Puberty-suppressing Hormones

Baroness Walmsley Excerpts

Monday 16th December 2024 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank the Minister for the Statement and the right honourable Secretary of State for the careful and sensitive way in which he delivered the Statement in the other place. In line with my right honourable friend the shadow Secretary of State in the other place, from these Benches we welcome the Government’s announcement. Whatever your politics, most people believe that one of the first duties of any Government is to protect their citizens, especially our children.

As the Secretary of State said, there has been too much heat, and perhaps toxicity, around the issue of services for children experiencing gender dysphoria, so I welcome the tone with which His Majesty’s Government have approached this issue—less heat, more light—and that they continue to take an evidence-based but compassionate approach. I also take this opportunity to thank the noble Baroness, Lady Cass, for leading the review on gender services for children. The Cass review highlighted the importance of putting scientific evidence above ideology and laid out the fact that we simply do not know enough about the long-term impacts of puberty blockers on children. That is why my right honourable friend in the other place, the Member for Louth and Horncastle, when Secretary of State, banned the routine prescription of puberty blockers for gender dysphoria, and later extended that ban to private clinics.

We welcome the decision of the Government to follow the recommendations of the independent Commission on Human Medicines to extend the banning order until a safe prescribing environment can be established for these medicines. This is a common-sense approach, and allows time for more evidence to be examined to consider the holistic and long-term impacts of puberty blockers on children. The Secretary of State announced the clinical trials to gather evidence but, given understandable concerns about the risks of any clinical trial, can the Minister reassure your Lordships that these trials will have robust safeguards to ensure the well-being and safety of any children taking part, while recognising the importance of having these trials in the first place?

The Secretary of State in the other place also spoke about alternatives to puberty blockers for children suffering from gender dysphoria. As someone who takes an interest in social prescribing, I welcome the Government’s recognition that medication is not always the best solution, so will the Minister share details of some of the alternatives to puberty blockers that will be offered to children?

Finally, noble Lords will be concerned that, despite the lack of evidence, puberty blockers were prescribed to children with gender dysphoria when their safety could not be guaranteed. What steps are the Government and the NHS taking to ensure that a similar situation does not occur again and that future decisions are led by evidence? I look forward to the Minister’s responses.

[Baroness Walmsley (LD)]

My Lords, on these Benches we welcome the tone of the Secretary of State’s Statement. I have often said that there are many ways of being human. Growing up can often be a very trying time for teenagers. How much more difficult, then, for those young people with gender distress who are struggling with finding out who they are while being different from their peers, and all without adequate support? It is high time that proper services were put in place for young people struggling alone with these issues. Their families too need help to support them at this difficult time. For too long, children and young people who are struggling with their gender identity have been badly let down by a low standard of care, exceptionally long waiting lists, even by the standard of mental health waiting lists, and an increasingly toxic debate.

We always want to see policy based on the evidence. With any medical treatment, especially for children and young people, the most important thing is to follow the evidence on safety and effectiveness. It is crucial that these sorts of decisions are made by expert clinicians, based on the best possible evidence. It is also important that the results of the consultation and the advice of the Commission on Human Medicines are made public.

Some might wonder why the treatment is deemed not safe for gender dysphoria patients but safe enough for children with early-onset puberty. More transparency might clear up the confusion and give more confidence to patients and their families. However, the Secretary of State himself admits that he does not know what effect the sudden withdrawal of this treatment for young people already embarked on a course of puberty blockers will have. These are the young people with the most urgent need for other types of care in the current situation, so what clinical advice have the Government taken about the effect of withdrawing these drugs on the physical and mental state of young sufferers of gender incongruence already on the drugs, and what physical and psychological support will be offered to them?

In the current circumstances, plans for a clinical trial are welcome, but we would like to know the criteria for those eligible to participate. What assessment have the Government made of the recent Council of Europe report, which raises the ethical and rights implications of offering participation in the trial to only a small group of patients? If the only way to continue access to these drugs is through participation in the clinical trial, whose scope, length and start date have yet to be announced, this lays the Government open to accusations of coercion and breaches of human rights.

