Wheelchair and Community Equipment Strategy

Baroness Merron Excerpts

Thursday 11th December 2025 Lords Chamber

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

My Lords, I am most grateful to my noble friend Lord Hunt, not just for securing this important debate on a vital issue, as the noble Lord, Lord Kamall, said, but for his campaigning, along with other noble Lords, groups and individuals outside your Lordships’ House over many years. I am also grateful to noble Lords not just for their contributions but for sharing their experiences, some of which are painful to relate and to hear.

On the maiden speech of the noble Baroness, Lady Gerada, I welcome her experience and approach. I welcome her to your Lordships’ House. The noble Baroness spoke of choosing to speak in this debate because of its featuring, among other things, dignity and fairness. I was touched by her description of what and who a GP really is within their community. I know that we all look forward to hearing more from the noble Baroness. Perhaps I might say that the Government have promised more GPs—and we are delighted to have more GPs sitting on our red Benches.

This has been an affecting debate, not least as people described the impact of services not being, as they should be, in the right place. I am sure we would all agree that there is more work to do, but I will take this opportunity to outline what the Government have done and are doing. We are focused on ensuring that disabled people have access to the services and support that they need to lead a fulfilling life. My ministerial colleague, Zubir Ahmed MP, is the relevant Minister and I look forward to sharing the points and questions raised in this debate with him.

Integrated care boards are responsible, as the noble Lord, Lord Kamall, just quoted, for the provision and commissioning of local wheelchair services based on the needs of their local population. I am glad that the noble Lord, Lord Kamall, recognised the importance of flexibility. However, flexibility cannot be an excuse for not providing—a point I have heard rightly and repeatedly today.

There are no plans to publish a national strategy for wheelchair provision. I know that will be disappointing to noble Lords, but NHS England has developed policy guidance and legislation to support ICBs, which are crucial in this, to ensure the commissioning of effective, efficient and personalised wheelchair services, including the wheelchair quality framework, published in April, in collaboration with the NHS England national wheelchair advisory group.

Local authorities have a statutory duty to arrange for the provision of community disability equipment to meet the assessed care and support needs of people in their area. Our 10-year plan for health gives that freedom and autonomy to serve local people to local commissioners. In this regard, it is important that we are giving systems a greater degree of control and flexibility over how funding is deployed to get this done.

I have heard about delays to wheelchair provision. I say this not as any excuse at all, but the pandemic continues to have an impact on wheelchair services, not least because some providers have not only reduced their services—with the inevitable outcome—but now face a backlog of referrals. I was interested to explore that some services have also experienced lower referral rates during the pandemic. This of course led to a surge in referrals later. It has meant that waiting times for both adults and children have fluctuated, as services have worked to recover.

However, we need action to address waiting times and I absolutely recognise the impact that delays have. To that point, in October, we published the NHS Medium Term Planning Framework, which requires all ICBs and community health services to actively manage and reduce waits over 18 weeks, and to develop a plan to eliminate all 52-week waits.

The noble Lord, Lord Blencathra, rightly referred to the need to focus on measuring outcomes. The community health services situation report will be used to monitor ICB performances against waiting time targets in 2026-27, and currently monitors waiting times for children, young people and adults under wheelchair, orthotics, prosthetics and equipment. These targets will guide systems to reduce the longest waits. Additionally, the model service specification for wheelchairs sets out that wheelchair assessments have to take place in the most suitable environment, including hospitals, the key thing here being that they are based on the need of the individual.

My noble friend Lord Hunt and other noble Lords rightly spoke of delays in discharge being linked to temporary or short-term loan wheelchairs rather than long-term provision. Access to temporary wheelchair provision to support hospital discharge is determined locally by ICBs; it does not fall within the remit of NHS wheelchair services, which provide services to people of all ages with long-term mobility needs. I heard the point made very clearly about the technology and quality of wheelchairs, which is one of the things I will be raising and discussing with Minister Ahmed.

Reducing waiting time is part of improving the quality of wheelchair services, but it is not the whole story. The quality framework, which the noble Lord, Lord Shinkwin, asked about, is very much designed to assist ICBs and NHS wheelchair service providers to get it right. I have heard, from the experience of noble Lords in the Chamber and also from those outside, that this is not always the case, and I understand that. However, the quality framework sets out the quality standards relevant to all suppliers and aligns with the CQC assessment framework. To the point raised by the noble Lord, Lord Blencathra, and the noble Baroness, Lady Brinton, this is about aiming to tackle the inequalities that we know exist—I acknowledge that—in outcomes, experience and access.

NHS England statutory guidance sets out how ICBs should be working with people, communities, key partners and local authorities. That is why each ICB must have executive leads who work closely with local authorities and who promote integrated working for the benefit of people, including those with a learning disability, autism, Down’s syndrome, and children and young people with special educational needs and disabilities.

As was referred to in the debate, NHS England introduced personal wheelchair budgets in 2019 and gave a clear framework for ICBs to commission personalised wheelchair services, focusing on outcomes and also on integrated care, giving people greater choice over the wheelchair provided—and I have heard what noble Lords have said today.

The noble Baroness, Lady Lane-Fox, spoke quite correctly about the impact of the quality of services on the ability to be in the employment market. That is about quality of life as well as the economy, and I share her views.

The noble and right reverend Lord, Lord Harries, and the noble Lord, Lord Rennard, discussed dissatisfaction with services; I heard that mentioned a number of times. NHS bodies and local authorities must arrange for dealing properly with complaints.

The approach of the 10-year health plan identifies disabled people as a priority group. Our neighbourhood health service will support disabled people, and the 10-year plan focuses on choice and control over their care. I have heard what noble Lords have said, and I will take that back. I hope the steps we have made will make a difference, but I recognise that there is so much more to do.

Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I hesitate to rise as I want to ensure that everyone feels that their voice has been heard in this debate. We do not want to make law on a basis on which people look back and say that we did not properly debate a particular issue. If all noble Lords who wish to speak in this debate have spoken, I am very happy to make my contribution, but if there are any other noble Lords who wish to make their point, I should give way.

Well, that answers that question; I tried my best. I want to make that point clear. It is really important that everyone who feels they want to speak can do so, but I also say to noble Lords, including my noble friends, that it is also important to respect the rules and conventions, to speak to the amendments and not to repeat Second Reading speeches or make wider debates. I hope we can get that appropriate balance. I have taken time making those points, so I will try to be brief.

I pay tribute to the noble Baroness, Lady Berger, especially for the way in which she delivered the Select Committee process that preceded our deliberations in Committee. The evidence submitted to that committee will be invaluable to noble Lords as we continue our work to scrutinise the Bill.

Without making a long speech, I will reflect on the specific amendments on changing the minimum age. I was talking to a noble and learned friend about this, and he said that, frankly, the law around age is a mess—and that has come out in some discussions. Sometimes we are speaking from our own experience. My two children are in their 20s, and I wonder whether they would really have the capacity to make this decision. But at other times, I sit in awe of them and the decisions they make. They express maturity way beyond 20 years, and, in fact, more maturity than much older people.

It very much depends on the individual in these cases. We have to look at whether there is a way to achieve that right balance; otherwise, we will just be making another age limit. You can join the Army at 16 but you cannot serve in combat until you are 18. The Government are talking about reducing the voting age to 16, but then we are hearing debates on neurological competence and capacity. It is important that we understand and express these points.

The point that came out for me in this whole debate about neurological development is that there is no such thing as “the science”. Science is contestable. We heard this from noble Lords who are experts in their field. We must be very careful about saying that “the science says this”. It also has implications for other decisions.

I turn to a couple of points which may already be treated in the Bill. I want to check the understanding of the noble and learned Lord, Lord Falconer of Thoroton, on what is in the Bill. The noble Baroness, Lady Hollins, asked: what happens if a new treatment is available? Clause 2 says

“which cannot be reversed by treatment”,

which probably takes care of that point, but I would like the noble and learned Lord, Lord Falconer, to share his interpretation and say whether it addresses her concerns. The noble Baroness, Lady Hayter, said that we should think about these young people who will be suffering and in pain, yet nowhere in Clause 2 are the words “pain” or “suffering”. We must be very careful to read what is in the Bill when we are making these points.

I welcome the intervention by the noble and learned Lord, Lord Falconer, that while he is quite clear about 18, he is sympathetic to the idea of cognitive development and maturity between 18 and 25, and there might be some discussion. Who knows—I cannot speak for the noble and learned Lord, who has looked into this issue very deeply—but perhaps in those discussions he may be persuaded. He is saying 18 at the moment, but clearly he is open to enhanced measures for those aged between 18 and 25. That is something that I hope the whole Committee will welcome.

There are many other points that I could make, but it is important to hear from the Government and what the noble and learned Lord believes in response to the points that have been raised.

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

My Lords, I am grateful to noble Lords for their contributions to this debate on the age of eligibility for those who are provided with assistance under the Bill. I have made it clear previously, and reiterate, that I will keep my comments limited to the issues on which the Government have major legal, technical or operational workability concerns.

The amendments tabled by the noble Baronesses, Lady Berger, Lady Lawlor and Lady Hollins, seek to raise the age at which an individual would be eligible for the provision of assistance under the Bill. The points that I wish to raise here relate to the European Convention on Human Rights. There are potential risks that I am raising to inform the decision-making of noble Lords, but the underlying policies are rightly a matter for Parliament. Under the convention, the amendments in this group could give rise to legal challenge; for example, that excluding people who are under 21 or 25 from accessing assisting dying may not be justified under Articles 2 or 8 of the EHCR, or that this amounts to unjustified discrimination under Article 14.

Noble Lords will be aware that differential treatments, such as raising the age of eligibility, may be lawful if it is possible to persuade the courts to agree that the age limit is justified, necessary and proportionate. There would need to be a reasonable justification for restricting access to assisted dying to people aged either 21 and over or 25 and over. Noble Lords will want to consider this in relation to these amendments.

[Lord Harper (Con)]

Can the Minister be clear? If we decided to limit—whether by age or in some other way that the noble and learned Lord, Lord Falconer, might decide—and put that into primary legislation, is that then not the law of the country? All that the European court could then do is say that it is not compatible but remains the law—or is the Minister saying something different? If we pass primary legislation, that is the law of the land, is it not?

[Baroness Merron (Lab)]

The point that I was making just before I sat down was that noble Lords will want to consider the points that I have raised in relation to these amendments. I am sure that they will take into account what the noble Lord has just said too.

[Lord Falconer of Thoroton (Lab)]

My Lords, I am grateful to everybody who has contributed to the debate. I have made my position moderately clear in relation to what we should do—and I sense that the Committee is happy that we should take that course.

I completely understand the points about people aged 18 being impulsive and often emotionally immature. On the point made by the noble Baroness, Lady Stroud, that is why the Sentencing Council refers to it. However, it is a different question here as to what the age limit should be. If people are emotionally immature, they will not have a settled view about what to do in these circumstances, but some people will. The noble Lord, Lord Kamall, asked: what happens if there are new developments in medicine that would extend life? The answer is that you would not have six months or less to live, which I think was the answer that he was giving in relation to it.

I have made my position clear. I invite the noble Baroness, Lady Berger, in the light of where we have got to, to withdraw her amendment so that we can move on to the next issue.

--- Later in debate ---

[Lord Wolfson of Tredegar (Con)]

My Lords, I can be extremely brief, because of the confirmation given by the noble and learned Lord and also knowing that the substantive issues of domestic abuse, interpreters and various other matters will be dealt with in their appropriate place.

At the risk of underlining my reputation as a legal geek, I invite the noble and learned Lord’s attention to his Amendment 350, and in particular the Member’s Explanatory Statement. I understand the amendment, but I do not understand the statement. The amendment leaves out from “to” to end of the line and inserts “section 12(4) and (7)”, which are about “sharing of specialists’ opinions”. The Explanatory Statement says:

“This is a drafting change (consequential on subsection (4) being added to clause 12)”.


Now, Clause 12 already has a subsection (4), and the noble and learned Lord’s amendments to Clause 12 are to subsections (5) and (8). I do not know whether the Explanatory Statement has confused me and in fact the change is not consequential on a new subsection (4) being added but just stands in and of itself. It may be that I am confused unnecessarily, but if the noble and learned Lord could just clear up that minor point, I would be grateful.

[Baroness Merron (Lab)]

My Lords, I, too, shall be brief. All but three of the amendments in this group have been tabled by the Bill’s sponsor and, as has been discussed, they make a series of drafting changes to the Bill, including making sure that terms are consistent throughout and removing ambiguity and duplication.

The Government are neutral on all the policy choices reflected in these amendments, as they are on the Bill as a whole, but have as usual provided drafting support to make the Bill legally workable. As a part of the discussion today, it is of course for the sponsor and for Parliament to determine whether any of the amendments that the sponsor has chosen to table have changed the intent of amendments that were debated in the other place.

Amendment 7 in this group, tabled by the noble Baroness, Lady Coffey, seeks to amend Amendment 6 by changing a reference in Clause 1(2)(b) from “a preliminary discussion” to “their first preliminary discussion”. It does not make any wider changes to the Bill to provide for more than one preliminary discussion to take place, so this may lead to uncertainty. As with all amendments that have not had technical input from the Government, noble Lords may wish to note that the current drafting of this amendment may require further consideration to make it fully workable, effective and enforceable.

Amendments 8 and 9, on which I raise no major workability issues, appear to be trying to achieve the same purpose as Amendment 6, tabled by the Bill’s sponsor. But I would note that Amendments 8 and 9 have not had the technical drafting support from officials and therefore may not be fully workable, effective and enforceable.

[Lord Falconer of Thoroton (Lab)]

My Lords, I am grateful for all the interventions. These changes are only drafting changes. Some legitimate points were made, particularly by the noble Baronesses, Lady Finlay and Lady Lawlor, but they did not really go to the drafting points.

I go to the concerns various Members have expressed. Amendments 6 and 7, tabled by the noble Baroness, Lady Coffey, would prevent doctors having a conversation with people—I am not saying this in a bad or a good way, but that is what she wants to do—particularly before they reach 18. There is a point there, but it is nothing to do with the change I have introduced in my Amendment 6. My amendment would simply make it clear that there has to be a preliminary discussion before you can go ahead to assisted death. I have done that to make it clear that it is one of the eligibility conditions; it says nothing about what should be talked about or whether such a conversation should take place under the age of 18.

In fact, as the noble Baroness, Lady Coffey, said, Clause 6 states:

“No registered medical practitioner or other health professional shall raise the subject of the provision of assistance in accordance with this Act with a person under the age of 18”.


I do not think that the noble Baroness’s amendment would add to that protection. The key point is that all Amendment 6 is doing is saying that you have to have a Clause 5 discussion.

The next point, raised by a number of Peers, is that I am watering down the protection in relation to domestic abuse. That, as a matter of drafting, is wrong. It is only a matter of convenience that, having defined domestic abuse as including everything so defined in the Domestic Abuse Act 2021, you get coercion, control and economic abuse as forms of domestic abuse. To avoid having to repeat that every time the Bill refers to training, I have simply referred to domestic abuse, and that is then defined at the top of page 41. I very much hope that people will accept that that is the position.

The noble Baroness, Lady O’Loan, who is shaking her head, raises a different point about the position in relation to abuse that is not domestic. Perhaps your lawyer is exercising undue influence on you. That is a point that I will respond to in writing, but it is not a point raised by my drafting change, because all the restrictions have been in relation to domestic abuse, not to what the lawyers would call undue influence. But it is a perfectly legitimate point, which I will come back to in correspondence with her.

