NHS: Breast Screening Programme

Baroness Merron Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Morgan of Drefelin]

To ask His Majesty’s Government what assessment they have made of the take-up of the NHS breast screening programme.

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

Breast cancer survival rates have improved by 41% since the mid-1970s and 86% of women survive their cancer beyond five years. I pay tribute to NHS staff and to my noble friend Lady Morgan for making such a contribution to these improvements. Take-up of breast screening is just below 70%, and NHS England has developed a national uptake improvement plan, including expanding access to screening, reducing inequalities, improving IT systems and ensuring that communications are inclusive and accessible to all.

[Baroness Morgan of Drefelin (Lab)]

I thank my noble friend for that very kind and generous Answer. As we know, screening uptake has been in decline for more than 10 years now. There is no NHS region that has met its 70% minimum standards since 2019-20. Importantly, uptake for women on their first invite is really worrying. Will the Minister commit to keep feet to the fire on this issue, and work closely with the department and NHS England to press down on any potential complacency because breast cancer outcomes have improved so much? Screening is a simple way to stop women dying of breast cancer, and it is not rocket science. Please can we do all we can to improve uptake?

[Baroness Merron (Lab)]

My noble friend makes a very clear and definite point about the link between breast screening and outcomes. I certainly can give her the assurance that we will continue to seek to drive up rates of breast cancer screening. It is important to say that the reason for the take-up not improving as one might have hoped since Covid is multifactored and complex, as I am sure she understands. We all know that research shows that women are more likely to attend breast screening if it is in a unit that is easy to get to, if it is convenient, and if we can help women to get over the problems of fear of the test, awkwardness or embarrassment. I give my noble friend the assurance that the NHS is working on understanding all that, and all that will be in collaboration with charities and key stakeholders.

[Baroness Bloomfield of Hinton Waldrist (Con)]

I also begin by paying tribute to the noble Baroness, Lady Morgan, for her excellent work with Breakthrough Breast Cancer and more recently with Breast Cancer Now. Can the Minister reassure me that the Government will look again at the ceasing of breast cancer screening after the age of 70, when the incidence of disease occurring in that age group is still high, and would be higher were it not for the success of earlier breast cancer screening? This cohort of women should not be ignored.

[Baroness Merron (Lab)]

If a woman in the age group to which the noble Baroness refers has concerns, she may request follow-up and investigation. But it is the case that we follow the scientific advice, which is that going beyond that age as a matter of course will not give the rewards that we would hope. I can certainly reassure any woman in that age group that she will be seen should she have concerns, and she should present herself as soon as possible.

[Baroness Walmsley (LD)]

My Lords, artificial intelligence has been very efficient in helping to interpret breast imaging, reducing false positives and false negatives, and significantly reducing the workload of the second reader. We know that early detection is key to reducing mortality, and I understand that AI can be used to identify patients with high risk so that they can be screened more frequently and proactively. What work is being done to use AI to identify high-risk individuals, so they can be screened more frequently?

[Baroness Merron (Lab)]

It is important to ensure that the service is there for those who are at greater risk. The noble Baroness is right to refer to the growing interest in and potential use of AI, which is indeed very exciting. The National Screening Committee is very aware of this point. The committee is working with the National Institute for Health and Care Research and NHS England, and has designed a research project to see whether AI can be safely used to read mammograms in the breast screening programme, and whether that is acceptable both to women and to clinicians. That work will continue.

[Lord Patel (CB)]

My Lords, I join others in commending the work that Breast Cancer Now has done in improving outcomes for women through breast screening and improving breast cancer outcomes. However, the problem remains when it comes to wider issues about care of patients with cancers. We know that early diagnosis achieves the best results for all cancers, yet we are woefully low in the percentage of people who are picked up with early cancers. There is another more serious issue, which is unwarranted variations in the care of all cancer patients. Unwarranted variation is when care that is clearly demonstrated to be effective in reducing death rates is not given to cancer patients. That has to be absolutely unacceptable. Eliminating unwarranted variation in cancer care ought to be one of the performance measures that integrated care boards are measured on—I hope that the noble Lord, Lord Darzi, is listening.

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[Baroness Merron (Lab)]

I am sure that the noble Lord, Lord Darzi, is listening, but if he is not I will ensure that the noble Lord’s comments are drawn to his attention. I can say to your Lordships’ House that this Government intend to transform the NHS from a late-diagnosis, late-treatment health service to one that catches illness earlier and also prevents it in the first place. It is that shift that will make the greatest change. I have been interested to see that, across all the screening programmes, something like 15 million people are invited for screening and 10 million take it up. That still leaves us with 5 million people to work on. It is important to note that the 10 million take-up figure for screening saves a considerable number of lives. We need to continue to drive up the take-up on screening, across the various cancers and not just breast cancer. As noble Lords will know, there are programmes in respect of cervical and bowel cancer, and there will be a lung cancer screening programme as well.

[Lord Evans of Rainow (Con)]

My Lords, I begin by paying tribute to the noble Baroness, Lady Morgan, for her excellent work with Breakthrough Breast Cancer and more recently with Breast Cancer Now. We are very lucky to have her in your Lordships’ House. We know that the NHS wants to shift the emphasis from cure to prevention and screening, which, whether for breast cancer or other conditions, is a vital part of prevention. The previous Conservative Government took action to drive up breast cancer screening, with new breast cancer screening units and our community diagnostic centre programme. What steps will the Government take to further increase the uptake of breast cancer screening?

[Baroness Merron (Lab)]

The measures that the noble Lord refers to did indeed assist, but as I mentioned earlier we have a stubborn problem in returning to pre-Covid rates. The improvement plan that exists sets out the priorities and the interventions, but also the monitoring of what is working and what is not. The kinds of things that are being tested and introduced now include, for example, new IT systems to enable communication with women in 30 different languages, and new IT systems that mean people know when their appointment is and are reminded of it. All these things sound quite straightforward, but they have not been in place across the country and it is important that they are. I mentioned the importance of addressing fears and embarrassment, improving information and reassurance to women, as well as more convenient times and booking systems. It is very important that we make better use of mobile screening units, so that screening is near to where women are.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, undoubtedly breast screening is vital—I know that from a personal perspective—but I ask my noble friend whether consideration could be given to lowering the breast cancer screening age to 40, to include for diagnosis those with triple-negative breast cancer, because many in the younger cohort are diagnosed with it.

[Baroness Merron (Lab)]

As my noble friend will be aware, we keep a very close eye on the science and the advice, and we will continue to follow that. I emphasise, and it was raised in an earlier question as well, that the NHS has been proactively writing to those women at very high risk of breast cancer who may not have been referred. I give an assurance that women who are at greater risk are not forgotten.

Social Care Reform

Baroness Merron Excerpts

Monday 2nd September 2024 Lords Chamber

[Lord Young of Cookham]

To ask His Majesty’s Government what plans they have to reform social care.

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

My Lords, adult social care reform is critical to achieving this Government’s aim that everyone lives well for longer. Our vision is to create a national care service underpinned by national standards and delivered locally, supporting people to live independently for as long as possible. We will also establish the first-ever fair pay agreement for care professionals. We will engage widely with the sector and people with lived experience to inform these plans.

[Lord Young of Cookham (Con)]

My Lords, I welcome the proposals to improve pay and conditions for those working in the adult care sector that the noble Baroness just announced. But is she aware of the widespread dismay at the cancellation of the proposals for reform, due to come in next year, without anything being put in their place, particularly against the background of what Wes Streeting said during the campaign:

“We don’t have any plans to change that situation and that’s the certainty and stability I want to give the system at this stage”?


The former Health Minister, Lord Warner, said that the Government’s announcement was “misguided”. He went on to say, on the plans for reform:

“A Royal Commission and a vague aspiration for a National Care Service is … kicking the can along the road”.