We welcome the plans for additional treatment centres in Manchester and Bristol as well as London, but can the Minister say why they will not be up and running for two years? Is it lack of funding, lack of premises or lack of sufficient therapists with the appropriate specialist training? This is a very sensitive area, so the wrong people could do more harm than good. If that is the reason, is there a plan for training up more qualified therapists in time for the opening of the regional treatment centres? I very much look forward to the Minister’s replies to these questions.

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

My Lords, I start by thanking the noble Baroness, Lady Cass, for her work in this very important area. I also refer to the actions taken by the previous Government, which set in train the action we are continuing. As both the noble Lord, Lord Kamall, and the noble Baroness, Lady Walmsley, rightly said, this is about keeping children safe. There is nothing more important than evidence-based action—which is what we have before us—and taking the necessary steps.

The Cass review made it clear that there is not enough evidence about the long-term effects of using puberty blockers to treat gender incongruence to know whether they are, first, safe and, secondly, beneficial. It is important to bear both in mind. The Commission on Human Medicines independently found that clear evidence of unsafe prescribing exists and recommended that there should be a ban until there can be a safe prescribing environment. That is where we start, and last week’s laying of legislation stops that unsafe prescribing to children and allows time to develop the necessary safeguards, as recommended by the commission. I should just clarify that the legislation is indefinite, not permanent. There will be a full review in 2027 so this continues to be a very live issue.

The clinical trials, referred to by both the noble Lord, Lord Kamall, and the noble Baroness, Lady Walmsley, will be a world first. It is important to pay tribute to that. In addition to the work currently being undertaken to respond to the recommendations of the Commission on Human Medicines, the trial is presently undergoing development and approvals. The aim is to begin recruitment early in the new year. I am sure there will be an opportunity to update the House on that detail.

In answer to the point from the noble Baroness, Lady Walmsley, the numbers will be uncapped, which is important. I am sure we all agree that better-quality evidence is critical. The development of the clinical trial between the National Institute for Health and Care Research and NHS England will provide the better-quality evidence that we are all looking for.

The noble Baroness, Lady Walmsley, spoke about new services. To make the situation clear, NHS England has already opened three new services in the north-west, London and Bristol. The fourth will be in the east of England and will open its doors in spring next year. The noble Baroness also asked about the timetable; we are on course to have a service in every region of England by 2026. I cannot always confirm developments of that nature, so I am glad to do so because it will help reduce the waiting list, which noble Lords are rightly concerned about. It will also bring services closer to home, which is crucial too.

Furthermore, this is a very specialist area, so recruitment and training are key. This is part of the reason for the—I would not call it a delay—realistic timetable. There is also the need to work with local trusts and take into account all the various operational considerations, so realism rather than delay is how I would put it to the noble Baroness.

I agree with the points made by noble Lords on the Front Bench about tone and discourse. I am very grateful to the noble Baroness, Lady Walmsley, and the noble Lord, Lord Kamall, for welcoming the way the Secretary of State made the announcement and what the announcement refers to. We have a real responsibility in this House—and outside it—to handle conversations on this topic extremely sensitively. This is about people’s lives. I absolutely agree with the point just made: the public debate has been frighteningly toxic. Irresponsible statements made recently have put young people at risk of serious harm and that has to stop. That is one of the many reasons I welcome the Statement—and the tone and discourse this evening.

On the point made by the noble Lord, Lord Kamall, about alternatives to puberty blockers, no exact alternatives are being offered. However, within the new services there will be an emphasis on, for example, psychosocial support.

In response to the point made by the noble Baroness, Lady Walmsley, about the—she did not use this word, but perhaps I might—transparency of evidence, all the commission’s recommendations have been published in full as part of the Government’s response to the consultation. The full advice, as I hope the noble Baroness will understand, was prepared solely for Ministers, but we are considering whether it should be published. I know the noble Baroness will understand that, as with all advice prepared for Ministers, there are legal and other matters that must be considered before it can happen.