--- Later in debate ---

[Lord Wolfson of Tredegar (Con)]

My noble friend is absolutely right; on that point they do change the policy intention. I am grateful. I would welcome the thoughts of the noble and learned Lord, Lord Falconer of Thoroton, on that.

Finally, in the absence of my noble friend Lord Howe, I have been asked on his behalf to formally speak on his Amendments 301A and 305A. In speaking to those amendments, I want to highlight the threshold which is set for determining whether an individual is in England and Wales at the time of the first assessment. I hope the noble and learned Lord will be able to pick up this point.

As the Bill is drafted, the question as to whether somebody is ordinarily resident in England and Wales rests on what is called the

“opinion of the coordinating doctor”.

My concern is that an opinion without any further evidential requirement may be too low a bar, particularly given the need to guard against the risk of what has been called death tourism. In other parts of the Bill, the noble and learned Lord has used the word “satisfied”, and I think we would agree that that entails a higher evidential bar than merely “opinion”—indeed, that is also higher than “believes” or “reasonably believes”. “Satisfied” is a higher standard. When the noble and learned Lord replies, can he use that opportunity to explain why the test here is only “opinion” and not “satisfied”, as that test is used in other parts of the Bill?

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions to this debate on the issue of residency and eligibility criteria. As I have already made clear and will now repeat, I will confine my comments to amendments on which the Government have major legal, technical or operational workability concerns.

First, I turn to the amendments which narrow the residence criteria in respect of eligibility for assistance under the Bill. Amendment 11, tabled by the noble Baroness, Lady Finlay, would change the residence criteria for assistance under the Bill from requiring a person to be “ordinarily resident” to “permanently resident”. Unlike “ordinarily resident”, “permanently resident” does not have a set definition in the context of UK immigration law. It is possible that it would be taken as referring only to those who have citizenship or indefinite leave to remain, which is a much narrower scope than the current wording of “ordinarily resident”.

Similarly, Amendments 23, 309, 300A and 306A would restrict access to assisted dying support to British citizens or people with indefinite leave to remain. This may result in migrants on long-term work or study visas who have resided in England and Wales for longer than 12 months being denied access to an assisted death, thereby potentially giving rise to indirect discrimination based on race. These amendments may be subject to challenge under Article 14 of the ECHR when read with Article 8, on the basis that this may amount to unjustified discrimination. This differential treatment would require an objective and reasonable justification.

In addition, under various international agreements, the UK has an obligation not to discriminate against EU, EEA and Swiss nationals on the basis of nationality, although the agreements do not prevent restrictions on the basis of residency. Since these amendments would prevent individuals from those countries from accessing these services on an equal basis to UK citizens in the same circumstances, they are likely to be contrary to the UK’s international obligations under those agreements.

Amendments 11A, 258A, 306B and 449A, tabled by the noble Baroness, Lady Coffey, seek to change the residency requirement from “ordinarily resident” to “domiciled”. These amendments would add complexity and potential uncertainty to the eligibility requirements. “Domiciled” refers to the determination of a person’s permanent home largely for tax purposes, meaning that a person can be domiciled in a place without being resident there. It is not a familiar concept in domestic law outside of taxation, so it is unclear how it would apply in this context. Further elaboration in guidance would be needed to make these amendments workable. It is also unclear what practical impact this change would have when the Bill would still require people to be physically present in England and Wales in respect of the steps under Clauses 8, 10, 11 and 19.

I will next turn to Amendment 14, in the name of the noble Lord, Lord Moylan.

[Baroness Coffey (Con)]

Before the Minister moves on, Kim Leadbeater specifically introduced this concept of England and Wales, and, in Committee, Stephen Kinnock did not raise any issues with it at all in terms of operability or similar. I am astonished to hear some of the other elements that are now coming out for the first time in the consideration of this Bill.

[Baroness Merron (Lab)]

I am sorry to hear of the noble Baroness’s surprise. I am simply setting out where the Government have particular concerns within the scope to which I referred. My noble and learned friend Lord Falconer may be able to comment more appropriately, if he wishes to do so, on the points that she raises.

Amendment 14, in the name of the noble Lord, Lord Moylan, would widen the eligibility criteria to include UK citizens of pensionable age who are living abroad. There are two main issues with this amendment. The first is that the UK has obligations under international agreements that enable residents of partner countries to receive certain benefits, including some health service provision, in the UK. These agreements are, as I mentioned, with the EU, EEA states and Switzerland. As I set out, these agreements prevent restrictions based on nationality, although they permit those based on residency. Therefore, the amendment would have the effect of opening access to provision of assistance under the Bill to EU, Swiss and EEA residents of pensionable age, provided that they satisfy other eligibility criteria. Widening access only to UK nationals of pensionable age would be contrary to the UK’s obligations under those agreements.

Secondly, by including those who have “moved to live abroad”, the amendment would enable pensionable-age citizens from Northern Ireland or Scotland who have moved abroad to access the provision of assistance, in accordance with the Bill, if they satisfy the other eligibility criteria.

For all the other amendments in this group, on which I make no comment, any workability concerns are less significant. For example, Amendment 10 would remove two eligibility criteria from Clause 1, while Amendment 13 would change the requirements relating to ordinary residence in England and Wales. As Clause 1 is largely descriptive, these amendments would have limited legal effect without corresponding amendments being made to operative provisions later in the Bill.

While these are choices for noble Lords, these amendments may introduce inconsistencies and ambiguity into the Bill. As noble Lords will be aware, these amendments have not had technical drafting support from officials, so the way in which they are currently drafted means that they may not be fully workable, effective or enforceable—but, of course, the issues raised are rightly a matter for noble Lords to consider and decide on.

[Baroness Finlay of Llandaff (CB)]

Given that Jersey and the Isle of Man, if I am correct, are not EEA countries, how is the contract for health service delivery affected by this Bill in the light of the problems that I highlighted right at the beginning of what has turned into quite a lengthy debate? I was trying to look at a carve-out for those countries so that those contracts could continue, but I was told that it was deemed out of scope of the Bill.

[Baroness Merron (Lab)]

I am sure the noble Baroness will understand that I am restricted in the comments that I can appropriately make here. I heard my noble and learned friend Lord Falconer say that all these matters needed consideration, and I am sure that he will expand further on that very point.

[Lord Falconer of Thoroton (Lab)]

I will come to that question when I go through the points.

The purpose of Clause 1(1)(c)—namely, that to qualify you have to be ordinarily resident in England and Wales and have been so resident for at least 12 months—is, as noble Lords have said, to avoid people coming here specifically for the purpose of having an assisted death. It therefore would not be adequate to say that people should be ordinarily resident at the moment they apply, because they would have come specifically for that period. Hence you need a period, and 12 months is taken as a reasonable period in relation to that.

The phrase “ordinarily resident” appears right throughout the statute book in a whole range of settings and reflects the policy choice made by regulations or statutes. It says, “We want to give this right to people who permanently live in this country”, using the word “permanently” not in a legal sense but in an ordinary sense. In applying that phrase, the courts have not generally had any real difficulty as to what it means. It is a reflection of this Parliament saying that we want to give particular rights to the people who live here, and sometimes we say, as we are suggesting here, that we do not care what their citizenship status is—if they live here permanently, they get that right. For example, in relation to the National Health Service we say that if people live here permanently, they get that right.

With the greatest respect to the noble and learned Baroness, Lady Butler-Sloss, the cases have made it pretty clear that you can be ordinarily resident here but have temporary absences abroad—for example, if you go to work as a diplomat abroad, serve in the Armed Forces or take a job that takes you away for two months. The big case is somebody whose family lived here and who went to be educated in India for a period of time, who is still held to be ordinarily resident here. With the greatest respect to the noble Lord, Lord Mackinlay, I do not think that adopting the phrase “ordinarily resident” gives rise either to injustice or to legal difficulties.

I will deal with the points made by individual Peers. I am very sympathetic to the point from the noble Baroness, Lady Finlay, as I made clear in my intervention. I do not think she was putting in the word “permanently” other than to probe the question of those who live on the Isle of Man or Jersey and get all their medical treatment habitually in England. When the doctor in England says, “I will help you go home to the Isle of Man to get an assisted death”, assuming that it becomes legal in the Isle of Man, the doctor there will be committing a criminal offence under the Bill unless there is an amendment.

The BMA has proposed an amendment that, if you help somebody go home for an assisted death—home being, say, the Isle of Man or Jersey—and it is legal there, that should not be a criminal offence. I talked to the BMA about that. We need to work together to see whether we can get an amendment that satisfies the point that the noble Baroness, Lady Finlay, has made. I would welcome her input in relation to this.

Supply of Blood and Blood Products

Baroness Merron Excerpts

Wednesday 3rd December 2025 Lords Chamber

[Baroness Hayman]

To ask His Majesty’s Government what steps they are taking to ensure the supply of blood and blood products this winter.

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

My Lords, NHS Blood and Transplant has expanded donation capacity to meet the nation’s needs, opening three new donor centres and additional mobile sessions, adding 3,900 weekly appointments. However, blood stocks remain fragile, and we urgently need more donors, with 71,000 appointments still to fill over the festive period. I urge everyone, including noble Lords, to donate. Noble Lords will have the opportunity at tomorrow’s dedicated parliamentary session in Portcullis House to help to ensure a resilient and reliable blood supply this winter.

[Baroness Hayman (CB)]

My Lords, I am grateful to the Minister for that encouraging reply, and particularly for the reinstatement of the parliamentary donation service. However, as she says, this is a very heavy winter season for the NHS. It is a heavy flu season and a heavy holiday season, which puts pressure on donors. Is she confident that she will fill those extra donor slots and that there will be security of supply for the winter? Is she looking at specific campaigns aimed at those of black heritage and younger people, because it is important to get people early? She might remind Members of this House that you can start being a blood donor in your 60s but, if you start earlier than that, you can go on for a while longer.

--- Later in debate ---

[Baroness Merron (Lab)]

I certainly echo the noble Baroness’s comments. It is thanks to the generosity of donors—including the noble Baroness herself, who is I know is approaching her 50th donation—that overall blood stocks are at target levels, but she is right about the extra pressures coming through because of winter. The launch of the national campaign to highlight the constant need for blood in this season and to recruit new donors was set under way last month. We also have targeted media campaigns; for example, in areas of the country with larger black heritage communities to highlight the urgent need for more donors from that group.

[Lord Evans of Rainow (Con)]

My Lords, I confess to 120 donations and thank the Minister for all the work that she is doing on this, particularly for tomorrow’s session, but she is absolutely right that only a tiny proportion of the population are blood donors. Talking personally, it is not always straightforward for working people to get those appointments. The noble Baroness is right that we are very short on black and ethnic-minority donors. With that thought in mind, would it be possible to look at artificial intelligence to make it easier for working people, particularly from ethnic minorities, to make those appointments during the working day?

[Baroness Merron (Lab)]

The noble Lord is also to be congratulated, of course. As he said, despite our having some 790,000 regular donors, only 2% of the population gives blood, so we are not full up and we look forward to more donors. To the point that the noble Lord raises, which is important, we are increasing capacity for appointments to donate, but we are also looking at additional digital and logistical improvements, including in how people can book appointments. We are also piloting a new appointment reminder and better communications. There is room for improvement, and we are taking those steps. The noble Lord makes very good points in this regard.

[Lord Scriven (LD)]

My Lords, following on from the previous question, to address the major barrier of donor inconvenience, will the Government look urgently at consulting employers and unions on a national campaign to encourage the adoption of a “donate time” policy, offering a flexible blood break for employees to attend donation sessions during the working day?

[Baroness Merron (Lab)]

That is part of the potential solution, in addition to where donors go, how they are communicated with and how easily they can make appointments. We will certainly put the noble Lord’s suggestion into the mix; it is certainly something that I have discussed in respect of the Civil Service, and it varies across departments.

[Lord Watts (Lab)]

My Lords, we are seeing reductions in the number of donors, whether it be in blood or in organ donation. Are we not getting to a serious situation where the Government need to think about how they can increase donations to historic levels?

[Baroness Merron (Lab)]

I am not sure that I agree with the reflections of my noble friend, although I do agree that we have a shortfall of some 200,000 donors to shore up and grow our blood supply. As I said, the situation remains fragile, which is why we need more support. We are constantly working to identify gaps and opportunities to strengthen and diversify the donor base through a donor base resilience programme, launched just this year. It is not just numbers; it is also the range of people, as we heard in earlier questions.

[Baroness Watkins of Tavistock (CB)]

My Lords, does the Minister agree that during Covid we used non-traditional venues to encourage vaccination? I will give an example that we talk about a lot: football clubs. In Plymouth, that resulted in people who had never been able to see the football club go and get their vaccination. I believe that if we invested heavily in similar approaches, we would get many more young people giving blood. Will the Minister comment on that?

[Baroness Merron (Lab)]

The noble Baroness is quite right. We have to go to where people are and not just expect them to come to us, and using a whole range of venues is important, as are mobile donation facilities. This is constantly kept under review: the service is constantly reviewing where the most successful places are and looking at new venues and new opportunities to take up.

[Lord Kamall (Con)]

My Lords, to continue on the line of the noble Baroness, Lady Watkins, I remember that when we were looking at vaccine hesitancy, we looked at how we could reach certain communities—they do not like being called hard to reach because they feel they are being patronised. Quite often, it was through faith organisations; sometimes, it was through community leaders. What work has been done on the lessons learned from the vaccine hesitancy campaigns to encourage more people to give blood? I want also to ask about guidelines. I was speaking to a noble friend who said she had volunteered to give blood but was told that because she had passed the age of 66 and had never given blood in the UK before, she was not allowed to donate. Can we have some clear guidelines for those who are willing to give blood, especially Members of this House?

[Baroness Merron (Lab)]

Of course, is the answer to the noble Lord. On his point about reaching certain groups, we have invested across 51 organisations this year that are very much rooted in the community, and 31 of the projects across those organisations have worked nationally to boost awareness, understanding and behaviour change in black, Asian, mixed-heritage and minority-ethnic communities, where we need more people to come forward to donate blood in order that we have the blood we need for the conditions that they are there to meet.

[Lord Wallace of Saltaire (LD)]

My Lords, I should admit that I never decided to become a blood donor. Once, when I was at Chatham House, a van from the blood donor service was due to come to St James’s Square the next week and my secretary informed me that she had booked me in to give a donation. I thereafter donated for 20 years. That shows that there are a lot of us who would sort of get round to it if we thought about it, and taking the caravans to businesses and working with the businesses to encourage their members to donate is one way that clearly helps to get passive potential donors to say yes.

--- Later in debate ---

[Baroness Merron (Lab)]

The noble Lord gives a good example—sometimes we need other people to sort us out to give blood—but the main point he makes is absolutely right: we need to speak to people through our campaigns. Each donation can save up to three lives. We need to tell people the effect of what they are doing too, and I am glad that we are taking innovative steps to raise awareness, including advertising on London buses.

[Lord Markham (Con)]

I thank the Minister for letting me get in just in time. I am interested in plasma. As many noble Lords will be aware, we have been importing 100% of our plasma needs ever since mad cow disease, so it is an area in which we are quite vulnerable and I know the blood services are trying to correct that. Can the Minister give us an update on where we are on that?