So should the Government not adopt the proposals put forward unanimously by two Lords Select Committees, chaired by the noble Baroness, Lady Andrews, and the noble Lord, Lord Forsyth, and make progress straightaway?

[Baroness Merron (Lab)]

I understand that, whenever there is a change in direction, there is concern. I take the noble Lord’s point. The inherited commitment to implement the adult social care charging reforms, which would have been on course for next month, was undeliverable because the previous Government did not guarantee the money to do that. It would have cost nearly £1 billion next year, rising to £4 billion by the end of the decade. There were many false dawns in respect of this long—and repeatedly—promised change. It is also the case that there was not adequate preparation to implement the charging reforms. Councils warned that they were impossible to deliver in full in the previously announced timeframe. With all that in mind, I am sorry to say that we, as the new Government, had little alternative but to say that these were not funded or on course to be delivered. We will have to ensure that we offer a national care service, along with a new deal for care workers. We will continue to consult and listen to those with lived experience in order to get it right.

[Baroness Andrews (Lab)]

My Lords, the noble Lord was kind enough to reference the Select Committee report. I think he would agree with me that the value of that report was that we were able to reveal the extraordinary voices of those with lived experience and the many unpaid carers who live such very hard but dignified lives. I have great confidence from what the Minister has just said that the Government will listen to those voices, because they know that there is no quick fix. This is a hugely complex problem, and the fair pay agreement is a very important first step. I have great ambitions, as we set out in that report, for a coherent and systemic change in the aspirations that we hold for social care, as well as the practical delivery. I hope the Minister shares those.

[Baroness Merron (Lab)]

My noble friend is absolutely right that there is no quick fix, and I think that is understood. The national care service, for example, is a 10-year vision, which will mean long-term reform of the sector, underpinned by national standards, making sure that locally delivered care will be of a high quality and consistent across the country. That is what people will want. As my noble friend said, we will continue to consult those with lived experience as well as engaging with workers, trade unions and the sector to make sure that we offer a new deal for care workers.

[Baroness Howarth of Breckland (CB)]

I congratulate the Government on the long-term care planning that they have, and the vision. As a long-term sufferer of cancer and therefore a consumer of both health and social care services over a period of time, I encourage the Minister to take a shorter-term view. Many of us do not have that long to wait for the 10-year plans and thereafter. Something needs to happen quickly, not only to reform social care but to have that integration of health and social care, because most of us with complex needs need them to work together and be on one spectrum.

[Baroness Merron (Lab)]

I very much take on board what the noble Baroness has said, and I understand that for many, including her, time is of the essence. I have described the long-term plan but there will be endeavours to improve things in the shorter term; for example, trialling neighbourhood health centres, which will bring together a number of services under one roof to ensure that health and social care are provided close to home, so that people can access the care that they need. We will also develop local partnerships between the NHS and social care so that we can get people home from hospital rather sooner than they have been of late—and, indeed, when they are ready. But it is about patient-centred care, which will always be at the heart of what we do.

[The Lord Bishop of Southwark]

My Lords, I welcome the Minister to her post. Does she recognise that one principal reason why fundamental issues around adult social care have not been addressed in the past 25 years is not only the complexity and cost—it is because adult social care is largely invisible and lacks political priority? Do the Government intend to address this?

[Baroness Merron (Lab)]

I thank the right reverend Prelate for his kind words of welcome. I take the point about invisibility in this area, but it would be fair to say that this Government will want to make this extremely visible. It is an issue that will not go away, and also one that is absolutely crucial, not just for those who rely on social care but for the good functioning and provision of the National Health Service. The two are inextricably linked, and we cannot sort out one without the other.

[Baroness Tyler of Enfield (LD)]

Since 2015, the number of working-age adults requesting care has increased significantly faster than those aged 65, and very few of them are self-funders, so while I welcome the Government’s commitment to establish a fair pay agreement for the workforce, it will work only if it is matched by commensurate local government funding increases; otherwise, it will just squeeze already overstretched care provider and local council budgets. What plans do the Government have to ensure that local authorities have sufficient funding to meet this commitment?

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[Baroness Merron (Lab)]

The noble Baroness raises an important point about actually making it work, but certainly the fair pay agreement is crucial to professionalising the care service and, indeed, raising the visibility of and regard for those who work in this sector, which is nearly 1.6 million people. We will be working closely, as I mentioned, with trade unions, local authorities, the sector and all those with an interest to make sure that the first ever fair pay agreement for care professionals can work and will deliver what we want, which is a stable, well-regarded and well-trained workforce.

[Lord Evans of Rainow (Con)]

My Lords, during the passage of the Health and Care Act, the previous Government came up with a compromise solution to fund healthcare for an ageing population. It was by no means perfect but it made a start, while addressing the concerns of the Treasury. The new Government have scrapped this scheme but have not yet proposed an alternative. A report from the Health Foundation claimed that Labour’s plans for social care are the most general, with a headline commitment to create a national care service but no detail about timescales or resources. Can the Minister give us any indications on the timeframe, such as “the end of 2024”—preferably a date, rather than “in due course” or “in the fullness of time”?

[Baroness Merron (Lab)]

I welcome the advice from the noble Lord and I will resist using those terms, which I am sure he will appreciate. However, as noble Lords have already understood, this is not going to be done overnight; we are talking about a 10-year vision but we will be talking about steps along the way. I think it is very important that we make progress on the national care service in the short term, because we have to build the foundations, by working with the sector and those with lived experience, to develop those new national standards. It will be work in progress and I hope that noble Lords will be patient but also press me about what progress we are making.

NHS Continuing Healthcare

Baroness Merron Excerpts

Monday 2nd September 2024 Lords Chamber

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

NHS continuing healthcare fulfils a unique function within the health and social care system, providing support for people with the highest levels of need by fully funding their health and social care. To monitor its effectiveness, the department works closely with NHS England, the wider sector, such as the Parliamentary and Health Service Ombudsman, and voluntary organisations which represent people with lived experience. This includes assurance work and projects to promote consistency in implementing this care.

[Lord Crisp (CB)]

My Lords, I thank the Minister for her very positive response. As she says, NHS continuing healthcare is vital. However, there are problems. Some of those are about finance, but I want to ask her specifically about the criteria for eligibility both nationally and locally, which are obscure and difficult. First, at the national level, can the Minister define precisely the level of nursing or other health services that a local authority can legally provide and which therefore do not have to be provided by the NHS? Secondly, almost 85% of applications other than fast track are refused, yet people have been encouraged to apply by health and care workers locally. Does the Minister agree that more needs to be done to ensure there is a clear understanding of who may or may not be eligible, rather than wasting so much of patients’, relatives’ and professionals’ time on unsuccessful applications?

[Baroness Merron (Lab)]

I do understand the concerns raised by the noble Lord and agree that we need to take a close look at all these areas. I have already raised that with officials and with Minister Kinnock, who is the responsible Minister in this area. On the second question, there is indeed a relatively low conversion rate, and I understand that the decision was originally made to ensure that everyone who might be eligible is actually assessed. The assessment acts as a gateway to other NHS-funded care but, having looked at it, this could perhaps be made somewhat clearer. On the first question, the noble Lord will understand that I cannot give a definitive answer, and he will be aware that legislation does not limit the number of hours or the cost of nursing care that a local authority may provide. However, the Care Act 2014 sets out that local authorities can provide nursing care only in very limited circumstances—for example, where it is a minor part of overall care, such as basic wound care.

[Lord Balfe (Con)]

What action are the Government taking to hold integrated care boards to account to ensure that the National Framework for Children and Young Persons’ Continuing Care is implemented equitably and consistently across all local areas? I declare my interest as the joint chair of the all-party group for children with short lives.

[Baroness Merron (Lab)]

It is crucial that we provide the right support to children and young people. NHS England’s regional teams are working with local systems to explore the delivery of continuing care to that younger group. It is important to say to your Lordships’ House that we do not currently collect data on, for example, children and young people, but we will be doing so from April next year. That will help us capture evidence, which will enable us to improve things in the way the noble Lord and his all-party group want to do. We continue to welcome views from stakeholders and partners in this regard.

