Maternity Services

Baroness Taylor of Bolton Excerpts

Thursday 25th January 2024 Lords Chamber

Moved by

[Baroness Taylor of Bolton]

That this House takes note of the delivery of maternity services in England.

[Baroness Taylor of Bolton (Lab)]

My Lords, I am pleased to have this debate today. I thank those who have put their names down to speak. It is really interesting to see the level of expertise on this subject here, which proves the value of this House in contributing to wider debates.

One of the reasons that I wanted to discuss this issue was the pressure on maternity services that I have been hearing about in my local area. In Kirklees, we have no NHS birthing facilities whatever; it is one of the largest metropolitan areas in the country. The unit at Huddersfield Royal Infirmary was suspended more than 12 months ago and the Brontë Birth Centre in my former constituency of Dewsbury, whose opening I remember with a fanfare as something to be celebrated, has been closed since August 2022. The basic reasons for these closures have been the crisis in staffing and the level of staffing shortages. The local trust is trying to reopen the Brontë centre, working with a neighbourhood trust, but the problems of staffing are having a real input and will be a deciding factor.

No one can doubt the critical importance of maternity services. Those of us who have given birth will recall many details, good and less good, of that experience. The experience of maternity care can affect the future of both mother and baby. A difficult birth experience can affect bonding and early relationships—a point emphasised to us by the Royal College of Psychiatrists. Everybody who is involved in maternity services will know the significant responsibility that they have. Thankfully, most pregnancies end in the birth of a healthy baby, although that in itself does not mean that the mother’s experience has been optimal. On the other hand, some expectant mothers have their own views of what their experience should be; sometimes, those views are not realistic and can create extra pressure on midwives and others. Locally, I know that the trust has reported more high-risk women wanting births in settings designed for low-risk women, creating extra pressure and highlighting the complex problems that many midwives have to face.

I want to start with the recent important reports on the overall state of our maternity services. The report from the Care Quality Commission is absolutely critical here but I believe we have all received many briefings from mothers of babies, the Maternity & Midwifery Forum, the Nuffield Trust, Mumsnet, SANDS, the Royal College of Obstetricians and Gynaecologists and, of course, the Royal College of Midwives. They have all consistently reported a very alarming situation.

The Care Quality Commission tells us that maternity services were under pressure prior to Covid and that that has worsened. Covid did not help but we cannot continue to use it as an excuse for all the failings in all our services across the board. The pressures on maternity services have been building for more than a decade. The commission also tells us that almost half of all the maternity services inspected in 2023 were rated as either in need of improvement or inadequate—an increase on last year, with things moving in the wrong direction.

Many factors have been highlighted by the CQC. Staffing shortages—especially retention issues, which I will come back to in a minute—are top of the list but it has also reported systematic racism, leadership issues, and workplace and environment issues. All of these are significant and each needs attention but we should not lose sight of the overall situation and the fact that nearly half of these units are causing concern. In those circumstances, we need to stop and think about what needs doing—and doing urgently. I know that there has been considerable ministerial churn and that current occupants may try to distance themselves from previous decisions. Although new Ministers must say that there should be greater emphasis on women’s health, et cetera, the same party has been in government for 13 years and decisions taken during those 13 years have made the situation worse. I think that Ministers in that Government are culpable.

To my mind, the most significant problem is clearly the shortfall in staffing, in particular the imbalance in the workforce because of retention problems. The fact is that many senior midwives, gynaecologists and obstetricians are leaving their professions. There are concerns about the number of students going into midwifery and their experience but the problems of retention make the situation critical.

Earlier this month, the BBC reported on midwives being concerned that staff shortages were causing safety issues. One midwife reported that she kept patients safe only by the skin of her teeth; another said that she had quit because she could not face the possibility of the consequences of poor care. I know of one experienced midwife who left her chosen profession after being in sole charge of six women in labour and being afraid for her own mental health because of all the pressures that that responsibility brought.

The Royal College of Midwives says that staffing is the most important issue. We hear that some trusts have one in five jobs unfilled. In Kirklees, the figure is 18%, but it is not a matter of just getting more students into midwifery. Retention is a serious problem and burnout is a real issue. If we cannot retain experienced midwives, we cannot give student midwives the support and the mentoring that they need during placements.

