Vaccine Health Technology Assessment

Baroness Ritchie of Downpatrick Excerpts

Thursday 8th January 2026 Grand Committee

Asked by

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what plans they have to include wider societal and economic benefits within the vaccine health technology assessment, rather than limiting evaluation solely to clinical outcomes.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I was delighted to secure this debate as this is a subject of significant importance and one in which I have a close interest. Health and economic growth are rightly identified by the Government as two of their central priorities and they sit at the core of the NHS 10-year plan. Vaccines lie at the intersection of these ambitions, yet the way we currently assess their value does not reflect the full contribution they can make to either. Vaccines are among the most effective public health interventions ever developed. For more than two centuries, they have saved lives, reduced pressure on health services and enabled societies and economies to function. Yet, despite this well-established record, the health technology assessment of vaccines in England remains too narrow.

At present, vaccine assessment focuses predominantly on direct clinical outcomes and immediate health system costs. While these are clearly important, they do not capture the wider societal and economic benefits that vaccines deliver, benefits that are directly relevant to both national growth and the long-term sustainability of the NHS. Vaccines keep people in work and children in school, and they enable carers to care. They reduce absenteeism, protect productivity and help prevent avoidable demand on already-stretched NHS services. In doing so, they support economic growth and help deliver the Government’s ambition of a healthier, more productive population, as set out in the NHS 10-year health plan. This matters because vaccines are fundamentally different from many other health technologies. They prevent disease before it occurs, reduce transmission and generate benefits that extend well beyond individual patients. Assessing them through a narrow clinical lens risks undervaluing prevention and slowing access to innovations that could deliver long-term health and economic gains.

Recent evidence from the Office of Health Economics provides compelling data in this regard. Its latest report provides estimates of the annual burden associated with respiratory illnesses for four selected vaccination programmes from the NHS routine schedule, as well as the projected costs and savings associated with those vaccines. Despite the delivery of national vaccination programmes for these four disease areas, a significant burden of disease remains. The report shows the costs to the NHS and quantifies the broader socioeconomic impact of vaccines, specifically the impact that they can have on reducing the UK welfare budget and workplace absenteeism and increasing UK productivity—helping to support the Government’s priorities on health and growth.

Key findings include the fact that the cost to the NHS of treating the unprotected population for these four respiratory illnesses alone is £3.9 billion. The cost to the wider economy is £3.6 billion, making a total of £7.4 billion a year. At the same time, the UK spends only 1.07% of health expenditure and 0.1% of GDP to cover immunisation programmes in the national schedule. A 10% reduction in the current burden, through higher coverage with the same vaccine, a future vaccine with higher efficacy or improved effectiveness at the same coverage levels, or a combination of the two, could deliver significant benefits—£384 million in annual NHS savings and £356 million in lower productivity costs. These findings are undoubtedly compelling and reinforce the point that vaccines should be viewed not as a short-term cost but as a strategic investment with benefits that extend well beyond the health system.

The experience of the Covid-19 pandemic made this abundantly clear. Vaccines were not only a health intervention; they were essential to economic recovery, educational continuity and social stability. Yet our routine assessment frameworks have not fully embedded this lesson.

I say gently to my noble friend the Minister that if the Government are serious about delivering their growth agenda and the ambitions of the NHS 10-year health plan, prevention and vaccines in particular must be valued accordingly. That requires assessment frameworks that recognise long-term, cross-government benefits, not just short-term clinical outcomes. I thank the Minister for the recent response she gave to my Parliamentary Question on this issue.

I welcome the recent positive decision by NICE to revise its cost-effectiveness thresholds. This is an important and constructive step. However, with these revised thresholds, the current framework does not systematically include broader socioeconomic benefits. I therefore ask the Minister whether these changes will feed through to JCVI evaluations of vaccines and immunisation programmes.

Crucially, while changes to thresholds may improve flexibility at the margins, they do not address the more fundamental issue that vaccines are still assessed using methodologies that fail to capture their full, long-term societal and economic value. I therefore urge the Government to consider how vaccine health technology assessment can evolve, including clearer guidance on incorporating societal and economic impacts, improved alignments between NICE, JCVI and the NHS, and an explicit recognition that prevention requires a different evaluative approach from treatment.

In closing, I ask my noble friend the Minister whether His Majesty’s Government will commit to establishing an independent committee to evaluate this existing vaccine health technology assessment process. Such a review could assess whether current approaches are fit for purpose, consider international best practice and make recommendations on how wider societal and economic benefits can be appropriately and consistently incorporated.

This is not about lowering evidential standards; it is about measuring the right outcomes over the right time horizon in support of the Government’s priorities on health, growth and NHS sustainability. If we continue to undervalue vaccines, we risk missing one of the most effective tools available to improve population health, reduce pressure on the NHS and support long-term economic prosperity.