[Baroness Pitkeathley (Lab)]

My Lords, I wonder if other noble Lords share my experience of people who should have continuing care never even being told about its existence. As the noble Lord, Lord Crisp, said, the criteria are obscure, but they are even more obscure if nobody tells you that you could be eligible. Would the noble Baroness be sympathetic to the idea of being much more open about the existence of this facility to both patients and their families?

[Baroness Merron (Lab)]

I thank my noble friend for that observation and certainly agree that, in all these areas, it is very important that people understand what might be available and how they might best apply. As I said to the noble Lord, Lord Crisp, the assessment is potentially a gateway to other NHS funding. I feel quite strongly that that needs to be clarified, so that people know what they are going into. I will take my noble friend’s comments on board and discuss this within the department.

[Baroness Barker (LD)]

My Lords, this issue has been a football between health and social care for many decades. We have never sorted out whose responsibility it is to do assessments and to make sure that those who are assessed know about the local services to which they can apply. How will the Government sort out that fundamental part of the problem?

[Baroness Merron (Lab)]

As the noble Baroness is aware, the responsibility for this lies with integrated care boards and a framework applies to both adults and children and to young people. It is for NHS England to ensure that the framework is properly applied. Certainly, the framework for children and young people has not been revisited since 2016 and we need to look at whether it is doing the job it is intended to do, because we want people to be getting the care they need. Each case is unique and complex and, as a person-centred service, that brings its own complexities. We should therefore ensure that the frameworks are applied correctly and get to the right people at the right time.

[Lord Evans of Rainow (Con)]

My Lords, I take this opportunity to warmly welcome the noble Baroness to her place; I look forward to working with her. During consideration of the Health and Care Act, the last Government committed to moving away from care homes. Are this Government also committed to allowing those needing care to be given support to live at home? What changes do they believe need to be made to the NHS continuing healthcare programme to allow them to stay at home, rather than be in care homes? The noble Baroness and I have exchanged comments about this in private, and I am very happy to discuss it again with her at a later date.

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[Baroness Merron (Lab)]

I thank the noble Lord for his welcome, and I welcome him; I hope we have set the standard on this first Question on the first day. What matters is that people are getting the right care in the right place, and that it is provided near to where they want it. We think that continuing healthcare is one means of doing that; of course, care homes are another. It is about getting in place what is right. I will be very pleased to speak to the noble Lord outside the Chamber on this matter.

[Lord Laming (CB)]

My Lords, I too welcome the noble Baroness to her post. Does she agree that our society would benefit greatly if we gave more recognition to the load that carers carry in these situations? According to the evidence they gave to our committee, unpaid carers sometimes feel that they are regarded by the health service simply as the chauffeur getting the person to hospital, whereas they are actually providing a huge amount of care. Can the noble Baroness assure the House that recognition will be given to unpaid carers?

[Baroness Merron (Lab)]

I am pleased to take this opportunity to give great recognition to the role that unpaid carers play; they are absolutely crucial to ensuring that people get the care they need, either directly or perhaps by being advocates. I also thank the noble Lord for his kind comments. While unpaid carers are very busy looking after those they care for, they need to be able to look after themselves and their own health needs. We will apply ourselves to this issue.

[Lord Dubs (Lab)]

My Lords, I declare an interest, in that a member of my family gets social care and has been trying to get continuing healthcare, without success. When people live in a local authority area where social care support is inadequate, the temptation is always to apply under the NHS. Is that not the problem? It simply puts more of a burden on those doing the assessments. Can this be resolved?

[Baroness Merron (Lab)]

I hope it can be. When we look at continuing healthcare and the assessment and service it provides, we will certainly take it on board.

Vaping Products: Usage by Children

Baroness Merron Excerpts

Monday 2nd September 2024 Lords Chamber

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

My Lords, I congratulate the noble Lord, Lord Storey, on securing a debate on this important and current issue. I, too, appreciated his introduction and the way in which he and the noble Lord, Lord Bethell, described the explosion of vaping and put it in the context of a situation that has perhaps gone way beyond being an aid to quit smoking, something that I think that speakers in this debate, including the noble Lord, Lord Naseby, acknowledge.

I share many of the concerns raised about the growing problem of youth vaping. The rate of children who vape has tripled in the past three years, and nearly one in five children has tried vaping, which I find deeply disturbing. This cannot go on. I assure noble Lords—I hope this is one debate in which I can bring good news to most noble Lords—that we will take bold action to reduce the number of children using potentially harmful products because the health message is very clear: if you smoke, vaping is much safer, but if you do not smoke, do not vape. Marketing vapes to children is unacceptable.

I am pleased to have the opportunity to provide an update on what this Government are doing to tackle the issue through the upcoming tobacco and vapes Bill, as well as on the action that we are taking now by strengthening enforcement activity and education. It is shocking that vapes and other nicotine products are being deliberately promoted to children. This should never happen. That is why His Majesty’s Government will go further than the previous Government, as was set out in the Labour manifesto. We will ban vapes being branded and advertised in ways that appeal to children and will stop the next generation becoming hooked on nicotine. The tobacco and vapes Bill will make that manifesto commitment a reality, and I am sure that noble Lords will be interested to know that I can say that it will be introduced very soon.

Noble Lords focused, rightly, on limiting the appeal of vapes to children. It is cynical to target vapes to children through not only direct marketing but colourful packaging, vibrant in-store displays and the large variety of apparently appealing flavours, such as gummy bear and cotton candy. This is abhorrent, as the noble Baroness, Lady Walmsley, rightly pointed out. To reduce the appeal of vapes, we will limit the range of flavours available and introduce limitations on packaging and shop displays. This will be done through secondary legislation as soon as possible after the tobacco and vapes Bill has passed. We will undertake consultation on these measures to inform our approach in order that we can get it right.

There has been much reference today and previously in your Lordships’ House to disposable vapes. They are also playing a significant role in driving youth vaping. They are cheap and easily accessible, with more than 50% of child vapers using them, as the noble Lord, Lord Storey, highlighted. Single-use products are causing significant environmental harm, with 5 million disposable vapes being littered or thrown away in general waste every week. I am sure that noble Lords will welcome the fact that my ministerial colleagues in Defra are reviewing proposals to restrict the sale and supply of disposable vapes and will outline their plans shortly.

We are also considering introducing an excise duty on vaping products. We know that young people are price-sensitive; this could therefore be an effective way to reduce the appeal of vapes. However, as noble Lords have indicated, we do have to get the balance right. We need to prevent youth access on the one hand while utilising them as a proven quit aid for adult smokers on the other. So it will be important to maintain a price differential with tobacco to support adult smokers to quit.

Noble Lords were right to raise a number of points about enforcement measures. We are taking strong action against businesses which knowingly sell vapes to children, and which sell illicit and unregulated vapes, which we know can be very dangerous. I am sure the noble Lord, Lord Storey, and other noble Lords will be pleased to know that the tobacco and vapes Bill will introduce new fixed-penalty notices in England and Wales, which can be issued by trading standards officers for breaches of certain offences, such as age of sale. This will allow trading standards to take quicker action against retailers who break the law instead of escalating to a court process.

The noble Lord, Lord Storey, and the noble Baroness, Lady Walmsley, asked whether the Government will consider introducing a vape licensing scheme. As was rightly pointed out, licensing may well be beneficial for strengthening enforcement, supporting legitimate businesses, deterring rogue retailers and, ultimately, of course, supporting the mission of improved public health. It is an area that we are actively considering for inclusion in the Bill.

[Lord Foster of Bath (LD)]

I apologise for interrupting the Minister. Just before she leaves the issue of enforcement, can she confirm whether additional resources will be made available to the various enforcement agencies?