I will say a word on mental health support, which is so important for children and young people. An offer of an appointment with a mental health professional has been made to everyone on the national waiting list for children and young people’s gender identity services. Those who joined the waiting list on or after 1 September will have an appointment with a mental health professional or paediatrician before being referred to specialist gender services. Those who are not on the waiting list and are directly affected by the restrictions can access NHS mental health services through a dedicated single point of contact, supported by clinical nursing.

I hope that is helpful, and if there are any points I have missed—

[Baroness Walmsley (LD)]

Can the Minister address the issue of the children who are part-way through a course of treatment? Will they get mental health support as a priority?

[Baroness Merron (Lab)]

For those who are already on puberty blockers, there is an immediate withdrawal. But I hope that what I have outlined on mental health support covers all the areas the noble Baroness, and indeed all of us, are concerned about. The approach is as compressive as possible, and the new gender services I described should make it even easier to provide the service. It is not a matter of waiting until 2026; we absolutely understand the need to provide that support now, and we are making that available.

Bread and Flour Regulations 1998

Baroness Walmsley Excerpts

Wednesday 11th December 2024 Lords Chamber

[Baroness Merron (Lab)]

I will be glad to look into that and to update the noble Lord and your Lordships’ House on the matter.

[Baroness Walmsley (LD)]

My Lords, I congratulate the noble Lord, Lord Rooker, on his persistence; these Benches have always supported him. I welcome that more NTDs will be prevented. However, given that we have to wait yet another two years and that the Government’s guidance for women who wish to become pregnant or who are pregnant is to continue taking folic acid supplements, are the Government looking at creative ways of making it easier for them to do that —for example, having them available for free in antenatal clinics or at family hubs?

[Baroness Merron (Lab)]

As I mentioned earlier, while 24 months is a realistic transition, not everything will wait that long. It is the case, as the noble Baroness says, that there is still advice to women who could become pregnant to take folic acid supplements, and it is important that we keep that message going. However, 50% of pregnancies are not planned, so it is not possible to prepare by taking supplements. We are looking at all ways of effectively getting the message across.

Bread and Flour Regulations 1998

Baroness Walmsley Excerpts

Wednesday 11th September 2024 Lords Chamber

[Baroness Merron (Lab)]

My noble friend has been a tremendous campaigner. Indeed, he reminded me that this is, I believe, his 22nd Question on this matter, so I do not wish to test his patience. I absolutely assure him that, as he said, the policy is being taken forward as a UK-wide measure and all the necessary preliminary legislative steps have been taken, including the public consultations he mentioned, which were reported on earlier this year. Subject to renewed collective agreement in England, Defra will lay legislation later in 2024.

[Baroness Walmsley (LD)]

My Lords, I am hearing that, unfortunately, the Government are not being very ambitious in the level of fortification that they will propose. They are considering a level that will reduce neural defects by only about 20%, whereas 1 milligram of folic acid in 100 grams of flour could reduce neural tube defects by 80%, which is a massive amount. Can the Minister at least reassure me that the appropriate committees will look at the level of fortification being proposed, so that it is appropriate and safe?

[Baroness Merron (Lab)]

I assure the noble Baroness that that has already happened. As I am sure your Lordships’ House is aware, the proposal is to add 250 micrograms of folic acid per 100 grams of non-wholemeal wheat flour. I emphasise that this fortification would be in addition to the foods that are already voluntarily fortified, such as a wide variety of breakfast cereals, so we are not talking about just bread. The feeling among the experts, to whom we listen, and the committees to which the noble Baroness referred is that this is the right level at which we can provide reassurance, and so this is where we are focusing our efforts.