There have been some suggestions that existing midwives feel threatened by some of the training changes that were introduced a few years ago, and there is always a question about the balance between theory and practice. Certainly, the profile of students in midwifery and nursing generally has changed. I know from my time as chair of the University of Bradford, which has a fantastic department in this respect—maybe the Minister would like to visit—that the profile of students coming into nursing has changed significantly, especially when bursaries were cut by this Government. The intake of mature students declined sharply and immediately, and it has not fully recovered. It has been pointed out to me that having mature students among the student group helps everyone to develop and understand what all the pressures can be. Of course, many students are feeling the cost of living crisis and want to work to survive financially, which is obviously not easy if you are on a midwifery course. I worry about the figures for those dropping out of their courses in the early years.

One factor that particularly worries me is that I am told that there is less continuity of supervision of students on the ward during placement. Each student used to have one named mentor, but I am told that this is no longer the case and that students therefore report that they no longer feel part of a team or that they belong, and that this was also affecting the drop-out rate. Overall, this is a worrying picture. Unless the Government address the retention issue, we will not make the substantial improvements that we need.

I must also talk about maternal mortality. The latest report shows that it has risen to its highest rate in 20 years. A key finding is that the maternal death rate for black women is three times higher than that for white women; for women from Asian ethnic backgrounds, it is two times higher; unsurprisingly, women living in the most deprived areas have a maternal mortality rate twice as high as that for the least deprived. This is not a revelation; other reports have talked about it for a long time. There is no excuse for a lack of action here. I note that the Select Committee in the Commons pointed out that, at the time it was writing its report, the Maternity Disparities Taskforce had not met for nine months. That cannot be acceptable and shows a worrying level of complacency.

I have outlined a very depressing situation, and urgent action is needed. Midwives and others deserve credit and recognition for the work that they do—my noble friend Lady Thornton will tell us about the remarkable achievements in her area of dealing with the consequences of female genital mutilation, and I know from a colleague in the other House, Jess Phillips, that midwives are often critical in helping women escape from abuse—but, overall, we have a crisis. For such a significant service as maternity, in 2024 this is unacceptable. It is up to the Government to provide a proper lead to solve this. I emphasise again that the No.1 priority must be the retention of experienced nurses and midwives. We need a raft of measures to reduce the pressure on midwives and allow them to feel that they can do the job that they are trained to do and want to do to the level that they want to achieve. If the retention issue is not tackled urgently, there will be no space to deal with all the other issues such as updating training. This is all against a general backdrop of serious health inequalities which exist in this country anyway.

We are now in 2024. It is just wrong that maternity services are causing such concern. Every woman deserves the best while pregnant and during childbirth, and every midwife deserves the right conditions in which to work. The Minister said at Question Time earlier that he believed in evidence and common sense. I urge him to attach that common sense to the some of these problems that we are facing this year.

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[Baroness Taylor of Bolton (Lab)]

My Lords, I thank everybody who has taken part in this debate. I think we have all learned from each other, and it has been really interesting to see the different levels of experience and how they have come together, but I hope the Minister is acknowledging that, despite people coming at this from different levels of experience, the actual message is extremely clear: we have a crisis in maternity services and unless the Government take action quickly, we are going to see more of the scandals that have alarmed us so much in recent years. We all recognise the dedication of the staff and acknowledge that they do their best, but we are facing a very depressing situation and, indeed, a crisis. I know there have been calls for new inquiries and new plans, but, as my noble friend Lady Warwick said, we have many of those but we do not have the building blocks and the progress to underpin what actually needs to be done.

I am struck by the fact that we have this cycle of problems. Current midwives are overworked, so they do not have time for extra training, or to mentor students, or to listen to mothers, as several Members have said is vital. Therefore, they get burned out; therefore, we have fewer midwives and all these pressures intensify. I think that that is really the crux of where we are now. Unless we can break that cycle and find some way of giving experienced midwives the support they need, this problem is going to continue. Of course, there are problems in terms of students and drop-out rates. The noble Baroness, Lady Watkins, mentioned the cost of second qualifications, and I do not think we should ignore that as one of the reasons why so many experienced nurses are deterred from moving into midwifery. Similarly, my noble friend Lady Donaghy raised issues about pay structures. These are points that Ministers could take on board and move quickly on, and I hope that the Minister, having listened to so many voices, will feel he can have some confidence that things need to be done in certain ways.

Similarly, I welcome the evidence that the noble Baroness, Lady Gohir, gave us, which everybody took note of and understood and was a bit surprised about, in terms of the lack of data on some of the crucial issues of systemic racism that she uncovered. Maybe the answers lie, as the noble Lord, Lord Allan, suggests, in different ways of working with the IT systems, but it is something I think the Minister could make real progress on very quickly and I hope the debate has helped in this respect.