[Baroness Merron (Lab)]

The noble Lord, Lord Foster, must have predicted that this is the very next point I am coming to; I am grateful for the warm-up. The noble Lord, Lord Foster, and the noble Baroness, Lady Bennett, asked about funding in respect of enforcement. I can share with your Lordships’ House that we are providing more than £20 million per year to HMRC and Border Force to support their illicit tobacco strategy.

We will continue to work with local authority trading standards to understand how new funding can support them to undertake local-level enforcement and help introduce new measures in the tobacco and vapes Bill. I know that this is of great concern to the LGA and the many vice-presidents that we have the pleasure of hearing from in your Lordships’ House. Any future funding decisions will, of course, be confirmed through the spending review process, but we are alive to the points that noble Lords have made on this.

To further comment on enforcement capability, we are providing £3 million of funding over two years to a programme being led by National Trading Standards called Operation Joseph, to reduce the sale of illegal vapes and nicotine-containing vapes to under-18s. This builds on existing work by trading standards officers across the country to tackle illicit vapes.

On educating children, this is a key issue, as noble Lords will be aware. We are also educating children on the dangers of vapes, to prevent their use in the first place. The school curriculum includes reference to the health risks of vaping and information is available on the Talk to FRANK website. Resources for teachers, including lesson plans, are also available on the DHSC’s School Zone.

I turn to the question of short- and long-term harms. While we know that vaping is less harmful than smoking and can be an effective way to quit, we do not know the long-term health harms that may emerge from vaping, and the potential risks to children. To fill that evidence gap, the department is exploring options to commission research on the long-term impact of vaping, so that we can fully understand the harms of vaping and the potential impact on our children. I listened closely to my noble friend Lord Winston’s contribution on the need to understand the harms in an evidence sense. Clearly, this is something to which we will need to apply ourselves.

I turn to further specific questions that noble Lords have raised. The noble Lord, Lord Bethell, asked about the proper supervision of vapes and their contents. I can say to him that there will be new powers in the Bill to allow us to be agile, and to respond appropriately and quickly to the latest evidence on vaping and nicotine products. We will have powers to have better oversight and control of the market and respond more quickly to technological developments, ensuring that only safe vaping products are used by smokers.

The noble Lord, Lord Naseby, and the noble Baroness, Lady Walmsley, asked about public health resources. It is absolutely right that we have to provide children and young people with evidence-based information, which is why we will continue to work with the Department for Education to update the curriculum and provide teachers with the latest resources.

My noble friend Lord Winston asked about regulation of the content of vapes. This is indeed an issue; to address it, we will extend non-vaping restrictions to non-nicotine vapes to reduce their appeal, and to align our regulatory approach and ensure that children are unable to access these products.

In conclusion, I hope that the strong measures that I have outlined today will demonstrate that we will bring about definitive change to stop future generations becoming hooked on nicotine. I thank all noble Lords for their thoughtful contributions today. I look forward to discussing this issue further once the Tobacco and Vapes Bill is introduced to this Chamber. I know that today’s debate will greatly inform the passage of that Bill and its content.

NHS Blood and Transplant Service: Blood Stocks

Baroness Merron Excerpts

Tuesday 30th July 2024 Lords Chamber

[Lord Rooker (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I declare that, until my late 70s, I was a regular donor, which stopped when I met with chemotherapy.

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

My Lords, there has been an excellent response from altruistic donors since NHS Blood and Transplant issued an amber alert for O-group blood on 25 July. I thank everyone who has booked an appointment and who has already donated, because they will have helped save up to three lives each. Since Thursday, 25,000 new donors have registered, website traffic has increased almost fourfold and booked appointments have doubled. O-negative stocks have risen from 1.7 days to 2.9 days.

[Lord Rooker (Lab)]

I thank my noble friend. That Answer is excellent news, but volunteers have to be treated carefully. There are 800,000 of them. Can my noble friend tell me how many of the 25 donor clinics are open seven days a week? That is for the convenience of the donors. Secondly, why was it left until there were only 1.6 days of O-negative blood left before the alert was issued? Finally, what are the stocks of the special blood, of any group, that is required for newborn babies?

[Baroness Merron (Lab)]

I will need to come back to my noble friend on that last question, but I assure your Lordships’ House that action was taken to increase the number of donors and the supply of the necessary blood even before the alert was announced. An alert creates better conditions, because more people come forward and rally. I thank them very much for that. On the donor centres, it is possible, of course, to give blood every day of the year apart from Christmas Day.

[Baroness Walmsley (LD)]

My Lords, as the universities return in the autumn, many new students will be recruited to be blood donors, which is a very good thing, because they often remain blood donors for many decades. The system needs to recruit 140,000 new donors every year for various reasons. But what about other young people? Will the Government do what they can to help the blood transfusion service to devise ways and means of encouraging other young people to become blood donors and, we hope, carry on doing so for decades?

[Baroness Merron (Lab)]

The noble Baroness is absolutely right that we need to encourage young people to come forward and to stay in the system. I have been in discussion with the chief executive and the chair of the service about how we can build more resilience and extend the number of donors. I am sure noble Lords will be pleased to know that, with the assistance of the actors Hugh Jackman and Ryan Reynolds, there is an exciting partnership with the Disney action film “Deadpool & Wolverine”, which is exactly intended to reach new and younger donors, and donors of black heritage. I am sure it will.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I declare my interest as former chair of the Human Tissue Authority. I understand that this alert was in part triggered by the cyberattack, and that Synnovis has largely stabilised the system for wider testing, but can the Minister say when the system will be wholly stabilised for blood transfusions? Can she also say whether any backlog has been created as a result of the cyberattack and what steps will be taken to create resilience so this cannot happen again?

[Baroness Merron (Lab)]

The noble Baroness is right in her observations. What I can say is that, while there has been a dramatic and somewhat sustained increase in the need for O-group blood, that is now improving. There has not been a negative effect on elective surgery; I think that is an important reassurance. In the future, obviously cyberattacks are going to be something that we are going to have to always be mindful of. That is why the service, at my request, is working to come up with plans for greater resilience, and such work is already ongoing within the department and across government.

[Lord Patel (CB)]

My Lords, does the Minister agree that, as a country, we should be pleased that, throughout the four nations of the United Kingdom, we are self-sufficient now in blood and all blood products and do not have to import, as we used to in the past? Furthermore, the problem that occurred was because, apparently, demands became suddenly high and the stocks were there for about only 1.4 days; normally, they are there for about four days. For a person being transfused, it is better if they are transfused with freshly donated blood, rather than blood that has been on the shelf, because it will last in their bodies for longer. The problem, particularly for recipients and donors of O-group blood, was, I hope, temporary and will be addressed.

[Baroness Merron (Lab)]

I assure the noble Lord that it is indeed a temporary problem. However, it is likely the alert will go on for a little while yet, not least because, as I mentioned, we can benefit from keeping it in place. I absolutely associate myself with the assessment that it is so much better to be self-sufficient within the United Kingdom, and that will be of great benefit. It is important to realise that this is a situation that we must live with but not be at the mercy of. I also assure the noble Lord and the House that this is because of external factors and not internal factors to do with the service, as was the case in 2022.

[Lord Kamall (Con)]

I thank the noble Lord, Lord Rooker, for raising this important issue and for his supplementary question. I also thank the Minister for her answers so far. Can she tell your Lordships whether the department has found an obvious reason why these stocks were low, and whether it was a confluence of factors or an unusual occurrence? I was speaking to a noble Lord who is an existing blood donor; he told me that when he read about the shortage he had not yet been contacted. What have the Government and the NHS learned from this experience about what does and does not work, both in the UK and in other countries, when it comes to encouraging the public to come forward to donate blood to avoid future shortages?

