Learning Disabilities Nursing

Baroness Merron Excerpts

Tuesday 17th June 2025 Lords Chamber

[Baroness Monckton of Dallington Forest]

To ask His Majesty’s Government what steps they are taking to develop and maintain the specialist branch of learning disabilities nursing.

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

My Lords, we recognise the vital role that learning disability nurses play in supporting those with learning disabilities, and we are committed to developing that workforce. We continue to work with partners to attract people into the profession through various routes, including apprenticeships, and provide a non-repayable grant and additional learning disability nursing payment. Later this year we will publish a refreshed workforce plan to ensure that the NHS has the right people with the right skills in the right places.

[Baroness Monckton of Dallington Forest (Con)]

I thank the Minister. The Darzi report highlighted that people with learning disabilities have greater health inequalities than the general population and are four times more likely to die from treatable causes. The Mencap campaign Nurses Not Hearses confirmed that services where there are learning disability nurses have fewer such deaths. However, this nursing workforce has reduced by 42%, universities are closing their courses—there is not one left in the south-east—and the profession is at risk of extinction. Will the Minister commit to ensuring that learning disability nursing is embedded in upcoming policies, including the 10-year plan?

[Baroness Merron (Lab)]

I pay tribute to the noble Baroness for her work as a campaigner in this area, particularly through Team Domenica. I know that through my office she will be meeting the Minister for Care next month to discuss all these important issues. It certainly is the case, and is totally unacceptable, that people with a learning disability die earlier on average than the general population. In England alone, we are talking about 1.5 million people with a learning disability, and they have significant health inequalities. Learning disability nursing is one of the four specialist fields of nursing, and those areas will be attended to in the forthcoming workforce plan. That will tie in with the 10-year plan, which is the first plan that will be published and noble Lords will not have to wait too long for it. The commitment to improving care for those with learning disabilities, and, if I might say so, with autism, is absolutely going to be in there; the noble Baroness will recall the discussions that we had, for example, on the Mental Health Act. I hope that this will show the way in which we are going, but I certainly agree with her about how much more there is to do.

[Baroness Finlay of Llandaff (CB)]

My Lords, will the Government undertake to ensure that in their workforce plan the training of undergraduate nurses in all courses, and for undergraduate medics and allied health professions, includes training on managing a situation where people have degrees of impaired mental capacity, and that judgmental views on disability are removed from any aspect of discussion because they are prejudicial to the way that people are handled when they present as emergencies? The problem is that people with learning disabilities can present at any time of the day or night to any of the services.

[Baroness Merron (Lab)]

The noble Baroness is quite right. One of the difficulties is that sometimes there is misdiagnosis, where it is incorrectly assumed, for the very reasons that the noble Baroness gives, that the presenting condition is the learning disability when actually it is a different condition. I agree about the need that the noble Baroness outlines. In reports such as the LeDeR review and Transforming Care, there is a national focus on reducing health inequalities and increasing awareness of this very point about diagnostic overshadowing. I will ensure that that is key to what we are doing.

[Lord Scriven (LD)]

My Lords, the Minister just referred to the LeDeR report, which points out the persistent avoidable deaths of people with learning disabilities. Yet we now have a seven-month delay for the latest annual report, which shows a lack of urgency. Does the Minister agree that this leads to a genuine perception that the sector’s critical concerns are not being prioritised, and that this in itself hinders promotion of learning disabilities nursing?

[Baroness Merron (Lab)]

It is probably helpful to say to your Lordships’ House that there have been significant changes to how we respond to care for individuals with learning disabilities within the UK. Like in other specialist areas, there is a move towards multidisciplinary teams, which I certainly welcome. I also emphasise the role of learning disability nurses, who are absolutely key, as is the training of all staff. That is why we are so committed to rolling out the Oliver McGowan training, which I know is highly regarded by all staff.

[Lord Watts (Lab)]

My Lords, we inherited a shortage of nurses and doctors, and it is important that we train and recruit new nurses. But does the Minister agree that, in the meantime, we have some marvellous people from the Philippines who are acting as our nurses and supporting our health service, and that it is important that we do not cut them off while we train our own people?

[Baroness Merron (Lab)]

I agree. We have many excellent staff from countries around the globe who are very committed, professional and hard-working. I presume my noble friend is referring to changes in international recruitment. I can assure him that that is why, certainly in respect of care staff, there is a transition period until 2028 to make sure that we have the recruitment in the right place.

[The Lord Bishop of London]

My Lords, the NHS England 2025 best practice guide has a number of suggestions for growing the learning disability nursing workforce, including requiring CQC-registered providers to provide staff with training for learning disabilities and autism. Can the Minister say what the Government are doing to ensure that this is implemented equitably across the integrated care systems?

[Baroness Merron (Lab)]

We are very focused on that, and NHS England is working with all areas of the country and local services to ensure that that is the case. There is a national plan for learning disability nursing that has been developed with key partners and focuses on four priorities: attracting, retaining, developing and celebrating the workforce. It is very important that we elevate the standing of learning disability nurses, to whom we are all grateful.

[Lord Kamall (Con)]

My Lords, I thank my noble friend Lady Monckton for raising the important issue of a workforce that understands how to deal with those with learning disabilities. Given the importance of this, will the Government consider committing to a targeted health promotion strategy, perhaps in partnership with local community organisations and sections of the private sector, to enable all children with a learning disability to access early promotion, intervention and prevention services to help them develop healthy habits and to improve long-life health outcomes for this vulnerable group?

[Baroness Merron (Lab)]

This is indeed a vulnerable group, as the noble Lord says, and it is probably best that I refer to the upcoming 10-year plan, which will deal with inequalities throughout a number of sectors, including the most vulnerable and including this group.

[Lord Patel (CB)]

My Lords, coming back to original Question, in which the noble Baroness, Lady Monckton, alluded to a drop in recruitment of 42% and only one place where such learning disability nurses are trained, is there not a need to expand ways of getting more people to train for learning disabilities without the penalty of fees for three years and for them instead to train as apprentices, where they do not have to incur such fees? Is that not an impediment to the recruitment of more nurses?

[Baroness Merron (Lab)]

Certainly, apprenticeships are important, and that is one of the ways we have expanded the routes into the nursing profession, including learning disability nursing. That means that the apprenticeships we are applying allow opportunities for people from all backgrounds and in underserved areas, which is another important area of ensuring that we remove the barriers to training in clinical roles.

Human Medicines (Amendments Relating to Hub and Spoke Dispensing etc.) Regulations 2025

Baroness Merron Excerpts

Tuesday 17th June 2025 Grand Committee

Moved by

[Baroness Merron]

That the Grand Committee do consider the Human Medicines (Amendments Relating to Hub and Spoke Dispensing etc.) Regulations 2025.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee

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

My Lords, as I know we all acknowledge, community pharmacies play a vital role in our healthcare system by ensuring that patients have access to medicines and acting as an easily accessible “front door” to the NHS. They dispense around 1.1 billion NHS medicines every single year.

Traditionally, all dispensing processes have been done in a single pharmacy or by a dispensing doctor. In hub-and-spoke dispensing, routine tasks such as sourcing, preparing, assembling and labelling medicines are carried out at a central “hub”, which is separate from the “spoke” pharmacy where the prescription is received. Hubs often make use of automated processes to realise economies of scale and to increase efficiencies. Such arrangements already exist in the UK, but the Medicines Act 1968 restricts their use to community pharmacies that are part of the same legal entity. Not all pharmacy businesses are able to invest in their own hub-and-spoke model, as compared with the larger pharmacy chains.

The Government are committed to supporting the community pharmacy sector and to cutting the red tape that frustrates it. The proposed changes have been a long time coming. If approved today, as I hope they will be, they will allow all pharmacies, including small independents, and dispensing doctors to utilise hub-and-spoke arrangements if they choose to do so.

Staff in hub-and-spoke arrangements report a calmer, more focused environment—I think we would all welcome that. In hubs, there are fewer disruptions and the use of automation reduces the risk of dispensing errors. At spokes, staff have more time for complex cases and patient care, making better use of their skills—something that the Government aim to support. The legislative changes we are debating will help all pharmacies and dispensing doctors realise these benefits, instead of limiting them to a few.

Turning to the details of the SI, we propose to amend the Human Medicines Regulations 2012 and the Medicines Act 1968, using the powers in the Medicines and Medical Devices Act 2021. The proposed changes to the Medicines Act 1968 adjust the definitions of “wholesale dealing” and “retail sale”, and remove the legal restrictions that prevent hub-and-spoke dispensing between different legal entities. The amendments go beyond simply removing the barrier that currently limits hub-and-spoke dispensing to pharmacies within the same legal entity. Noble Lords will, I hope, be pleased to know that the amendments include additional elements to ensure the safe and effective implementation of the policy by putting in place provisions to ensure accountability, governance and transparency for patients.

The proposed changes to the Human Medicines Regulations 2012 create a new model of hub-and-spoke dispensing, establishing a framework for the sharing of patient information between the hub and the spoke, and set criteria for the newly permitted arrangements. These criteria are: that both a hub and a spoke must be pharmacies registered with the pharmacy regulator, unless a spoke is a dispensing doctor practice; that there must be written arrangements between any hub and spoke, which must include a comprehensive statement in relation to their responsibilities, to ensure that each party is clear about the processes and activities for which they are responsible; that the medicine label includes only the name and address of the spoke, so that patients know who to ask any questions about their medicines; and that the spoke must conspicuously display a notice on its premises and online in relation to the dispensing arrangements.