[Baroness Merron (Lab)]

We are making considerable progress in diversifying where plasma comes from. We are also making good progress in demand management and ensuring that there is no waste in blood products, which will also greatly assist us. I shall be pleased to write to the noble Lord with a full description of the advances that we are making; it is an exciting time in that respect.

Tobacco and Vapes Bill

Baroness Merron Excerpts

Committee stage
Wednesday 26th November 2025 Grand Committee

[Lord Robathan (Con)]

My Lords, I rise briefly to support my noble friend Lord Kamall on the Front Bench. I have not taken part in these debates before, but I have to say that I find it quite disturbing that we should be making laws because perhaps we do not like walking down a street where people are puffing vapes. I do not, but there are lots of things I do not like that people do, and I am not going to ban them all—well, perhaps I would, actually, but I am not going to.

Similarly, if you cannot be hooked by passive vaping, as my noble friend Lord Kamall said, I am not quite sure why we are taking it so seriously. As I understand it, vaping is not addictive; nicotine is addictive, but vaping itself is a different matter. It also seems to me that we are legislating unnecessarily. I am afraid, to broaden the subject slightly, that this will lead to yet further influxes of cheap and nasty vapes, which may or may not be, as the noble Baroness just said, influenced by other matters.

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

My Lords, I am most grateful to noble Lords for their contributions to this debate. Let me first turn to the opposition to Clause 138 standing part of the Bill, which has been proposed by the noble Lord, Lord Udny-Lister. Clause 138 amends the Health Act 2006 to insert new provisions relating to vape-free places in England. These provisions allow the Secretary of State to designate certain places and vehicles as vape-free, but only where they are also smoke-free.

The noble Lord, Lord Kamall, asked about evidence. The fact is that evidence is developing, as the noble Lord himself rightly acknowledged, but we do know that while vapes are less harmful than smoking, there is a reason why the Chief Medical Officer says:

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


Vapes are not harm-free; there are legitimate concerns regarding the unknown long-term health impacts of vaping. They produce aerosol that exposes people to nicotine and potential toxicants, which poses health risks to children and medically vulnerable people in particular; for example, they can trigger asthma attacks. It is therefore important and right—I say this to the noble Lord, Lord Robathan—that the Government act to protect more vulnerable groups from potential health harms. I should also say that evidence suggests that, in adolescence, the brain is more sensitive to the effects of nicotine, so there could be additional risks for young people compared to adults.

As the noble Baroness, Lady Walmsley, said, many businesses and enclosed public places already have in place, on a voluntary basis, schemes to prohibit vape usage on their premises. We want to introduce legislative requirements to make it clear to the public where it is illegal to use vapes and to enable enforcement agencies to enforce accordingly. I know that noble Lords understand the reasons for wanting to be clear about what is and is not legal, and this Bill and the provisions in it are very much part of that.

Again, as the noble Baroness, Lady Walmsley, welcomed, the main answer to all the questions today— I will continue to go through the various amendments—is that we will be consulting on making indoor settings that are subject to existing smoke-free legislation vape free. The consultation in this area and beyond is crucial, because we also plan to consult on making some outdoor places where children are present vape free—for example, children’s playgrounds, and the outdoor areas of schools and early years settings.

The noble Lord, Lord Kamall, asked about how we will recognise the difference between harms. I can assure him that this is an area we absolutely want to get right. We do want to ensure that adult smokers who are using vapes as quit aids are doing so in appropriate places, such that they do not return to smoking. That is exactly why we will consult before making regulations and carefully consider the responses to ensure the policy seeks the appropriate balance.

Amendment 182A tabled by the noble Lord, Lord Howard of Rising, would mean that some indoor areas, for example nightclubs, would not be able to be made vape free. I am grateful to the noble Baroness, Lady Walmsley, for her views on this. As I have already outlined, vapers pose potential risks to both users and non-users, especially indoors. We had a debate in an earlier group about the workability or otherwise of designating particular areas as able to police themselves. It is quite important to say to the Committee that the vast majority—around 90% of those over 16—do not currently vape. Just because someone is in an over-18 setting does not mean that they are content to be exposed to these second-hand harms.

As discussed, this is a particular concern for medically vulnerable people whose conditions may not be in the least visible to the vaper, who I am sure does not wish to cause harm—for example, those with asthma. Additionally, people who wish to vape will still be able to do so in outdoor hospitality settings—for example, in the outdoor smoking areas of an over-18 nightclub. We have been very clear that we will not be consulting on including those outdoor areas in the scope of vape- free places.

Ultimately, the Bill grants powers to make places vape free and does not itself make any place vape free. The consultation will ask questions relating to areas that should become vape free, any necessary exemptions and any additional evidence on the second-hand harms of these products. Therefore, in our view there is no change needed to the primary legislation.

It is appropriate now to turn to Amendments 181 and 184, tabled by the noble Lord, Lord Kamall, which would seek to limit the locations that can be designated as vape free. As I have already outlined, the current power allows us to respond to evolving evidence at a later time and ensures the Bill is future-proof. The noble Lord asked about the process. I can confirm as I have done previously that the power for vape-free places will be through an affirmative regulation. That will mean, as the noble Lord knows, a debate in both places. The noble Baroness, Lady Walmsley, talked about vape-free areas being specified in the Bill. I hope I have explained why that is not the case. It is particularly important as we talk about evolving evidence that we look to the future. That is why we will be consulting and why we will turn to regulations.

The noble Lord, Lord Kamall, mentioned vape-free schools and asked whether that measure applies to children or adults. I can confirm that it is about the area rather than the people in it. So there are no limitations on people of a certain age; it is the area that would be designated.

I turn to Amendments 182 and 187 in the name of the noble Lord, Lord Udny-Lister, which relate to vape-free policies in schools and colleges in England that are made vape-free places. It is my view that these amendments are not necessary. As I have said, we have already made it clear that we will consult on making schools, sixth-form colleges and early years settings vape-free places. Public consultation will allow us to gather views from a wide range of stakeholders, including those who run education settings. Enforcement officers will have the power to issue on-the-spot fines or pursue convictions where they deem it necessary for the offence of using a vape in a vape-free place. However, we anticipate—this may be helpful to noble Lords—that there will continue to be a role for internal sanctions for pupils found vaping on the premises. Schools are already required to publish a behavioural policy.

In relation to education provisions for pupils on vaping, we have worked closely with the Department for Education to incorporate education on the risks of vaping and nicotine use in the recently updated relationships, sex and health education statutory guidance for schools and teachers; I am sure that the person referred to by the noble Baroness, Lady Bennett, will benefit from that in future.

I appreciate the points made by the noble Lord, Lord Kamall, and his intention in Amendment 183, to which the noble Baroness, Lady Walmsley, also spoke. I agree that it is important that patients receiving care in a mental health setting have access to appropriate smoking cessation tools; that is particularly true given that smoking rates among those with a long-term mental health condition are far higher than in the general population. As I have mentioned previously, in England, we are considering making inside hospitals—but not outside them—smoke-free. I appreciate and am alive to the fact that there are particular considerations in the case of mental health facilities, but I assure noble Lords that we are keen to get things right in this area and are going to follow the evidence. We want to ensure that vapes can continue to be accessible as an effective quitting aid for adult smokers; noble Lords have made strong and important points about this. As outlined, we believe that the details of any exemptions are best explored through the consultation process, although we understand the intention behind the amendment.

I hope that this provides reassurance and understanding to noble Lords that the settings that will be in scope of the vape-free policy will be fully considered by consultation and then considered under the affirmative procedure. I hope that the noble Lord feels able to withdraw his amendment.

[Lord Kamall (Con)]

My Lords, I thank the Minister for her response; I also thank all noble Lords who spoke on this group. I am grateful to the Minister for confirming that any further extension of the designation of vape-free places will be done via the affirmative procedure, which is very welcome.

I have a couple of outstanding questions; I suspect that the Minister and her department were not able to get the answers quick enough, thanks to the power of the internet or whatever, so I wonder whether the Minister could write to noble Lords on these matters. First, is there any evidence yet from studies of passive smoking in outdoor settings? As I said, the studies I looked at were all on indoor settings; nothing has been done on outdoor settings. It would be good to know what evidence the department currently has. I also ask the Minister to share that evidence, with the appropriate links, so that we can all understand it. usbI understand that the consultation is all about seeking further evidence, but it would be interesting to know what evidence the department currently has—on the understanding that the evidence is evolving, as the Minister rightly said.

--- Later in debate ---

[Earl Howe (Con)]

My Lords, my noble friends Lord Howard of Rising and Lord Udny-Lister, who is unfortunately not in his place, are to be thanked for enabling us to focus on the issues around the use of heated tobacco. We have touched on this subject at earlier stages but, when previously discussing heated tobacco, the Minister promised to write to noble Lords about the evidence that her department possesses of the harms caused by heated tobacco. I am sure that is high on her agenda, but the question is crucial in the context of these amendments since, whatever the answer is, it will have a direct bearing on the use of the Secretary of State’s powers to designate locations as heated tobacco-free.

There are various published studies, as she will know. A study published by UCL found that people who switched from cigarettes to heated tobacco had lower levels of exposure to harmful chemicals than those who kept smoking, but higher levels of these toxins than those who stopped using tobacco altogether, which I guess is not a surprising finding. Other studies state that it is too soon to know how using heat—not burn—products will affect someone’s health in the long term, since research looking at these tobacco products is still, I understand, in its early stages and, in the main, funded by the tobacco industry. We therefore need clear evidence, born of independent research, on both the relative harm of heated tobacco compared to burning tobacco, as well as the absolute levels of harm that result from its use.

I am a non-smoker. I understand the concern that heated tobacco should not be a loophole for large tobacco firms to get around the law, but I am also concerned that in the absence of long-term evidence, portraying heated tobacco as being in the same category as cigarettes carries the risk of failing to reduce harm for that small percentage of smokers who wish to quit but have not taken to vapes for one reason or another.

Pending fresh research findings, I think, alongside my noble friends, that there remains a legitimate question about how the Government intend to treat spaces, both indoors and outdoors, where heated tobacco is used, and about whether they believe there is a clear proven case for including heated tobacco in the generational ban. In particular, does the Minister consider uncovered outdoor areas to be different in this context from enclosed spaces, in terms of both health risk and social behaviour? As she knows, the hospitality industry has concerns about extending the indoor smoking ban to outdoor hospitality areas such as pub gardens, and I welcome the assurance she gave on that a few minutes ago. The indication from the Government thus far is that hospitality areas will not be caught by any outdoor ban, but if that is true of smoke tobacco, can the Minister confirm that there is no similar intention as regards the outdoor use of heated tobacco?

[Baroness Merron (Lab)]

My Lords, the amendments in this group relate to limiting the Government’s ability to create heated tobacco-free places in England. I am grateful for all the contributions to the debate.

The noble Lord, Lord Udny-Lister, opposes Clause 139 standing part of the Bill. Clause 139 provides the power to designate certain places and vehicles in England as heated tobacco-free. Places can be designated heated tobacco-free only if they are smoke-free. As I have mentioned, we plan to consult on making heated tobacco-free all indoor places that are currently smoke-free. We also plan to consult on making certain outdoor spaces heated tobacco-free. As with smoke-free places, the consultation will cover children’s playgrounds, the outdoor areas of schools and early years settings, and areas outside healthcare settings where medically vulnerable people may be present.

The noble Earl, Lord Howe, asked an important question about evidence, and I will write with more detail as soon as possible. However, I reiterate what I said in debates on previous groups and elsewhere: there is no safe level of tobacco consumption and all tobacco products are harmful, including heated tobacco products. I am grateful to the noble Baronesses, Lady Bennett and Lady Walmsley, for their supportive comments. Laboratory studies show evidence of toxicity from heated tobacco and that the aerosol generated by heated tobacco devices, like other forms of tobacco, contains carcinogenic compounds. Recent evidence has also indicated that exposure to second-hand emissions from heated tobacco products is associated with significant respiratory and cardiovascular abnormalities in bystanders.

The noble Lord, Lord Udny-Lister, also tabled Amendment 185. The noble Earl, Lord Howe, asked me to repeat—I am glad to do so—that, as I have made clear, we are not planning to consult on making outdoor hospitality settings in England heated tobacco-free.

Amendment 184A tabled by the noble Lord, Lord Howard of Rising, seeks to exempt areas where it would be reasonable to expect that only over-18s are present from any future restrictions on heated tobacco places. This amendment is similar to the one already discussed in relation to vape-free places, which would mean that some indoor areas, for example nightclubs, could not be made heated tobacco-free.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I am most grateful for this discussion. I say at the outset that, although I do not support accepting the amendments, I have a lot of sympathy with a number of the points made, which I will come on to. However, while I completely understand the pressure on small retailers—I will come on to that—I struggle to accept that the Bill is the fount of all evil, which I feel is the direction we are going in. I certainly agree with the noble Baroness, Lady Bennett, who spoke about the need to see the Bill in its overall context. I associate myself with those comments.

I absolutely agree with the intention behind Amendment 191, tabled by the noble Lord, Lord Kamall, and introduced by the noble Earl, Lord Howe. I hope I can reassure noble Lords that the Government are committed to supporting businesses to implement the measures in the Bill, which much of this discussion has been about. As I have said previously, we will continue —it is a continuing thing that is not in the past—to work closely with retail bodies such as the British Retail Consortium and the Association of Convenience Stores on the implementation of the measures, which will include the development of guidance.

I heard the concern of noble Lords about what guidance will be given. Again, I understand those points but, to say it in other words, we will support retailers through this transition. As the noble Baroness, Lady Walmsley, mentioned, what is being asked of retailers is not unusual for them; they are very familiar with age verification. I will come back to that later. The measures in the Tobacco and Vapes Bill will come into force across a range of dates and therefore it is important that the associated guidance is available at the appropriate time. In other words, there will be time to make this transition and there will be support for that. We are firmly committed to publishing the guidance in a timely manner.

Turning to Amendment 188, tabled by the noble Lord, Lord Kamall, I say to nearly all noble Lords who have spoken that, although I understand the intention of the amendment, it is unnecessary. As noble Lords have acknowledged, the Government are already taking action to tackle the absolutely unacceptable rise in retail crime. The Government will not stand for violence and abuse of any kind against shop workers. Everybody has a right to feel safe at their place of work and we have long championed specific protections for retail workers.

To protect the hardworking and dedicated staff who work in stores, the Crime and Policing Bill introduces a new offence of assaulting a retail worker, which the noble Baroness, Lady Fox, referred to. The Bill also removes legislation which makes shop theft of goods to the value of £200 or below a summary-only offence. That sends a clear message that any level of shop theft is illegal and will be taken seriously. I hope that that is helpful to the noble Lord, Lord Howard.

Alongside legislative action, we are also providing over £7 million over the next three years to support multiple policing bodies to help to tackle retail crime. As I have mentioned, we will continue to work closely with retailers and will utilise the lead-in time to best support them in preparing for and implementing the measures in the Bill. This will include government communications and information campaigns to inform both the public and retail workers.

The noble Baroness, Lady Fox, asked what assessment the Government have made of the impact on small businesses. Page 82 of the impact assessment specifically addresses this. As noble Lords are aware, an impact assessment should be expected and is required for any Bill. That means that the Regulatory Policy Committee also took a view; it published an opinion on the impact assessment and provided a fit-for-purpose rating. This included a green rating for the assessments of small and micro businesses’ assessments. I hope that will be useful.