--- Later in debate ---

[Baroness Merron (Lab)]

The lessons-learned exercise started from day one—we are not waiting for the end of the alert. The approach that has been taken is to increase the number of appointment slots available, to launch new and innovative campaigns, and to seek to reduce the use of O-negative blood. On all these levels, there has been a tremendous response from the public and clinicians, and from all stocks. Even if we put the cyberattack to one side, it is certainly the case that collections of blood have been lower in recent months due to the impact of sporting events, bank holidays and the weather. All of these would have been manageable; it is the cyberattack that tipped the service over—by that I mean “over” to the point where it is now.

[Baroness Morgan of Drefelin (Lab)]

My Lords, I am delighted that my noble friend is looking at resilience with respect to the supply of universal O-group blood. Is she concerned that it could be indicative of the pressure that pathology services have been under for many years? If we see cyberattacks, we obviously have to be resilient to those, but we also need to be resilient in the strength of the pathology services across our NHS, so that when you have unusual happenings such as this, there is some back-up. Will she consider that when she looks at the resilience question?

[Baroness Merron (Lab)]

I thank my noble friend. That is a very important point and I will consider it in our deliberations. It is worth saying on resilience that work was already in place—for example, new centres are planned to be opened in Brixton and Brighton. I make that point not just because of expanding capacity but because the location of them will widen the range of donors. We absolutely need to continue. That is why I have asked the chief executive and the chair to come back to me with their plans to make us even more resilient.

[Lord Hayward (Con)]

My Lords, the Minister just referred to widening the levels of contributions from certain communities. Is she satisfied that all communities are adequately targeted about giving blood, and if not, what efforts are being made to ensure that greater contributions are made from different elements of society?

[Baroness Merron (Lab)]

I am sure that we could do better; that will be part of the ambition. That is why the ongoing campaign is focused particularly on those of black heritage, as well as younger donors. I will be very interested to look at the data to assess the response. It is important we make it as easy as possible to give blood, and that will be underlying all that we do.

Coronavirus: UK Deaths

Baroness Merron Excerpts

Monday 29th July 2024 Lords Chamber

[Lord Robathan]

To ask His Majesty’s Government what initial assessment they have made of the number of deaths in the United Kingdom from coronavirus compared to other countries, and of whether the policy of lockdowns in 2020 was effective.

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

My Lords, estimates of excess mortality from the Office for National Statistics show that, between January 2020 and July 2022, the UK’s cumulative overall mortality rate was 3.1% higher than expected. Using this measure of excess mortality, the UK was ranked 15th highest out of 29 European nations examined by the ONS. Research funded through the National Institute for Health and Care Research estimates that national lockdowns saved more than 470,000 lives in the UK in the first few months of the pandemic.

[Lord Robathan (Con)]

I welcome the noble Baroness to her position. She may not remember, but I did ask the same question of the last Government. I am sorry that the noble Lord, Lord Vallance, is not answering the question, because he has an encyclopaedic personal knowledge of this—and I would like to welcome him to his position as well. I will pick up the noble Baroness on what she has just said, because it appears that the Swedish model had a lower death rate than the UK model. We know the impact on the economy, on mental health and particularly on children’s education that the lockdowns had, and the important thing, as the noble Baroness will know, is to not make the same mistakes again. So could she please examine this more carefully and come forward with an initial assessment on whether lockdowns, on a cost-benefit analysis, were worth having?

[Baroness Merron (Lab)]

I thank the noble Lord for his kind welcome and I hear his disappointment that it is not my noble friend Lord Vallance—who will be extremely flattered—answering. On the matter of lockdowns, I start by paying tribute to the British public; it was they who rallied to ensure that lockdowns could save lives. Before Oral Questions, I met with the Chief Medical Officer to discuss the very point that the noble Lord has raised. I say to the House that, when looking at other countries, it is very important to consider the complexity of comparison; it is just not possible to draw direct comparisons. But what I can say is that we are of course waiting for the Covid inquiry, which will shine a light on a number of the matters that the noble Lord has raised.

[Lord Patel (CB)]

My Lords, on a previous occasion when the noble Lord asked the same Question and cited the Swedish mortality rates, I cited a study carried out in Scandinavia comparing the Swedish model with Scandinavian countries that implemented lockdowns. It clearly showed that the death rates were lower in those Scandinavian countries that implemented lockdowns. To satisfy the noble Lord today, I asked ChatGPT to compile all the evidence. It said:

“In summary, while lockdowns during COVID-19 were effective in reducing death rates from the virus itself, they also had complex and varied impacts on overall public health. The net effect on mortality rates includes both the direct benefits of reduced transmission and the indirect consequences of restricted mobility and access to healthcare”.


Will the Minister agree that there is now some evidence that lockdowns were effective in reducing mortality?

[Baroness Merron (Lab)]

I thank the noble Lord for his informed observations. It is true to say that every Government were making decisions based on balance and that, with that, as the noble Lord said, not locking down would have meant that more lives would have been lost. It is important to put on record that the clear majority of professional opinion in this country was that lockdowns absolutely had their place. Even though there was a balance in terms of difficulties with mental health, access to services and the impact on the economy, in Opposition we supported the then Government, as we would in any national emergency.

[Baroness Neville-Rolfe (Con)]

I too welcome the noble Baroness to her role. On a less complex point, lockdown is a very expensive policy and should be used in very limited circumstances. So does the Minister agree in particular that damaging lockdowns in schools—this is about the education of our children—always need to be avoided if at all possible?

[Baroness Merron (Lab)]

I thank the noble Baroness for her kind welcome. Of course, this was a decision taken by the last Government, supported by the Official Opposition. I would say that these kinds of factors were complex rather than “less complex”. Nobody wants to have to lock down a country, but there are rare occasions when we have to consider that. Of course, circumstances changed under lockdown: the fantastic work of the vaccination programme and the vaccine allowed us to unlock. So it is always a moving feast—but I take note of the noble Baroness’s point about the impact on young people.

[Lord Scriven (LD)]

My Lords, the last Government decided to stop various methods for testing Covid-19 last year, other than for those in hospital. Other countries, including the USA, still collect data and the World Health Organization publishes it. So could I ask the Minister to help with public health screening and planning? Will the Government potentially look at this kind of testing being done again and the results published?

--- Later in debate ---

[Baroness Merron (Lab)]

I will look into the noble Lord’s point and come back to him in greater detail. But, fortunately, we can observe at least that Covid-19 is now a relatively mild disease for the vast majority of people. That allows us to put in place a more targeted programme aimed at those who are at higher risk of developing serious Covid-19. It is important that we take technical and expert advice about where we put our efforts.

[The Earl of Clancarty (CB)]

My Lords, following on from the last question, will the Government ensure that the large number of long Covid sufferers do not become victims of the Government’s drive to get the unemployed back to work when what they need primarily is the right medical care and, if necessary, financial support while they get well again? The clue is in the name of the condition; this could be a long process for many, as the Minister will appreciate.

[Baroness Merron (Lab)]

I certainly do appreciate the point made by the noble Lord and certainly, as of April this year, there were some 90 adult post-Covid services introduced across England, along with an additional 10 for children and young people in the manner of hubs. I hope that will be a great support. Long Covid remains something of a new challenge, but these services are offering integrated assessment, medical treatment, rehabilitation and direct access to diagnostics and I can assure the noble Lord that we will not take our eye off the ball.

[Lord Sikka (Lab)]

My Lords, a report by the Institution of Health Equity earlier this year stated that, between 2011 and 2019, over 1 million people died prematurely from a combination of Covid, austerity and poverty, which is a shameful record for the last Government. Can the Minister assure the House that this Government will not neglect the poor and will protect and enhance the real value of wages and benefits?

[Baroness Merron (Lab)]

I can certainly assure my noble friend that we will be working across government to join up our approach because, as I have mentioned in a previous question, the complexity of all this is not to be ignored. Indeed, it is the case that people’s incomes, where they live, the lives that they are managing and how their health is—whether they are, for example, obese or smokers—all impact on health and affect excess deaths. It is our duty to find ways of reducing avoidable deaths and we will do so.