The changes also establish an information gateway. This achieves several purposes, such as the conditions for lawful sharing of the relevant patient data between the different legal entities that operate these arrangements.

On the timescale, it is proposed that all legislative amendments come into force in the October this year across the UK. This will allow time for secondary legislation to be amended, as appropriate, across all four nations, and give the pharmacy sector time to explore the relevance and possibilities of the new hub-and-spoke arrangements to its businesses.

I hope that I have been able to set out what we are proposing and the rationale behind it. I look forward to what will, I am sure, be an informed and constructive debate. I beg to move.

[Viscount Stansgate (Lab)]

My Lords, I broadly support these regulations. I hope that my noble friend the Minister will not mind my intervening briefly to ask a couple of questions; I have no wish to detain the Committee.

Obviously, I understand that community pharmacies have been playing an increasingly expanded clinical role in treating minor illnesses and improving medicines’ safety and optimisation. To improve the efficiency of dispensing, these regulations will help support community pharmacies in taking on a more clinical role. The purpose of these regulations, which is to free up smaller pharmacies and enable them to undertake hub-and-spoke models, is, I am sure, a good one. First, does my noble friend the Minister have any idea of how welcome this will be to smaller pharmacies? Is it expected that a great deal of them will undertake these new arrangements outwith the previous restriction on being in the same legal entity?

Secondly, having recently been to my local pharmacy and having talked to the pharmacists there, I was struck by the strain that they are under, both in terms of their workload and financially. Am I right in thinking that this hub-and-spoke model, which will be made more widely available, will in some way help smaller pharmacies deal financially with the situations that they face? Am I wrong in thinking that there is a financial dimension to this? If there is, I would be very grateful for any reply that the Minister can give, but, in summary, these regulations are a step in the right direction.

--- Later in debate ---

[Lord Kamall (Con)]

My Lords, I thank the Minister for introducing this statutory instrument in her usual succinct way and all noble Lords who spoke in this debate. We on these very efficient Benches—so efficient that we have only one person here today, which is very good for productivity—recognise the Government’s intention to modernise pharmacy through the introduction of hub-and-spoke arrangements and to increase efficiency and free up pharmacies to focus more on patient care, finally getting away from the 1945 model that we have been stuck with where patients try to get an appointment with their GP in the morning and, if they are fortunate enough to see them, get triaged off to a pharmacist or to secondary care. This is much more efficient, and we welcome it.

I also welcome what many other noble Lords have said about more diagnosis and testing occurring at the level of the pharmacy. As we saw, one of the silver linings of Covid was the fact that people got more used to home testing. If we can see more home testing and more pharmacy testing out in the community, maybe we can reach those communities that we have found very hard to reach until now. We thought about this lots when I was in government; all Governments think about how to reach those hard-to-reach communities.

That said, while the aim is understandable and commendable, we have some concerns. First, the Government have chosen to proceed with only one model—the patient-spoke-hub-spoke-patient model—rather than the two models proposed by the previous Conservative Government, the other of which was patient-spoke-hub-patient. We see this as a significant narrowing of options, particularly when the consultation revealed a divided response from stakeholders. As the noble Lord, Lord Scriven, said, while large pharmacies were very much in favour of the model that the Government ended up choosing, many smaller and independent pharmacies remained opposed, as well as patients and providers who may have benefited from the second model, where patients are dispensed to directly.

In the world that we live in, with Amazon, eBay and the advent of direct-to-consumer online pharmacies, which will dispense only if there is a valid prescription—they are not just selling stuff off prescription—it is really important that we encourage that innovation. It would be wonderful for patients, particularly those with limited mobility who find it difficult to get to pharmacies, to be able to order on the NHS app, have it approved and know it will be delivered to them within so many hours or days. That would be a far more efficient model. I hope that we are not inhibiting online pharmacies with all those safeguards.

I completely understand that there is always a balance between innovation and safety and precautions. Can the Government explain why they chose only one model? Was it because of concerns over safety, good lobbying or the interests of larger pharmacists being heard over the smaller pharmacists? We would be very interested in that. We are concerned about limiting it to a single model, particularly when we know that community pharmacies dispensing for GPs and distance sellers are finding innovative solutions.

Secondly, there is funding and support. The updated impact assessment openly admits that there is considerable uncertainty over the cost of establishing these hubs, their operating expenses and the level of uptake. Once again, there is an impact on smaller pharmacies. How do the Government intend to avoid the risk that smaller providers could be left behind or forced out of the market, reducing choice for patients and challenging the role of small community pharmacists? Are they concerned about this? In addressing that, have they looked at any incentives or ways to help smaller pharmacists who may not have the resources for that upfront investment?

Thirdly, the question of oversight and transparency remains. The Minister will be aware that I ask a lot of questions on patient data and accountability of data. The Government are yet to clarify who will be responsible for collecting and publishing data on the implementation and impact of these new arrangements, particularly in light of the abolition of NHS England. This oversight is crucial not only to ensure patient safety and quality of service but to understand the broader impact on costs and service delivery.

Let me be clear: we support the idea of the single patient record and the federated data platform. One of my jobs when I was a Minister was to make sure that we joined up and digitised the data as quickly as possible. We know what efficiencies that could lead to in our healthcare, but patient safety and data protection must be addressed with rigour. The framework for sharing patient information between hubs and spokes is a key feature of this reform, yet the SI and the supporting documents provide limited detail on how patient confidentiality will be maintained and how the risk inherent in multiparty data sharing will be mitigated.

We do not oppose the principle of modernising pharmacy dispensing through the hub-and-spoke model. We were disappointed that one model was chosen, as we thought we could have some innovation with the other model. Without clearer information and incentives to smaller providers, we worry about smaller community pharmacies being pushed out, particularly in the light of having only one model. How will the Government make sure that that risk is avoided? We urge them to engage more fully with all stakeholders, clarify their plans for funding and data governance, remain open to innovation and not close down other options prematurely. With that, I look forward to hearing from the Minister.

[Baroness Merron (Lab)]

My Lords, I thank noble Lords on all sides of the Committee for their helpful contributions to today’s debate. I get a sense of support for where we are going and questions about how it will happen, which I completely accept. This instrument is part of a package of measures to relieve pressure in community pharmacy and improve patient care and the ability of the NHS to serve patients, particularly in a community setting—one of the main pillars of change for our NHS fit for the future. It builds on legislation that is already in place to enable pharmacies to increase efficiency by dispensing medicines in their original packs. Pharmacy technicians are now able to act under patient group directions to supply medicines, and the Government will shortly bring forward legislation to enable them to be authorised to do more in the pharmacy.

My noble friend Lord Stansgate raised a number of issues; he asked how it has been received and raised the financial sustainability and attraction of these measures. I reiterate that the changes being introduced are enabling. They are purely voluntary. It is entirely up to pharmacists, which are independent businesses—it is important to remember that—to decide whether they feel that engaging one, two or several hubs is going to be beneficial to their business model. It is up to them to decide.

--- Later in debate ---

[Lord Kamall (Con)]

I appreciate the response from the Minister. She said that she will keep this under review. As part of that review, are the Government or officials looking at ways in which they could mitigate concerns about model 2 in terms of those relationship and safety concerns? That would perhaps enable investigation of a future model 2.

[Baroness Merron (Lab)]

It would be fair to say that the review will be on how well this is working rather than an attempt to move to model 2. In all the modelling, we believe this is the best way to go. Patient safety is paramount, as it always should be, as is the expansion of services to individuals, but we will keep the whole matter under review.

There were two other questions. The noble Lord, Lord Scriven, asked about the fee structure. The spoke will still receive the fee for dispensing and the paying hub for the services it provides. We are not planning to dictate how the fee structure will work between hubs and spokes, as I said in an earlier answer.

[Lord Scriven (LD)]

This is an important point. This could create market distortion. If there was a hub with a number of community pharmacies as part of its parent group, is the noble Baroness saying that it could give an advantage to those pharmacies against an independent pharmacy that was not part of the hub group and therefore could charge that pharmacy a higher fee for providing exactly the same service? That could create market distortion. It is important that we understand that that could not happen within these regulations. If the Minister cannot give that answer, I ask her and her officials to go away, think about this carefully and write back. It is an important point.

[Baroness Merron (Lab)]

The whole point of the regulations, as well as cutting red tape, is about levelling the playing field. I understand the point the noble Lord is making, and I re-emphasise that arrangements between hubs and spokes are for them to make, rather than us to set. I am happy to look at the point the noble Lord makes and to write to him further with more detail.

[Baroness Finlay of Llandaff (CB)]

I will pick up on this because it is a concern. In her summing-up speech, the Minister spoke about the business interests of the hub and the spoke. A concern is whether you could have a hub, which will be a large, possibly even multi- national, provider that could create a monopoly. As has been recognised during this debate, in rural areas, in particular, dispensing doctors are often a small group. Pharmacy services have a relatively low turnover but are important to such communities that are a long way from other places and where the services provided by the pharmacist are particularly important. Yet, as a small spoke, they may not have the power to negotiate with a strong central hub that may well be driven by shareholders and profit. There is a little bit of me that would really like this to somehow be a not-for-profit arrangement over the whole of it, but I realise that that is not feasible.

[Baroness Merron (Lab)]

Perhaps it might be helpful to noble Lords if I refer to the Competition and Markets Authority in this regard because it noted that the proposed amendments that we are speaking of today are broadly competitive. It also acknowledged that there could be potential long-term competition risks if the market develops in such a way that pharmacy access to medicines, for example, is through an increasingly limited number of hub suppliers.