I turn to Amendment 200A, tabled by the noble Lord, Lord Howard. This would require the Government to create a financial assistance scheme specifically to subsidise the cost of purchasing age-verification technology to enforce on the sale of nicotine products. I heard the comments of the noble Baronesses, Lady Walmsley and Lady Bennett, who spoke against that amendment.

There are no plans to mandate the use of age-verification technologies to enforce the age of sale of nicotine products. It will be for businesses to decide how they ensure that they sell only to people 18 years or over, including whether to use age-verification technology to support them in this. As I mentioned earlier, as did the noble Baroness, Lady Walmsley, checking that a customer is over a certain age is a well-established and well-trodden path for retailers. They should continue to take reasonable steps and exercise due diligence to ensure that they do not sell products to anyone underage. Most retailers already follow recommended practice, and I am grateful to them; they regularly ask for identification from customers to verify their age.

To provide clarity for retailers on the types of ID that can be used, the Bill provides powers to specify in regulations the steps that may be taken to verify a customer’s age and satisfy the age of sale defence. This will include the types of digital identities that can be used, and work will continue with the Department for Science, Innovation and Technology, which is leading on this work. I emphasise that the Government are absolutely committed to supporting retailers through the changes brought in by this legislation, including through the publication of clear guidance in which they will be fully involved.

I hope that I have provided helpful reassurances and that the noble Lord will feel able to withdraw the amendment.

[Earl Howe (Con)]

My Lords, I am grateful to all noble Lords who have spoken in this short debate, including the Minister for her reply. Perhaps I could repeat that my amendment was intended as a probe to raise a set of general concerns surrounding the retail sector. I was reassured by the Minister’s reply, including her references to the provisions of the Crime and Policing Bill. But we need to bear in mind, as we debate the Bill, that retailers are not the source of the problem that the Bill seeks to address—yet they will be the ones to lose out.

The Bill is projected to cost retailers more than £1 billion in profits over the next 30 years, plus what I am sure will be a considerable amount more from the reduced footfall that many will see over time. The noble Baroness, Lady Fox, was right: there is considerable worry in the sector, which is exacerbated by the uncertainty surrounding the timetable for the Bill’s implementation. It would be helpful, perhaps when we reach the next stage of the Bill, for the Minister to give us an idea of how the Government intend to proceed as regards the processes of consultation—consideration of submissions, as well as the actual implementation—and what the outline timetable will look like. The transition needs to be as inclusive and smooth as possible, and practical guidance and support will be essential, especially for small retailing businesses. I have no doubt that the Government have this in mind, but we may need to return to it on Report, just to underline the point. Meanwhile, I beg leave to withdraw the amendment.

--- Later in debate ---

[Earl Howe (Con)]

My Lords, the Committee will be grateful to my noble friend, with his considerable experience in health policy, for the clear and cogent way in which he introduced his amendment. I am very supportive of the principles behind the amendment, as it seeks to ensure that decisions taken after the passage of the Bill are informed by robust, independent evidence and that Parliament is equipped with the relevant and authoritative information it needs to provide proper oversight of the regime for vaping and nicotine products, information that is constantly updated as the body of evidence evolves.

Critically, this principle applies equally to the Government. Proposed new subsection (5) in the amendment would require Ministers, when making regulations under the Act, to have regard to the proposed panel’s reports and recommendations. That is a sensible idea. My noble friend Lord Young of Cookham was right to remind us that there has for some time been a gap in the public health mechanisms regarding the production of such reports. If we were to recreate a mechanism of the kind suggested, the regulatory frame- work would evolve in response to the realities of science and the market rather than outdated information.

It is also important to recognise, as the amendment implicitly does, that although our primary concern here is health, regulation in this space cannot be viewed in isolation from the wider economy. When sales of currently legal products are restricted or prohibited, this inevitably impacts businesses, consumers and, sometimes, wider society, and those economic effects can themselves have unintended consequences for public health and people’s lives. There is also plenty of evidence of unintended consequences and the effectiveness of previous episodes of prohibition. The risk of a rise in consumption of illicit products is an obvious example, as is misinformation propounded on social media. The Government should make and review decisions with as clear a view as possible about those sorts of trade-offs.

For those reasons, I hope the Government will take on board the very sensible suggestion contained in this amendment.

[Baroness Merron (Lab)]

My Lords, I am most grateful for this debate, which concludes the work of the Committee. As I have said before, I certainly share the intention of the noble Lord, Lord Lansley, who tabled this amendment, to ensure that regulations are based on the best available evidence. I appreciate the consideration he has given to the amendment and the reason he put it forward.

I say in response that we continue to monitor emerging evidence, which we have much discussed, on vapes and nicotine products, including commissioning independent research through the National Institute for Health and Care Research. For example, we commissioned a comprehensive analysis of all youth vaping studies—referred to in the debate—which was published recently, and a five-year-long living evidence review that will collate the latest and most robust research into the health impact of vaping. This living evidence review is accompanied by a scientific advisory panel, which includes independent experts, appointed independently from the Government on merit, who the Government can call on for advice on the latest evidence. Further, as the noble Lord, Lord Young, mentioned, earlier this year we announced a landmark 10-year study that will include in its investigations the long-term health effects of vaping on young people’s health.

I agree with the noble Lord, Lord Lansley, that misperception of the harms of vaping is of concern; I take that point. Vaping absolutely can play a role in helping adult smokers to quit, as we have discussed, but children should not be vaping and nor should non-smokers. We are committed to carefully considering the scope of restrictions, to avoid unintended consequences and the misperception of harms, which is an area for further work.

We also fund a vaping expert panel, which provides valuable guidance for trading standards professionals on the enforcement of regulations. Under many of the powers in the Bill there is a requirement to consult before making regulations and, on 8 October, we published a call for evidence on issues where more evidence is needed before we can consult on specific proposals. We will monitor the impacts of measures brought in by the Bill and subsequent regulations. We will also be able to update regulations in future to ensure that policy is responsive to evolving evidence, should this be necessary.

It is our view that we have access to appropriate expert advice, which I know is the noble Lord’s intention, and we will consider the best available evidence in making regulations. I hope that he will feel able to withdraw his amendment.

[Lord Lansley (Con)]

My Lords, I am grateful to all those who contributed to the debate. It is both helpful and timely at the conclusion of Committee to have exactly this debate. In a funny way, perhaps we should have had it at the beginning, because it helped to fill out some of the details of the ways in which the evidence base for the vaping and nicotine product regime will be assessed and understood.

Brain Tumours: Causes and Treatment

Baroness Merron Excerpts

Monday 24th November 2025 Lords Chamber

[Baroness Mattinson]

To ask His Majesty’s Government what steps they are taking to improve the scale of research into the causes and treatment of brain tumours.

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

My Lords, research is vital to ensure that people get the most effective treatments and the highest quality care. We are committed to furthering investment in brain tumour research: between 2018-19 and 2023-24, NIHR invested £11.8 million and UKRI invested £46.8 million in this area. The new NIHR brain tumour research consortium does promise a step change, with further announcements being imminent. In addition, the national cancer plan will seek to improve every aspect of cancer care, including outcomes for those with brain tumours.

[Baroness Mattinson (Lab)]

My Lords, I thank the Minister for her reply, but I want to press for more urgency to beat this terrible disease. Brain cancer is now the biggest killer of children and adults under the age of 40 in the UK. Behind every statistic is a person, like my old friend Georgie Maynard, a mother of three who received her own devastating diagnosis two and a half years ago. Georgie has co-founded the Brain Cancer Justice group, and she is here today. She wants to know why the UK’s brain cancer survival rate ranks only 22nd out of 29 wealthy nations, why just 1% of the cancer research budget is allocated to brain cancer, and why only 12% of people with a brain tumour are able to participate in trials. In particular, the whole-genome sequencing is vital for brain tumour research, yet just 5% of brain tumour patients can access it.

Last September, the Tessa Jowell Brain Cancer Mission published its recommendations. Will the Minister agree to review these recommendations and meet with the Brain Cancer Justice group to discuss how they can be incorporated?

[Baroness Merron (Lab)]

I thank my noble friend for the opportunity to meet Georgie just before Questions. I am happy to write to my noble friend with answers to all those questions. On the last two, yes, we continue to work very closely in partnership with the Tessa Jowell Brain Cancer Mission to drive further progress against its recommendations. I will certainly speak with the Minister who deals with this area—Ashley Dalton MP, who is currently ensuring that the cancer plan can be published at the beginning of the forthcoming year—about the suggestion of a meeting. We have very much engaged with the cancer community on the cancer plan, and we continue to be keen to do so.

[Lord Patel (CB)]

My Lords, I thank the Minister for promising us a cancer plan by the beginning of next year. I hope it will be forthcoming, because it will be good to look at how cancer care will change. Regarding brain tumours, the problem is that the symptoms are often vague and mild, so early diagnosis is much more difficult. We need more research into the early diagnosis of tumours. Furthermore, we need much more research than the numbers mentioned by the Minister. One of the success stories, one hopes, in 2026 will be drug gene therapy and viral immunotherapy, which will be put through clinical trials early next year to treat glioblastoma, the major brain tumour killer. I hope we will have more funding, because £30 million, £40 million or even £50 million will not do.

[Baroness Merron (Lab)]

I want to convey to the noble Lord our ambition in this area. I completely accept the point he makes—although not all of them—about the challenge of diagnosing rarer cancers, including brain tumours. Research is absolutely vital. Last September, we announced new research funding opportunities, bringing the brain cancer research community together, because we want to drive step change for patients in the way the noble Lord seeks. Funding decisions will arise from this call, and announcements are expected imminently.

[Lord Sharpe of Epsom (Con)]

My Lords, my son survived a brain tumour, but he was lucky, because in the UK between 40% and 60% of brain tumour diagnoses happen after the patient has arrived at A&E, having often been misdiagnosed—to follow on from the noble Lord’s question—earlier. That is a much worse outcome than many for other cancers. As the Minister said, brain tumour cancers are the leading killer of people under the age of 40. Will she therefore commit to a public awareness campaign to explain some of the difficult symptoms the noble Lord just identified, and the seriousness of brain tumours? Such awareness is sadly lacking among the public.

[Baroness Merron (Lab)]

I take the point the noble Lord makes, and I am sorry to hear of his son’s—and of course his family’s—experience. One of the things we are working on is increasing public awareness of brain cancer research opportunities. That is not quite the same as the point the noble Lord made, but extending that through the NIHR’s “Be Part of Research” initiative is important. The national cancer plan will give us the opportunity to review what communications and campaigns we run with the public. That will be a good opportunity to consider the point he makes.

[Lord Scriven (LD)]

My Lords, Georgie’s brother is Charlie Maynard MP, who has been campaigning on this. One of the issues raised is that in the UK it takes significantly longer to open a clinical trial for these patients than in most comparable nations, due to the excessive administrative burden. Will the Government therefore commit to looking at a fast-track designation for trials involving cancers with unmet needs, such as glioblastoma?

[Baroness Merron (Lab)]

We certainly do need to cut more red tape on cancer treatments. For example, we recently accelerated patient access to ultrasound cancer treatment through our innovative devices access pathway pilot. That is just one way in which we will have the potential to help companies, which is crucial to bring game-changing cancer treatments to fruition and to NHS patients even faster.

[The Lord Bishop of Leeds]

My Lords, would the Minister agree that it is important to recognise and praise the treatment that is already available while challenging to do more? I was diagnosed with a benign tumour and the treatment was exemplary. On the real upside of this, I have a lot of documentary evidence that I have a brain.

[Baroness Merron (Lab)]

I have never doubted that about the right reverend Prelate, but I am sure that the whole of your Lordships’ House is very pleased that he is with us. It is absolutely right and proper to pay tribute to all those in the whole system who provide care, treatment, diagnosis, research and so on. It is a team effort, and I am glad that he has benefited so well from it.

[Lord Kamall (Con)]

My Lords, being diagnosed with a brain tumour is devastating not only for the person involved but for their family. As my noble friend Lord Sharpe said, brain tumours can lead to memory loss, cognitive changes and reduced physical ability. Those symptoms are sometimes not picked up beforehand, but even when someone is diagnosed with a brain tumour those very symptoms sometimes lead to misunderstandings among friends and family members, and can lead to isolation. Given this, can the Minister outline what steps NHS England and the department are taking to raise awareness among families and friends of all the symptoms and side-effects of brain tumours, so we can avoid those misunderstandings and ensure that the patient continues to receive care from their loved ones?

[Baroness Merron (Lab)]

It is an important point, as the noble Lord, Lord Sharpe, raised. As I said, the national cancer plan will give that opportunity to address challenges and needs such as those the noble Lord raised. We are also establishing a brain tumour research consortium through the NIHR, which will bring together researchers from different disciplines. The scientific advancements it will drive will be how to prevent, detect—to the point raised by the noble Lords—manage and treat brain tumours. That will also be of great assistance.

[Lord Winston (Lab)]

My Lords, the Government should be congratulated on trying to improve their work on brain cancer. Talking about treatment, one of the issues is that one of the greatest advances and most important areas is brain imaging using magnetic resonance imaging, PET scanning and even electrical recording in a sophisticated way, but access to these important technologies still seems somewhat deficient. Will the Minister say whether the NHS has plans to increase access to brain imaging? It seems a very important area in treatment.

[Baroness Merron (Lab)]

We certainly want to see services properly available across the country and people not being disadvantaged because of where they live or what the services are. Again, from what I know of it—we will soon see it—the national cancer plan will improve every aspect of cancer care, including outcomes for those with brain tumours and access to the services my noble friend outlines.

Mental Health Bill [HL]

Baroness Merron Excerpts

Consideration of Commons amendments and / or reasons
Monday 24th November 2025 Lords Chamber

Moved by

[Baroness Merron]

That the House do agree with the Commons in their Amendment 1.

1: Clause 5, page 11, line 22, leave out “by a constable or other authorised person”

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

My Lords, with the leave of the House, I will speak also to Amendments 2 to 21, including Amendments 19A and 19D. It is a pleasure to return this Bill to this House; I very much appreciate the support and engagement of noble Lords throughout its passage.

Let me turn first to the government amendments in the other place, other than the minor and technical amendments, which are there for clarification. We have clarified the duties on NHS bodies to make arrangements regarding advance choice documents, otherwise known as ACDs. NHS bodies must actively inform individuals about ACDs, rather than taking a minimal approach. The Bill requires that information and help are provided to people who wish to make an ACD through discussion with a suitably qualified person. NHS bodies should consider the advantages of making an ACD within 12 months after discharge and aim to provide support. Additional guidance on these duties will be in the revised code.

I thank my noble friend Lady Keeley and the noble Baroness, Lady Barker, for raising concerns about the unequal application of the Human Rights Act. The Government have now made it so that registered private providers delivering Section 117 aftercare or in-patient mental health services, funded by local authorities or the NHS, are treated as carrying out public functions under the Human Rights Act and act compatibly with the convention rights. This amendment will apply UK-wide.

I turn to the amendments made by this House on police powers. I thank the noble Baroness, Lady May, for her constructive engagement and for establishing the review of the Mental Health Act when she was Prime Minister, which has brought us to this place today. We have removed the amendments made to Clause 5 that would have added police and other authorised professionals to Sections 2, 3 and 5 of the Mental Health Act. Extending police and other authorised professionals to these sections would be inappropriate—a view that is shared by the police.