I look forward to the Minister’s response on how the Government intend to take this forward and the contributions of other noble Lords on this very important issue.

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[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 Lady Ritchie for her thorough introduction and for securing this debate. I am also grateful to all noble Lords for their considered contributions. The subject of today’s debate reflects my noble friend’s steadfast commitment to improving access to immunisation and her tireless efforts to ensure that vaccination matters continue to receive the attention that they undoubtedly deserve. As the noble Lord, Lord Kamall, said, this is a very important debate to have and I welcome the probing that it provides.

Let me say at the outset that I believe we in the UK can be proud that we have one of the most extensive vaccination programmes in the world. We protect people across their life course and it is underpinned by rigorous scientific evidence and a commitment to equitable access—a point made both by the noble Lord, Lord Kamall, and my noble friend Lady Goudie.

The question of international comparators was raised. Our vaccination progress serves as a global benchmark for innovation and best practice, and many nations look to align their immunisation schedule with ours.

I will focus on the specifics as best I can in the time available. On the JCVI, the noble Lord, Lord Bethell, made a number of comments suggesting what I might say, and in a number of cases he will be entirely right, so I am grateful to him for shining a light on some of those points. Decisions on introducing or changing vaccination programmes are informed by advice from the Joint Committee on Vaccination and Immunisation. It is an independent and expert committee and world leader in this field, as has been recognised in this debate. It bases its advice on high-quality data, disease burden, vaccine safety and efficacy, and the impact and cost-effectiveness of programmes, and it ensures that we maintain public confidence in our policies. I know that all these things are important to noble Lords.

On the current approach to evaluating vaccines, the cost effectiveness analysis used by the JCVI compares the cost of a vaccine relative to the health benefits it provides. I appreciate that this debate is about extending beyond that, but that is what it does. It looks at the health benefits provided for a vaccinated individual and others—this point was raised in the course of the debate—and it considers direct cost savings to the health and social care system resulting from immunisation, such as averting hospitalisation and the need for social care.

My noble friend Lady Ritchie suggested that the current approach somehow undervalues prevention, can delay innovation and does not take into account benefits beyond those to the individual patient. I would put this rather differently to my noble friend, because the methodology is entirely focused on prevention. As I mentioned, the positive benefits are not just for the person who has been vaccinated but for those around them. We look to reduce the incidence of infection, and we are also mindful about the transmission of conditions and infections to others.

My noble friend also asked about changes to thresholds. I can say to her that we are actively considering the impact of changes to thresholds in vaccination programmes. Perhaps I will only be a little cautious, but there is the potential that such a change would increase the costs of existing programmes, perhaps by incentivising higher prices from suppliers. But there is a recognition of the role that such a change could play in encouraging innovation, and I know that my noble friend is very keen to see that.

I am not sure this came up too much in the debate, but it is an important point. Our use of data to establish cost effectiveness has ensured that we get value for money from manufacturers, and that has allowed us to deliver a comprehensive programme. It is important that we continue to keep that value for money.

On wider societal and economic impacts, it is the case that wider benefits can be highlighted by officials or the JCVI when advising government on vaccination programmes, but it is also true that it does not account for the impact of vaccination that I have heard all noble Lords call for. A key reason for this—the noble Lord, Lord Bethell, pre-empted this—is that the wider benefits cannot be quantified consistently across all vaccination programmes. There is currently a lack of available high-quality data on socioeconomic benefits. As the noble Lord said, robust data may be available for very few programmes. Basing decisions on wider benefits would create disparities whereby vaccination programmes with high-quality data and wider benefits were considered more valuable. So we do not have the basic situation to achieve what we all want.

There are also many uncertainties when modelling socioeconomic benefits. Unpaid care was mentioned, for example; I think my noble friend Lady Goudie referred to it. Quantifying the impact on that would be extremely complicated, and there is no clarity on how estimating or modelling this or other impacts should be approached. That concern was echoed by NICE when it did an appraisal on this very topic in 2022, and it agreed to maintain the approach that it currently takes.

On the point about supply that I mentioned earlier, there can also be a risk that by adding wider benefits into formal evaluation methods we send a signal to suppliers that we could be open to paying higher costs for the same vaccines or medicines. I see noble Lords both nodding and shaking their heads, which is the purpose of a debate.

There are additional ethical concerns. As was mentioned, vaccination programmes for working populations, important though they are, could be preferred over programmes for those who are not economically active. That is not a basis on which we would want to proceed because it would exacerbate inequalities and undermine the equity of our approach.

I recognise that my noble friend Lady Ritchie has raised this Question as part of a focus to broaden vaccination access. That is a goal to which we are absolutely committed. We have been putting plans into action to provide new programmes—for example, launching programmes to protect infants and older adults against RSV. Just this month, we announced that a vaccine against chickenpox would go into the routine childhood immunisation schedule. That is expected to save the NHS some £15 million a year in costs for treating vaccinations.