[Lord Lilley (Con)]

My Lords—

--- Later in debate ---

[Baroness Bennett of Manor Castle (GP)]

I thank noble Lords. Following on from the question from the noble Earl, Lord Clancarty, about long Covid, and of course continuing new cases are arising even from apparently initially mild infections, we also face the threat that I hope the Government are watching closely of H5N1 in terms of other respiratory diseases, and we know it is only a matter of time before another respiratory pandemic faces us. What steps are the Government taking to look at air filtration and ventilation systems to provide a better public health system that is more resistant to future diseases in schools and other public buildings and perhaps to provide ways for people to assess in premises they visit how good the ventilation and filtration is for them to be able to go into those environments?

[Baroness Merron (Lab)]

The noble Baroness offers some helpful suggestions as to areas that we can be looking at, but this for me all comes under the headline of resilience and certainly we are monitoring potential emergencies, including the one that the noble Baroness refers to. I can assure her also that preparedness will not just focus on respiratory means of passing on disease but will now look at all of the five routes of transmission, and I feel that will make us a much more resilient country.

Black, Asian and Minority-Ethnic Women: Maternal Mortality Rates

Baroness Merron Excerpts

Monday 29th July 2024 Lords Chamber

[Baroness Gohir (CB)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and declare my interests as set out in the register.

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

My Lords, I first pay tribute to the noble Baroness for her work with the Muslim Women’s Network, and for her excellent campaigning to end appalling inequities in women’s experiences across the country. Interventions such as enforced continuity of care for the most deprived and initiatives to tackle racism are key. However, further, urgent action is required. This Government are committed to closing the black and Asian mortality gaps and to ensuring safe and compassionate care for mothers and babies alike.

[Baroness Gohir (CB)]

I thank the Minister for her comments. A number of maternity reports tell us exactly what is contributing to the poor outcomes for minority-ethnic women and their babies. Will the Government bring the recommendations in those reports together to ensure that hospital trusts and medical professional bodies follow them? Will the Minister consider appointing a maternity commissioner, because it would save lives?

[Baroness Merron (Lab)]

I certainly agree with the noble Baroness that the maternity landscape is extremely crowded; there have been a number of reports and inquiries, along with investigations. I shall look very closely with officials at the recommendations from those reports as well as those that are forthcoming. With regard to an independent commissioner, I feel that there is general agreement about what the issues are, and the most important priority is to take action. Of course, in reviewing what is going on, as I am now in this post, I will consider all suggestions, and that includes the one from the noble Baroness.

[Baroness Uddin (Non-Afl)]

My Lords, I also thank my noble friend Lady Gohir for her continuous campaign. I declare an interest having been involved in these matters in Tower Hamlets for some 40 years. I congratulate the Minister on her ministerial role. When she seeks to consolidate these matters and take the best course of action, will she ensure that she looks at the reports that have been on the shelves at the Royal London Hospital trust for the best part of 40 years?

[Baroness Merron (Lab)]

I thank the noble Baroness for her kind remarks and good wishes. Certainly, all reports will be considered because we will look for what works.

[Baroness Benjamin (LD)]

My Lords, sickle cell disorder affects mainly people whose heritage is from Africa, the Caribbean and Asia, and the Sickle Cell Society’s report, No One’s Listening, shows that people with sickle cell experience discrimination when they engage with the NHS. We know that black and Asian women are four times more likely to die in childbirth. Can the Minister assure the House that NHS maternity units have the right level of training, staffing and systems to support safe care for expectant mothers living with sickle cell? I declare an interest as a patron of the Sickle Cell Society.

[Baroness Merron (Lab)]

The noble Baroness is quite right to draw the House’s attention to the important matter of sickle cell. We look to specialist midwives to assist us in this. I have been asked for a particular assurance and it is correct that the noble Baroness seeks that. I shall be pleased to look into it to be able to come back to her in much greater detail.

[Baroness Sugg (Con)]

My Lords, the previous Government introduced the first ever UK women’s health ambassador, who can help to co-ordinate the complex changes that are needed to reduce the mortality rate for black, Asian and minority-ethnic women and their babies. Can the Minister commit to continuing to support the ambassador’s work?

--- Later in debate ---

[Baroness Merron (Lab)]

I pay tribute to the noble Baroness for her work promoting good health for women and girls, and I look forward to working with her and with other noble Lords across the House. One of the first calls that I made was to the women’s health ambassador and I will certainly look to her to drive forward the change and improvements in patient safety and patient experience that we desperately need.

[Baroness Prashar (CB)]

My Lords, while I welcome the Minister’s commitment to look at all the recommendations that have been around for a pretty long time, and it is frustrating that action has not been taken, can she give a commitment that once she has considered those recommendations, and if there is a plan of action, she will report to the House on what that plan is likely to be?

[Baroness Merron (Lab)]

I will indeed be very pleased to report back to your Lordships’ House on this matter. It is something that greatly concerns me, because it cannot be acceptable that women go into childbirth, which should be a happy and safe occasion, and perhaps come away with trauma, and in some cases families experience death as well. We cannot have a situation like that. I have been very moved by the stories I have heard and will commit to working to put improvements in place, and to sharing that with noble Lords.

[Lord Kamall (Con)]

My Lords, I welcome the Minister to her place. I look forward to working constructively with her as we did when our roles were reversed. Has she read the report by Sands, the baby loss charity? It gave examples of Asian parents being dismissed as either being too anxious or exaggerating their claims, while black parents were stereotyped as feisty or dramatic by some NHS staff. When I was a Minister, a young female civil servant told me about her friend, a young Afro-Caribbean lady whose baby died during birth. When she tried to get the records for what happened that evening, she was told that they had somehow magically disappeared. She was being gaslighted. We know that the majority of NHS staff are highly dedicated but, when we hear stories such as this, what does the Minister believe should be done to tackle the culture of cover-up and gaslighting by that small minority of NHS staff?

[Baroness Merron (Lab)]

I thank the noble Lord for his kind remarks; I am very pleased to see him again across the Dispatch Box. The duty of candour is extremely important in all this. Racism in this area is not just towards mothers and families; as the noble Lord said, it is also towards staff. Clearly, we need to tackle this for both patients and staff. The patient’s voice is key. Even at this early stage, it is quite clear to me that women, and people of black, Asian and minority-ethnic heritage, are not being listened to. We will bring forward plans to put this right. As part of the report to which I referred earlier, I will be glad to update the House in this regard.

[Baroness Blackstone (Lab)]

My Lords, I declare my interest as set out in the register. Given the complexity of the causes of these unacceptable mortality rates, what is the Minister’s department doing to ensure that there is a cross-government approach to ending the maternal mortality gap?

[Baroness Merron (Lab)]

My noble friend is quite right: this is a cross-government matter. There are complex reasons why black, Asian or minority-ethnic people are suffering far worse than those who are white. They include socio-economic factors such as deprivation and health inequalities being felt across the whole range. It is not going to be possible to solve this without cross-government co-operation. I look forward to working with my ministerial colleagues to put it right.

[Baroness Hussein-Ece (LD)]

My Lords, I too welcome the Minister’s commitment to addressing this very serious issue. As other noble Lords have mentioned, there have been numerous reports over the years from different trusts highlighting the crisis in maternity services. Training will help, but we hear constantly that a shortage of maternity nurses in many trusts is leading to such situations. The noble Baroness also mentioned that women are simply not being listened to. This has come out in many reports. Will she ensure that women’s voices are heard when they are in labour and giving birth, as they are the experts about their own bodies?

[Baroness Merron (Lab)]

I can say yes to the noble Baroness on the second point, because if we do not listen to patients, we will not get it right. The Government are committed to training more midwives and health visitors and to incentivising continuity of care, as well as to making sure that the National Health Service is focused on tackling inequalities that can be described only as shocking. I absolutely agree about training, but we also need leadership and a determination from the top to put this right, as well as practical plans.