I hope that what the Minister said about the Brontë Birth Centre in Dewsbury is correct: we want to see it open in April, but it is dependent on the staff being available. Incidentally, when we lose a place such as the birth centre in Dewsbury or the facility in Huddersfield, we do not just lose the maternity and labour provisions for women, we lose the student placement positions that allow us to train more people, so it really is a very serious situation.

We can all agree that women deserve good, local facilities when they are in maternity services. All women need proper care. All midwives, I would say, deserve the joy and the pleasure of seeing women cared for properly and the healthy births that the noble Lord, Lord Patel, talked about. I think that to achieve that, we need a step change, and I hope that this debate has been one significant step forward in urging Ministers to look at this problem with a new eye and new determination. I beg to move.

Motion agreed.

National Health Service: 75th Anniversary

Baroness Taylor of Bolton Excerpts

Thursday 30th November 2023 Lords Chamber

[Baroness Taylor of Bolton (Lab)]

My Lords, I congratulate my noble friend Lord Hunt on securing this debate and on outlining not just current problems but potential ways forward, which is what we should be concentrating on. This is an important debate, because few issues are more significant for us as individuals and indeed as society. Our individual and collective health and well-being very much depend upon a robust NHS. The figures my noble friend gave, including the 7.8 million on the waiting list, showed very clearly that we do not have that today, I am afraid.

Time is always limited in these debates, and there are certainly many aspects of the current state of the NHS that warrant mentioning—alas, far too many to mention. However, unusually, I want to start by mentioning some of the briefings we have probably all received in the last few days since this debate was announced. I was particularly struck by the briefing paper from the Association of Directors of Adult Social Services. It highlighted that in August, more than 470,000 people were waiting for a care and support assessment to begin, up 8% on March of this year. It highlighted the almost universal view that increased pressures on the NHS will put even more pressure on adult social care—a significant and growing problem.

We also had an interesting paper from a well-known opticians, pointing out that greater use of the glaucoma referral system, with optometrists working with the NHS, can significantly benefit patients and the whole of the NHS service; a similar situation arises with audiology services. The Royal College of Psychiatrists told us in its detailed paper about the contribution that early support hubs can make. The Bowel Cancer UK group gave us striking figures that nine in 10 people will survive bowel cancer if diagnosed early, but only four out of 10 are actually being diagnosed early. The most significant point about all these examples is that they highlight issues that are not simply about asking for more funds. They are pointing out and giving examples of how early invention can not only benefit patients and individuals but reduce long-term costs.

All of those examples and that theme link up with what we were told by Universities UK, which has outlined the problems we are seeing with applications from students for positions in critical areas of nursing and the whole range of medical specialties. Even if we did get the increase in the number of students, we are also short of clinical academics and people to do the teaching to get the placements they need in our hospitals. This area is particularly critical to the way forward. Although the Government sometimes boast about increasing student numbers, there is still a very long way to go before we recover from the cuts made from 2010. That is one of the reasons why we are in such a serious situation.

I want also to mention one other issue that particularly alarms me. In October, just a month ago, the Care Quality Commission rated 65% of maternity services in England as inadequate or requiring improvement. Its report says, having inspected 73% of all maternity units:

“The overarching picture is one of a service and staff under huge pressure”.


Despite the efforts of staff, who are often praised because of their efforts by people on the receiving end, many women are still not receiving the safe, high-quality care they deserve. The CQC went on to say that this was particularly a problem for ethnic-minority women, for whom the service was particularly poor. Its overall assessment was that we have a deteriorating position in maternity services. All of us who have children know that the moment a child is born is one of the most important times of your life. It really is alarming that, in 2023, 75 years after the establishment of the health service, which was partly formed to improve maternity services, we have that situation.

I must just mention a related issue from my local area. Last week, it was reported that no babies have been born in Kirklees for around 18 months. Kirklees is one of the largest metropolitan council areas, covering Huddersfield, Dewsbury, Batley and lots of other smaller towns, yet there are no facilities for childbirth there. The units in Huddersfield and Dewsbury have been closed. Just imagine being a pregnant woman going into childbirth and having to travel potentially for an hour in those circumstances. The reason given is staffing issues. There are plans for the future, but in some cases it will take nearly two years before that service becomes available.

I have the figures for the increasing number of doctors, midwives and consultants under a Labour Government, but I end by echoing what my noble friend said: we fixed it last time; we are going to have to fix it again.