As the noble Baroness, Lady Finlay, suggested could happen, we might have only a few larger hubs emerging. I understand the concern that that could affect the availability of medicines for patients and their pricing. However, because of the recommendations from the Competition and Markets Authority, the department has committed to review the impact on competition once the hub market is sufficiently established. We will then assess whether action is needed to alleviate any barriers to the development of what, I believe, we all want to see: a dynamic, competitive hub market.

[Lord Scriven (LD)]

I am sorry to pursue this, but, in the impact assessment, the Government do not state how many hubs will be created. How can they reassure communities that these regulations will not distort the market? It is a very important issue for community pharmacies, which are dispersed. There is now a genuine concern that the Government do not even know how many hubs will be created—that links to the exact point that the Minister just made on the number of hubs.

[Baroness Merron (Lab)]

It is not possible to predict—although I do not think the noble Lord, Lord Scriven, is asking me to do so—how many pharmacies will take up this arrangement, because it is an enabling piece of legislation, not a requirement. It is also a matter between those businesses. To remind noble Lords, we already have provision in place for suitable pharmacy provision across the country, whether it is rural or urban, and that sits outside the regulations we are talking about today.

The noble Lord, Lord Scriven, asked about the regulation of hubs, and I can assure him that they will be registered pharmacies regulated by the General Pharmaceutical Council in Great Britain or the PSNI in Northern Ireland. The General Pharmaceutical Council has great experience in inspecting hubs and has substantial intelligence on what practical arrangements have been adopted by hub-and-spoke operators that work well. The pharmaceutical council will also ensure that all standards for registered pharmacies are met and—to the point raised by a number of noble Lords, including the noble Lord, Lord Kamall—that patient safety is protected.

To conclude, I emphasise that hub-and-spoke arrangements are not new, as large companies already operate their own hubs. This is probably a discussion for another day, but some people might suggest that that was an example of some market influence, if I can tactfully put it like that. In the meantime, I thank all noble Lords for their contributions, consideration and questions, and I beg to move.

Motion agreed.

Adult Social Care

Baroness Merron Excerpts

Monday 16th June 2025 Lords Chamber

[Lord Wood of Anfield]

To ask His Majesty’s Government what steps they are taking to remedy skills shortages and workforce gaps in the provision of adult social care.

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

My Lords, the Government are committed to recognising the adult social care workforce as the professionals they are. In April we expanded the care workforce pathway with four new role categories providing guidance on care workers’ career development. We are continuing the learning and development support scheme, backed up by up to £12 million in funding, and introducing new digital workforce tools. That is in addition to introducing legislation for the first ever fair pay agreement for care workers.

[Lord Wood of Anfield (Lab)]

I thank my noble friend for that Answer. I draw the House’s attention to my interests in the register. Social care workers do an extraordinary job, including with my own mother, but there are huge skills shortages in this sector, estimated at over 130,000 at present. Partly as a result of that, the sector is dependent on foreign workers, who make up 20% to 25% of the workforce, yet last month the Government said the recruitment of overseas care workers will end in 2028. That is the year when the report by the noble Baroness, Lady Casey, on the future of social care will be published. What is the Government’s strategy in the interim period now that 2028 is the cut-off date for recruitment from overseas—before the plan for reform of the sector has been published?

[Baroness Merron (Lab)]

It is probably worth me saying that, while the changes announced in the recently published immigration White Paper mean that overseas recruitment for adult social care will end, as my noble friend said, that is because, as he will know, the Government wish to reduce reliance on an overseas workforce. That is why there is a transition period. Until 2028 the visa extensions and in-country switching will be able to continue. The Government are also taking a range of actions to make the sector more available, more highly professionalised, more skilled and better rewarded than we have seen thus far. In all these ways, the transition period is important. The estimate is that the transition period will allow this change to be made, and better support and professionalisation for domestic as well as existing international workers can continue.

[Lord Laming (CB)]

My Lords, can the Minister go a bit further on that very helpful reply? Taking into account the range and nature of the personal care that these social care staff provide daily, is it not time that we got on urgently to professionalise the service, to make sure that they all get the proper training and that their status is rewarded with appropriate recompense?

[Baroness Merron (Lab)]

Yes, indeed. I pay tribute to the adult social care workforce who work hard, day in, day out, to provide the standards that the noble Lord refers to for those in our communities who are often the most vulnerable. I could give a range of examples but will refer in particular to the learning and development support scheme, which was launched in September 2024. It provides funding for eligible care staff to complete courses and qualifications, including a new level 2 adult social care certificate, and has been backed by £12 million this financial year. I give that as just one example; I am sure the noble Lord will be welcoming of the other actions that the Government are taking.

[Baroness Barker (LD)]

My Lords, the spending review announced £4 billion for social care, but that £4 billion will come from the NHS and not until 2028. Can the Minister confirm that there was nothing in the spending review about the two intervening years, in which local authorities are supposed to implement the fair pay award?

[Baroness Merron (Lab)]

Your Lordships’ House will be aware of the financial situation that we inherited and seek to put right. The Government have made available up to £3.7 billion in additional funding for social care authorities in 2025-26, and the noble Baroness is right that just last week the spending review allowed for a further increase of over £4 billion to be made available for adult social care in 2028-29. We are taking a whole range of actions. The Employment Rights Bill, which we will come back to later today, seeks, for the first time ever, to bring in fair pay and professionalisation for those in the adult social care workforce. So it is not that nothing is happening in the meantime. We are making progress and ensuring that the funding will be available so that we have not just a decent adult social care workforce but a way of tackling what no Government have managed to tackle before.

[Lord Kamall (Con)]

My Lords, given the persistent workforce gaps in adult social care over many years, and given the concerns that there are over immigration—even though immigrants often do the work that local people do not want to do—can the Minister outline what plans the Government have, with a clear structure, to make this a more attractive career, particularly to young people in the UK? What are the Government doing in partnership with social care providers, which are stretched at the moment, to look at alternative ways of funding training and skills development and to make sure that this is an attractive career for those in the UK, rather than always having to rely on immigration?

--- Later in debate ---

[Baroness Merron (Lab)]

As the noble Lord rightly outlines, this is a move, over a number of years, to reduce the reliance on international recruitment. I am really glad that just a couple of weeks ago the Department for Education announced the launch of a health and social care foundation apprenticeship, set to begin in August this year. This is focused on young people and will give them a paid route into the sector so that they can earn as well as gain skills and experience. It will be a wonderful foundation for young people, ensuring that they are encouraged into what is an extremely valuable sector and will have the right skills, including technical skills, and the ability to carry out the job. That is just one of the measures but it is an extremely positive initiative, as the noble Lord calls for.

[The Lord Bishop of London]

My Lords, given the well-documented regional and social economic disparities in access to adult social care, in what way are the Government, in focusing on the shortages in the workforce, focusing their efforts on tackling this inequality in access?

[Baroness Merron (Lab)]

In general terms, of course, the independent commission into adult social care will be part of our critical first steps towards delivering a national care service. The commission, as the right reverend Prelate is well aware, will be chaired by the noble Baroness, Lady Casey. I agree with the right reverend Prelate that there are particular demands in certain local areas, and the strategy will take account of that, including the fact that, based on the growth of the population aged 65 and above, the sector may need 540,000 extra new posts by 2040. That is a big challenge, but by setting up the professionalisation, the training, the skilling and the fair pay for people, it is one that we will be in a much better place, across the country, to be able to deliver on.

[Baroness Butler-Sloss (CB)]

In supporting the noble Lord, Lord Laming, I ask the Minister whether anything can be done officially to raise the status of care workers. Status is often very important for people wondering what sort of job to have.

[Baroness Merron (Lab)]

The noble and learned Baroness is absolutely right about status, which assists retention as well as recruitment. Clearly, the first ever fair pay agreements will make that possible. The need to work with various partners across the sector was raised in an earlier question. The way in which those negotiating bodies will work will absolutely bring together all the partners in the sector to get to the right place. That will certainly include fairer pay, which we will see through the Employment Rights Bill, but also training and skills and the care workforce pathway, the care certificate and having a skills record. These represent a comprehensive package to raise the status in the way that the noble and learned Baroness asks for.

Cardiovascular Illnesses

Baroness Merron Excerpts

Thursday 12th June 2025 Grand Committee

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

My Lords, I associate myself with the congratulations to the noble Lord, Lord Booth, on securing such an important debate. I am very grateful to him for doing that on the back of his personal experience. It shines a light and, while I realise that it is difficult, what he has done is worthwhile. Many of us will be affected by cardiovascular disease, either directly or indirectly, which is why we heard the noble Lord’s message so clearly.

As we have all said, too many lives are cut short by CVD. In 2023, an estimated 6.4 million people were living with cardiovascular conditions and almost a third of CVD-related deaths in England occurred among the under-75s, which gives us the scale of the challenge. Over 1 million people report cardiometabolic conditions as being the main or secondary reason for being out of work due to long-term sickness. This is a challenge on so many levels.

I thank the noble Lords, Lord Kamall and Lord Weir, for understanding that this requires a systematic approach across government, which we seek to have. In seeking to build a health and care system that is fit for the future, we are shifting the focus of our NHS from sickness to prevention. That is supported by the investment and direction of the Chancellor’s spending review of just yesterday. It is also why our health mission sets out an ambition to reduce premature mortality from heart disease and stroke by a quarter within a decade.

