one of the arguments for those who believed in creating an independent mental health commissioner was that they would be a voice for the patients. With that strengthened role for the CQC, where is that voice for the patients? That was one of the justifications for those arguing for creating a mental health commissioner. We decided not to support that because we thought that function should be part of what the CQC does. Could the Minister reassure us on that point?

[Baroness Merron (Lab)]

For me, it is about not just somebody speaking for others but getting those voices heard. I hope that the noble Lord and all noble Lords have heard my acknowledgement of the importance of that. Those with lived experience need to be properly heard and their voice amplified. I have given a number of reassurances on that point.

With that, I hope that the noble Baroness can withdraw her amendment.

[Baroness Tyler of Enfield (LD)]

My Lords, I thank all noble Lords who have contributed to this group and the Minister for her responses. I also thank the noble Lord, Lord Kamall, for supporting my suggestion about a pilot for the responsible person. I have noted that the Minister has said that a pilot is not really necessary because what the Government are doing goes further than that. That is one way of looking at it, but I have to be honest and say that it is not quite how I see it. I completely take the point that we need to see what happens when the PCREF has bedded down. Let us see what it achieves, but if it does not achieve what we all want to see then we will need to think at that point about whether a responsible person would make the sort of difference that was being talked about at that very helpful round table.

I look forward to hearing more about the various actions that the Minister mentioned in relation to the CQC. I of course look forward to meeting the new chief inspector and will be interested to hear how they see their role, particularly the extent to which they think they are an advocate, providing a voice for people with mental health difficulties. This gets to the very heart of this Bill and the very reason why we have it in the first place. It is an incredibly important issue. We could talk about it for a long time, but we cannot. The hour is late and it is incredibly unfortunate that we have had such a truncated second day of debate. I know that these things happen but, given the importance of the topic, it is extremely unfortunate. Having said that, I beg leave to withdraw my amendment.

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The noble Lord is right to focus our minds on the recently published and very troubling announcement on mental health spending. I therefore hope that the Minister will be able to deliver, at the Dispatch Box, some robust assurances on mental health spending, as well as on parity of esteem more generally, which will obviate the need for the noble Lord to press his amendment and will satisfy honour on all sides.

[Baroness Merron (Lab)]

My Lords, I am grateful for all the contributions and considerations this evening, to which I have listened closely.

I first turn to Amendment 50 in the name of the noble Baroness, Lady Tyler. Workforce is absolutely a critical factor in enabling these reforms and we have committed to recruiting 8,500 more mental health staff over the course of this Parliament. The impact assessment sets out our expectations for the additional workforce that is required to deliver the Bill.

However, there are already various mechanisms in place to monitor and address concerns about the mental health workforce. The amendment would be duplicative and unnecessary. Providers registered with the CQC—both NHS and independent services—are required to deploy enough suitably qualified, competent and experienced staff, as outlined in Regulation 18 of the Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. If CQC finds a breach in Regulation 18, it can take action.

The Mental Health Act Code of Practice also states that local authorities should ensure that there are sufficient approved mental health professionals and independent mental health advocates. All staff in CQC-registered providers must receive the appropriate training that is necessary to enable them to carry out their duties under Regulation 18 of the Health and Social Care Act Regulations 2014.

At a national level, CQC reports on workforce sufficiency as part of its monitoring of the Mental Health Act report. We would argue that this is a much better process than requiring integrated care boards to mark themselves on how well they are fulfilling their duties.

Furthermore, as I said on Monday and wish to reiterate, we are committed to laying an annual report on implementation, which will set out progress made and future plans for implementation. This will include information on the expansion of the workforce, including second opinion appointed doctors, Section 12 doctors and approved clinicians. It will also include details of the key statistics and outcomes under the Mental Health Act, including detention rates, community treatment order rates and other key metrics, such as racial disparities and outcomes for children and young people, all of which noble Lords rightly seek. I hope this annual commitment will be welcomed by your Lordships’ House and that this, combined with the existing workforce monitoring I have referred to, will allow the noble Baroness to withdraw her amendment.

On Amendment 59, I also understand —as does the noble Earl, Lord Howe—the intention of the noble Lord, Lord Stevens, which is to ensure that we invest in delivering these reforms. I want to be clear: as I said in Committee, there are already mechanisms in the NHS Act to prioritise mental health spend to deliver these reforms.