Long Covid

Baroness Taylor of Bolton Excerpts

Thursday 17th November 2022 Lords Chamber

[Baroness Taylor of Bolton (Lab)]

My Lords, I join those who have congratulated my noble friend on, and thanked her for, introducing this debate. I am sure that she is very pleased with the expertise we have had in the House today, which shows the kinds of contributions we can make to furthering issues of this kind. I am not an expert on health matters in any way, but it has been striking how significant the big picture of the problems facing everyone is, and we should all be aware of the difficulties that are being created.

The estimates we have heard about are of 2 million cases or more, because it is self-reporting. It means that this is a very significant problem both for individuals who are affected but also for society and, as the noble Lord, Lord Bethell, was saying, for the economy as a whole. Long Covid affects the individual, but it also affects their family, friends, employment, society as a whole and the economy, as we have heard. The cases we have heard about show the extent and range of problems that are involved. I was struck by the BBC today talking about a young girl in the north-east who had missed virtually two years of education because of long Covid, which obviously affected the whole of her family.

We have heard today about key workers in particular who have had their lives turned upside down. It has been difficult for them as individuals and for their families, but it is also a great loss for all of us if they are not in the National Health Service participating as key workers. The fact that many are not able to return to work is a very significant problem for us all. I listened to what was said about medical research. I think we were all very struck by what the noble Lord, Lord Kakkar, said, and I hope the Minster can accept that that is a particular way forward.

Regarding the impact on the economy and society, I want to pick up what my noble friend Lady Thornton said about the need for employers to have better guidance on how they should react. I would like to know more about what is happening here, because we are suffering very significant skills shortages in many areas, which is holding back our economic progress. The fact that individuals vary in how they are affected by long Covid needs to be more widely understood. Somebody may be okay one day but not the next, which is not easy for employers to deal with. The need for greater flexibility on employment is important, but we also need co-ordination across government.

Turning to the impact on individuals, the situation seems to be extremely varied. Early on, there was probably a lack of understanding by medics and others, but many people who suffer from long Covid, as was being said on other illnesses, find that doctors and medics generally vary in their understanding. Some people feel that it is very difficult to be taken seriously for problems of this kind. The idea of a post-Covid assessment service is clearly very welcome, but it is concerning to hear that over a third of the people who need that service must wait for several months—and that is not months since they first got Covid but months since they first realised that there was a longer-term problem. So we need to get a grip on that difficulty.

The right reverend Prelate referred to issues in his area, where only 17% of people were getting access. The issue of a postcode lottery in any area of health is a problem—and it certainly is here—as is the difficulty that sometimes arises with statutory sick pay. Not all people are entitled to it, and people tend to go back to work because they have no option and need the money, which can lead to longer-term problems in the end. So we need some better co-ordination on the part of government to ensure that everybody is covered.

I will raise two particular points with the Minister. The first is the fact that Covid is not over, and I worry about complacency settling in on this issue. Mention was made that, in the early days, it was in the media all the time, but now it is hardly ever mentioned. People are not coming forward for vaccinations as much as they should. We do not know what the next variant will be or when it will hit us, and the Government must be prepared to step up their game to make sure that we do not become too complacent.

Secondly, the current Chancellor of the Exchequer was chair of the Health Select Committee and, if the Minister looks up the tweets and statements made by Jeremy Hunt when he had that role, he will find many quotes that the department can use to get leverage for extra funding in this area. So I recommend that he does his homework on the present Chancellor of the Exchequer; his department might find that very useful.

Abortion: Misoprostol

Baroness Taylor of Bolton Excerpts

Tuesday 20th March 2018 Lords Chamber

[Lord O'Shaughnessy]

I am not aware of any research, but I shall ask the department to see if there is any. If there is, I shall write to the noble Baroness.

[Baroness Taylor of Bolton (Lab)]

My Lords, if the information we have just had is correct that more women, especially young women, are buying abortion drugs online, surely that proves the point that we need to improve the abortion services that we have within the NHS and the advice that is given to young women.

[Lord O'Shaughnessy]

No, I do not think it proves that. The fact that illegal drugs of all kinds are being bought online, whether they are illegal drugs or prescription drugs bought illegally, is a feature of modern life. Rates of abortion in the under-18s are falling, as is the teenage pregnancy and conception rate. Those are separate issues.