It is important to go straight to the points that have been raised. Many noble Lords rightly raised prevention. As they are aware, around 70% of CVD cases are linked to preventable risk factors such as obesity, high blood sugar and smoking, to mention but a few. The noble Lord, Lord Moynihan, talked about the importance of exercise and I certainly share his view on that. I assure him that we work across government on this and I take his point that this is not particular to my department. We work very closely with the DCMS to ensure a joined-up approach.

I remember hearing the noble Lord’s solution some years ago, I think on the Health and Care Bill. We have not committed to it, but the principles behind what he says are absolutely right. For example, we are working on better health resources, which include free evidence-based apps, websites and other digital tools, which will help people make and sustain improvements to their health. To take one example, I know the popularity of Couch to 5K. We will continue this work.

The noble Lord, Lord Rennard, referred to the landmark Tobacco and Vapes Bill that is progressing through your Lordships’ House, which will help deliver our ambition for a smoke-free UK. We need to remember that smoking still claims some 80,000 lives every year. It is a cost not just to individuals and their families and communities but of some £3 billion to the economy, yet this is a preventable cause of death. Noble Lords will have heard in yesterday’s spending review that we are investing at least £80 million per year in tobacco cessation programmes and enforcement to support the Bill.

The noble Lord also referred to obesity. There is a wide range of weight management services, from behavioural support in the community to hospital-based specialist services. This year, we will extend the NHS digital weight management programme to people living with obesity and awaiting knee and hip replacement surgery, which picks up on his point about preparation for treatment where necessary.

The noble Lord, Lord Rennard, expressed disappointment in the Government’s response to the Lords committee report on food and nutrition, which I very much welcomed. I am sorry that he is disappointed, but I have drawn to the attention of his noble friend the noble Baroness, Lady Walmsley, that, just this week, following a recent Question in the Chamber, there was a change in the advice given by the department on the use and appropriateness of prepared baby foods, which she was rightly concerned about.

A number of noble Lords talked about the NHS health check. It supports people to manage their risk through referral to weight management or smoking cessation. It is free and aimed at those aged between 40 and 70. It prevents around 500 heart attacks or strokes a year. It is about identifying early.

I absolutely accept the points made by my noble friend Lady Winterton and the noble Lord, Lord Kamall—I am particularly interested in this matter—about the National Audit Office report and the Health and Social Care Committee’s inquiry on doing more to extend engagement with and take-up of the check. One of the things is a new development that will be piloted from this summer: a new NHS health check online, which people can complete at home. It will be piloted through the improved NHS app and, specifically, we will be independently evaluating the impact on equalities to inform the development and rollout.

We have also engaged community pharmacy by investing heavily in blood pressure checks. Nearly 3 million checks have been delivered in over 9,000 pharmacies in the past year, and we are also embarking on new trials. So we are looking at ways in which we can engage better and, if I may say so, improve the NHS check as well.

The noble Lord, Lord Weir, rightly raised the great potential of AI and technology. I can tell him that a considerable announcement on this was made just this week when I was in Cambridge. We are slashing red tape that currently inhibits innovation while protecting patient safety and encouraging innovation—something for which the industry and many others have been calling for some time. We are also getting the regulatory regime in the right place and investing in research, innovation and being up to date. Some years ago, we could not have dreamed of regulating AI but, now, we are absolutely right to look at how we do that. As the noble Lord said, technology and AI are absolutely key.

I turn to the points on inequalities made by the noble Lords, Lord Weir and Lord Kamall, and my noble friend Lady Winterton. Our approach is called Core20PLUS5 and it is a national approach to support the reduction of healthcare inequalities at both the national and the local system levels. One of the five clinical priorities in that framework is the treatment and management of high blood pressure, which is, of course, a key risk factor for CVD. That is just one of the areas.

Noble Lords, in particular my noble friend Lady Winterton and the noble Lord, Lord Weir, asked whether we would commit to a CVD action plan. We have already set the ambition. We are committed, as noble Lords are aware, to publishing a 10-year health plan in the not-too-distant future and to delivering that shift from sickness to prevention. In all of that, we are considering policies—along with, of course, our workforce plan, which will be published in the summer on the back of the spending review, as well as all that will follow from that. We are carefully considering the policies, including those that have an impact on people with CVD, as we develop the plan.

The noble Lord, Lord Weir, rightly raised that men may be less likely to come forward to seek advice. We are in the consultation phase of developing a men’s health strategy, to which I hope he will contribute, and part of that is about recognising the point that he made. We are determined to close the gender gap in care. We also know that, among people with CVD, women are less likely than men to achieve target cholesterol levels. That has to change, so we will pursue it.

I congratulate the noble Lord, Lord Polak, on his work in this area. I believe he introduced me to Hilary in the House. I heard his request for a meeting, and I will pick that up with the department. While I never like to disappoint him, the position at the moment follows the advice given by the UK National Screening Committee, which concluded that introducing population-level screening for sudden cardiac death in young people would run the risk of causing more harm by misdiagnosing some people and by providing false reassurance to those at risk of sudden cardiac death whose risk may not be picked up by screening tests. However, I am sure we will have the opportunity to pursue this further.

A number of other points were raised, which I will of course review. In closing, I say to the noble Lord, Lord Booth, that I absolutely hear what he said about recognition, diagnosis and issues in aftercare. We will address this through the number of future developments that I referred to and the NHS long-term plan that is already in existence. I hope that he will be less disappointed should he or a loved one have to seek treatment, care or aftercare in the future, and I thank him.

Complications from Abortions (Annual Report) Bill [HL]

Baroness Merron Excerpts

Committee stage
Friday 6th June 2025 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, I thank my noble friend Lord Moylan again for bringing to our attention the issue of the reliability of statistics on the complications of abortion. It is absolutely right that, in all healthcare, we have correct and accurate data that health service providers can use to understand the safety of procedures.

It is the usual practice for Committee to include discussion of the amendments that have been tabled to the Bill, but here, of course, there is only the proposition that the only substantive clause should not stand part. This, therefore, has necessitated a general discussion of the underlying principles behind the Bill in a restatement on this side of the Chamber of our positions.

At Second Reading, I said that our view was that the Bill performs “an important service” by highlighting

“the absence of accurate, comprehensive statistics in respect of abortions”,—[Official Report, 13/12/24; col. 1990.]

but I explained in the same speech that improved data collection and reporting does not require legislation for it to be delivered. In short, I do not depart from that view, but this Bill has allowed an informed debate to emerge about data in this field. It presents an opportunity to urge the Government to do more to rationalise data recording and collection, so that proper evidence-based medicine can be implemented. In this respect, I endorse what my noble friend Lady Finn said about data collection and statistics more generally.

In answer to a Written Question asked by my noble friend, the director-general of the Office for Statistics Regulation stated that that office—the OSR—had not completed a compliance check on the abortion statistics collected by the Office for Health Improvement and Disparities since as long ago as 2012. That raises important issues of data quality. I am glad to note that it has now been agreed that the OSR will carry out a long-overdue compliance check on those statistics, but only after the Department of Health and Social Care has been able to update the design of the abortion notification system. This seems, to me and to others on this side, the wrong way round. Surely it would make more sense to complete these compliance checks before making alterations to the ANS. That way, the department will be able better to understand any deficiencies in the system—and we know there are some. I hope the Minister will be able to comment on this and address it.

Overall, my noble friend has raised an important concern. I suggest that the Government must now take steps to ensure that the data are gathered on a more reliable and consistent basis.

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

My Lords, I thank the noble Lord, Lord Moylan, for tabling this Private Member’s Bill and my noble friend Lady Thornton for tabling an amendment. I very much appreciate the contributions made by a number of noble Lords.

The stated main purpose of the Bill is to impose a legal duty on the Secretary of State to

“publish and lay before Parliament an annual report on complications from the termination of pregnancy in England under the Abortion Act 1967”.

The purpose of such an annual report, as I understand it, would be

“to inform policy and safe practice regarding the termination of pregnancy”.

I know that noble Lords appreciate that this Government are entirely committed to the priority of patient safety.

--- Later in debate ---

[Lord Moylan (Con)]

For clarification, is the Minister saying that the digitising and adapting of the abortion notification system that her department plans to carry out will be done in collaboration with the Office for Statistics Regulation? Or is the intention that the department does the work in its own box, so to speak, and then the Office for Statistics Regulation comes in and checks it? She seemed to hint that, for the first time, it might be the former, which would be quite encouraging.

[Baroness Merron (Lab)]

As I said, we are developing work with the OSR. As with all ways of developing work, that means working in a way that will get us to the place we wish to get to. I do not quite recognise the latter way forward that the noble Lord referred to, but I will be happy to write him further on this matter.

I can assure the noble Baroness, Lady Finn, that our focus in the women’s health strategy is on turning those commitments into action. I draw the noble Baroness’s attention to the provision of free of charge emergency hormonal contraception at pharmacies from October this year. We are also setting out how we will eliminate cervical cancer by 2040 through the new cervical cancer plan, we are and taking urgent action to tackle gynaecology waiting lists through the elective reform plan. Those are all tangible improvements to women’s health. I assure the noble Baroness that the women’s health strategy is very much kept under review to see how and where it can be improved.

The noble Baroness, Lady Finn, asked about the linking of records. It is not currently possible to link the abortion notification system with wider health records data, because of the unique identifiers on the abortion notification system data. However, as I said earlier, we are reviewing the wording of the form so that it will be easier for clinicians to complete, which will, I hope, bring about some improvements.