We have removed Clause 50 from the Bill, which would have extended emergency police powers under Sections 135 and 136 of the Act to other authorised persons. Health and care professionals lack the training, equipment and access to rapid back-up needed to use such powers safely, and stakeholders are concerned about staff having the authority to use reasonable force. A blanket extension of powers to multiple agencies would risk confusion and delay in emergencies due to a lack of clarity over who should respond.

There are strong views on either side of this issue, and there are situations where health professionals feel that they do not have the powers they need. That is why I am announcing longer-term plans to launch a consultation into emergency police powers of detention. We will consult on the powers available to different professionals in different situations and settings, in particular—but not limited to—the operation of the emergency powers in Sections 135 and 136. The consultation will seek views on powers and joint working approaches to ensure that health and social care professionals and police have the appropriate powers to act in order to prevent people harming themselves and others when in a mental health crisis. We firmly believe that this is the right approach to a complex issue that requires careful consideration and consultation.

I turn to community treatment orders. Clause 6(3) has been removed from the Bill, as CTOs already comply with the code and have an initial six-month period. The responsible clinician may renew a CTO if there is a risk of serious harm without it and a reasonable prospect of therapeutic benefit. Following positive engagement with the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler, I can confirm that the Government will review the statutory forms that relate to CTOs, with the aim of strengthening them to ensure a clear audit trail of the reasons for applying a CTO and associated conditions.

Regulations will require that statutory care and treatment plans specify any CTO conditions and their justifications, which will also be clarified in the code. We will work with the Tribunals Service and the judiciary to ensure that the patient’s plan is considered alongside other evidence at tribunal hearings. We will clarify in the code that, where a tribunal recommends that the responsible clinician reconsider CTO conditions as it does not consider them necessary, the responsible clinician should review and, potentially, revise those conditions. The code will set out that the responsible clinician should inform the patient of their decision after considering the tribunal’s recommendation, which should be recorded in writing. We will engage on the code before publication and involve the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler, in the process. As the tribunal is responsible for considering all relevant evidence, this may include recent recommendations made at past tribunal hearings regarding the conditions placed on the person, including the detail and rationale of any current conditions.

I can confirm that since September 2025 we have increased the quantity and frequency of reporting on racial disparities in key metrics, such as detention CTOs and length of stay by ethnicity. Much of this data was previously published annually but it is now published monthly, allowing for closer monitoring of progress. The data is publicly available on the Mental Health Act annual dashboard and, along with implementation of the patient and carer race equality framework, will be used by the Care Quality Commission as part of its inspection regime.

On the debriefing amendment, I thank the noble Earl, Lord Howe, and the noble Lord, Lord Kamall, for their constructive engagement. We have removed Clause 35, which required independent mental health advocates to consult people about their in-patient experience after discharge. This removes policy duplication and additional strain on advocacy services, whose focus is on supporting detained patients’ rights. The code will clarify the processes of care planning. Supporting someone to make an advance choice document should include the opportunity to reflect on past experiences. The 10-year health plan commits to making patient feedback central to quality improvement.

The Government have tabled amendments in lieu regarding the appointment of a nominated person for a child under 16 who lacks competence, and I am most grateful to the noble Baroness, Lady Berridge, for her continued work on this. The Bill now states that an approved mental health professional, or AMHP, must appoint either

“a person who has parental responsibility … a person named in a child arrangements order as a person with whom the relevant patient is to live”

or

“a person who is a special guardian”.

If there is no suitable person willing to act, the AMHP must consider the child’s wishes and feelings when deciding who to appoint.

On the amendment tabled by the noble Baroness, Lady Berridge, to the Government’s Motion, I understand the intention to prevent a parent who has had parental responsibility limited from being appointed as a nominated person by an AMHP where a child lacks competence to make the appointment. The amendment tabled would mean that a special guardian or person named under a child arrangements order as someone with whom the child must live must be appointed. It is not appropriate for legislation to say that a particular individual must always be appointed nominated person. If they are not able, or even willing, to perform the role effectively, requiring them to take this role and ruling out other options risks harming the child’s interests.

As we know, legislation can be a blunt tool. It is far more appropriate to set out nuances such as this in the statutory code to ensure that the child’s individual needs are considered. That is why we previously agreed to set up an expert task force to consider these very complexities. Part of this role includes ensuring that clear guidance is given to AMHPs on who to appoint in a range of scenarios to avoid unintended consequences. At this late stage, in order to get this right, we should not be hurriedly working through these complexities as part of the legislation. We should develop detailed guidance, in consultation with professionals and patients, through drafting the code of practice. I therefore ask the noble Baroness not to move her amendment.

In conclusion, I hope that noble Lords will support our position and pass the legislation without amendment. I beg to move.

[Baroness Berridge (Con)]

My Lords, I will speak to Amendment 19D in my name. I thank the Minister and her officials for the frequency of their engagement on the Bill. I put on record my apology for not spotting possible issues with the Government’s Motion, to which I have tabled the amendment, much earlier. I thank the Minister and her officials for meeting with the approved mental health professionals, the professional group dealing—often late at night or at a weekend—with our sickest children, who do not have the competency to appoint a nominated person for themselves.

I specifically recognise the inconvenience to the Bill team, but this matter relates to the protection of mentally ill children and has been flagged at every stage since the Wessely review in 2018, when a consultation was suggested. In recent meetings with the Minister, I understood that what was to be achieved was that the appointment of nominated persons would reflect existing court orders made by the family court on child protection grounds. The mischief that the approved mental health professionals want to solve is that they do not want to have any discretion to appoint as a nominated person anybody not in accordance with an existing court order. They want to see this achieved through the mandatory appointment of the special guardian in priority to anybody else, the rationale being that special guardianship is usually used to avoid care orders, adoption or long-term fostering.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for the thank yous and the appreciation for the whole team, which, as noble Lords have said, is extensive. I also appreciate the welcome for the number of improvements that we have made to the Bill by being able to work together. I am grateful to noble Lords for their contributions, as I said at the outset. We have made significant progress on the Bill. Even today, the amendments and discussions reflect the complexity of these reforms and the shared determination to deliver legislation that will make a real difference.

I will seek to address some of the points that Peers have raised—as always, I am very happy to pick up points outside the Chamber. I turn first to those raised by the noble Baroness, Lady Berridge. She asked about having strong requirements for local authorities rather than special guardians. Stakeholders, including the Office of the Children’s Commissioner, agreed that the main priority should be whether the child is under a care order—that is, the local authority has parental responsibility—and that this should be considered under a separate tier to a special guardian or child arrangements order.

I will now pick up the point that the noble Baroness, Lady Berridge, and the noble Lord, Lord Kamall, raised about why there is no use of the word “or” in the legislative drafting. On this point, I am advised that, by default, the absence of “and/or” on the page means “or” as a matter of drafting. The modern style is to say “and” when you mean “and”, but to leave—I hope that the noble Lords, Lord Meston and Lord Pannick, and some of their colleagues can assist. I will start that sentence again: the modern style is to say “and” when you mean “and”, but to leave “or” silent if the latter is what is intended. This is the key point: we are clear that it must be a single person who is appointed.

On the issue that the noble Baroness, Lady Berridge, raised about the creation of a hierarchy, we simply do not agree that a person with residual parental responsibility should always be blocked from being a nominated person, as the child arrangements order or special guardianship may be in place for reasons other than the parent being a risk to the child. However, we agree with the general principle that the AMHP should be aware of, and consider the implications of, any child arrangements order or special guardianship. In most cases, it is true that they will still appoint those people to be the nominated person, rather than the person with residual parental responsibility. It is considered that allowing flexibility allows judgments to be taken on a case-by-case basis, taking into consideration specific circumstances and what is most appropriate for the child or young person, rather than a blanket exclusion. We will provide clear guidance in the code, following consultation and engagement with experts and professionals. I hope that will allow a way forward to deal with the complexity.

The noble Baroness raised a point about a parent having malevolent intent. I stress that, if the AMHP later finds that the special guardian will be a more suitable person, the legislation allows them to terminate the appointment of the nominated person and appoint the special guardian instead. If there are any outstanding issues that I have not covered either in my speech or in this response, I will be happy to discuss those with the noble Baroness, as I have continued to do. As I said earlier to noble Lords, I believe that this discussion, these questions and the amendment all show the complexity that we are all seeking to resolve.

The noble Baroness, Lady May, asked a number of questions about the consultation. My department will lead the consultation, and we will be working with the Home Office and stakeholders to scope it. While I cannot give an exact timeline for the review, and I am sorry to be unable to do so, I can say again that before launching the consultation we are going to be working closely with the Home Office, the NHS, social care colleagues and the police to consider the options to consult on that support better outcomes for patients and the services. I will be pleased to set out further details on the timetable in due course.

The noble Baroness, Lady May, asked what happens at the end of the review. I am sure she will understand that I do not want to pre-empt the outcome of the process. However, on a future vehicle to implement the review, while obviously we cannot commit to a legislative means to do that, we will be taking forward the consultation results and outcomes when parliamentary time allows. I will be pleased to keep the noble Baroness updated on all these developments.

The noble Baroness, Lady Hollins, mentioned my colleague the Minister, Stephen Kinnock MP, who did a sterling job of taking through this legislation in the other place. She asked about his work with lived-experience groups. I say to your Lordships’ House and to the noble Baroness in particular that, after Royal Assent, our first priority will be to draft and consult on the code of practice. We will be engaging with people with lived experience, their families and carers, and with staff, professional groups, commissioners, providers and others to do this, alongside launching a public consultation. The code will be laid before Parliament before final publication. Realistically, we expect that this process will take at least a year, but the nature of our discussions means that it is important that we get this right.

The noble Baroness, Lady Tyler, asked about confirmation of an implementation timeline. While of course legislation is important, implementation is what delivers the results. We estimate, as the noble Baroness has heard me say, that full implementation will take around 10 years; that does not mean we wait 10 years but, realistically, that is how long full implementation will take, due to the time needed to train the workforce and the need to ensure that the right community support is available. Noble Lords will be aware that this timeframe necessarily spans multiple spending reviews and multiple Parliaments, so we are limited—I hope noble Lords will understand this—in the detail that can be given about future spend and timelines. I quite understand why noble Lords raise this issue.

I acknowledge the dedication and thoughtful engagement shown by Members of your Lordships’ House throughout the passage of the Bill. The amendments made by the Government reflect not only technical refinements but, importantly to me, our response to the concerns and insights that were raised by Peers, MPs, stakeholders and those with lived experience. I believe that those concerns and insights have improved the Bill’s clarity and effectiveness, and I hope that noble Lords will support these amendments. It is thanks to what I regard as exemplary cross-party working that we are in a position to pass the Bill into law and begin implementation. It is about bringing positive change as soon as possible for those whose lives are touched by the legislation that we have debated. I commend the Motion to the House.

Motion on Amendment 1 agreed.

Moved by

[Baroness Merron]

That the House do agree with the Commons in their Amendments 2 to 17.

2: Clause 5, page 11, line 33, leave out “by a constable or other authorised person”

--- Later in debate ---

Moved by

[Baroness Merron]

That the House do disagree with the Commons in their Amendments 18 and 19 but do propose Amendments 19B and 19C in lieu—

18: Schedule 2, page 81, line 25, leave out from beginning to end of line 3 on page 82 and insert—
“(3) If no local authority has parental responsibility for the relevant patient but there are one or more other persons who have parental responsibility and who are willing to act as the nominated person, the approved mental health professional must appoint one of them.”

--- Later in debate ---

Moved by

[Baroness Merron]

That the House do agree with the Commons in their Amendments 20 and 21.

20: Schedule 3, page 92, leave out lines 22 and 23 and insert—
“(c) the patient is not liable to be detained under this Act or any other legislation or by virtue of a court order.”

NHS: Wheelchair Services

Baroness Merron Excerpts

Monday 24th November 2025 Lords Chamber

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what assessment they have made of the provision of wheelchair services by the NHS and social care authorities.

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

My Lords, integrated care boards are responsible for the commissioning of local wheelchair services based on the needs of the local population. NHS England has developed policy guidance and legislation to support ICBs to commission effective, efficient and personalised services. This includes a Wheelchair Quality Framework, published in April, which is designed to assist ICBs and NHS wheelchair service providers in delivering high-quality provision that improves access, outcomes and experience.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to my noble friend, but does she recognise that the work by the Wheelchair Alliance and the All-Party Group for Wheelchairs Users would suggest that, if you leave this to local health bodies and local authorities, they simply will not improve the current inadequate and patchy service? The All-Party Group for Access to Disability Equipment has reported that

“63% of carers and 55% of equipment users said that services are getting worse”.

Given what my noble friend said about the quality framework, which I very much welcome, does she accept that nothing will change unless this is enforced from the centre, with strong performance management?

[Baroness Merron (Lab)]

I accept the observations that my noble friend has made; I know he has been a voice on this for many years. I share with him the impatience for change and welcome the work of the APPG and the Wheelchair Alliance. The NHS Medium Term Planning Framework, which was published just in October, requires that, from 2026-27, all ICBs and community health services must actively manage and reduce the proportion of waits across all community health services over 18 weeks and develop a plan to eliminate all 52-week waits. I expect that wheelchair provision and services will improve through this as well as other means.

[Baroness Watkins of Tavistock (CB)]

Can the Minister comment on whether we keep any statistics in relation to people who have to stay in hospital who avoid discharge because of the length of time taken to get wheelchairs?

--- Later in debate ---

[Baroness Merron (Lab)]

I will be pleased to write to the noble Baroness about the specific data that is available, but we know that, because of issues to do with aids and adaptations, sometimes people’s leaving hospital is not as timely as it should be. That is not in their interests. We certainly expect local authorities, for example, which have a statutory duty, to make arrangements to do so and also for ICBs to make the provision so there are not the hold-ups that the noble Baroness refers to.

[Baroness Manzoor (Con)]

My Lords, as the Minister said, the NHS provides the funding for wheelchair access, but the wheelchairs are mostly necessary in community settings and in the home, and there is a gap between social services and the NHS using different criteria to assess the health needs of the patient. What are the Government going to do to address this so that people get the service that they need?

[Baroness Merron (Lab)]

The provision of the right type of wheelchair is crucial, but we also need to expand care options to boost independent living at home. We have done that in part through an additional £172 million for the disabled facilities grant, which goes hand in hand with people being able to live at home. This could enable around 15,600 extra home adaptations. Introducing care technology standards for those who are using wheelchairs and those who are not will also enable proper care standards and independent living.

[Lord Rennard (LD)]

My Lords, I declare an interest as the conference chair of the National Association of Equipment Providers. As a teenager, I pushed my mother everywhere in a wheelchair; we had to buy it second hand through the Liverpool Echo. Wheelchair provisions have improved greatly since then, but how can the Government work with the Wheelchair Alliance and with trade associations to ensure that retailers have skilled clinical staff who are trained to undertake assessments and prescribe appropriate wheelchairs and other forms of assistive technology?

[Baroness Merron (Lab)]

The points that the noble Lord has raised are crucial—not least that, as I alluded to earlier, one type of wheelchair does not suit everybody. That is why I am keen to see the results of the Wheelchair Quality Framework, which, as I mentioned to my noble friend, was published in April. That sets out quality standards and statutory requirements, including offering personalised wheelchair budgets, which would assist in the circumstances that the noble Lord describes.

[Lord Weir of Ballyholme (DUP)]

My Lords, I declare an interest as a frequent wheelchair user and as a member of the all-party group. Some concerns have been expressed that the competition for contracts for wheelchairs is very limited and that a number of wheelchair providers are not even submitting their names to be considered for those contracts because they feel that it is not worth their while. What action are the Government taking to ensure that there is sufficient choice within the NHS and that the market is large enough to ensure that companies will actually bid for those contracts?