The important matter of improving uptake has been raised. We are delivering vaccinations in new ways via community pharmacists, and pilots for administering vaccinations within health visits are starting this month. Through this targeted outreach, we offer an opportunity to increase uptake and reduce inequalities by providing vaccinations to those who might not otherwise access vaccinations. We are also working with healthcare professionals so that they can confidently discuss immunisation with concerned patients, because it is vital to tackle vaccine information. We are exploring innovative delivery models and delivering trusted messaging, to take up the point made by the noble Lord, Lord Rennard, who spoke about other influences that we would not welcome.

A number of questions have been asked, and I will be glad to write to noble Lords to pick up their specific points. I realise that my remarks in general will not be the ones that my noble friend and other noble Lords will have hoped for, but I hope I have been able to outline some of the difficulties while appreciating the points that have been made.

[Baroness Ritchie of Downpatrick (Lab)]

Before my noble friend sits down, I ask that she and her ministerial colleagues in the Department of Health and Social Care give particular attention to establishing the independent committee to evaluate the existing vaccine health technology assessment process so that the impact of vaccines on the economy, education and wider society can be seen clearly.

NHS: Winter Preparedness

Baroness Ritchie of Downpatrick Excerpts

Tuesday 16th December 2025 Lords Chamber

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

First, we have started earlier and done more than ever before to prepare for the winter pressures. The good news is that the flu vaccines are working well to protect people against severe disease, and they are certainly working well in comparison to how they used to. In fact, we are the first country in the world to show vaccines working this well. On the uptake of vaccinations, 60,000 more NHS staff have been vaccinated this year than last year, which is extremely welcome. We have delivered over 17 million flu vaccines, which is tens of thousands more than we had delivered this time last year. We have a particular programme of communication and support and availability to those groups which are less likely to take up vaccinations. Vaccinations are our best line of defence against RSV and flu. I will be pleased to provide more detailed information to the noble Lord.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, given that not all babies are currently able to benefit from protection under the two-pronged approach to the RSV programme, what efforts will be made to ensure that other babies, such as those born to unvaccinated mothers, who remain at risk, will be included in any extension to the RSV vaccination programme?

[Baroness Merron (Lab)]

I know my noble friend is very familiar with the maternal RSV programme, not least because of her campaigning, for which I pay tribute to her. It only began in September, and it is already proving successful. We want to see more pregnant women being vaccinated; we have updated and made available information resources in 30 languages for better access to vaccinations. We encourage maternity services to have early discussions with pregnant women about vaccination, and we ensure that training is in place to allow staff to have the knowledge and confidence to address concerns and build confidence. I hope that this answer is helpful not just to my noble friend but to the noble Lord.

Breast Cancer

Baroness Ritchie of Downpatrick Excerpts

Monday 15th December 2025 Lords Chamber

[Baroness Ritchie of Downpatrick (Lab)]

My Lords—

[Baroness Finlay of Llandaff (CB)]

My Lords—

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[Baroness Merron (Lab)]

The answer to that latter question is yes, and the noble Baroness will not have to wait too long to see the national cancer plan.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, as a breast cancer survivor, I cannot estimate enough the benefit of breast screening leading to early diagnosis. In that respect, I urge my noble friend the Minister to talk not only to her ministerial colleagues in the devolved Administrations but to oncologists within the Department of Health to ensure that we get an earlier date for publication than 2027. Women, particularly those over 70, want reassurance about the prevalence or non-prevalence of cancer within their body.

[Baroness Merron (Lab)]

We certainly do speak with the devolved Governments, as my noble friend highlights. As I have said, this whole area is guided by the scientific and independent advice of the UK National Screening Committee, which is closely involved in the AgeX trial to which I have referred. I assure my noble friend that action will be taken as quickly as possible.

Terminally Ill Adults (End of Life) Bill

Baroness Ritchie of Downpatrick Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

I confess I was slightly aghast by the Committee stage in the other place. MPs had tabled amendments to include much more explicit protections in the Bill as safeguards for individuals who might be vulnerable to coercion in all its forms and to more subtle interventions that could be characterised as encouragement. Amendment after amendment along these lines were rejected. I hope that this Committee will adopt a different approach and tighten up the drafting of the Bill precisely so that autonomy is meaningful and not just a slogan.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I support the amendments to Clause 1 in this group. I speak in particular to Amendment 48 in my name. This seeks to strengthen the safeguards against someone being coerced into an assisted death by removing the words “by any other person” from Clause 1(2)(b). This would extend the notion of coercion by recognising that coercion or pressure can come from a multitude of places—an institution, a circumstance or another individual. I am sure there is agreement across your Lordships’ Committee that nobody should feel obliged to opt for an assisted death. This amendment aims to strengthen and clarify the eligibility criteria in the Bill in recognition that they are perhaps its most important safeguard.