I say to the noble Baroness, Lady Freeman, that the Government are focused on moving the NHS from analogue to digital across all areas of healthcare, in order to provide the improved data collection that many noble Lords have called for during the debate.

The noble Baroness, Lady Bennett, called on the Government seriously to consider the implications of money flowing in from the USA with a view to obtaining influence—a point also referred to by the noble Baronesses, Lady Brinton and Lady Barker. I can confirm that this matter is being considered more widely across government.

As noble Lords may remember, the Government have expressed reservations about the Bill as legislation is not required to produce an annual report. We believe that the aims of the Bill can be achieved through existing routes, thereby rendering further legislation unnecessary. In 2023, the department published a report on abortion complications and could choose to do so again. However, it has no plans to publish ongoing separate additional annual reports on abortion complications as there is no operational need to do so. I hope noble Lords will understand—some have made this point—that we have to uphold a duty of care not to legislate when other reasonable processes are available, as there are in this case.

Clause 1 agreed.

Preterm Birth Committee Report

Baroness Merron Excerpts

Friday 6th June 2025 Lords Chamber

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

My Lords, I am sure I speak for all of us when I say that it feels somewhat overwhelming at the end of a debate such as this, not least because noble Lords have been very generous and open about their personal experiences and those of their friends and families, and I am grateful to all noble Lords for being willing to do that. Of course, I join in all the thanks to the noble Lord, Lord Patel, not just for his expert chairing of the committee, which has given us the quality of report that we have got, but for his introduction today. My thanks are also due to all members of the committee; I am sure they are proud of the report.

I heard that this is a report that should not sit on a shelf, and I quite agree. It has shone a light on many of the challenges. As the noble Earl, Lord Effingham, said, no one action on its own will make a difference. Having given evidence to the committee, read the report and overseen the response of the Government, I feel that that the more we look into this, the greater the complexity we find.

We have sought to take each item as best we can. Is there more to do? Completely. Do we start in a difficult place? Yes, we do. So I am grateful for the report. I also associate myself with the thanks that were given to all those who provided evidence. I am sure it will have been an extremely affecting experience to hear from parents and others who have been affected in this way. What the report is about, and what I wish to be about, is protecting the most vulnerable—the babies, the women and their families—and I know that everybody has come from that place today.

I say to the noble Baroness, Lady Wyld, that, as she knows, I welcome the challenge that she and the committee make to the Government, and I will seek to be as helpful as possible today. I know I will not be able to provide every answer, but it is right that the questions are answered. If there are particular areas that I do not get to address, I will of course pick them up afterwards.

I say to the noble Baroness, Lady Brinton, who I know was deeply affected by the words she shared, that she affected us all. I am sure it was hard for her, but the noble Baroness brought into the Room exactly why we are here.

What is the scale of the problem before us? In 2023, the year for which we have the most recent figures, there were almost 4,600 preterm births. That is just over 8% of all births, a very considerable amount. I share the view that rapid improvements are needed to improve not only outcomes but the experience of women and their babies.

We have heard today about the many risks that contribute to preterm birth, which include pre-existing health conditions such as high blood pressure and diabetes, multiple pregnancy, factors such as smoking and obesity, maternal age, and assisted reproductive technology such as IVF. We also know that preterm birth is more prevalent for women from black and Asian groups and for those women living in the most deprived areas, and that situation cannot be allowed to continue.

The impact of being born pre term is significant, as we have heard. Not least, preterm babies are more likely to die in their first 28 days or their first year of life, and in fact the number of child deaths from prematurity rose between 2019 and 2023. We know the scale of the challenge before us. Preterm birth increases the risk of chronic conditions, and babies born pre term require more hospital-based care in infancy and childhood. I was interested to hear put on record by noble Lords, including by my noble friend Lady Goudie, that preterm birth can place significant emotional, financial and logistical stress on families. I welcomed and was glad to support the launch of the Create Health report that shone a light on many of those matters.

This is an important point to make, and it was made to some extent in the debate, but in some cases preterm birth is medically appropriate—this is something I can recall discussing with the committee—because, in that instance, it is safest for mother and baby. One of the difficulties with the target from the previous Government, I felt, was that it did not make that distinction, so it is important that we get any further targets right.

So what actions are under way? My department works with NHS England and across the sector, including with the charities referred to by the noble Earl, Lord Effingham, and I add my thanks to those charities and third-sector organisations. We are working on a range of actions for now and into the future to tackle some of the deeply entrenched issues.

The noble Lord, Lord Patel, and others made positive reference, which I share, to the Saving Babies’ Lives care bundle. This has been co-developed with clinical experts and professional societies, and it draws very much on front-line learning and experience to provide a package of interventions to reduce variations in care, which we know are out there, and to improve neonatal care quality and outcomes. The implementation of the care bundle is one of the conditions required to ensure compliance with safety requirements.

The noble Baroness, Lady Brinton, raised the point that, as of May this year, some 97% of maternity services were fully compliant with the care bundle. That figure has increased by 10% since last year. I assure her that the remaining small percentage is nevertheless significant, and we are following up with them to ensure that they will become fully compliant. The elements of the care bundle address the committee’s recommendation, but we seek to go further.

Noble Lords, including the noble Earl, Lord Effingham, raised the two-year and four-year assessment checks for children who were born pre term. They are extremely important and we are looking at what further actions are needed to ensure that children receive those follow-up assessments, because of their importance.

All 150 maternity and neonatal units in England are taking part in the NHSE perinatal culture and leadership programme. A number of noble Lords, including the noble Lord, Lord Patel, and the noble Baroness, Lady Wyld, were absolutely right to highlight the importance of the maternity and neonatal estate in supporting parents being fully involved in their babies’ care. So I am glad that, just last week, the allocation of some £750 million through the estates safety fund was announced. This is to start tackling—it can only be a first step—the maintenance backlog. The £750 million will support 400 hospitals, mental health units and ambulance sites. I say very specifically that it includes over £100 million for maternity units to enable better care for mothers and their newborns. I know that the noble Baroness, Lady Seccombe, is rightly exercised about this.

I say to the noble Baroness, Lady Wyld, and other noble Lords that I understand the frustration about the time that has been taken for NHS England to publish the findings of the maternity and neonatal estates survey. Noble Lords will not have to wait much longer for that, and I too look forward to seeing it.

A number of interventions rightly centred on the workforce. There are still shortages across the workforce. Overall, the refreshed workforce plan, which will be published in the next few months—in answer to the questions—will seek to transform the services over the next decade to ensure better care for patients.

My noble friend Lady Blackstone asked what is happening to understand obstetrics staffing and managing the workforce more broadly. As I say, that will be covered by the workforce plan. However, it is the responsibility of trusts to ensure that they have the right staff in place.

On the workforce, the noble Baroness, Lady Wyld, asked about professional development, and other noble Lords, including the noble Baroness, Lady Sugg, asked about the inclusion of midwifery. I completely agree that it is crucial that staff have the training they need to make sure that they have the right knowledge to provide the right care. The new workforce plan will follow the 10-year health plan and the spending review. Noble Lords will understand that I cannot pre-empt exactly what it will say, but I can say that it will look at the wide range of issues that face the workforce, and that will of course include midwives. Colleagues across NHSE and the department remain committed to delivering on this in respect of the workforce, and I will be very much focused on having the midwifery service that we need.

On the survey, I understand the concerns that were raised about trainee midwives being very worried about their future employment prospects. This was raised by a number of noble Lords, including the noble Baronesses, Lady Bennett, Lady Penn and Lady Sugg, and my noble friend Lady Blackstone. I can share with your Lordships’ House that there is, in some way, a positive position—this is not a way of glossing over the difficulties—in that there are fewer vacancies currently because of improved retention. In fact, the NHS nursing and midwifery workforce has grown in recent years, so we have branches of nursing and midwifery where the new graduate supply is greater than the number of posts available this year. I appreciate the tension, and I assure noble Lords that NHS England is working with educators, employers and regional teams to support newly qualified nurses and midwives in securing employment. This includes developing resources to support learners through the recruitment process and identifying suitable opportunities and support.

The noble Baroness, Lady Penn, asked about NHS England’s abolition and where responsibility will lie. The specifics are being worked through, but the central team leading the change will ensure that nothing is lost in terms of what we need to do. The service that we are concerned about here—provision—will remain a priority. The abolition of NHSE will remove duplication, and I therefore expect to see improvements in this area.

The noble Baroness, Lady Seccombe, made an important point about nurses training to be midwives. I am grateful that the noble Baroness spoke to me about this separately. I agree that nurses who train to become midwives bring a whole wealth of experience, and NHSE offers funding to support this shift. However, I recognise that we may need to go further in order to support nurses to remain on the relevant courses and to take up posts in maternity units. So the funding offer for this will be reviewed later this year.

The noble Lord, Lord Patel, spoke about the importance of community services and health visiting services. Through our plan for change, we will ensure that children and their families are cared for by the right professional. We will strengthen health visitor services.

The noble Baroness, Lady Bertin, spoke very sensitively about mental health issues, as well as a number of other points. Specialist perinatal mental health services are now available in all 42 integrated care systems, and very important they are indeed.

I agree with noble Lords, including the noble Lords, Lord Weir and Lord Patel, on the importance of a woman’s health before pregnancy. More work is required to improve awareness of pre-conception health and pregnancy, taking into account—this is another key point—that many pregnancies are not planned. That is why the point about early education and support is so crucial. The 10-year plan, which we will see shortly, will set out how we will tackle the inequities that lead to poor health.