--- Later in debate ---

[Baroness Merron (Lab)]

This is a very important point, not just for the supply chain but also for the technology, particularly if we are thinking about those with more complex needs; the wheelchair has to support and meet those complex needs. We know that there is a lack of investment in new models and that there has been disruption in the supply chain. While I do not seek to blame, that was a particular issue arising out of the pandemic. We are indeed working on better technology in terms of wheelchairs and other aids and adaptations and seeking to iron out difficulties in people making bids for contracts. If the noble Lord has examples, I would be very pleased to hear about them.

[Baroness Pitkeathley (Lab)]

My Lords, can my noble friend comment on the problem, which carers often report, of being unable to return the wheelchair to its source when it is no longer needed?

[Baroness Merron (Lab)]

My noble friend raises a point that applies not just to wheelchairs but to other aids and adaptations. There is indeed a very considerable issue. That is a matter for local services, but it is absolutely something that we will work with them on as part of how we improve services, because it also includes the safe and timely return.

[Lord Kamall (Con)]

My Lords, as well as the concerns raised by the noble Lord, Lord Hunt, about NHS wheelchair services, we know that, in addition, there are over 1 million wheelchair users of different types in the UK, and we know that people still face considerable difficulties in accessing health and social care buildings. Of course we understand that some buildings are old and will have to be retrofitted, but what specific conversations is the department having with charities, expert groups, owners of buildings and developers to raise awareness of the need and how to improve access, particularly for those older buildings?

[Baroness Merron (Lab)]

The noble Lord is right, and his comments about buildings apply not just to NHS buildings either but to the whole range. I can assure the noble Lord that across government we have continuing discussions about this, because it is not, as the noble Lord says, just a matter of getting the right wheelchair; it is also about them being accessible in terms of the buildings. It is also the reason that I mentioned to his noble friend about adaptations to people’s homes so that wheelchairs can be used there too.

[Lord Laming (CB)]

My Lords, does the Minister agree that one of the problems is that the need is often not identified until the person is heading for discharge from hospital, whereas if it was foreseen at a much earlier stage and there was proper co-ordinated planning between health and social care, a great deal of these delays could be reduced? Will the Minister do all that she can to improve the relationship between health and social care at local level?

[Baroness Merron (Lab)]

I would certainly agree that timely provision of wheelchairs and other aids and adaptations does support people not only to remain as independent as possible for as long as possible but to leave a hospital setting if that is in their best interests. We now have the better care fund as a framework for integrated care boards, the NHS and local authorities to make joint plans and to pool budgets for the very purpose the noble Lord mentions, which is about delivering better joined-up care. That can indeed include wheelchairs. That is a very systematic approach, doing exactly what the noble Lord is requesting.

Terminally Ill Adults (End of Life) Bill

Baroness Merron Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

Nevertheless, given the Bill’s subject matter, there are two watchwords that we should carry in our minds, particularly in the light of the speech of my noble friend Lord Shinkwin. They are “reassurance” and “clarity”. Amendment 3 and others in this group would serve to deliver reassurance through greater clarity. That is why I suggested that the noble and learned Lord, Lord Falconer, should consider these amendments with a sympathetic eye, because they serve to put the Bill’s intentions around coercion beyond any reasonable doubt and they do so without in any way undermining the Bill’s underlying aims.

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

My Lords, I thank all noble Lords who have spoken today for their contributions on these important issues. As I have already made clear, I will keep my comments limited to the amendments on which the Government have major legal, technical and/or operational workability concerns.

On that basis, I will speak about Amendments 118 and 118B. Amendment 118, tabled by my noble friend Lord Hunt, could prevent a person from accessing assistance where there is no clear connection between their individual circumstances and the crime that their close relative is under investigation for or has been convicted of, even if the said crime took place some years in the past. Amendment 118B, tabled by the noble Lord, Lord Farmer, would expand the meaning of “close relatives” to include “friends”. It is not clear who would determine the meaning of “friends” in this context. I should also say that disclosure of personal data engages Article 8 of the ECHR and is regulated by the principles set down in the Data Protection Act. Detailed financial assessment of those connected to a person seeking assistance is likely to interfere with the privacy of those individuals, particularly where there are no signs of coercion. The necessity of doing so is difficult to assess in the round rather than considering this on a case-by-case basis.

I turn to Amendments 222 and 612, in the name of the noble Baroness, Lady Hollins. Amendment 222 proposes a new clause to oblige the Secretary of State to provide specialist psychological assessment and support for persons considering an assisted death and their families. It would also oblige the Secretary of State to establish bereavement support services offering psychological support before an assisted death to all persons concerned. The Bill does not require families to know about an assisted death in advance, so requiring the offer of psychological services to them could create an undeliverable obligation on the Secretary of State.

Amendment 612 would mandate the video recording of a person being assisted to end their own life. The amendment would also require the person to confirm in the video recording their identity, their wish to die of their own free will, their capacity and that they are acting without persuasion or coercion. The amendment would require that this recording is sent to the coroner within 72 hours of death and it would create a regulation-making power for the Secretary of State concerning the practical arrangements for the recording, storing and transmission of the recordings. Requiring that a person’s death be video recorded where they did not wish the event to be recorded could risk being a significant intrusion into their family and private life under Article 8 of the ECHR. Since the Bill includes several safeguards, this intrusion is unlikely to be considered justified, and this amendment could also raise GDPR issues and concerns.

Amendment 460, in the name of the noble Baroness, Lady Finlay, specifies a range of actions the panel must take into account when considering a person’s psychosocial and safeguarding circumstances. It includes a requirement to offer immediate access to safe housing and financial support where abuse is disclosed. As the Bill is drafted, neither the panel nor the commissioner is provided with such a function and it is not clear how this would interact with local authority responsibility for housing provision.

As for the other amendments in this group where I make no detailed comments, although they may be deliverable, some would be challenging to implement. For example, Amendment 47 would require assessing doctors and the panel to assess a person’s state of mind or private thoughts. Amendment 58 would require an assessment of indirect structural disadvantage, including poverty or lack of care. Although I raise specific workability issues with only a small number of amendments in this group, noble Lords will be aware that the other amendments in this group have not had technical drafting support from officials. The issues raised by these other amendments are rightly a matter for noble Lords to consider and decide on, but I note that the way in which they are currently drafted means that they may not be fully workable, effective or enforceable.

[Lord Falconer of Thoroton (Lab)]

My Lords, in this debate we heard deeply personal information from the noble Lords, Lord Empey, Lord McCrea, Lord Watts, Lord Polak, Lord Griffiths, Lord Carlile of Berriew and Lord Shinkwin, and the noble Baronesses, Lady Hollins, Lady Hayter and Lady Grey-Thompson. I express my profound respect for people being willing to share in that way. I make it clear that in nothing that I say do I in any way intend to disrespect any of what must have been quite difficult statements to make. I really treasure many of the things that have been said, whether for or against the Bill.

As all noble Lords engaged in the debate know, at the heart of the Bill—there is no dispute about this—the decision to have an assisted death has to be where the patient, to quote the Bill,

“has a clear, settled and informed wish to end their own life, and … has made the decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person into making it”.

There is no dispute in the Committee that there have to be appropriate and sufficient safeguards to ensure that there is no coercion.

The current safeguards in the Bill are as follows: first, a doctor has to be satisfied that the person is not being coerced. Secondly, a second doctor has to be satisfied that the person is not being coerced. Thirdly, a panel has to assess that the person is not being coerced. Fourthly, the first doctor—after a period of reflection, in signing a second declaration by the patient—has to be satisfied again that the person is not being coerced. Finally, the doctor providing the assistance has to be at the last moment satisfied that the person is not being coerced.

The two doctors who give the certificate at the beginning must both have had specialist training in domestic abuse, including training on identifying coercive control and domestic abuse, and including identifying the effect of financial control. The panel considering the matter must consist of a psychiatrist, a social worker and a senior lawyer. If either of the two doctors have any doubt about the position in relation to capacity, they have to consult a psychiatrist. Anybody who by dishonesty, coercion or pressure induces the patient to either execute a declaration that they want an assisted death or take the assistance is guilty of a criminal offence. If all that the person does by dishonesty, coercion or pressure is to induce the person to execute a relevant document, the maximum sentence is 14 years. If, on the other hand, if they induce the person to take their own life, then the maximum sentence is life.

The question before the House in this debate is whether those protections are adequate to ensure that there is not coercion. I have before me a number of amendments. Amendment 3 is proposed by the noble Baroness, Lady Finlay: she would like “independent” to come before “decision”. I wholeheartedly agree with her that the decision must be independent, in the sense that it is a free decision made by the person, unpressured or coerced in the way that I have described. I am always influenced by what the noble Earl, Lord Howe, says in relation to that; he said, “Reassure us”. There is no dispute between me and the noble Baroness, Lady Finlay, that it has to be an independent decision. Is it clear enough in the Bill? With the deepest respect to both the noble Baroness, Lady Finlay, and the noble Earl, Lord Howe, I point out that it specifically says that the person should have

“made the decision that they wish to end their own life voluntarily and … not been coerced or pressured by any other person into making it”.

With respect, I say that it is clear enough on the face of the Bill.

I turn to Amendment 45, that of the noble Baroness, Lady Fox, which would insert “encouraged” in addition to “coerced” and “pressured”. I have thought very carefully about this, and I am against putting it in. The reason is that I see the reality: somebody who is thinking about an assisted death will want to talk frequently to those who love them. They may want to talk to the multidisciplinary team which is looking after them. Let us suppose somebody says, “I really, really want to go now. Should I take that opportunity?” If somebody says, “I encourage you to make the decision that is best for you,”, what the noble Baroness is proposing is that that becomes a criminal offence, potentially imprisonable for 14 years or for life. To me, that does not seem sensible.

I turn to Amendment 46. The noble Baroness, Lady Finlay, asks for “influenced” or “encouraged” to be added. I have dealt with “encouraged”. With regard to “influenced”, the multidisciplinary team or the person’s loved ones may well—with the best motives—influence somebody to go ahead with it. I do not criticise them for that if that is what the person wants and if it helps. It seems to me, again, wholly inappropriate to go beyond “coerced or pressured”.

On Amendment 47, the noble Baroness, Lady Coffey, suggests that it should be “external or internally” pressured that one is concerned with. We can understand external pressure—that is, somebody pressurising someone else to do it, and pressure carries with it an inappropriate degree of influence—but how does one in practice deal with an analysis of what would make me, for example, want my life to end? My noble friend Lady Merron also referred to that. The pain, the lack of dignity, the sense that I am not the person that I was in front of my own children is internal pressure. It might include me thinking, “I do not want to go on with this; in part, I’ve only got two or three weeks to live, and I want it to end”. The internal pressure is making me come to that conclusion. It is impossible to ask people, in particular the law enforcement authorities, to investigate what is going on in my mind. I have thought very carefully about that. I reassure the noble Lord, Lord Ashcombe, that I have given each of these amendments very careful thought, because they are important, but, again, I do not think that is a practical solution.

Medical Nuclear Radioisotopes

Baroness Merron Excerpts

Thursday 20th November 2025 Grand Committee

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

My Lords, I congratulate the noble Baroness, Lady Bloomfield, on securing this valuable debate. I think we should judge its value not by the number of people here but rather by the quality of the contributions. This is an important issue and, as the noble Lord, Lord Patel, said, the noble Baroness introduced this in a very comprehensive way, which was extremely welcome.

The Government are committed to delivering critical services that depend on the reliable supply of medical radioisotopes, to which both noble Lords referred. I agree with the noble Baroness and her reflections on the positive health outcomes, also supported by the noble Lord, Lord Patel. These isotopes support positive health outcomes, both for diagnostics and for therapeutics. I was looking at the figures: in England alone, some 700,000 procedures are carried out using radioisotopes every single year. This figure is expected to increase, not least because of their value in the process.

There are three main uses for medical radioisotopes; each relies on different manufacture to get the desired result. PET-CT scans, primarily used for cancer and cardiovascular diagnostics, use isotopes from a comprehensive network of UK-based cyclotrons. SPECT scanners are mainly used to confirm the cancer stage, to identify blood clots and to assess organ functions. These scanners use isotopes manufactured abroad in reactors; the noble Lord, Lord Patel, drew our attention to this. This is also the case for radioisotopes that are used for therapeutics.

As the noble Lord pointed out when he expressed concerns about delays to treatment and the impact on patients—the point was well made—the UK does not currently manufacture medical radioisotopes in reactors. Instead, we have in place a supply chain with isotope sources from multiple countries to aid resilience. I will come on to the point that the noble Baroness made about when that supply chain is disrupted. This gives us access to a global network of expertise and high-quality medical radioisotopes.

The noble Baroness made a strong case in advocating for the Welsh project ARTHUR, a reactor specifically designed for the purpose of medical radioisotope manufacture. The Minister for Medical Technology and Innovation, Zubir Ahmed MP, recently met Liz Saville Roberts MP to discuss this matter, and I can assure the Committee that the Government are in active discussions about this project. I note the points made about the suitability of the area and the potential benefits of this project. The UK Government have not made a formal assessment of the project at this time but are supportive of any manufacturing capacity that can improve reliable access to medical radioisotopes, as has been called for. A domestic reactor would certainly be a welcome addition to the overall supply.

The noble Baroness understandably highlighted the severe shortage of a specific medical radioisotope in 2024. I agree that this was caused by a global disruption to its manufacture. The underlying issue was that several nuclear reactors used for its manufacture were undergoing critical repair work. As noble Lords can imagine, these repairs are normally planned ahead and co-ordinated to ensure that there is always enough capacity to deliver critical isotopes. However, the safe running of reactors will always determine whether they will be taken offline for repairs. In this instance, critical repair work was identified and meant that multiple reactors were closed down at the same time.

Due to a diligent response from the Department of Health and Social Care, NHS England, industry and the NHS services impacted, I am glad to say that the patient impact from this severe shortage was limited. I am grateful to all those who worked to ensure this. However, it underscores the need for multiple available sources of medical radioisotopes. A Welsh reactor—or perhaps a Scottish one, although I would rather not dwell on the argument around the devolved Governments and locations—could be an important addition to this supplier base.

Also raised were the issues with the supplies for PET-CT scanners earlier this year. I can give an assurance that, when there are specific supply issues, such as the one the noble Baroness referred to that impacted north England and the Midlands, the department works with suppliers to recover supplies and services. We are aware of the difficulties and issues that both noble Lords have raised. I hope that response is of some assistance.

We are working to support services and improve outcomes for patients. The noble Baroness said that the Government should explore long-term solutions, so let me outline some of these actions. First, we are committed to a thriving life sciences sector and the development of high-skilled jobs in that sector. The Government have made up to £520 million available through the life sciences innovative manufacturing fund; that is available for any private manufacturing proposal, including for medical radioisotopes in the UK.

Medical radioisotopes support life-saving services, including for diagnostic tests; this Government are committed to supporting the improvement of these services. Therefore, we have announced £6 billion of additional capital investment over five years across new diagnostic, elective and urgent care capacity. This includes funding to increase capacity for both testing and reporting across community diagnostic centres and hospitals.