NHS: Breast Screening Programme

Baroness Walmsley Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Merron (Lab)]

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

[Baroness Walmsley (LD)]

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

[Baroness Merron (Lab)]

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

Vaping Products: Usage by Children

Baroness Walmsley Excerpts

Monday 2nd September 2024 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, a YouGov poll this year showed that almost 1 million young people under 18 have tried vaping, almost half of whom have only tried it once or twice. That leaves half a million who regularly use a product that is illegal for people to sell to them, and which is probably harmful to their physical, mental and social health. This indicates that half of those who try vaping once or twice go on to become regular vapers. Most children who try their first vape obtain it from a friend, although some obtain it from companies that give them away free, which unfortunately is still legal. You have to ask why companies do that. The answer is obvious: to encourage a child to like the vape and buy more, and for many to become addicted to the nicotine in them and carry on vaping for years. Will the Minister confirm that this loophole will be closed?

Children are being manipulated by the manufacturers, some of which are tobacco companies trying to remain profitable for as long as possible by using attractive packaging, colours and flavours; it is a bit like some unhealthy foods. More research, as we have heard from the noble Lord, Lord Winston, needs to be done on the toxicology of these colours and flavours—perhaps the Minister could say whether the Government are funding any.

Research has shown that children are more attracted to colourful branded packaging than to vapes in a plain package, such as is now mandatory for cigarettes. For adult smokers who wish to carry on—probably for good reasons—branded or unbranded packaging does not make much difference at all, and this indicates that, at the very least, removing brand imagery from single-use vapes, which are the product of choice for children, could have an impact in reducing the appeal of e-cigarettes for young people without compromising their legitimate appeal to adult smokers who are using them to quit smoking tobacco. Colours, images and flavours attractive to children must go: will the Government legislate for this?

Far too many young people find it easy to obtain vapes from shops, street markets and online. There seems to be very little enforcement of these illegal practices, but I think this is because of a lack of resources among local authorities to do it. Will the Government consider the impact of this lack of enforcement and introduce a licensing system with substantial fines for those who sell vapes without a licence and for all outlets who sell to children, as well as any unlicensed vaping products? Research shows that a third of vapes reaching UK retailers do not comply with regulations, and there should be fines for selling these, too.

For many young people, it is hard to avoid the promotion of vaping. Nearly three-quarters of 11 to 17 year-olds reported that they were exposed to vape promotion, which is an increase from previous years. Only one in five said they did not see promotion of e-cigarettes at all. The most common source of exposure, as my noble friend Lord Storey said, is in shops and online. Why do companies spend the money on the promotion? The answer is clear: because it works. Vapes should always be behind the counter in plain displays, and that should apply to petrol station shops and convenience stores, too. I was at a petrol station the other day and there were multicoloured vapes right next to the till—far too attractive. We have to make vaping boring, because research by the NUT found that about 30% of young people vape by the time they leave school, and some of its research found that some of the vapes had been adulterated with other drugs—including heroin, which is unbelievable.

Vaping was introduced and made legal in this country to help smokers stop killing themselves with tobacco and to protect the NHS. That is what vapes were meant for—all well and good. The Government are rightly proposing to gradually phase out the legal selling of cigarettes by raising the age of a customer to whom it is legal to sell them. If vapes are harmful—and of course they are, because they contain the addictive element nicotine—why not also phase out their sale except in medical circumstances? Children’s lungs and brains are more sensitive to nicotine and all the other additives than those of adults. That is why the current age restriction was introduced in the first place. But the horse has already bolted. Although four out of five children aged 11 to 17 have never tried vaping, which is good, over a third of those who have tried it have never smoked; that is significant. Yet this is a product that is promoted as a device to help people stop smoking.

There is already evidence that young people below the legal age are addicted to vapes because of the nicotine in them. I heard a young man on television the other day saying that—and by the way, he said “unfortunately”. That was clear from the YouGov poll. In 2020, only 26% of young vapers reported strong, very strong or extremely strong urges to vape, but this year it is up to 44%. Only one in 20 young vapers say they usually use a so-called nicotine-free version. Presumably they are the clever ones who understand the dangers of nicotine addiction, but some are choosing products with levels of nicotine even higher than the legal level for adults, and that is very dangerous. Local authorities report children approaching them for help to stop vaping, but they do not have any resources to provide that service and that must change, alongside the new legislation which we are expecting soon. Can the Minister say whether the Government plan to provide those public health resources alongside that legislation?