Research was raised by my noble friend Lord Winston, the noble Baronesses, Lady Owen and Lady Bertin, and the noble Lord, Lord Weir. Since the committee hearing in September 2024, the NIHR has commissioned three new research awards, including research to investigate the prevention of preterm birth as well as interventions to improve health outcomes for preterm babies. Over the last five financial years, research programmes invested in 77 research awards focusing on preterm birth. Again, across their full duration, that was a total of £93 million of funding—and, yes, I totally agree about the importance of research. I will write to my noble friend Lord Winston, following up on his point urging the Government to use opportunities that the biobank presents.

On the important matter of miscarriage, I share the view that my noble friend Lord Winston and other noble Lords set out. We are taking steps to improve data on miscarriage and fill the very considerable current gaps. There is a new digital standard which will record new information on previous miscarriage and baby loss. I am looking at how effectively that is being applied, and I am also looking forward to the review of the Tommy’s graded model of care in respect of miscarriage, so I very much take the points on board.

A number of further actions are being taken to improve maternity safety, including the maternity outcomes signal system, the maternity safety support programme and the avoiding brain injury in childbirth programme. I am pleased to say that all local areas have published equity and equality action plans, which set out tailored interventions for those from ethnic minority backgrounds and those living in the most deprived areas. This will be another important focus for the 10-year plan. Fourteen maternal medicine networks have been set up across England, made up of 17 specialist medical care centres, and high-quality neonatal care is being networked together across England. We are investing £45 million in increasing neonatal cot capacity and assigning care co-ordinators. We are taking further actions to tackle obesity and smoking—and again, that will be referred to in the 10-year plan.

I say to noble Lords, in closing, that there was much richness in the committee report and in today’s debate, for which I am entirely grateful. I look forward to using what has been written, what has been said and further discussions, so that we can provide the service that we all want to see.

Primary and Community Care

Baroness Merron Excerpts

Thursday 5th June 2025 Lords Chamber

[Lord Hacking]

To ask His Majesty’s Government what steps they are taking to support primary and community care settings to integrate in vitro point of care diagnostics.

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

My Lords, we recognise the value of point-of-care diagnostics in enabling earlier detection, reducing avoidable hospital admissions and supporting more personalised care. As part of our 10-year plan, we will ensure that more tests, including in vitro point-of-care diagnostics, take place in the community, which will be closer to people’s homes. Use of in vitro point-of-care testing is encouraged where clinically appropriate, including in community diagnostic centres, and is supported by the development of 27 pathology networks.

[Lord Hacking (Lab)]

I thank my noble friend the Minister for her very positive reply, but I will take it a little further. Do the Government appreciate the enormous potential benefit of in vitro diagnosis for the National Health Service and patients? On the latter, patients would be able to go to their local pharmacy, away from the queues in their GP surgery or local A&E department, and be diagnosed and treated in a matter of minutes. My second question is: what government funding support will be given to pharmacies having to buy the diagnostic machines or boxes, which cost about £2,000 each, and to support the necessary training for pharmacy staff?

[Baroness Merron (Lab)]

This is a good news story, and I certainly share my noble friend’s view of the benefits that he outlined. Community diagnostic centres are now delivering additional tests and checks in 169 sites across the country. They have delivered almost 4.5 million tests, checks and scans since last July, and we have committed to expanding the number of existing CDCs and their opening times. In England, Pharmacy First clinical pathways have been developed closely with various experts, including pharmacists. The funding for the core community pharmacy contractual framework has been increased to over £3 billion, representing the largest uplift in funding of any part of the NHS. We are grateful for the role that pharmacies play.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister agree that, when we discuss in vitro testing, we should also talk about in vivo testing? That involves taking a history and doing a thorough physical examination of the patient on the spot, but it seems to be going out of fashion. I will illustrate that with the story of a member of staff who had consulted me. He had been investigated at the “St. Elsewhere” hospital for six months, but they had missed the fact that he had ruptured his Achilles tendon. I did an in vivo spot diagnosis. I put my index finger down his Achilles tendon—with his permission, of course—and I could feel the gap in his Achilles tendon where it had ruptured. They had not examined him. Is it not time that we did this inexpensive business of taking a history and doing a thorough physical examination?

[Baroness Merron (Lab)]

I am very glad that the noble Lord asked for permission. I take his point. I know that he understands the value of in vitro point-of-care testing, but he makes the good point that what matters is what is clinically appropriate in the circumstance. We would all expect that to happen for the benefit of the patient.

[Lord Scriven (LD)]

My Lords, I will follow on from the Minister’s Answer. While being supportive of the general trend, what metrics and measures have the Government put in place to ensure that those tests indeed create positive patient outcomes and healthcare efficiency to help future induction of the tests in the NHS?

[Baroness Merron (Lab)]

We will ensure, through our 10-year health plan, that the additional tests, including in vitro point-of-care diagnostics, are taking place in the community. I look forward to being able to provide more information to the noble Lord.

[Lord Kamall (Con)]

My Lords, we on these Benches welcome the Government’s stated commitment to innovation in primary care and the commitment to continue the rollout of community diagnostic centres, which were started by the previous Government. However, unfortunately, last year the Patients Association highlighted barriers to the rollout of point-of-care diagnostics, particularly in rural areas. Is the Minister aware of those concerns, and what plans does the department have to tackle those barriers?

[Baroness Merron (Lab)]

Our commitment to moving towards a neighbourhood health service obviously allows for attention to be given to different circumstances, including in rural areas. It will mean that more care can be delivered locally and that problems can be spotted earlier, including any problems with rollout. We will shortly provide details of a national neighbourhood health implementation programme. We liaise with various groups, including the Patients Association, and I am grateful for their input and for flagging up any difficulties, which we absolutely seek to resolve.

[Lord Patel (CB)]

My Lords, while I accept that in vitro diagnosis at the point of care has great benefits, it is important to address the challenges that we will need to face. They include quality control and the standardisation of equipment used, as well as making sure that the appropriate people are trained, that assessments are made of the results obtained and that proper, good outcomes are delivered. Who will be in charge of delivering this, at the integrated care board level and the national level, to make sure that it is effective?

[Baroness Merron (Lab)]

The noble Lord is right that it is one thing to provide a service; it is another—and so important—to make sure that it is provided appropriately and accurately. ICBs will have their own arrangements. Within that, NHS England is currently responsible for ensuring that this takes place. We will ensure that there are regular updates. If any noble Lord is aware of particular difficulties, I would be very pleased to hear about them; for example, if there is a problem with quality control.

[Lord O’Neill of Gatley (CB)]

My Lords, does the Minister agree that even deeper and wider embedding of diagnostics across the NHS, including more in community pharmacists and GP surgeries, would help in the fight against not only antimicrobial resistance but other infectious diseases? In addition, it would stimulate the venture capital business in diagnostics. All these factors together have the potential to boost NHS productivity dramatically, and would therefore help to boost the country’s growth trend.

[Baroness Merron (Lab)]

I certainly agree with the very strong points that the noble Lord has made. This is obviously a health improvement policy for patients and to support the NHS, but it is also about developing growth and the opportunity for new ways of doing things. We welcome and support innovation.

[Lord Markham (Con)]

Building on a point made by the noble Lord, Lord Hacking, and others, there are many examples where the ideal place to do a diagnostic test is in a primary care setting. Urinary tract infections are a typical example of that, because you can solve it quickly in that setting, avoiding future hospital visits and much pain and suffering. However, that means taking budgets away from secondary care settings and giving them to primary care GPs, pharmacists, et cetera. Are the Government prepared to do that to see these benefits arise?

[Baroness Merron (Lab)]

We are constantly reviewing how best to support where we need to go. In this case, it is about getting tests done closer to home. The noble Lord is right that, for a number of people, the GP practice is a good place to do that, but not in all cases. What matters is doing what is appropriate. We announced an £889 million uplift for general practice in 2025-26, which is the largest uplift to GP funding since the beginning of the five-year framework in 2019, and we have also agreed a new GP contract. The noble Lord will be aware that we recently announced over £1 million to help the quality of the primary care estate, to ensure that we can provide some 11 million further appointments this year. While I accept that this issue is about configuration, I assure the noble Lord of our support for GPs.

Creon

Baroness Merron Excerpts

Thursday 5th June 2025 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what steps they are taking to address the shortage of Creon, a cancer medication, reported by the National Pharmacy Association, and what steps they plan to take to prevent similar shortages in future.

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

My Lords, while some supply constraints remain, predominantly with the higher-strength product, Creon stock is regularly being delivered to pharmacies. Alternative products and unlicensed imports are also available. Guidance has been issued to the NHS on prescribing available alternatives and utilising serious shortage protocols to limit quantities dispensed, with actions for integrated care boards to ensure that patients are not left without Creon or an alternative. We continue to work on the long-term supply resilience of Creon.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank my noble friend the Minister for that Answer, but there are some suggestions that pharmacies are struggling to obtain this important medication, which addresses pancreatic enzyme therapy. Given the struggles that pharmacies are facing, could my noble friend the Minister therefore outline what consideration has been given by the Government to provide a national plan to address shortages and to support patients with alternative care? What approval would be given to highly trained pharmacists to use their professional judgment to supply alternative medicines, where that is medically safe and appropriate, in the event of the prescribed version being unavailable to ensure that patients can enjoy longer, healthier lives?