In early 2026, which is nearly upon us, the Government will publish their national cancer plan. This will set out how we will improve diagnosis, treatment and waiting times in order to improve outcomes for cancer patients and increase survival rates. UKRI, the UK’s national funding agency for science and research, also supports the overall service delivery and has recently invested £32 million for novel total-body PET-CT scanners. All these interventions will, as I say, improve the situation for patients and improve services.

In conclusion, as the noble Lord and the noble Baroness have called for, this Government are committed to ensuring robust and reliable supplies of medical radioisotopes to deliver critical services. We are supporting the development of manufacturing and delivery capabilities in the UK, where this is appropriate, alongside working closely with international partners and suppliers. We are also committed to the economic and industrial development of the UK science sector. That is why we have made available investment funds that are open for applicants who are looking to expand or improve UK manufacture of medicine and medical technology products. This includes UK-based manufacture of medical radioisotopes or their adaption for diagnostic or therapeutic applications.

[Lord Patel (CB)]

I know that intervening on the Minister is unusual in a short debate, but we are not exactly short of time. I think the Minister said that if we had a reactor, it would be a useful addition. It would not be a useful addition; it is a necessity. She did not define any solid plans—unless I missed them—where the Government have a clear intention to establish a nuclear reactor for producing radioisotopes. There is a promise that we will have good contractual agreements with the supply chain lines that the Minister mentioned—I cannot make the Minister’s speech, but I am asking the question—but those cannot be guaranteed because there are only six reactors in the world and they are more than 50 years old. Maybe the Minister could comment on that.

--- Later in debate ---

[Baroness Merron (Lab)]

I understand the noble Lord’s point. The point I am trying to make is that a supply chain is important. I was indeed careful in my choice of words, not least because, as I mentioned elsewhere in my speech, the Government have not made a formal assessment of, in this case, the ARTHUR project. So I am limited in how far I can go on the most obvious presentation before us today, but I understand the point made by the noble Lord.

I thank the noble Lord, Lord Patel, and the noble Baroness, Lady Bloomfield, for raising this important matter, which is important for the whole of the Government.

Tobacco and Vapes Bill

Baroness Merron Excerpts

Committee stage
Monday 17th November 2025 Grand Committee

I suggest to the Minister that we need a nuanced approach here, not a blanket approach. I very much hope that she will take on board the points that noble Lords have raised in this important debate.

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

My Lords, I thank noble Lords for bringing forward these amendments. For the convenience of the Committee, I will speak to them as a group. I am also grateful for noble Lords’ contributions and reflections throughout.

The clauses within Part 6, to which these amendments refer, taken in their totality will ban advertising and sponsorship of tobacco products, herbal smoking products, cigarette papers, vaping products and nicotine products. By doing this, it will bring all these products in line with tobacco. There has been—as the noble Baroness, Lady Walmsley, helpfully made reference to—a significant growth in awareness of vaping promotion, with some 55% of all children aged 11 to 17 aware of promotion in shops in 2025, which is up from 37% in 2022. It is unacceptable that children are exposed to vape adverts on the side of buses and in shop windows as they make their way to school or elsewhere. It is also unacceptable that a family going out to watch football could be exposed to vape branding on the kits of players who should be role models to children.

The noble Baroness, Lady Bennett, raised nicotine pouches. There are currently few restrictions on the advertising of these products, and they are highly promoted in shops and on social media. As a demonstration of this, awareness of nicotine pouches has risen from 38% in 2024 to 43% in 2025.

I understand why the noble Baroness, Lady Walmsley, asked about non-nicotine vapes. However, the reality is that non-nicotine vapes may be used as a gateway to nicotine vapes. In addition, nicotine could be manually added to the device. We have to take all that into account and, on that basis—to go directly to her question—we do not plan to include them in a consultation.

The noble Lords, Lord Johnson and Lord Moylan, spoke about the banning of vaping and nicotine products being deliberately branded and advertised to children. That is of course a manifesto commitment. We are doing it, as I have said a number of times, to stop the next generation becoming addicted to nicotine.

We also know that there is strong support among the public for doing this. Measures to restrict vape advertising are supported by some 77% of adults in Great Britain, who are keen to see bans on the advertising and promotion of vapes, so we will not be consulting on the whole matter of advertising. I can say to the noble Baroness, Lady Bennett, that addictive products of the nature she has described should never have been handed out for free. The Bill will address this by ensuring that free samples of these products cannot be given out to adults and children of any age.

The Government have already published a thorough impact assessment of the measures in the Bill, including the effect of the prohibition on the advertising and sponsorship of vaping and nicotine products. I say to the noble Baroness, Lady Fox, that the advertising ban aims to reduce the risk of young people being exposed to vape promotion and advertisements, not the ability of adults to buy vaping products.

I reassure the noble Lord, Lord Howard—and I say this to all noble Lords—that we are committed to helping adult smokers to quit. That is best led by the appropriate health authority, such as the NHS. The noble Lord, Lord Bourne, was right to say, “If you don’t smoke, don’t vape”. We will return to this in a later group, but I can tell him that the Bill allows public health authorities to take certain steps to promote vapes as a means of smoking cessation. That is the right place for this to be.

Further to that, the NHS can provide tailored advice to the individual with the necessary behavioural support. We have invested an additional £70 million in 2025-26 to support local authority-led stop smoking services in England to help people quit smoking, and we will continue to run targeted campaigns to help current smokers quit.

The noble Earl, Lord Howe, asked about an assessment of how the bans will impact businesses, smoking cessation services, et cetera. We will continue to monitor the impact of these changes following implementation.

With that, I hope the noble Lord, Lord Howard, will be able to withdraw Amendment 160.

[Lord Moylan (Con)]

Since the noble Baroness has said so clearly that the purpose of the advertising ban is to prevent information being communicated to children and young people, and that that was a manifesto commitment, why does the ban have to be drawn so widely? Clause 119 has a list of defences that can be advanced for those who are accused of breaching the various preceding clauses on advertising, but none of them says that it is a different matter if the communication is with adults. Is this not drawn far too widely to be justified by her laudable ambition?

[Baroness Merron (Lab)]

I am glad that the noble Lord regards it as a laudable ambition. We will come to exemptions in the next group, and I look forward to doing so.

[Baroness Fox of Buckley (Non-Afl)]

I, too, am slightly confused by this. I was reading something the other day from the DCMS, boasting about the creative industries, and one of the big and most profitable parts of the creative industries in this country is advertising and marketing. It is considered to be something we are proud of. Lots of products have age issues. If you are a cider producer, you have to advertise, but you do not want a six year-old drinking it. We have discussed things such as fizzy drinks, so I appreciate this. This appears to be a blanket catch-all. It does not seem to take up the ways we have learned, in the advertising and marketing world, how, in a society that has children in it at the same time as adults, you can have a sensible restriction on advertising sometimes without depriving everybody of the gain of the advert. NHS information, while useful, is not the same as marketing choice, giving people ideas of the options they might have with vapes, which are not all the same product.

[Baroness Merron (Lab)]

I thank the noble Baroness. This kind of question also comes up in respect of other products: for example, the 9 pm watershed, in terms of the advertisement of high-fat, high-sugar, high-salt foods in order that that advertising is not affecting children and young people. So, this is a constant discussion: that is not a criticism but an observation, of course. What is interesting to me in respect of tobacco is that the evidence found that partial bans are not as effective as a comprehensive ban when it comes to the aim, ambition and intent to reduce tobacco consumption. Similar assumptions can clearly be drawn on vapes. I hope that helps in terms of clarifying the point I am making, even if it may not satisfy the noble Baroness, which I understand.

[Lord Howard of Rising (Con)]

I beg leave to withdraw the amendment.

--- Later in debate ---

[Earl Howe (Con)]

My Lords, in this group of amendments we have seen a logical continuation of our debate on the previous group, since in their various ways these amendments pose the question of what are the appropriate constraints to place around products that are of considerably less concern in a health context than tobacco products. We are back in the realm of deciding what is proportionate and how to secure better clarity and consistency in the operation of the Bill’s advertising and design provisions.

Although he has not been here to speak to it, my noble friend Lord Udny-Lister’s Amendment 161A struck me as a point worth raising. It would protect designers and creative professionals from being criminally liable based on mere suspicion or indirect association because it would work to raise the threshold of proof of intent. One could imagine that in some cases it could be difficult to prove that someone designing an advertisement had reason to suspect that it would be published. In any event, is it right that someone who has been asked by their employer to design a vape advertisement should be criminalised because they know or believe it may be used in some context? I am afraid that the word “draconian” comes to mind.

On my noble friend’s Amendment 161B a very similar thought came to mind. Are the Government really saying that the offence of designing an advertisement for a vape merits a prison sentence? There are mixed messages coming out of the Government at the moment. How should the sentencing provisions in this part of the Bill be read alongside the provisions of the Government’s Sentencing Bill? What is the overall message? The Sentencing Bill will require almost all sentences of less than 12 months to be suspended. On the one hand, the Government are creating imprisonable offences, and on the other, they are saying that people should not actually go to prison, even if they are sentenced to it. At the very least, the Minister needs to explain to the Committee why the sentence on summary conviction is to be different in Scotland than in Northern Ireland, which might have been a point my noble friend Lord Udny-Lister would have made.

Turning to my Amendment 167 and the very well worded amendment, if I may say so, from the Liberal Democrats, the underlying purpose of each is the same, which is to urge the Government to regulate, rather than ban, vape advertisements so that in narrow clinical contexts, such as smoking cessation clinics, they can be deployed for public health purposes. Amendment 168A in the name of my noble friend Lord Howard of Rising has a very similar purpose.

In Amendment 169 I am asking the Government to consider a further exemption for advertisements located discretely in specialist vaping shops. Why not allow that? As my noble friend Lord Moylan has asked in his Amendment 170, why prohibit such specialist shops providing information online subject to suitable age-gating checks? That in turn raises a further question from my noble friend in his Amendment 168. In adult-only environments, why should displaying an advertisement for a vaping product be against the law given that, as we need to keep reminding ourselves, vapes are and will remain legally available for purchase by anyone aged 18 or over? Why are the Government treating vape advertising in exactly the same way as tobacco advertising? What is the justification? Amendment 170A from my noble friend Lord Howard asks that question in a different form. Why should we not allow factual product information to be provided at point of sale in an age-restricted area in suitably licensed premises?

Finally, Amendment 172A from my noble friend Lord Udny-Lister would prevent overreach. It would ensure that brand restrictions target only genuine attempts to promote nicotine or tobacco, not completely unrelated products such as clothing or other merchandise. I think my noble friend has identified an issue that requires clarification from the Government, and I would welcome the Minister’s comments.

[Baroness Merron (Lab)]

I am most grateful to noble Lords for bringing forward this group of amendments, which reference Part 6 provisions, and for the contributions that have been made.

I will start with Amendments 161A and 161B, which are tabled in the name of the noble Lord, Lord Udny-Lister. The current drafting of Clause 114 makes it an offence, when acting in the course of business, to design an advert that would promote a relevant product and be published in the UK. If an organisation knows or has reason to suspect their advert has a promotional purpose or effect and will be published in the UK, it has committed an offence by designing the advert.

I say to the noble Earl, Lord Howe, that the inclusion of “has reason to suspect” is deliberate, not least because it mirrors the approach taken in the existing Tobacco Advertising and Promotion Act. This wording is designed to avoid loopholes and to ensure that those who are involved in the design of ads cannot evade responsibility by claiming ignorance where it is clear from the evidence that they had reason to suspect what they were designing an advert for. I hope the noble Earl will understand that we will, therefore, not seek to weaken existing legislation or allow any uncertainty that could be exploited.

I turn to Amendment 161B. I sympathise with the intention to align penalties across the UK but, of course, it is important that we respect Scotland has a separate criminal justice system. There are maximum penalties for this type of offence; they are fixed in line with the criminal justice system in each jurisdiction. I hope that that is helpful to the noble Earl, Lord Howe.

I turn to Amendment 172A, which was also tabled by the noble Lord, Lord Udny-Lister. It seeks to restrict the scope of the offence of brand sharing. Brand sharing, also known as brand stretching, is a form of indirect advertising and should be seen as such, not least because it promotes the use of a service or product by putting its branding on other products or services or vice versa. The clause is drafted in a manner that already limits the offence that could be created under this power to cases where the purpose or effect is to promote a relevant product. Brand sharing, as defined in the Bill, would be unlikely to capture the types of case about which the noble Lord is concerned in his amendment; it is our view, therefore, that this amendment, as it stands, would introduce unnecessary complexity.

I turn to Amendment 168 in the name of the noble Lord, Lord Moylan. The Bill as drafted takes decisive action to ban the advertising and sponsorship of all vapes and nicotine products, delivering on our clear manifesto commitment to stop vapes being advertised to children—something on which the noble Baroness, Lady Northover, spoke. The ban is essential to creating what we seek: a strong, consistent regulatory environment; and to provide clarity for businesses and enforcement bodies. I can say to the noble Baroness, Lady Walmsley, that guidance will be produced on advertising.

This Bill already includes defences for the limited circumstances in which advertising would be appropriate. As I have said in our debates on earlier groups, we are not considering any other exemptions for adult-only spaces, not least because of the risk of loopholes; these were referred to by the noble Baroness, Lady Northover. However, I take this opportunity to correct a statement that was made in the other place: this prohibition will apply to all advertisements for relevant products, not just those for specific products. In practice, this means that anyone acting in the course of business could commit an offence if they promote a relevant product, whether that is a generic product, a category of products or a specific branded product.

[Lord Moylan (Con)]

I think the noble Baroness has addressed Amendment 170. Does she therefore not share the view of the noble Baroness, Lady Walmsley, which was, as I understood it, that my Amendment 170 is unnecessary because there is nothing in the Bill that prohibits specialist vape retailers communicating on the internet? I would like clarity on that.

[Baroness Merron (Lab)]

Of course; I am going to come on to the point about online advertising.

Amendments 167 and 169, tabled by the noble Lord, Lord Kamall, Amendment 168A, tabled by the noble Lord, Lord Howard, and Amendment 171, tabled by the noble Baroness, Lady Northover, all seek to create exemptions to allow for the promotion of products for the purposes of smoking cessation—something that was also spoken to by the noble Lord, Lord Young. As I mentioned on the previous group, I repeat the assurance to noble Lords that the Bill as drafted will allow certain public authorities to continue to take steps to promote vapes as a means to quit smoking. This is a matter that I will come back to on Report.

The offences in Part 6 apply only to those acting in the course of business. For example, following the passage of the Bill, local stop smoking services will still be able to take steps to promote vapes to smokers as a less harmful alternative. The noble Lord, Lord Young, raised an important question about GPs and pharmacists having such a facility. I assure him that we will be further reviewing whether the Bill provides the necessary approach considering the points that he made.

I also mention something relevant to an earlier group—I may be stepping a little outside of things here, but I remember the noble Baroness, Lady Fox, in particular, making this point. The advertisement offences will not prevent a retailer offering verbal smoking cessation services to their customers. While I am sympathetic to the intention to ensure that vapes remain accessible and visible to adult smokers, there are already strict rules in place for nicotine vape advertising. Under current legislation, it is illegal to advertise nicotine-containing vapes on television, radio, most online platforms and in newspapers and magazines. Companies are not allowed to market a vape as a smoking cessation product or to make medicinal claims about products unless these have been authorised as a medicinal product by the MHRA. As noble Lords have heard me say many times, we believe that promoting smoking cessation is best led by the appropriate health authorities, including the NHS, which can provide tailored advice to the individual with the necessary behavioural support.