I have deep concerns, as many of us do, about how we protect vulnerable people from unnecessary, unwanted death. I am especially anxious that we should be aware of the risk of coercion in all its forms, which is an issue that I raised during Second Reading. This includes somebody who feels coerced through a lack of real choice.

The National Audit Office’s recent report into the state of the palliative and end-of-life care sector is stark. As we know, funding is stretched and provision is disparate. As things stand, there is a lack of real choice for many people about the end of life. The knowledge of this could easily be internalised by people, leaving terminally ill patients in certain regions or who are part of particularly vulnerable marginalised populations feeling that they have no choice but assisted dying, whether or not another person is explicitly pushing this.

Therefore, my Amendment 48 seeks to ensure that such cases are not left out of the Bill’s definition of coercion. I ask my noble and learned friend Lord Falconer, in his summing up, to give consideration to this, so that it remains possible to detect and prevent any death that the person has not freely chosen.

[Baroness Butler-Sloss (CB)]

My Lords, I do not like this Bill, but I am here, like many other Members of this House, to agree on amendments that will make this a better Bill, and I hope it will be effective.

When my father died, the family nanny, who had also been his housekeeper, needed somewhere to live, and my brothers and I paid for her to live in a very nice care home, where she was entirely happy, until I went to see her. On each occasion, she said to me, “I shouldn’t be alive. I ought to die. It is not right that you and your brothers are having to pay for me”. I have this direct knowledge. She was perfectly happy when I was not there and, of course, we continued to look after her until she died.

But the Bill, once it is passed, is absolutely certain to be enlarged in all sorts of ways, as happened with other Bills in other countries once they became law. There are various reasons why it would be a good thing to enlarge it. For example, it seems to me bitterly unfair that those with locked-in syndromes such as motor neurone disease would be extremely unlikely to benefit from the Bill in the last six months, because many—those I have known—have been unable to do anything themselves in the last six months. The word “encouragement” is absolutely crucial. It does not have to be coercion. It does not have to be abuse. It could be nice people listening to a loved one and realising that they are saying, “I ought to die”, and consequently saying, “Yes, why not?” That would be extremely unjust.

Goodmayes Hospital Mental Health Facility

Baroness Ritchie of Downpatrick Excerpts

Thursday 13th November 2025 Lords Chamber

[Baroness Merron (Lab)]

These are very serious issues, and we continue to work on them. We are also very grateful to the Health Services Safety Investigations Body, whose reports highlight extremely important concerns and safety recommendations, with an aim to help us improve in-patient mental health services. Therefore, I can say to the noble Baroness that we are in the process of formally responding to those recommendations made within this report, in addition to the changes I have referred to. As the Mental Health Minister, I am invested in making sure that we continue to drive forward improvements to patient safety and accountability.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, given the testimony presented by my noble friend Lady Berger, what assurances can my noble friend the Minister provide to your Lordships’ House to underpin the Mental Health Act by way of financial spend, to ensure that it is protected for mental health services to deal with all the challenges that have happened over the last number of years and into the future?

[Baroness Merron (Lab)]

The Mental Health Bill, which is, I hope, within touching distance of Royal Assent, is absolutely crucial. It is a reform of an Act which was 41 years old; it will undoubtedly be crucial. I am grateful to many noble Lords for their participation in getting us to the right place. It will deliver on our government commitment to modernise the legislation. I hope my noble friend is aware that implementation is absolutely key, but there are rightly a number of points within the Bill—which I hope will become an Act—which will take effect only when services are in the right place. It would be wrong to do so without it.

Human Medicines (Authorisation by Pharmacists and Supervision by Pharmacy Technicians) Order 2025

Baroness Ritchie of Downpatrick Excerpts

Tuesday 21st October 2025 Grand Committee

[Baroness Hollins (CB)]

My Lords, some concerns about the order have been drawn to my attention, so I have a few questions for the noble Baroness. Pharmacy technicians, on entry to the register, have an NVQ 3 qualification, which is equivalent to two A-levels. By contrast, pharmacists have a level 7 qualification, a master’s degree, which is a different basic training, with pharmacists obviously having much greater scientific and clinical knowledge. There is a worry that large pharmacy corporations could create pressure or targets which result in pharmacy technician supervision replacing pharmacist supervision for financial gain, which could put patients at greater risk because of the knowledge gap between the pharmacist and the pharmacy technician.

With 16% of 237 million drug errors annually being due to dispensing errors, I ask the Minister, who will, after all, be legally responsible in the event of any patient harm, why supervision is not defined in legislation or in the draft SI. I could not find any evidence of definition. The noble Baroness said in her introduction that pharmacists would be required to make a clinical check, but I cannot see that in the order.