It may be helpful to look at why children use vapes. Most say they just try it to see what it is like, not realising that it could become addictive; some say it is because their friends do it and it is cool to vape. Some say they think it is helping with their mental health; that is very worrying, and nobody seems to be telling them that becoming dependent on vaping could do entirely the opposite.

That brings me to education and information. Many teachers are concerned about the disruptive effect of vaping on children’s education. Some children crave nicotine so much that they vape in class, or in the cloakroom, and it has even been reported that they miss lessons in order to vape. Teachers are crying out for resources to help them educate children about the many harms of vaping, which half of them know is better than smoking, but half of them think is just as harmful and do it anyway. Are the Government planning to ensure that appropriate resources are provided for teachers to help children discuss the issue of vaping in a way that is respectful of the pressures on young people and therefore likely to be more effective? This is a complex issue with strong public health, economic and educational consequences, and I look forward to the Minister’s reply.

NHS Blood and Transplant Service: Blood Stocks

Baroness Walmsley Excerpts

Tuesday 30th July 2024 Lords Chamber

[Baroness Merron (Lab)]

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

[Baroness Walmsley (LD)]

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

[Baroness Merron (Lab)]

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

National Health Service: 75th Anniversary

Baroness Walmsley Excerpts

Thursday 30th November 2023 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I congratulate the noble Lord, Lord Hunt of Kings Heath, on his excellent introductory speech. He hit all the nails very firmly on the head.

As the NHS reaches its 75th year, it is a very different and much larger beast than when it started out. The challenges are not just greater but different. On the upside, to a great extent we have conquered infectious diseases through vaccination and sanitation. Because of the success of medical science, our population is ageing, leading to greater demand for healthcare. On the other hand, we have a high level of health inequality and poverty, and a food system that does not provide a healthy diet for many people. Preventable diseases are now the greatest cause of illness and death. In 1948, people walked everywhere; many did manual labour, so obesity was rare; they ate seasonally and cooked their meals at home, and ultra-processed foods did not exist. But the air was not necessarily cleaner, because we burned coal to heat our homes. Today, we lead a very different life.

So, post-Covid, the NHS has five major challenges. There is the state of social care, causing too many people to enter hospital and stay there for too long. Linked to that, there is a crisis in ambulance service response times and A&E waiting times, causing excess deaths and harm. Many diseases, including cancer, are being diagnosed far later than they could be, leading to poor outcomes. Long waiting lists for urgent and elective care are leading to damage to the economy as people cannot work while they wait. There is too little preventive work to help people lead healthier lives.

The Government’s response is a focus on increasing the front-line workforce while ignoring the poor communication and system planning in the service. While we certainly need to train and retain more health professionals, especially in deprived areas, they are not the only people the workforce plan should be focusing on. We need system planners and communications experts. The money available for the NHS to tackle these problems is not infinite, which means we need greater productivity.

Nobel laureate Paul Krugman said:

“Productivity isn’t everything, but in the long run, it is almost everything”.

A crude definition of productivity is the ratio of inputs to outputs. Some think this is all about individuals working harder, but NHS staff are all already working extremely hard. It is not about working harder but working smarter. It is about improving outcomes. It is also not just about national initiatives. There is bound to be poor buy-in for national initiatives when staff on the ground often have a better idea of what could be done better. That is not to say there is no room for national initiatives, but they do not need to be designed by McKinsey.