I should be clear that all tobacco products are harmful to health, including heated tobacco, which contains tobacco and generates aerosols with carcinogens. The department therefore does not recommend the use of heated tobacco products to quit smoking.

I turn to Amendment 170 from the noble Lord, Lord Moylan—

[Lord Lansley (Con)]

Forgive me for interrupting, but I did not quite follow. Where in the Bill is the reference to the ability to place an advertisement for a product that is authorised as a medicinal product, where it also happens to be a vaping product? I do not know where that is to be found in legislation.

[Baroness Merron (Lab)]

I will be happy to come back to the noble Lord and be precise about that while I am going through the rest. If I do not get the opportunity to do so, I will of course write.

I turn to Amendment 170 from the noble Lord, Lord Moylan, and Amendment 170A from the noble Lord, Lord Howard. I am sympathetic to the intention of ensuring that consumers have the information they need to make a purchase. This was spoken to by not only the noble Lord, Lord Moylan, but the noble Lord, Lord Johnson, and the noble Baroness, Lady Fox. However, Amendment 170 is not necessary because retailers, as I have said, will continue to be able to provide the necessary factual information about products to enable purchases. Amendment 170A is also not necessary because the Bill does not prohibit businesses displaying the categories of information that this amendment refers to, as long as the information is not promotional.

The noble Lords, Lord Johnson and Lord Moylan, referred to online providers. The Bill builds on existing legislation and effectively bans all advertising of relevant products, including online. On the particular point raised by the noble Lord, Lord Johnson, we expect enforcement bodies to take a proportionate approach, as they currently do with the advertising of tobacco products.

The noble Lord, Lord Howard, asked about government engagement. We will continue to engage with independent vaping associations and other vaping businesses, but I remind him and the Committee, as I said probably on day one, that the UK Government are committed to Article 5.3 of the World Health Organization Framework Convention on Tobacco Control, which means the protection of public health policy from the vested interests of the tobacco industry. So I have not met and will not meet British American Tobacco.

I will need to write to the noble Lord, Lord Lansley, and will be glad to do so. I hope this will allow the noble Lord, Lord Howard, to withdraw Amendment 161A.

[Lord Howard of Rising (Con)]

I beg leave to withdraw.

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, I will speak first to my Amendment 176. As the noble Lord, Lord Kamall, said, his Amendment 178 does something very similar. As I have often said, policy should be based on evidence, so this amendment seeks to tease out exactly what evidence the Government plan to use when designating a new area as smoke-free.

The Government have already said that their consultation on further smoke-free areas will focus on schools, playgrounds and hospitals. It is fairly clear that areas in and close to schools should be smoke-free, in the same way that local authorities now have powers to prevent the opening of new fast-food outlets near schools because of the health dangers of much of their sales.

However, some playgrounds are very large and it is possible that a parent waiting on a bench for a child, well away from the play equipment, may want to smoke a cigarette—if they are of legal age, of course. Although it would set a bad example, it would be hard to understand the level of risk to the children playing; it would depend how far away they are. As for hospitals, many of them have already designated their grounds as smoke-free, although it has been hard to enforce. Many of us will have seen people smoking outside St Thomas’ Hospital, underneath the “No smoking” sign. Many hospitals have distinct outdoor smoking shelters. The matter is complicated, which is why my amendment probes the Government on the criteria they will use.

On the other hand, Amendments 175 and 179 seek to specify in the Bill the areas that can be designated as smoke-free. This could restrict the Government from acting in other areas in future. Obviously, we want the same rules in all parts of the UK, to save confusion. There are several reasons why the Government should not be limited in this way, and they must bear in mind the different circumstances that prevail in different areas. For example, as the noble Baroness, Lady Bennett, mentioned, there are many children on beaches, and discarded cigarettes are a real litter problem, according to coastal local authorities. As she said, transport hubs may also come into focus, because of the crowded conditions in many of them, especially at certain times of the day such as rush hour. We think the Government need flexibility on this issue. Indeed, somebody might be more affected by second-hand smoke in a transport hub than at the far side of a very large playground, which is why I would like to see an evidence test.

We do not support Amendment 177 in the name of the noble Lord, Lord Udny-Lister, as the Government may want to restrict smoking in uncovered hospitality areas in the future. However, if they do so they will have to explain the reasons why, and we could debate it then. The fact is that the prohibition on smoking in indoor hospitality venues has proved very popular with customers and landlords alike and has certainly not had a damaging effect on footfall or expansion of the sector. The same might apply to uncovered hospitality areas in the future, if they are considered for the ban.

[Baroness Merron (Lab)]

My Lords, as we have heard, all the amendments in this group seek to limit the powers in the Bill to make additional places smoke-free in England. On Amendment 176, tabled by the noble Baroness, Lady Walmsley, we know that passive smoking, whether indoors or outdoors, poses a risk to health. The rule of thumb is: if you can smell cigarette smoke, you are inhaling it. This is particularly important for children, pregnant women and those with pre-existing health conditions such as asthma or heart disease, which may not be visible to the smoker.

However, despite these well-known and very well-evidenced harms, trying to ascribe specific harms to locations is somewhat challenging, as this debate shows. For example, as the noble Baroness, Lady Walmsley, mentioned, in a large children’s play area it is difficult to evidence that exposure to second-hand smoke has caused a specific harm in a specific place. I can assure noble Lords that we are extremely mindful of this. Therefore, the test referred to in the amendment is overly restrictive, technically very difficult to do and not necessary, given the extensive evidence of harm to vulnerable people. It would also likely lead to a scenario in which we are unable to protect the most vulnerable in society from the harms of second-hand smoke.

Similarly, on Amendment 178, tabled by the noble Lord, Lord Kamall, as I mentioned, we know the harms of passive smoking. There is strong indirect evidence but, as I said, it can be difficult to demonstrate this evidence in specific locations. Again, this restrictive test would prevent areas where there are harms of second-hand smoke to children and medically vulnerable people from becoming smoke-free. Furthermore, as this amendment would apply in England only, it would leave England with more restrictive smoke-free provisions than the devolved nations. 

Amendments 175 and 179 were tabled by the noble Lord, Lord Kamall. As we have made clear but I would like to reiterate, in England we plan to consult on extending smoke-free places as and when. In the first instance, it would be to the outdoor areas of schools and early years settings, children’s playgrounds and healthcare settings. I can assure the noble Lord, Lord Kamall, and the noble Baroness, Lady Walmsley, that all proposed smoke-free locations will be subject to consultation both now and into the future and that regulations will be subject to the affirmative procedure. We will be guided by public health advice. The noble Baroness, Lady Bennett, rightly observed that the powers within the Bill allow us to respond to evolving evidence at a later time, particularly where there is evidence of clear harms to children and vulnerable people.

On Amendment 177 tabled by the noble Lord, Lord Udny-Lister, we have made it very clear—I am glad to take the opportunity to do so again, not least because the noble Lord, Lord Kamall, raised this—that outdoor hospitality settings will not be in scope of the consultation on smoke-free places. We fully recognise the balance that is needed to protect the most vulnerable as well as ensure that businesses are not financially impacted. We are confident that we have the balance right in deciding the places, which I have already outlined, on which we plan to consult.

However, the powers in the Bill, as has been observed, allow for additional places to be designated smoke-free in the future, subject to further consultation and parliamentary debate. The landscape may change significantly on tobacco legislation, as it has done over the years. Evidence and attitudes may also shift, again as we have seen over the years, so it is sensible to ensure that the Bill is future-proofed and can respond to evolving evidence. I therefore ask the noble Lord to withdraw this amendment.

[Lord Kamall (Con)]

My Lords, I am grateful to the wide range of noble Lords who spoke on these amendments. These are clearly intended as probing amendments, at this stage, to understand—as the Minister herself agreed—these wide sweeping powers to designate additional spaces as smoke-free. We are grateful because we were concerned about the level of scrutiny there would be. The Minister assured us that there will be consultation and that any changes will be by regulation following the affirmative procedure. We are very grateful for that and that perhaps answers some of the probing amendments that we have in future groups. For now, I beg leave to withdraw the amendment.

--- Later in debate ---

[Baroness Northover (LD)]

My Lords, I will speak to Amendment 186 in my name. I thank my noble friend Lady Walmsley for her support. This amendment would ensure that all pavement licences granted by local authorities are required to be smoke-free. Some noble Lords will remember that this House voted in support of this issue previously, but I will briefly cover the background for those who are less familiar with it.

Pavement licences were introduced during the pandemic when mixing inside was prohibited. They allowed hospitality venues to expand their seating outside at a time of great difficulty. We worked across parties to ensure that these outside spaces, as an extension of inside, should, like the interior areas, be smoke-free to protect the public, including children, and staff. We secured that, despite the familiar refrain that hospitality would go to the wall and so on. Then the industry indeed got to the Minister and the DCLG and, without consulting the Department of Health, this was ended. It is such a familiar story.

Meanwhile, outside areas proved very popular and became permanent fixtures in 2021. At that time, the House voted in favour of the amendment from the noble Lord, Lord Faulkner, regretting that smoke-free pavement licences had not been adopted by the Government. This amendment honours that vote.

When pavement licences were first introduced, there was a requirement that some seating in the designated area was smoke-free. However, unless outside spaces are vast—we do not expect that on a pavement—having smoking and non-smoking tables next to each other means that everyone experiences second-hand smoke exposure due to drift.

The LGA backed our campaign to make all these areas smoke-free. Some councils decided that they would make the spaces being smoke-free a requirement of pavement licences, which was perfectly acceptable within the regulations, such that there was no requirement to have a smoking section. So far, 11 councils have introduced 100% smoke-free conditions in pavement seating. This includes cities such as Liverpool, Manchester and Newcastle. Evidence from these local authorities shows that the scheme is popular with customers and businesses alike, protecting public health without having adverse economic impacts.

There is no risk-free level of exposure to second-hand smoke. Second-hand smoke is an irritant for people struggling with asthma or other lung conditions, and associated health effects from second-hand smoke include stroke, lung cancer and heart disease. I hope that hospitality settings are included in the consultation for smoke-free extensions for the Bill. Polling shows that 40% of people said that they would be more likely to visit pubs and restaurants if smoking was banned in outdoor seating areas.

Hospitality is an important sector of our economy, but the notion that it is somehow economically dependent on the continued consumption of tobacco and allowing smoking in outside spaces requires further examination of the evidence. These arguments were made when public places were made smoke-free in the first place. Now, few people could contemplate pubs and restaurants once more being full of cigarette smoke. All the same arguments were made about banning smoking in public places and that places would go under—not so. In fact, the debate helped encourage people to give up, as opposed to smoking more at home. Making pavement licences smoke-free, which has proved such a success in many areas, feels like a step in the right direction.

I will comment on other amendments in this group. Amendment 180, regarding cigar lounges, points to an interesting case. Where we make exceptions and create loopholes, they have the potential to be exploited. Following the powerful speech of the noble Baroness, Lady Ramsey, it seems that there has been a very liberal interpretation of the notion of “sampling” that goes beyond what Parliament intended in the 2000s. She pointed to the real health consequences of cigar smoking and the potential risk to staff. I point noble Lords to what the NIH—the National Institutes of Health—and the National Cancer Institute say on this:

“Yes. Cigar smoke … contains toxic and cancer-causing chemicals that are harmful to both smokers and nonsmokers. Cigar smoke is possibly more toxic than cigarette smoke … there is more … tar in cigars than in cigarettes”.


They say that there is no safe use. There are higher rates of lung cancer, coronary heart disease and lung disease than among those who do not smoke, and similar levels of oral cancer and cancer of the oesophagus as for cigarette smokers. Anybody can look this up for themselves; I suggest that, in terms of there being “no risk”, noble Lords should do so. We should do nothing to create loopholes in this Bill, and I look forward to hearing what the Minister says about that.

The noble Lord, Lord Kamall, and the noble Earl, Lord Howe, have challenged the proposition that Clause 136 stand part of the Bill. I listened with great interest to the discussion on why they wanted to probe smoking for artistic purposes. Of course, it used to be the case that smoking was a mainstay in films—I think of Humphrey Bogart smoking a cigarette in “Casablanca”, looking very cool with Ingrid Bergman melting before him. I would welcome hearing from the Minister what the Government plan to do in relation to this, because it came across as something that was very cool. We also do not want non-smoking actors to be led into a smoking habit. We hear about instances of that, where actors were not addicted but became addicted as a result of their roles. I know that the National Theatre has a smoke-free policy and that there are alternatives to smoking tobacco that can be used to portray it.

We know also that the depictions of smoking and vaping in the media increase the chance that young people will take up the habit, regardless of whether it is a positive or negative depiction. I realise that noble Lords are simply probing to elucidate what the Government are planning, and I look forward to hearing what the Minister says, but I also hope that the Minister is sympathetic to my Amendment 186. I also look forward to what she says in relation to the amendment from the noble Baroness, Lady Ramsey.

[Baroness Merron (Lab)]

My Lords, the amendments in this group seek to change the detail of exemptions and powers on smoke-free places. I am grateful both for the debate and the amendments, which raise a number of issues.

I start with the amendment introduced by my noble friend Lady Ramsey on behalf of my noble friend Lord Faulkner, who tabled it. It seeks to remove the existing exemption that allows individuals to sample cigars and pipe tobacco indoors in an enclosed and ventilated area in a specialist tobacconist. This amendment was also spoken to, although in a different way, by the noble Lords, Lord Johnson, Lord Murray and Lord Strathcarron. Tobacco is, as I have said, a uniquely harmful product. I sympathise with the aims of the amendment and agree with the intention. However, specialist tobacconists, as we have heard in the debate, are currently exempt because of the specialist nature of their trade. These businesses make up a very small percentage of the market in the UK.

I can assure my noble friend Lady Ramsey that there are a number of restrictions to the current exemption. For example, the sampling area is legally required to be enclosed, clearly signed and appropriately ventilated to prevent smoke spreading to non-smoking areas. Other tobacco products such as cigarettes cannot be sampled. I was interested to hear the example that my noble friend Lady Ramsey brought before the Committee. I know she will understand that I cannot comment on very specific circumstances, but this may or may not be a matter for enforcement. I am sure that my noble friend will look into that further.

It is important that the Bill balances the public health aims within it while ensuring that small and medium-sized businesses are not unnecessarily financially impacted. Ultimately, given our ambition to prevent future generations taking up smoking, we anticipate, as we have said in previous groups, that in the long term specialist tobacconists will have to pivot their business models. Given this, we expect the exemption currently in place, which we are not seeking to change, to be used less and less over time. I give the assurance that we will continue to monitor this niche market to ensure there is not a targeting of young people or an exploitation of the exemption. Of course, as this exemption is in regulations, it is possible to review this in the future, if required.

The noble Lord, Lord Strathcarron, asked about impact assessments. Any further impact assessments that are required will be prepared in advance of any legislation which is the normal process where there could be economic impacts. The impact assessments will be reviewed by the regulatory policy committee—again, in accordance with normal practice.

The noble Lord, Lord Kamall, and the noble Earl, Lord Howe, have indicated that they oppose Clause 136 standing part of the Bill. The clause recasts an existing regulation-making power that was found in the Health Act 2006. It allows the Secretary of State to make regulations permitting performers in England to smoke during a performance. The intention of the clause is to provide simplification and offer greater consistency with the Bill’s other provision. In practice, it is our assessment that this will not make a real difference, which I know is of concern to the noble Earl.