I understand that, in the government consultation, 58% of all respondents and 76% of pharmacist respondents opposed allowing pharmacists to authorise pharmacy technicians to supervise the preparation, assembly, dispensing, sale and supply of prescription-only medicines in pharmacies. Also, 51% of respondents and 65% of pharmacists disagreed with allowing pharmacy technicians to supervise the preparation, assembly and dispensing of medicines at hospital aseptic facilities in the way that pharmacists do under current law.

That generates a few questions. First, what is in place to prevent any one pharmacist—for example, one working centrally across a chain of stores—writing an authorisation for large groups of pharmacy technicians on the register to supervise medicines preparation, assembly, dispensing, sale and supply from, potentially, every pharmacy on the register, implying indirect supervision en masse? If this cannot be done in a single authorisation, could any one pharmacist write multiple authorisations to the same effect? Is it correct that an authorisation can be made without the explicit consent of the technician, and that, once made, it can be withdrawn or varied only by the pharmacist who gave it? If that is correct, individual pharmacists in pharmacies would be powerless to withdraw the authorisation if they were not the one who gave it, even if they were the pharmacist on the premises and had concerns. It seems that, even if the on-site pharmacist was not the one who issued the authorisation, they might be liable for something that occurred but which they were powerless to prevent. It just does not seem clear enough; that is the reason for my questions.

The government website states:

“Although the presence of a pharmacist in retail pharmacy is not explicitly stated in law, section 70(2) of the Medicines Act 1968 requires that a responsible pharmacist must be in charge of what happens at a retail pharmacy. This means, in law, the ‘physical presence’ of a pharmacist is inferred”.


Can the Minister confirm whether this inference is drawn from the responsible pharmacist regulations 2008, which have been revoked? The General Pharmaceutical Council’s rules are expected to allow for a pharmacist to be absent from a pharmacy, and for a pharmacist to be responsible for more than one pharmacy and, therefore, not physically present in all of them. How will authorisations be tracked so that a local pharmacist can know whether a given authorisation is current or has been withdrawn orally or in writing or varied? The authorisation could have been given by a different person, on a different date and on different premises.

It looks as if a pharmacy technician can hold two or more different authorisations—one of which could be oral, which may be useful in times of emergency or great pressure—but this order requires either verbatim recording or video recording at the time, stating either a date of expiry or that this overrides the previous authorisation. What happens if authorisations conflict? How will a conflict be resolved if, for example, one pharmacist allows the supply of certain drugs and another prohibits it?

This brings me briefly to the Terminally Ill Adults (End of Life) Bill, which, in its current form, provides sweepingly extensive powers for the Secretary of State to amend the entirety of the Human Medicines Regulations 2012 and to make regulations regarding the preparation, assembly and supply of lethal substances —particularly in Section 37(4). This could allow pharmacy technicians to supervise, prepare, assemble and supply highly toxic lethal mixtures. Many medicines are incompatible when taken together, which is a concern.

I apologise for the complexity of the questions and the confusion that this order has provoked.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Hollins, in this debate. First, I declare an interest as a member of your Lordships’ House’s Secondary Legislation Scrutiny Committee. Only last week, I met the Company Chemists’ Association, which very much endorses this order. This morning, I chaired a round table on vaccinations, which showed quite clearly that, if community pharmacies are able to execute vaccinations on a widespread basis, their other work in terms of dispatching and gathering together prescriptions can be done by fully regulated pharmacy technicians.

However, I take on board the point from the noble Baroness, Lady Hollins, in respect of qualifications and the wide gap in those qualifications. There are also issues to do with terminally ill adults and medication and prescriptions, particularly around contraindications. If that happens, it could have severe consequences for the patient.

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[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their valuable contributions to today’s debate. I noted the discussion between noble Lords about whether they could agree with several noble Lords at one time; the answer is yes because I can do so, too. I feel that the questions asked will shine a useful light.

I am grateful for the support that this order has received and for the understanding that it is about releasing capacity and meeting what people need these days, as compared to the situation in 1933—or, indeed, at any time since then. This is about our move from hospital to community; our reliance on and welcoming of the whole pharmacy sector; and what that sector can bring to us. This sector is a tremendously important part of our National Health Service and allows us to provide services when, where and how we need them; I add my thanks to pharmacists, pharmacy technicians and their professional bodies for their work in this area. I hope that, overall—I picked this point up—noble Lords will see that this order is about supporting pharmacy services, supporting patients and cutting the red tape that frustrates both the sector and those who use it.

I turn to the specific questions asked by noble Lords; I will of course be glad to write if I do not manage to address any of them. The noble Baroness, Lady Hollins, my noble friend Lady Ritchie and the noble Lord, Lord Scriven, raised concerns about the order, particularly in respect of pharmacy technicians’ qualifications. Let me say at the outset—this is quite a good framing, really—that pharmacists are of course absolutely critical in delivering pharmaceutical services, but the fact is that they cannot deliver without a dedicated team. That is what we are building on.