There are problems with measuring real productivity in the NHS: how to adjust for the mix and quality of outputs and recognising the difference between outputs and outcomes. The NHS produces a wide variety of outputs. GP appointments are not the same as hip replacements, but the service has quite sophisticated statistical ways of dealing with this. It is harder to adjust for quality. Doing two knee replacements rather than one looks productive, but not if the second was needed only because the first was botched; and especially, as in the case of a lady I know, if the patient has to see the consultant three times before he will accept that there is something wrong. Then we must ask, is the outcome better as a result of the NHS having done something? The lesson here is that it is productive to listen to patients. Unfortunately, the NHS has cut back on patient-reported outcome measures, which are a valuable way to assess outcomes. My first question to the Minister is: are there plans to reinstate or replace PROMs?

A recent internal paper about productivity said that NHSE is

“very good at generating ideas”

for efficiency initiatives but does not have clear processes to evaluate them. It added:

“The overall volume of initiatives means it is very likely that the system is overwhelmed, which means that initiatives are not as effective as they could be. Moreover, a lot of the initiatives we are taking forward lack the buy-in from front-line staff that is needed to make changes stick”.


The system and infrastructures that support waiting list management include IT and tools for proactive patient tracking, as well as the processes that staff follow to efficiently and accurately co-ordinate pathways for patients on waiting lists. Millions of hours of clinicians’ time are wasted due to inadequate IT systems. A recent BMA report found that four in five doctors believe that improving IT infrastructure and digital technology would help to tackle backlogs. Can the Minister therefore say whether systems analysts and IT and AI specialists are included in the workforce plan, as well as medical professionals? We did not just win the Battle of Britain using pilots.

Sadly, there are too many examples of the skills of our health professionals being wasted because of inefficient systems planning and poor communications. A recent example concerns former BBC journalist Rory Cellan-Jones, who suffered a broken elbow and facial bruising following a fall. He spent two unnecessary days in hospital and calculated that 90% of the staff time spent on his case could have been avoided with better planning and communications. It was eight days after his accident before he received appropriate treatment. It was not just a question of communication between staff, but communication with him. He says in his blog:

“Getting information about one’s treatment seems like an obstacle race where the system is always one step ahead. … But communication between medical staff within and between hospitals also appears hopelessly inadequate, with the gulf between doctors and nurses particularly acute. I also sense that, in some cases, new computer systems are slowing not speeding information through the system. On Saturday morning, as we waited in the surgical assessment unit, four nurses gathered around a computer screen while a fifth explained … all the steps needed to check-in a patient and get them into a bed. It took about 20 minutes and appeared to be akin to mastering some complex video game”.


It also took four hours to get the paperwork for his discharge.

My Lords, I have experienced a similar situation and it grieves me to see our skilled professionals not being used in the most cost-effective way. What are the Government planning to do about this?

King’s Speech

Baroness Walmsley Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I too thank the Minister for the tone of his introduction to this debate, but a King’s Speech is an opportunity for a Government to take stock of progress towards their objectives. One might therefore have expected that this Government would have looked at their earlier manifesto promises when drafting the gracious Speech and considering whether their 13-year tenure had in fact improved the health of the nation. Covid, of course, was an unexpected roadblock, but the very fact that it was unexpected is an issue in itself. One hopes that lessons are being learned from the Covid inquiry.

There are pluses and minuses in the Government’s thin programme for their last year in office. Like many other Lords, I regret that, despite all the work done on proposals for revising the Mental Health Act, including a White Paper, the Government have still not fulfilled the revision promised in successive manifestos, nor their promise to implement the recommendations of the Infected Blood Inquiry. Instead, despite that inquiry’s strong interim recommendations that compensation be paid now, the Government still insist on waiting until the final report.

There is, however, one measure in the gracious Speech of which I approve: the proposal to raise every year the age at which retailers can legally sell tobacco products to young people by one year. This does not ban smoking as such, but it should deter more people from starting. We know that most smokers start young and that tobacco is unique in that it either kills or shortens the lives of two-thirds of those who use it for any length of time. I have always supported measures to reduce smoking because it is different from all other ways in which people freely choose to damage their own health. It is addictive, harmful when used as recommended, can harm other people and costs us and the NHS millions every year. That is why there is overwhelming public support for, for example, the ban on smoking in enclosed public spaces.