Hormone Pregnancy Tests

Baroness Taylor of Bolton Excerpts

Thursday 16th November 2017 Lords Chamber

[Lord O’Shaughnessy]

As I pointed out in response to the noble Baroness, Lady Thornton, transparency is there in the evidence and minutes that will be published. The report that has come out is big and chunky and contains a huge amount of information. There was an independent member in Nick Dobrik, the thalidomide campaigner, and Mrs Lyon, who chairs the families group, was an observer. We touched on confidentiality agreements. As I said, there is nothing out of the ordinary in that. I think transparency is there. I come back to the point that the working group was set up to examine all the available evidence scientifically. The department provided its scientific and non-scientific papers for that effort. I know the report has not come up with the conclusions that the families wanted, but it is the right group to have made that judgment.

[Baroness Taylor of Bolton (Lab)]

My Lords, I understand that the Minister realises the concerns of those families who have been affected. He put the case and described how the inquiry was conducted very clearly but, as has been said, there is still quite significant concern outside this House among Members of Parliament and the families concerned. If we are talking about getting reassurance, perhaps it would be useful to have a proper debate on the findings of the report so that all these aspects can be laid out in greater detail, including the case from the Minister.

[Lord O’Shaughnessy]

I would certainly welcome such a debate. I know that was discussed in the debate in the other place on the Urgent Question. I want to emphasise the seriousness with which I take this issue. I had the opportunity to meet Yasmin Qureshi MP, who chairs the all-party parliamentary group, and Mr and Mrs Lyon in early August. I will be meeting them again in early December. I utterly sympathise with them in the experience they have had, and I understand that there is a need to reassure them that the process that has been followed is a proper process. I accept that, and I am making all the efforts I can to do it.

National Health Service (Charges to Overseas Visitors) (Amendment) Regulations 2017

Baroness Taylor of Bolton Excerpts

Thursday 16th November 2017 Lords Chamber

[Baroness Redfern (Con)]

My Lords, I refer to my entry in the register of interests. The regret Motion at first appears to imply that charging overseas visitors is something new. The requirement for the NHS to charge overseas visitors has been in place for 35 years—but, unfortunately, compliance and recovery rates have historically been extremely low.

I thank the NHS workforce for the fantastic job that they do; they are now treating levels of demand not seen before. Do noble Lords not think it only fair that any overseas visitor using our NHS should make a financial contribution, just as we all do when we are on holiday abroad and possibly want to access medical help?

It is important to emphasise that NHS England, NHS Improvement and the department have published guidance to support the embedding of the regulations, producing an average price list so as to better inform and enable patients to look at the up-front charges for anyone not eligible for free NHS care. Those people can then make informed choices about their care here or at home.

I am informed that, in order to protect the most vulnerable and to protect public health, the department remains committed to ensuring that vulnerable groups are always able to receive free care and that no patient will be denied urgent or immediate healthcare, regardless of their immigration status or ability to pay. This includes all maternity care in every setting, including diagnostic, and the treatment of infectious diseases.

Back in July, the department introduced new regulations to support improved cost recovery and make it fairer and more efficient for both the patient and the healthcare system. It saw recovery increase from £89 million to £360 million—all being transferred back into our front-line services.

Finally, with careful monitoring and ongoing assessments and with better use of existing data sources to improve efficiency, we will be able to see for ourselves the financial effectiveness and value for money through this process. These figures will be published in the new year.

[Baroness Taylor of Bolton (Lab)]

My Lords, I first congratulate my noble friend Lord Hunt on initiating this debate. Like him—and other speakers—I acknowledge that the NHS is under significant pressure and that there have been charges for a very long time. However, I say to the noble Baroness, Lady Redfern, that, if there is a problem with cost recovery, these regulations are not the answer.

I am prompted to intervene in this debate because of an organisation in Bolton, my home town: a local group called City of Sanctuary. Its role is to create a culture of welcome and safety for refugees and asylum seekers. As a Member of the other House, I had a considerable amount of casework dealing with refugees, asylum seekers and failed asylum seekers, so I know that its work is extremely important and that it has a great deal of direct experience. It has raised concerns about vulnerable groups, particularly those I have mentioned. I note that this category is not mentioned by the Minister in his letter.

There are three points I want to raise. I have read the Minister’s letter to all Members with care and I thank him for it. He tries to be reassuring, but I am afraid that he does not allay all the concerns that some of us have on the basis of the evidence that has been presented to us.