Pharmacy technicians are ready for these changes. Their training and expertise enable them to take responsibility for many activities that would previously have been the sole responsibility of the pharmacist. I can certainly say that post-registration training and professional guidance will be supporting these changes into practice. I say this to noble Lords: the answer to a number of the questions that have been legitimately asked is the professional guidance, because, as I know noble Lords will understand, this cannot all be laid out in legislation.

The noble Baroness, Lady Hollins, and the noble Lord, Lord Kamall, asked about definitions in respect of clinical checks. Let me start by talking about the professional guidance, which will set out what the pharmacist’s role is to be—including when and how there will be a need for a clinical check. It is important to say that the sector wanted pharmacy technicians to be able to work autonomously; that falls outside what “supervision” traditionally means. Therefore, we are introducing a second form of delegation, which will allow pharmacists to authorise a pharmacy technician to undertake or supervise dispensing activities without the need for direct supervision by the pharmacist. We are aware that we need to give the sector the legal clarity that noble Lords have asked for with regard to what “supervision” means in this context; I can refer noble Lords to a detailed annexe that was published alongside the consultation, but the point is well made.

The noble Baroness, Lady Hollins, my noble friend Lady Ritchie and the noble Lord, Lord Scriven, raised various questions in respect of what I will refer to as indirect supervision en masse and the need for a responsible pharmacist. So let me give the reassurance that these proposals do not remove supervision or change the legal requirement that a responsible pharmacist must be signed in at a registered premises when dispensing activities are taking place and when open to the public. We have stressed at every stage of formulating this policy our commitment to maintaining the legal requirement that noble Lords are rightly concerned about, whereby every community pharmacy must have a pharmacist on the premises.

The noble Lord, Lord Scriven, asked why there is a reference to “any member of staff”. The reason is that pharmacists will be able to authorise any member of staff to hand out checked and bagged prescriptions but they must be authorising only staff who are trained, competent and confident to undertake a task. There will be updated professional standards and guidance to ensure that good governance supports the safe implementation of these changes in practice. Therefore, it could not be, for example—the noble Lord might have had this in mind—an assistant in a supermarket who happens to be working in the pharmacy. That would not meet what is required. Again, that is an important point.

The noble Baroness, Lady Hollins, asked how authorisations will be tracked and what happens if there is conflict. I go back to my opening comments that practice matters cannot be set out in law. They will be addressed in professional standards and guidance, as I have said. That will be set by the regulators and professional leadership bodies to support the implementation of these changes into practice, and we look forward to working with those bodies. That should include professional expectations for record-keeping requirements when an authorisation is given. Training is to make clear to all staff—I return to the point raised by the noble Lord, Lord Scriven—that they need to follow standard operating procedures for when the authorisation is given, when they should consult the pharmacist and when a supply should not go ahead. That will all be part of that.

My noble friend Lady Ritchie and the noble Lord, Lord Kamall, asked about matters relating to Northern Ireland. As I mentioned, when pharmacy technicians become a registered profession in Northern Ireland, which is expected by April 2027, we will work with the Northern Ireland Department of Health to enact the other changes as soon as possible.

[Baroness Ritchie of Downpatrick (Lab)]

I thank my noble friend Lady Merron for that helpful information. Initially, up-and-running pharmacy technicians were to be registered by 2025. Why the two-year delay in terms of Northern Ireland? Maybe she would be so good as to ask Minister Nesbitt.

[Baroness Merron (Lab)]

I cannot give a specific answer, but I will be pleased to write to my noble friend and other noble Lords about the timetable rather than land Minister Nesbitt in it in any way, which I would never wish to do. But I can give the assurance to noble Lords that officials are in regular contact with their counterparts in Northern Ireland, and the measures we are talking about have been developed in collaboration with the devolved Governments and the four chief pharmaceutical officers across the UK. I hope that will be helpful.

The noble Baroness, Lady Bennett, asked about a focus on improved training before the regulations. Pharmacy technicians undertake two years of focused training in clinical settings, and they can provide clinical and dispensing services that are appropriate to their level of training at the point of registration. However, additional post-registration training is widely available to support technicians to prepare for these new roles. Assurance is also provided by the annual revalidation for all pharmacy technicians across the country. If we combine this with robust standard operating procedures and professional guidance, it will provide a clear frame- work to ensure that pharmacists can be confident to authorise pharmacy technicians to carry out, or to supervise others carrying out, activities while ensuring patient safety, which is at the heart of this, as well as service.