There will also be consultation on measures to tackle the widespread illegal sale of disposable vapes to children. Vapes have their place. They are of value to adult smokers who wish to quit, and are rightly sometimes provided free on prescription, but I believe that the vaping industry has cooked its own goose by the reckless and widespread promotion—and sometimes the free supply—of single-use vapes to children. That undoubtedly has to stop, because these things are addictive and not without danger. The massive environmental damage done by these brightly coloured gadgets, with their sickly-sweet flavours and colours obviously aimed at children, has been well-rehearsed elsewhere, so I do not need to elaborate. I hope that, after the consultation, the Government will clamp down firmly on this already illegal practice. Of course, public health budgets have also been cut and this has resulted in fewer smoking cessation services, which must also be addressed.

The Government have announced an NHS workforce plan. This is a step in the right direction, but many of us would have preferred the proposal of the noble Baroness, Lady Cumberlege, during the Health and Care Act 2022, supported by us. This provided for an independent review of current supply, an assessment of need of the right staff in the right places in the future, and a plan for how to fulfil that need over five and 10 years. The Prime Minister mentioned doctors, nurses and dentists, and of course we need more of those, especially in disadvantaged areas. However, current resources could be used better. Many of the care problems that patients experience are about systems, processes and communication. There is much efficient good practice, and I agree with the noble Baroness, Lady Donaghy, about the very cost-effective fracture liaison clinics, which save a lot of time and NHS bed days but are available in only half of trusts—that is the problem. Will the Minister ensure that the workforce plan includes staff skilled in designing and implementing efficient systems and processes which make the most of the resources we have?

Taking stock means looking to the future and focusing on the major challenges to the NHS. Three things are needed. The first, as has been said, is sorting out social care and integrating it with health services. Despite Boris Johnson’s promise of an oven-ready plan, which never materialised, social care is still suffering from lack of funding and enough properly paid staff with opportunities to develop their skills. If there ever was an oven-ready plan, it is well past its sell-by date and should be thrown in the bin. The recent Covid inquiry has exposed how very important this is, especially at times of extra stress on the system, but it did not feature in the gracious Speech.

The second is the need for more prevention of ill health. Preventable diseases, as has been said, are now the major causes of death, since modern sanitation and vaccination have conquered many of the communicable diseases. If Wes Streeting focuses on this, he will get my support. The three main factors needed here are action on healthy diets, clean air and healthy homes. The Government are failing on healthy diets despite having legislated for, but not implemented, several important measures that would have helped people make good food choices. Everyone, especially children, should have access to good, affordable food, and the Government should be doing a lot more to ensure that.

We have had many debates on clean air, but the legal limit for particulates in our air in the UK is still much higher than in other developed countries. Dirty air kills people through respiratory and cardiac diseases and interferes with the development of children’s brains. More action is needed on this now, rather than using it as a wedge issue at by-elections. Unhealthy, damp, cold homes also lead to respiratory diseases. It is a national disgrace that too many lower-income families are living in homes with mould growing on the walls and cannot pay their heating bills, and I did not hear anything positive in the gracious Speech about this.

The last factor is earlier diagnosis and treatment, and here there has been some progress. I welcome the units going around the country to check for early liver cancer, heart valve disease, lung cancer, et cetera, but what is needed is widespread access to treatment. I want to mention minimally invasive cancer therapies. These were invented here and are highly cost-effective. Can the Minister let us know what progress there is in extending these right across the country, instead of in only about half of it?

Children’s Health: Ultra-processed Foods

Baroness Walmsley Excerpts

Wednesday 25th October 2023 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I agree with every word of the noble Baroness’s excellent speech, as noble Lords will hear. We humans have evolved, along with our diets and our gut microbiome, over millennia. Ultra-processed foods, however, are the new kids on the block, and their availability and ubiquity in our diets correspond exactly to the increase in diet-related diseases. Figures show that 60% of the UK diet is UPF, and it could be worse for children. That corresponds with serious concerns about height and weight revealed by the UK child measurement programme. It is pretty obvious that something is going wrong.