The Minister says that the regulations require that up-front charging for non-urgent or immediately necessary care will become a legal requirement. That is the basis of these regulations. But there is an immediate problem with the definition of “non-urgent” or “needing immediate care”. I think particularly of those people, such as refugees and others, whose full medical history is not known, may not be available or may not be fully evident, or who may not have proper cognisance of it themselves. It can be a very real problem, I suggest, for both the patient and the doctor. The medical groups who have expressed concern about this have made a very strong case.

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We have also been careful to exempt from charging the diagnosis and treatment of specific infections that could put the health of the wider public at risk. This includes infectious diseases—which was raised tonight—such as pandemic flu and sexually transmitted infections. Finally, no one will be charged for primary medical care, which includes GP care, even if it is received outside a practice.

[Baroness Taylor of Bolton]

In the list the Minister gave, he did not deal with the point that the noble Baroness, Lady Hamwee, and I raised about failed asylum seekers who are still living in England.

[Lord O’Shaughnessy]

For clarity, they are not covered under the exemptions.

The second change the amendments make is to the requirement that any care not deemed immediately necessary or urgent by a clinician is paid for up front. The published guidance, again, for nearly 30 years, has recommended this. This practice ensures that a chargeable patient can make an informed choice about their care and therefore does not unwittingly incur debts when they could instead, for example, choose to wait for treatment until they have travelled home. Given that our NHS is facing unprecedented levels of demand, I hope noble Lords will agree that mandating this position is a sensible approach and that it will help make sure that all users of the NHS make an equitable contribution to ensure its continued success and viability.

The noble Lord, Lord Hunt, has asked whether this practice will not create barriers between vulnerable patients and treatment and result in racial profiling as the front line seeks to determine eligibility for free care. I have already drawn noble Lords’ attention to the exemptions in place and the fact that all GP and A&E services remain free for all. I am also clear that immediately necessary or urgent treatment—such as all maternity services—will never be withheld, regardless of the patient’s ability or desire to identify themselves or pay. To reassure the noble Baroness, Lady Taylor, and other noble Lords, it is for clinicians, and no one else, to determine whether a treatment is immediately necessary or urgent.

On whether patients may face discrimination, this is always unacceptable and not compliant with anti-discrimination legislation. As my noble friend Lord Leigh pointed out, our guidance is clear that simple, short questions should be asked by trained staff of all patients whose records do not already indicate residency status to assist in identifying those not eligible for free care. That information can then be captured in the patient record for the future.

To support the implementation of these regulations, we have developed with front-line staff a “cost recovery toolbox” containing extensive guidance and template letters to patients and clinicians, as well as patient and staff-facing leaflets and posters and a web-based forum for peer support. As my noble friend Lady Redfern pointed out, working with NHS England and NHS Improvement, the department has published operational guidance to support the introduction of the regulations. This includes an average price list to provide consistency in up-front charging. The department has recruited a senior, experienced cost recovery team of NHS professionals who have led improvement visits to over 20 NHS trusts over the last six months. Action plans are in place for each trust and the team will support improvement and the sharing of best practice across the wider NHS.

I would like to end on an issue which has been raised by many noble Lords in this debate: the assessment carried out before we introduced these changes. As I have explained, up-front charging did not represent a change in policy, but instead has existed for many years before the consultation on other amendments. Over the course of the consultation and decision-making process, the Government carefully considered the impact the charges may have and published a full impact assessment alongside the regulations. This concluded that the package of changes would identify up to £40 million a year for the NHS. This is additional income and takes into account any administrative costs associated with the changes. I will also place in the Library copies of the equality assessments carried out by my department to inform the regulations, so that Members of the House will be able to review how the impact on vulnerable and protected groups was very carefully considered prior to the introduction of these changes.

All noble Lords have asked about the implementation of these changes and it is right, of course, that we proceed cautiously and sensibly and that we review how we are doing. So I am very aware of the need to keep the impact of these regulations under careful review in order to make sure they are implemented as planned and with no unintended consequences. My department will therefore undertake a full, formal review of how these amendment regulations are implemented, and monitor delivery closely, particularly where healthcare is provided to the most vulnerable. If further action is needed I will commit to update the House accordingly.

I hope I have been able to reassure all Members of this House about the long-standing principles that underpin our approach to cost recovery, the care that has been taken to protect vulnerable groups, and the reflective approach we will take during the implementation of these policy changes. I believe that they provide an equitable and reasonable step forward in making sure that all the NHS’s users, wherever they come from, make a fair contribution to the sustainability of the NHS, which is what British citizens expect. On that basis, I ask the noble Lord, Lord Hunt, to withdraw his Motion.