[Baroness Merron (Lab)]

I can say to my noble friend that serious shortage protocols are a tool that we have and use to manage and mitigate medicine and medical devices shortages. They enable community pharmacists to supply a specified medicine or device in accordance with a protocol rather than a prescription, with the patient’s consent, without needing to seek authorisation from the prescriber. They are used in cases of serious shortage, and we develop those protocols with input from expert clinicians. In addition, we are currently examining options around pharmacists’ flexibilities, including how any risks could be managed, and further details will be set out on this. I hope this gives some reassurance to my noble friend.

[Lord Kamall (Con)]

My Lords, we know that these unexpected shortages occur from time to time, and that this obviously causes patients to worry. As the Minister said, I understand the advice is that alternative therapies are available but may not be sufficient for all patients. Given this, can the Government reassure patients that they are confident that those who cannot turn to alternative therapies will be able to get the appropriate doses of Creon that they require? Also, do the Government have any idea, or have they been given any indication, of when they expect this particular shortage to end?

[Baroness Merron (Lab)]

The supply situation has improved since last year and there is now sufficient stock of lower-strength Creon to meet normal demand. There are still some supply constraints, as I have said, with the higher-strength product stock, but stock is regularly being delivered to pharmacies. As we have discussed, alternative products and unlicensed imports are also available. I totally accept that patients may have concerns, and that is why we have worked closely to keep in communication with patients to assure them that they will not be going without the medication they need. For example, it may be that lower strength in multiple provision can be made, or there are the alternatives that I have described. If any noble Lords are aware of real-life examples of shortages, I would be grateful to hear about them, because we believe that we have made the arrangements, and I can reassure noble Lords that these very important medicines are being provided to those who need them.

[Lord Scriven (LD)]

My Lords, I suggest that the Minister ask her officials immediately to speak to the National Pharmacy Association, which published a survey at the end of last month that said that 96% of community pharmacies were finding problems with getting stocks of Creon and 89% of community pharmacies were having problems with alternatives. In light of that and the bigger picture, what actions are the Government taking to establish new suppliers and manufacturers of enzyme replacement therapy to reduce reliance on a limited number of manufacturers?

--- Later in debate ---

[Baroness Merron (Lab)]

The noble Lord makes a very good point, because the reality is that there are very limited manufacturers of pancreatic enzyme replacement therapy—which applies to a number of people, not just those who have pancreatic cancer—so I do understand that point. It is the case that several non-UK suppliers have expressed an interest in bringing their products to the UK, and they are currently under review with the MHRA. Of course, I hope noble Lords are aware that this Government prioritise UK life sciences, and that is absolutely key. We have established incentives to encourage manufacture, including up to £520 million to support businesses that invest in life-science manufacturing products.

[Lord Spellar (Lab)]

My Lords, may I put it to my noble friend the Minister that there is also an underlying problem, which was also revealed during COVID, that too often the end-use manufacturers are highly dependent on a supply chain that is often in countries that are either unreliable or, indeed, even hostile? These may seem to be basic supplies, but in fact they are enormously important for the final product. Should not the Government in this area, and indeed in others, be looking at this more seriously?

[Baroness Merron (Lab)]

I believe that we are looking at this very seriously. Of course, medicine supply chains are complex, global and highly regulated, so there are a number of reasons why supply can be disrupted and a number of reasons why supply might not be specifically as we would like. Unfortunately, some of those are out of government control. To be honest, we cannot prevent all medicine shortages, but we can take as many steps as possible. I can assure my noble friend that the whole point about increasing resilience of the UK medicine supply chain remains a key priority. We work with industry, we work with the regulator and we will improve the position of the UK as a destination for life sciences and manufacturing in this regard.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Minister referred to Creon being needed for a number of conditions. In Sheffield, when I was visiting POLARIS, the pulmonary lung and respiratory imaging centre, I met a mother of a cystic fibrosis patient—a young child, quite a small child—and that mother was suffering significant distress at having to spend time chasing around Sheffield to try to lay hands on Creon. The Minister just said that this is out of government control. Does she agree that this is a case where relying on markets to supply essential drugs is not working and that there needs to be more government control in the supply chain?

[Baroness Merron (Lab)]

The noble Baroness puts forward an interesting perspective. There will always be a number of matters that are outside any Government’s control. What is in the Government’s control is what action we can take. In terms of alternatives to Creon, for example, supplies of Nutrizym have more than doubled since last year, and Essential Pharma has also secured additional manufacturing capacity for Pancrex. In May last year, pancreatin preparations—the active ingredient in the medicine we are talking about—were added to the list of medicines that cannot be exported from the UK or hoarded in order to reserve supplies. These actions, along with some of the ones that I have just mentioned and more, all show a very active government position.

[Lord Kamall (Con)]

My Lords, since we have a bit of time, perhaps I may be allowed a supplementary. Given that part of the answer is to import unlicensed medicines, what quality-control procedures are there in place to ensure that people can be reassured that these unlicensed medicines are suitable and fit for patients?

[Baroness Merron (Lab)]

It would not be possible to prescribe them if they were not fit and safe for use. I am grateful to the noble Lord for allowing me to make that reassurance. There is very clear information on ordering and prescribing unlicensed imports on the NHS Specialist Pharmacy Service website, should the noble Lord or any other person wish to be reassured of what that means.

Young Children: Convenience Foods

Baroness Merron Excerpts

Wednesday 4th June 2025 Lords Chamber

[Baroness Walmsley]

To ask His Majesty’s Government what steps they are taking to address the nutritional content, labelling and promotion of convenience foods aimed at very young children, including fruit pouches and snacks.

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

My Lords, good nutrition is essential to our goal of raising the healthiest generation of children. Foods for infants and young children have to meet regulations on nutrition, composition and labelling standards. More widely, we are committed to tackling the child obesity crisis and government actions, including the junk food advertising ban, demonstrate the scale of our ambition in this area.

[Baroness Walmsley (LD)]

My Lords, I echo the comment of the noble Lord, Lord Kirkhope, “Oh dear”, because this issue is not new. In 2019, Public Health England drew attention to the fact that these products contain free sugars, they are not advised by the Scientific Advisory Committee on Nutrition for these young children and they are very misleadingly labelled. Every time the Government respond to this, they do what the Minister has just done and say that there are very good regulations about nutritional content and regulation. But does the Minister agree that regulations are only as good as their enforcement, and these are not being enforced? So, when the Government have their many conversations with the food industry, will they please get a grip and stop these companies producing products that are making our children obese, with rotting teeth?

[Baroness Merron (Lab)]

I hope the noble Baroness will be pleased to know that I recognise the view she states. I realise that this has gone on for some time and I am grateful for her work in this area, including through chairing the Lords committee that produced a very helpful report. I recognise that the current situation is not good enough.

On the matter of food regulations and enforcement, it is the responsibility of local authorities in England to enforce legislation where breaches are suspected. Local authorities will liaise with businesses to clarify and, if necessary, agree the action to put it right. It is indeed the responsibility of individual businesses to ensure that they comply with the law, and I assure the noble Baroness that that is a matter we will continue to press, as well as keeping those food regulations under review.

[Lord Farmer (Con)]

My Lords, even natural and additive-free food pouches are processed by heating and blending for shelf life and a texture suitable for babies. Cooking from scratch is increasingly rare, but particularly important when incomes are low. This basic but valuable skill should be included in all Start for Life infant feeding programmes, as baby food, home-blended from nutritious, pre-spiced, pre-salted adult food is of little cost to families. I ask the Minister: are family hubs being encouraged to help parents learn how to cook?

[Baroness Merron (Lab)]

I definitely understand where the noble Lord is coming from and also share the view about where he wishes to get to on this. Cooking lessons have not been specifically included in the programme, as I believe he may be aware, but the Start for Life website and email programme has advice for parents and carers, including healthy recipes and videos on weaning babies and feeding toddlers, and that has recently been updated.

I hope the noble Lord will welcome the fact that the family hubs and the Start for Life programme are central to the Government’s ambition to raise the healthiest generation of children. That is why we are investing approximately £57 million this year, including £18.5 million for infant feeding support.

[Baroness Boycott (CB)]

My Lords, one area that goes under the radar is sponsorship of big sports events. The Olympics has Coca Cola and McDonald’s; many other Olympic sports have things such as Monster. In particular, rugby has Red Bull. The recommended daily allowance of sugar for a child is a maximum of 24 grams. A single can of Red Bull contains not only coffee but 27 grams of sugar. It is completely anti-health, yet we allow these adverts to be all over our televisions. Some 25 years ago, the noble Baroness’s Government took the brave decision to take all cigarettes off any sporting activity. Will this Government think about doing the same for soft drinks that actually make children ill, not healthy?

[Baroness Merron (Lab)]

As the noble Baroness is aware, we continue to support the levy on sugar in drinks. That has actually had success, not least with reformulation. On the point about advertising to which the noble Baroness referred, as I have said, we are committed to bringing in the advertising ban, which will be in place in January. Indeed, industry—TV and online advertising—has already agreed to implement what will be in the regulations earlier than that.

Marketing sponsorship is a much broader point, but again it is one we take very seriously and continue to keep our eye on. I cannot give the noble Baroness the reassurance she seeks today, but I can assure her how seriously we take the impact of advertising and branding and who it is aimed at, particularly where we seek to support better health for infants and young people.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I welcome the Government’s review of the so-called “fizzy tax” and the consultation that will end in July. Could the Minister tell me whether this extends to and covers these pouches, which are very heavy in sugar? If not, can a review take place to try to apply the same principles we have applied on the fizzy tax to the pouches?