Whenever I raise the topic of ultra-processed foods with the Minister, he replies that the Government cannot take action because it is difficult to define them, since brown bread is an ultra-processed food. I would like to tackle that head on. Brown bread could be ultra-processed, but it does not have to be—it certainly is not in my kitchen. So let us look at definitions. You could say that UPF contains things you would not find in a normal kitchen. That is helpful, but not enough. More helpful is the NOVA system, which puts foods into four categories, only the fourth of which is ultra-processed. Brown bread is not always found in that group.

NOVA provides a framework for assessing the degree and purpose of processing, and the relation between dietary patterns and health outcomes. It should be seen as complementary to nutrient-based approaches. Some national Governments have already begun to introduce policies informed by NOVA.

Foods and diets are of course complex. Lots of HFSS foods—high in fat, salt and sugar—are UPF, which is often called junk food, and lots of UPF are HFSS, so it is important to untangle the two. One piece of research did that neatly. Two groups of people were given diets for a week that were comparable in fat, sugar, salt and quality and told they could eat as much as they liked. One diet was made of minimally processed foods and the other UPF. Those on UPF ate 500 calories more than the others and gained weight. When they swapped the two groups around, the same thing happened. Dozens more studies have controlled for fat, salt, sugar and diet quality and have still found ultra-processed diets to be strongly associated with poor health. Other research shows that UPF are designed to make people eat more. They are soft and easily digested, taste good, are energy dense and, as has been said, some people become addicted to them.

Not every UPF is bad; it is the quantity and the overarching dietary pattern that matter. Our priority should be rebalancing the diet as a whole, and that is where government dietary guidelines come in. In the UK, reformulation has long been the focus of policy but, given the overlap between UPF and HFSS, reformulation should be only a first step to addressing the health outcomes associated with ultra-processed dietary patterns.

Part of the issue is profit maximisation. The business model is this: you take cheap commodity ingredients, deconstruct them and put them together in a different way, bind them with cosmetic additives and then brand and market the product with the aim of increasing sales and normalising consumption. In a capitalist economy, financial resources flow to the sectors that are the most profitable, and UPF is hugely profitable.

So what to do? Research definitively demonstrates that existing guidelines are inadequate—there is not a word about UPF in government guidelines—so will the Government amend their guidelines to promote the consumption of minimally-processed foods, improve the food in schools and public settings, and implement the existing legislation on advertising junk food on TV and online and relating to “buy one, get one free”? Many people on lower incomes rely on cheap UPF, so policy should not place further burdens on them.

Domestic Violence and Brain Injury

Baroness Walmsley Excerpts

Monday 23rd October 2023 Lords Chamber

[Lord Markham (Con)]

Yes, on both counts. Unfortunately, domestic violence is something that affects all sorts of people from all sorts of backgrounds and minorities. About 5.7% of women and 3% of men, and a lot of children, are thought to suffer domestic violence. I am absolutely happy to give that undertaking.

[Baroness Walmsley (LD)]

My Lords, the Minister has clearly noticed the care taken by both players and officials during the Rugby World Cup to avoid head injury. However, there is no referee on behalf of women suffering brain injury during domestic violence. Will the Government support training programmes, such as those run by Headway, for professionals dealing with survivors and victims, and ensure that that training is extended to the police? Will they ensure that, at the end of those programmes, the trainees have resources to which to signpost victims?

[Lord Markham (Con)]

The noble Baroness is correct. We need to make sure that all our front-line services are trained to identify potential brain injuries—that is A&E, GP surgeries, the police and schools. There is already a programme in schools for children affected by domestic violence. We have also made sure that every ICB has to appoint a domestic violence and sexual abuse lead, so that they can identify these sorts of issues.