HIV: Testing and Medical Care

Baroness Ritchie of Downpatrick Excerpts

Monday 20th October 2025 Lords Chamber

[Baroness Merron (Lab)]

Although I cannot answer specifically, I would be very happy to write to the noble Lord about what information is in pharmacies. I know the noble Lord will appreciate, as your Lordships’ House has welcomed, the greater use of pharmacies, not least because they are more accessible for those who otherwise would be disadvantaged.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, HIV testing rates are vital. When the Minister meets the devolved Ministers for the nations and regions, particularly the Minister for Health in Northern Ireland, I ask that she talks to them about this important area, with particular reference to Positive Life Northern Ireland, which is a voluntary body doing enormously good work with those with HIV. It received a shortage of funding, or did not receive funding, from the department this year.

Alzheimer’s Disease

Baroness Ritchie of Downpatrick Excerpts

Monday 13th October 2025 Lords Chamber

Asked by

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what plans they have to ensure all people with Alzheimer’s disease have access to a timely and accurate diagnosis to improve access to care and quality of life.

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

My Lords, in the 10-year plan we announced that we would deliver the first ever modern service framework for frailty and dementia to reduce unwanted variation and narrow inequality in diagnosis and care for those living with dementia. It will set national standards and redirect NHS priorities to provide the best care and support, which will be central, along with access to a timely and accurate diagnosis.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank my noble friend the Minister for that Answer, but I will press her a little further. According to Alzheimer’s Research UK, one in three people in the UK living with dementia currently do not have a diagnosis. Unlike other major conditions, such as heart disease or cancer, dementia does not have national waiting time targets. Therefore, what plans do the Government have to introduce an 18-week referral to treatment target to give those people with dementia, and their carers and families, parity with other conditions?

[Baroness Merron (Lab)]

In our development of the modern service framework for frailty and dementia we are engaging with a wide group of partners, because we need to understand what should be included to ensure the best outcomes. I hope my noble friend will welcome that we are going to be considering what interventions should be supported to improve diagnosis waiting times—which are, I certainly agree, too long in many areas. In addition, we are considering all the options to help reduce variation, including reviewing metrics and targets, as my noble friend refers to.

Respiratory Syncytial Virus: Vaccination Programme

Baroness Ritchie of Downpatrick Excerpts

Tuesday 9th September 2025 Lords Chamber

Asked by

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what assessment they have made of the adequacy of the respiratory syncytial virus vaccination programme in ensuring all infants receive an equitable offer of protection from the virus.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, first, I thank the Minister for being present to respond to this debate; the noble Lord, Lord Kamall, on the Opposition Benches, who used to be the Minister responding to my questions and debates on these issues; and the Government Whip, who also used to respond to some of my questions.

RSV is a major public health threat, and vaccination is a key tool to combat the risk to infants. Each year, thousands of infants and older adults are hospitalised, causing pain and distress to families and significant costs to the NHS and productivity. Vaccination against respiratory syncytial virus is proven to significantly reduce the risk of RSV-related lower respiratory illness and to minimise potential disease progression and complications.

The UK was one of the first countries in the world to recommend and implement a maternal and adult national immunisation programme when it was rolled out across the nations and regions in September last year. The two programmes have been widely hailed as significant successes, both achieving higher than expected uptake. The RSV vaccine has been offered to pregnant women in England since September 2024 to address the significant burden of RSV-related illness, hospitalisations and deaths, particularly among infants under six months of age and older adults who are at increased risk.

The latest government data for RSV vaccine coverage of pregnant women in England is encouraging. Of the 37,328 women reported as having given birth in the survey month of April 2025, 54% had received the vaccine. The highest coverage was reported in the south-east, with 63.4%, and the lowest in London, with 44.8%. Coverage also varied by ethnic group: the highest coverage was reported among the “other ethnic groups— Chinese”, with 70.6%, and the lowest was among the “Black of Black British-Caribbean” category, with 25.6%.

The UK’s maternal RSV vaccination programme is already delivering positive results for patients and the health system, supported by emerging real-world data from other countries. Recent UK data published on the immediate impact of RSV vaccination is very encouraging, both for the effectiveness of the vaccine in preventing sickness and in alleviating hospital pressures—a key priority for the Government and the health system.

A preprint study from Public Health Scotland reported vaccine effectiveness against RSV-associated hospitalisation of 82.91%, averting an estimated 228 cases of RSV-related LRTI hospitalisation in infants aged greater than 90 days. Estimates from the BronchStop clinical research group highlight vaccine effectiveness of 72% against RSV-associated hospitalisation for infants whose mothers were vaccinated more than 14 days before delivery.

It is interesting to note the positive data from Argentina. Alongside the UK, it was one of the first countries to roll out the programme. This data adds further weight to the benefit of maternal vaccination against RSV, with similarly positive effectiveness against severe disease, hospitalisation and deaths.