To reiterate the point that I made previously, we believe that this amendment is not the right mechanism to ensure that we do that. I will return to the three main reasons for that, but I want first to refer to the point the noble Lord, Lord Stevens, made when he spoke of “shrinking mental health spend”.

[Lord Stevens of Birmingham (CB)]

It was the shrinking share of mental health spend.

[Baroness Merron (Lab)]

I thank the noble Lord for that correction from a sedentary position. Perhaps I could provide some more clarity, which the noble Earl, Lord Howe, also asked for.

The proportion of spend is almost exactly the same as it was last year, with a difference of just 0.07%. We understand concerns that the share of overall NHS funding for mental health will reduce slightly. However, this does not mean that mental health funding is being cut, and I would not want noble Lords to think that to be the case. To be clear, spending on mental health support will increase relative to 2024-25 and is forecast to amount to £15.6 billion—an increase of £680 million in cash terms, and equivalent to £320 million in real terms.

Perhaps it would be helpful for me to return to the three main reasons for not supporting this amendment. The first is—as the noble Earl, Lord Howe, helpfully referred to—what I would call a point of principle. Primary legislation should not be used to constrain spending in this way. Multiyear budgets for government departments will be set by the established spending review process, which considers spending in the round and in the context of the Government’s policy priorities. Additionally, it is Parliament that is responsible for scrutinising government spending and approving spending set by departments for the current financial year as part of the estimates process.

Secondly, the amendment as drafted applies only to spend under the Mental Health Act. The mental health system, as noble Lords will appreciate, does not structure its accounts based on the legal framework under which a patient is held. A single ward, for example, could contain a mix of patients under the Mental Health Act and informal patients who would not usually be considered to be under the Mental Health Act. Likewise, community services will support a mix of people, some on community treatment orders and others who are not. It would be impractical to require services to split costs based on the ever-changing patient mix within their care.

The third reason for not accepting this amendment, and perhaps the most fundamental point, is that the share of spend on the Mental Health Act could reduce over time, which is not undesirable. I will explain why. The genesis of these reforms is the review initiated by the noble Baroness, Lady May, to address the rising rates of detention. We all want to see more people cared for effectively in the community so that the need for the use of the Act is reduced. This would require more investment in preventive community services, which, I put to noble Lords, is surely the preferable model for supporting severe mental illness. In creating a legal requirement for the share of spend specifically under the Mental Health Act not to decrease, this amendment would actually preclude the shift from detention to prevention that I know we all want to see.

So, while I absolutely understand the intention, and I can commit that we will invest to deliver these reforms, we cannot support this amendment, which, for the reasons I have outlined, we believe is fundamentally flawed. For these reasons, I hope that the noble Baroness will withdraw her amendment and the noble Lord will not press his.

[Baroness Tyler of Enfield (LD)]

My Lords, this has been another incredibly important group of amendments. We are very short of time. I thank everyone who has contributed. I welcome that the Minister has committed to an annual report on implementation. I hope that there will be an opportunity for a debate in both Houses when that annual report is received. I was very grateful to the noble Earl, Lord Howe, for his support on my Amendment 50, which I will not be pushing to a vote. I do not consider it to be duplicative and unnecessary. If I did, I would not have tabled it. I thought that it was quite good, but I am not pushing it to a vote.

My final comment is that I was very pleased that there was widespread support for the very important amendment tabled by the noble Lord, Lord Stevens. It was variously described as modest, elegant, clever and other things. It had an awful lot going for it, but I leave it to the noble Lord, Lord Stevens, to say how he wishes to proceed. I beg leave to withdraw my amendment.

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[Lord Kamall (Con)]

My Lords, this will probably be the last time I speak on Report—and I am sure many people are grateful for that. Before I make my last remarks, I want to put on record my gratitude to the Minister, her officials and the Whips for the amount of time they have given us in discussing a lot of these amendments. It is certainly appreciated by our side and, I am sure, by other noble Lords.

Given the time, I will not take another hour. The sentiment behind this amendment is unquestionable. During my time as Minister, I was repeatedly reminded of the need to focus on prevention, and of course I agreed to that. As we know, the noble Lord, Lord Darzi, in his report on the state of the NHS, repeated his emphasis on the shift to prevention. If we believe in parity of esteem, where possible, this should be applied to mental health.