Northern Ireland Dentists: Amalgam Fillings

Baroness Merron Excerpts

Monday 22nd July 2024 Lords Chamber

[Baroness Hoey]

To ask His Majesty’s Government what plans they have to ensure that dentists in Northern Ireland will still be able to use amalgam fillings when the EU ban their use from January 2025.

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

My Lords, on 19 July, as a result of constructive work between the UK Government and the EU, the EU published a notice that recognises the unique circumstances of Northern Ireland and the representations that have been made by the UK Government. It set specific arrangements in place for Northern Ireland, providing an additional 10 years to still use amalgam fillings, or until an earlier time is agreed by the Minamata convention, to which the UK is party.

[Baroness Hoey (Non-Afl)]

My Lords, I thank the Minister for that Answer, which will be very much welcomed by dentists in Northern Ireland, but does she understand that there is a fundamental issue here? There are many more health and other regulations that will need that kind of begging of the EU to make a difference, because Northern Ireland is still under the Windsor Framework and the protocol. Will she commit to working to ensure that Northern Ireland’s place in the United Kingdom, as a fully integrated part of the United Kingdom, is restored, and that this Government will do what they can to make that happen as soon as possible?

[Baroness Merron (Lab)]

As the noble Baroness is more than aware, the Windsor Framework is exactly about safeguarding Northern Ireland’s integral position in the union and the UK internal market. I can assure your Lordships’ House that the Government are committed to implementing the Windsor Framework in good faith. This is a particular set of circumstances and the first opportunity to secure such arrangements, so it is important to see it in this light. I am glad that the noble Baroness welcomes this action by the Government; it is certainly intended to serve the good people of Northern Ireland, and I am glad to be able to present that today.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I refer to my entry in the Register of Lords’ Interests. I welcome the derogation on amalgam fillings, because that issue has been persisting for some time. It proves that a Labour Government are working to find solutions to the outstanding matters relating to the Windsor Framework. In that respect, will the Minister and her colleagues undertake to provide us with details of the resetting of the relationship between the UK and the EU? There are several outstanding matters relating to veterinary medicines and the EU’s carbon floor.

[Baroness Merron (Lab)]

I am glad that my noble friend welcomes today’s announcement. I am sure the House will appreciate the particular set of circumstances surrounding amalgam, which are extremely complex. This has required considerable collaboration between several departments, as well as the devolved Administrations. I hope it will be regarded as something very positive, but I can assure my noble friend and your Lordships’ House that I will discuss with my ministerial colleagues the points being raised about the Windsor Framework and the relationships that that entails.

[Lord Lexden (Con)]

Do the Government accept that there is indeed a considerable amount of further work to be done to ensure that the Windsor Framework provides fully for the free movement of all goods within our precious single market?

[Baroness Merron (Lab)]

Certainly, the Windsor Framework, under which some EU rules apply in Northern Ireland, is intended to help the EU and the UK work together constructively and to ensure the smooth flow of trade within the UK internal market. I am sure that my colleagues in the Northern Ireland Office will continue to keep that under review. I know that the Northern Ireland Secretary has been very involved in the amalgam issue.

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

My Lords, will the Minister confirm that the noble Baroness, Lady Hoey, is one of the people who got us into this mess in the first place?

[Baroness Merron (Lab)]

I thank my noble friend for his opinion; that is noted. The Question from the noble Baroness, Lady Hoey, was extremely welcome.

[Lord Caine (Con)]

My Lords, I congratulate the noble Baroness on her appointment. Clearly, we strongly support the derogation for Northern Ireland, on which we were working tirelessly prior to the election. While agreement is always to be preferred, the Stormont brake remains a crucial democratic safeguard for Northern Ireland in order to prevent the imposition of new EU laws and regulations that, in this case, could have had a devastating impact on dentistry and public health. In the event of that brake ever being activated, will the new Government commit to standing by all its provisions, including the exercise of a veto where necessary?

--- Later in debate ---

[Baroness Merron (Lab)]

I thank the noble Lord for his kind words of welcome and can assure the House that I will certainly do my best in my new role. On the important issue of what next, which I believe the question raises, this will now be a matter for the Democratic Scrutiny Committee in Stormont. It will look closely at what this new arrangement potentially means and will decide the next step, so I suggest that it is in the right place. Of course, we will continue to work closely with our colleagues in Northern Ireland. I believe there will be next steps after we have had the opportunity to hear what the committee says.

[Lord Harris of Haringey (Lab)]

My Lords, I refer to my interest, as listed in the register, as chair of the General Dental Council. Can the Minister express a view, on behalf of His Majesty’s Government, on the safety of amalgam fillings?

[Baroness Merron (Lab)]

Yes, I can confirm that amalgam is safe. The reason for this phase-down of the use of mercury, which is in amalgam fillings, is related to the environment. When mercury is released into the environment—for example, through emissions from crematoria—it can get into the food chain, where it accumulates mainly in fish such as shark and tuna. That can affect those who have a fish-rich diet, in countries such as Greenland, Brazil, Japan and China. However, there is no evidence whatsoever that amalgam is unsafe, and it is with that in mind that we have sought this arrangement for Northern Ireland.

[Lord Forsyth of Drumlean (Con)]

Further to the noble Lord’s rather ungracious question, can the Minister confirm that if we had not left the EU, it would not have been possible to continue with the use of amalgam?

[Baroness Merron (Lab)]

I am sure that there are many opinions in your Lordships’ House about what would have happened if we had not left the EU, and I think it is probably appropriate that I leave it there.

[Lord Scriven (LD)]

Does the Minister agree that it is the policy of the British Dental Association eventually to remove amalgam, so this is about not whether it is removed but the timing of its removal, in a way that helps to ensure continual dental services?

[Baroness Merron (Lab)]

It is indeed, and I thank the noble Lord for his observation, which is absolutely correct. We are very grateful to the British Dental Association for working closely with us not just on this issue but on how we are going to restore NHS dental services across the country, because that is a real task we are going to have to battle with.

Human Medicines (Amendments relating to Registered Dental Hygienists, Registered Dental Therapists and Registered Pharmacy Technicians) Regulations 2024

Baroness Merron Excerpts

Friday 24th May 2024 Lords Chamber

In conclusion, these regulations provide patients with access to a wider range of clinical services delivered by healthcare professionals with the right skills, at the right time, and support this Government’s ambition to improve outcomes for patients, while reducing demand on other parts of the service. I beg to move.

[Baroness Merron (Lab)]

My Lords, from these Benches, we support the overall terms of these draft regulations, particularly the measures on pharmacy technicians and dental hygienists, who have great value in providing timely and quality care to patients where it is safe and suitable for them to do so.

I know that the dental profession is very supportive of the intention to enable dental hygienists and dental therapists to supply and administer the majority of the medicines listed in the regulations. The Minister described the regulations as “common-sense”, and I certainly share that assessment.

However, I just draw the Minister’s attention to the inclusion of two medicines on the list: minocycline and nystatin. These were not supported by the BDA or the College of General Dentistry—I am sure the Minister is aware of this—for a number of reasons, including antimicrobial resistance. In the case of minocycline efficacy, it is not recommended in any national clinical guidelines and its use in dentistry is no longer accepted practice. Perhaps the Minister can therefore say whether the concerns of the key dental stakeholders were taken into account when the decision was made to retain these two drugs on the list. Can he also assure the House that there has been full and proper consultation with both the British Dental Association and College of General Dentistry on ensuring that the regulations are compliant with both national practice and existing clinical guidelines?

Efforts to increase the skill mix in our NHS dentistry workforce and across pharmacy more generally are welcome, but I am sure that the Minister will forgive me for thinking that we perhaps need to go rather further than technical tweaks if we are to reverse the crisis in which NHS dentistry finds itself. However, as I said at the outset, we support these regulations, and I hope that the Minister will be able to reassure us about the medicines that are included in the list.