The analysis estimates that just over £14 million of the £80 million annual cost is due to productivity losses and about £1.5 million to out-of-pocket costs incurred by parents or carers. The remaining £65 million is healthcare costs, including 467,230 GP visits and 33,937 hospitalisations per year in the UK for children aged under five with RSV.

The data on the impact of the older adult programme is also positive, highlighting the benefit to individuals, the NHS and the economy. The burden of RSV in older adults is equally significant. Each year in the UK there are approximately 3.6 million cases of RSV in adults, leading to an estimated 600,000 GP visits, 460,000 NHS 111 calls and 24,000 hospitalisations. The annual cost to the NHS of looking after adult patients with RSV is considerable.

The early data from the RSV programme is positive but now is a critical time to focus on uptake across all vaccine programmes to help reverse the trend in declining uptake. Although these very early successes must be celebrated, they also must be set against the background of a concerning dip in uptake across many other childhood and adult vaccination programmes, an issue already identified by the Royal College of Paediatrics.

Therefore, we should be reinforcing our shared public health goal of continuing to ensure vaccinations are widely available and doubling down on efforts to ensure they reach everyone. I was deeply concerned at the weekend to learn that there was a doctor from the United States speaking at the Reform conference, denying and decrying vaccinations and vaccines, which I thought was totally irresponsible.

The gap in uptake between the highest and lowest geographical areas in the UK for maternal RSV, and the significant differences in coverage by ethnic group, highlight the urgent need to improve uptake where it falls well below expectations. Extra care and attention must also be given to those who may have valid questions about vaccination, particularly newer vaccines. According to the latest UKHSA figures, none of the main maternal and childhood vaccines in England reached the WHO target of 95% in 2024-25.

This follows hard on the heels of findings published recently that showed one in five children will start primary school without protection against diseases like measles, mumps and rubella. In response to questions about the worrying fall in uptake across vaccine programmes, Minister Dalton cited a lack of access as a key challenge preventing eligible people taking up vaccines; that was considered to be one of the impediments. The ambition of the 10-year plan to enable healthcare to be delivered closer to where people live can only be a good thing for vaccine uptake, particularly if this means vaccination can be delivered across a range of settings, from GP practices to pharmacies, and via midwives for maternal vaccination programmes such as RSV, which is fast becoming an exemplar case.

As we approach a year since the launch of the RSV programme, we must continue to ensure uptake improves to support public health, help minimise the burden on our health system and to minimise the financial impact on parents, carers and employers. In this regard, I am very concerned that there is an equitable distribution and an equitable accessibility to those vaccines for all parents, particularly with infants.

Therefore, I have certain questions for the Minister. First, what steps are the Government taking to ensure that all infants are able to access protection going into their first winter respiratory season, including those who were born too early for maternal antibodies to transfer and infants whose mothers choose to not participate in the maternal vaccination programme?

Secondly, what steps are the Government and the NHS taking to avoid exacerbating inequalities by reducing the current variation in uptake of the maternal vaccination programme across regions and ethnic groups? Finally, will my noble friend the Minister commit to ensuring that comprehensive real world data is systematically collected and analysed from the maternal RSV programme, and will she outline the steps that the department will take to use this evidence when shaping future health policy and immunisation strategies?

I would like to thank the Minister for being here this evening to respond. I look forward to her answers and an update on accessibility and—shall we say—equal accessibility to those RSV vaccines for children and infants throughout the UK.

Suicide Reduction

Baroness Ritchie of Downpatrick Excerpts

Monday 8th September 2025 Lords Chamber

Asked by

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what steps they are taking to reduce the rate of suicide.

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

My Lords, our Plan for Change clearly commits to a renewed focus on preventing suicides. We know that one-third of all suicides are committed by people who are in contact with mental health services, and our new 10-year health plan sets out how we will strengthen and improve those services. We are committed to delivering an ambitious cross-government suicide prevention strategy to extend our reach, and recently published the new Staying Safe from Suicide guidance.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank my noble friend the Minister for her Answer. Wednesday 10 September is World Suicide Prevention Day; can my noble friend give the House further assurances that the Government are intent on delivering the suicide prevention strategy for England and the implementation of the ambitions contained therein? Will the Government work with civil society, including charities such as the Samaritans—which is currently subject to some restructuring—to ensure that suicide prevention is an integral part of the delivery of the NHS 10-year plan, to which the Minister has already referred?

[Baroness Merron (Lab)]

I am very pleased to be able to provide the assurances that my noble friend seeks. I reiterate our commitment to implementing the strategy. My colleagues and I continue to work closely with our trusted partners in civil and voluntary society and elsewhere. The Secretary of State will be joining the Samaritans this week at their World Suicide Prevention Day event. I am also pleased that the e-learning module from NHS England’s Staying Safe from Suicide guidance, which I mentioned earlier, will be launched later this week.