[Baroness Merron (Lab)]

On the matter of new taxation, my noble friend will understand that it is above my pay grade and outside my department. However, we have worked closely with industry in this area. On the matter of pouches, there is already advice that parents should ensure, where children and infants are using them, that it would be better to use the contents through spoons, rather than the item at the end of the pouch, in order to help guard against dental decay. In working with industry, some brands are already taking action to improve their baby food products: for example, the amount of sugar in Heinz creamy rice pudding has been reduced by more than half and Heinz has changed its labelling, which now says pouches are suitable for those aged six months-plus. This is an example of the work we can do. Yes, we have to do more and I am very aware of the danger that sugar represents to the youngest in our community.

[Lord Kamall (Con)]

My Lords, when there are concerns about nutritional content, there are three, perhaps more, possible approaches. First, you could ban the product, although prohibition does not always work. Secondly, you could try nudging consumers towards healthier choices—maybe by taxation or restrictions. Thirdly, you could work with local community organisations. In addition to family hubs and Start for Life, many local community non-state civil society organisations work with local families to help them cook and eat healthily together as a family. Given what has been mentioned already, will the Minister tell us what work the Government are doing with such local community organisations, apart from Start for Life and family hubs, to make sure that civil society is playing its role in educating our children?

[Baroness Merron (Lab)]

On the three ways forward that the noble Lord identified, the approach often has to be a mix of all three. It is the balance that is the point under debate, and it has to be informed by evidence. I certainly share the noble Lord’s view about the importance of civil society and working with community groups. Indeed, my department, but also the Department for Education and other departments, have worked closely with community groups in order to advance the policies and practices we need to improve the health of the youngest in our communities.

[Lord Scriven (LD)]

My Lords, the Scientific Advisory Committee on Nutrition recommends that free sugars are limited for babies and toddlers, yet it reported that our children have excess sugars and 20% comes from snacks aimed at young children. How do the Government plan to ensure that manufacturers are taking actions that do not directly contribute to childhood obesity?

[Baroness Merron (Lab)]

Further to my answer to the last question, we are taking a multifaceted approach. The advice that we give to parents and carers is important, because the noble Lord raises a very important point about not overusing snacks. Although the regulations are roughly the same across the UK and the EU, in the UK we recommend that six months is the point of weaning, whereas across the EU it is four months. So there is some lack of clarity, although we are very clear about where snacks are not needed, which is up to the point of 12 months. We work to ensure not only that people have regulations for protection but that parents and carers are aware of what they should do in terms of providing a healthy and balanced diet for their children.

Health: Ultra-processed Food

Baroness Merron Excerpts

Tuesday 3rd June 2025 Lords Chamber

[Lord Sikka]

To ask His Majesty’s Government what steps they are taking to address health harms associated with ultra-processed food.

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

My Lords, a nutritious diet is key to living a healthy life. Currently, there is insufficient evidence on the extent to which the processing of food itself negatively impacts health beyond poor nutritional content. We have commissioned research to further understand the health impacts of ultra-processed foods. We are focused on taking firm action to reduce the intake of foods and drinks that are high in saturated fat, salt or sugar, which also captures the majority of ultra-processed foods.

[Lord Sikka (Lab)]

My Lords, I thank the Minister. Research shows that ultra-processed food causes disease, disability and premature death. It costs the UK economy £268 billion a year, in the form of additional costs for the NHS and social care, welfare payments, productivity loss and lifelong human suffering. Instead of a free ride, manufacturers of ultra-processed food must bear the true cost of their trade. This could be in the form of a 5% levy on their turnover. Does the Minister agree and, if so, when will the Government introduce it?

[Baroness Merron (Lab)]

I am interested to hear my noble friend’s suggestion. This Government do not have that as part of their plan. However, on my noble friend’s point about the need for research, I heard what he said about evidence, but that is not the evidence that I have available. I assure your Lordships’ House that the Scientific Advisory Committee on Nutrition repeatedly reviews evidence and assesses the impact of processed foods on health in position statements, and it has made two recent publications on that. We continue to invest in research on ultra-processed foods.

[Lord Krebs (CB)]

My Lords—

--- Later in debate ---

[Lord Krebs (CB)]

My Lords, I declare my interests as recorded in the register. Last year, the author of the best-selling book Ultra-Processed People, Dr Chris van Tulleken, gave evidence to the Food, Diet and Obesity Select Committee, of which I had the privilege of being a member. He said that ultra-processed food

“is not a regulatory tool—I do not know anyone credible who is talking about using that definition to slap labels on things … the regulatory tool, in my view, should be fat, salt, sugar and calories”.

Does the Minister agree with Dr van Tulleken?

[Baroness Merron (Lab)]

I am grateful to the noble Lord for bringing his expertise and commitment to this area. It is indeed the case that the majority of foods classified or considered as ultra-processed foods also tend to be high in calories, saturated fat, salt and sugar, for which there is more definitive evidence, as the noble Lord has referred to. It is the case that many UPFs are already captured by the Government’s considerable programme of work to improve the food environment.

[Lord McColl of Dulwich (Con)]

My Lords, I congratulate the Government in general, and the Minister in particular, on taking such a sensible view about the great red herring that is ultra-processed food. There is no scientific evidence that it specifically causes obesity. Obesity is caused by eating too much of anything, and the answer is to reduce the amount of food that people eat.

[Baroness Merron (Lab)]

I am grateful to the noble Lord for his appreciation of the Government’s efforts in this regard. I believe we have to consider the role of ultra-processed foods, but that has to be based on evidence and scientific truth, rather than speculation. That is why the Scientific Advisory Committee on Nutrition has shown concern but cannot prove a direct link. It is not necessarily about the processing, but we know that high fat, salt and sugar is a problem for healthy living, and that is mostly a very good description of UPFs.

[Lord Rennard (LD)]

My Lords, in February last year, the British Medical Journal reported research involving 10 million people that found evidence highly suggestive of diets rich in ultra-processed foods being linked with the increased risks of premature death, cardiovascular disease, mental health disorders, diabetes, obesity and sleep problems. What is the timescale for the Government’s further research on the dangers of ultra-processed foods? How will reversing aspects of the ban on junk food advertising help?

[Baroness Merron (Lab)]

As the noble Lord will be aware, we are committed to implementing the TV and online advertising restrictions for less healthy foods and drinks. That is one of a number of steps that we are taking to tackle obesity, as per the question from the previous noble Lord. There is a direct link between advertising and intake, particularly with children, so I am glad that we will be introducing regulations to take effect in January—in fact, the industry has agreed to comply in advance of that, which shows a constructive approach. As for further information, the Scientific Advisory Committee on Nutrition will consider evidence again in 2026, next year, and make dietary recommendations. The Government continue to invest in research through the NIHR and the UKRI.

[Baroness Bennett of Manor Castle (GP)]

Further to the regulations that the Minister mentioned that are coming in January, the Labour manifesto promised to prohibit unhealthy food ads online and before 9 pm, which was to come into effect in October. Can the Minister confirm that the rules that are coming in January are in fact watered down and will not forbid the advertising of brands? Does she think that advertising a brand but not a product—say, McDonalds, Kentucky Fried Chicken or Greggs—will promote the consumption of fresh fruit and vegetables?

[Baroness Merron (Lab)]

First, I do not accept that the advertising restrictions represent any watering down. In May, a Written Ministerial Statement set out, to the noble Baroness’s point, that the Government will provide a brand exemption in legislation. The restrictions will come into force officially on 5 January. I realise that the noble Baroness regards this as not the position that she would choose, but I believe that it will provide certainty for businesses to invest in advertising campaigns with confidence and encourage them to develop more healthy products—that is the situation that we want—as well as protecting UK children from the harms of junk food advertising.

[Lord Kamall (Con)]

I thank the Minister for the answers that she has given so far on the evidence, because it is really important that any policy in this area is evidence led. When I looked at the British Heart Foundation website, I saw that it said that additives in ultra-processed foods

“could be responsible for negative health effects”

and that the

“actual processing of the food could … make a difference”.

It also says:

“Another … theory is that … ultra-processed foods could … affect our gut health”.


But what it says overall is that there is insufficient evidence here. We really need more research to be done. We are not sure whether it is something in the ultra-processed foods or the processing itself that makes them unhealthy. The Minister has touched on this already. We have talked about the timeframe for research, but when people are looking for a source to consider the dangers, or otherwise, of ultra-processed foods, are there any particular websites or sources that the Government could point people to, so that people are more aware of and more educated on the research on ultra-processed foods?

[Baroness Merron (Lab)]

The important point that the noble Lord raises is that our role is to encourage people to ensure that they are choosing a healthy diet and can achieve a healthy diet. As the noble Lord said, the word “could” is a bit of a problem. That is why we continue to invest in research and, as I say, work closely with the Scientific Advisory Committee on Nutrition.

[Lord Patel (CB)]

My Lords, several speakers have alluded to the evidence available that associates ultra-processed and processed food with disease or health conditions. Would the Minister agree that all the evidence cited is from observational studies? No studies report as a causative factor a direct link between processed and ultra-processed food and any disease—including the British Heart Foundation, the BMJ and the one that the noble Lord, Lord Sikka, mentioned. It is right that we should fund research that associates the causation of these food processes to disease.

[Baroness Merron (Lab)]

The noble Lord is absolutely right. There is concern, and I am very aware of it, about the effect of ultra-processed foods, but nobody knows whether it is the processing or the content. What we do know is that it is definitely the content. We also know that high-fat, high-sugar and high-salt foods damage people’s health. Our focus is on what we know, and it is important that we continue to do that while researching what other links there may be.