As this is the last day that the House is sitting in this Parliament, I, like my colleagues before me and, I am sure, after me, would like to take the opportunity to say to the Minister, the noble Lord, Lord Markham, what a pleasure it has been to work with him while he has been in his role. He has always carried out that role with the greatest courtesy, but also with care and determination to improve things, no matter what obstacles he perhaps found in his way. I thank him for his dedication to his role. As he is standing in for the noble Lord, Lord Evans—who was due to be standing in for the noble Lord, Lord Markham—I also thank the noble Lord, Lord Evans, similarly, for the manner in which he has conducted himself in this House. He too has always been most helpful and a real pleasure to work with and has always tried his best to make progress, as I know we all wish to do.

[Lord Markham (Con)]

I thank the noble Baroness for her kind words. Likewise, if the right words are “thoroughly enjoyed” then I have thoroughly enjoyed working with both the noble Baronesses on the Front Bench on that side, the noble Lord, Lord Allan—he is not here—and many other colleagues, including the noble Baroness, Lady Hayter. There are a number of common-sense things that we have managed to work through together.

I too take this opportunity to thank all noble Lords. It was a baptism of fire when I started two years ago, but I have come to really respect the function of the House and how well it holds our feet to the fire. We are all, in British society and in the Government, much the better for it.

On the questions raised, particularly regarding minocycline 2%, there were concerns raised, as the noble Baroness said, including by the British Society of Periodontology. However, when it was looked at, it was felt overall that it was best to keep it on the list because the concerns are quite low. On balance, it was worth keeping it on the list, but keeping it under watch—for want of a better word. Concerns were also raised around nystatin oral suspension but, again, it was felt that there were certain health benefits for certain groups of patients. But there will be training associated with these medicines, to ensure patient safety.

I will happily write in more detail on these—as is my wont; that is my “get out of jail free” card, in many cases—to make sure those questions are properly answered. I welcome the comments from the other Front Bench that these are sensible arrangements. With that, I beg to move.

Integration of Primary and Community Care (Committee Report)

Baroness Merron Excerpts

Thursday 9th May 2024 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I congratulate my noble friend Baroness Pitkeathley on her incisive introduction of what I consider to be a pragmatic and thoughtful report, although I am sure it did not make for pretty reading by the Minister. I thank all members of the committee for their thorough application to the task that was before them: to shine a light on integrating primary and community care to put patients at the centre, which is exactly how it should be. They have done it by offering solutions that are, to quote my noble friend Baroness Pitkeathley, “simple and virtually cost-free”. I am sure that your Lordships’ House would say to any incoming Government, “Watch and learn”.

I am delighted to commend the noble Lord, Lord Jamieson, on his excellent maiden speech, through which he surely honoured the memory of his late mother. As the noble Lord so clearly understands the links between health, housing, environment and other factors, I am sure that we can all look forward to his constructive future contributions.

Day in and day out, primary and community care services provide vital support to millions but, like much of the NHS, they are under considerable strain. Yet, as the noble Baroness, Lady Tyler, said, acute services receive more attention and priority from the Government.

The backdrop to this debate is that backlogs have now reached more than 1 million in community health services. The latest NHS data shows primary care delivering almost 30 million more appointments in March, which is an increase of 25% compared to the same period before the pandemic. Yet, as your Lordships’ House has noted on many occasions, the greatest economic returns from the NHS budget come from investing in primary and community care. This makes good sense.

Some £14 is added to the economy for every £1 invested, and, crucially, it lowers demand in the need for hospital and emergency care. This begs the question being probed in this debate, and which is the headline question to put to the Minister: if these points are accepted—and maybe they are not, in which case I am sure the Minister will say that—then why is there a concentration on acute services, at the expense of prevention and proper integration between primary and community care? There is also a lack of proper integration between the NHS and social care. Why has this situation been allowed not just to develop but to deepen in its severity?

The noble Lord, Lord Altrincham, highlighted that it was repeatedly put to the committee that poorly co-ordinated care undermines the quality of patients’ experiences and can have profound consequences for their long-term health. It should not be that somebody’s health and well-being gets worse because professionals do not contact each other; because patients are made to make inconvenient and unnecessary trips to multiple locations and practitioners; because staffing is inadequate; or because records are not being shared. It is telling that a broad range of witnesses repeatedly spoke of the problematic lack of integration between social care and the National Health Service, even though social care was not within the remit of the report.

For all this, I have heard noble Lords describe the Government’s response to this report as delayed, disappointing and failing to match words with the necessary focus and action. I welcome the principles behind the report’s key recommendations. I trust that the Minister will do likewise and tell your Lordships’ House what more the Government will be doing than is currently the case.

I am sure that many noble Lords will, like me, remember the ambitions articulated during the passage of what is now the Health and Care Act to formalise the integration of primary and community services. However, NHS leaders are telling us that this is not supported by the current commissioning and contracting arrangements. The policy continues, they say, to be developed in silos from the centre, both at NHS England and at the department. I will be interested to hear the Minister’s response to this observation.

For many of us, being treated at home, or as close to home as possible, is best for our health. It is how we want to be cared for. It is also the most efficient and cost-effective for the National Health Service. Nobody wants to be left waiting until hospital treatment is needed; that makes no sense at all. As envisaged in the Health and Care Act, integrated care systems still have the potential to create more joined-up health and care, with primary care being integrated into broader NHS services in the community, through schemes such as Pharmacy First and through the extension of access to services, such as by evening appointments to fit around the needs of local populations.

There is no appetite for further structural reform, but we need to know what is working and what is not. What assessment have the Government made of the effectiveness of ICSs? What are the obstacles to success and how will they be overcome? Is everything in place to ensure that ICSs can make the best possible use of their allocated funds to plan and innovate?

The report highlights the need for a seamlessly integrated patient-centric healthcare sector where patients are given the type of care that they need, when, where and how they need it, whether that be through access to a GP, a pharmacist or a district or mental health nurse. I can tell the House from these Benches that if the next Government are a Labour one, we are committed to making change so that more people get care at home in their community—shifting services out of hospitals and into the community, so that the NHS becomes as much a neighbourhood health service as it is a National Health Service.

The report also says that the Government should focus more on preventive rather than reactive care to tackle the needs of an ageing population, many of whom are coping with complex health issues which require intricate and continuous care. We share that view and are committed to change: we will focus on prevention, shifting the focus to embedding long-term planning, tackling the social inequalities that influence health, ensuring children have the best start possible, empowering people to take responsibility for their health, improving screening programmes and boosting capacity in local public health teams.

I was struck by the observation articulated by the noble Baroness, Lady Finlay, that the committee heard more frustration expressed by witnesses on the inadequacy of digital connectivity than almost anything else. They identified technical issues, cultural attitudes and misunderstandings about GDPR. The noble Baroness, Lady Barker, put it well: that currently, the co-ordination of patients’ data is no one’s responsibility. How do the Government intend to address that point?

What is the Minister’s view as to whether legislation and guidance need to be reviewed to ensure that the tension, whether real or unjustified, between data privacy and effective healthcare planning and provision is overcome? As the noble Lord, Lord Allan, raised, does the Minister consider that appropriate training has been and is being given?

Turning to the workforce, dealing with the problems of its recruitment, retention, numbers, training, morale and well-being will support the integration of services, as spoken to by the noble Baroness, Lady Redfern. What plans are there to include integration in training, and how will NHS and local government staff be made aware of other services and how to work closely with them? Does the Minister consider that the social care workforce should be a component of the NHS long-term workforce plan?

Putting patients at the centre is, as my noble friend Lady Armstrong wisely observed, far from outlandish. Wrapping the NHS around the patient, instead of the patient having to wrap themselves around the NHS, is how it should be. I hope that this report will contribute to that outcome.