If we can shift from a situation where we are treating patients and repeatedly detaining them, such that they are detained for longer, to a scenario where we can treat and prevent those conditions worsening, our mental health system will be better for it. I am sure that all noble Lords can agree with this. So we strongly agree with the intent here, which is in line with one of the Government’s other intentions: a shift from hospital to community.

However, when I have discussed this amendment with others, I have heard one concern that I am still reflecting on. This amendment states that ICBs, local health boards and local authorities must implement preventive policies. It has been suggested to me that this might be too prescriptive or may place a duty on smaller bodies that may not necessarily have the resources to implement such policies. Those who suggest this tell me that it may appear more reasonable to place that duty on the Secretary of State or the Department of Health and Social Care, which have the capabilities and resources to implement preventive measures. Such a policy could work if the department had to work with ICBs and local authorities, as well as local community non-state civil society organisations, to move towards preventive care. As I said, I am still reflecting on this, but I do not wish to detain the House while I make up my mind. So, with that, I look forward to the response from the Minister.

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions on Amendment 63A in the name of the noble Baroness, Lady Bennett. I am grateful for the appreciation of the noble Lord, Lord Kamall —and the appreciation shown throughout Report—for the whole team. Similarly, I reciprocate thanks to all noble Lords and their offices for their assistance in improving the Mental Health Bill.

As the noble Baroness observed, we agree with the intention of the amendment: there must be a focus on prevention and the commissioning of services must reflect the needs of the local community. However, we do not feel that it is necessary to place this requirement in statute. As the noble Baroness knows, the Government are currently co-developing the 10-year health plan with the public, staff and patients. As part of this, we are exploring ways to stimulate the shift from sickness to prevention so that we can deliver an NHS fit for the future.

I turn to the points raised by the noble Lord, Lord Scriven. First, progress is already being made to transform community mental health services. In the last 12 months, more than 400,000 adults have received help through new models of care that aim to give people with severe mental illness greater choice and control over their care. We are going further by piloting the 24/7 neighbourhood mental health centre model in England, building on learning from international exemplars such as those in Trieste, which I know the noble Baroness, Lady Bennett, has taken a great interest in. Six early implementers are bringing together their community, crisis and in-patient functions into one open-access neighbourhood team that is available 24 hours a day, seven days a week. This means that people with mental health needs can walk in or self-refer, as can their loved ones.

ICBs are already required to have policies that reflect their communities under the National Health Service Act 2006, as amended by the Health and Care Act 2022. Section 3(1)(i) of the NHS Act 2006 also specifies the duty of an ICB to commission certain health services, including

“such other services or facilities for the prevention of illness”.

An integrated care board must arrange for the provision of services

“to such extent as it considers necessary to meet the reasonable requirements of the people for whom it has responsibility”.

ICBs and their partner NHS trusts and foundation trusts, including their mental health trusts, are also required to prepare a joint forward plan, which describes how the ICB will arrange for NHS services to meet their population’s physical and mental health needs.

Given that these duties already exist, given the Government’s commitment to a shift from sickness to prevention, and given the progress being made on community transformation and expansion of crisis services, we do not consider that it is necessary to create any additional duties within the Mental Health Act and I hope the noble Baroness will feel able to withdraw her amendment.

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Moved by

[Baroness Merron]

64: Clause 52, page 64, line 23, at end insert—
“(3A) A statutory instrument containing (alone or with other provision) regulations under this section that amend or repeal provision made by primary legislation may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, each House of Parliament.(3B) Any other statutory instrument containing regulations under this section is subject to annulment in pursuance of a resolution of either House of Parliament.”Member’s explanatory statement
This amendment and my other amendments to clauses 52 and 53 would ensure that regulations made under the consequential amendment powers in the Bill that amend or repeal primary legislation are subject to the affirmative resolution procedure.

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Moved by

[Baroness Merron]

66: Clause 53, page 65, line 1, at end insert—
“(4A) A statutory instrument containing (alone or with other provision) regulations under this section that amend or repeal provision made by primary legislation may not be made unless a draft of the instrument has been laid before, and approved by a resolution of, Senedd Cymru.(4B) Any other statutory instrument containing regulations under this section is subject to annulment in pursuance of a resolution of Senedd Cymru.”Member’s explanatory statement
See the explanatory statement for amendment 64.