Healthcare Services: Acute, Primary and Community

Baroness Walmsley Excerpts

Thursday 25th June 2026 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, community and primary care services are at the heart of the Government’s objective in the 10-year plan to shift from sickness to prevention and from hospital to community. But the funding does not always support that.

Over the past nine years, the average increase in spend across health services has been 31% but primary care had only 24%. The patient population has grown by over 7 million since 2015, yet the number of GP practices has fallen by about 20%, leaving some rural areas without accessible cover. I heard a case only this morning of a rural GP who retired from a single-doctor practice; patients had to travel 12 miles to get to the nearest GP and there were no buses. The average list size is now 40% higher than a decade ago. Primary care, including dentists, optometrists and community pharmacists, is part of the prevention agenda yet there are major funding gaps and important aspects of the service suffer.

GPs control the patient’s health records, and their patients have in the past benefited from continuity of care, but this no longer always happens and the benefits have been lost despite evidence that continuity is beneficial and can save money. GPs are the first port of call for patients, the point of first triage or suspected diagnosis and the gateway to more specialised services. If people cannot get to see their GP, as my noble friend Lady Janke said, they eventually turn up at A&E, usually with a much more serious condition and at greater cost to the NHS.

Diet and vaccinations are key aspects of prevention. Some GPs employ dieticians, but nowadays it seems that the main response to obesity is through treatment rather than prevention. These injectable medicines are quite effective but their long-term cost-effectiveness is not yet proven. We need more dietician services in the community. Access to a healthy diet is dependent on many factors beyond the scope of primary care. The Minister will therefore not be surprised that my first question to her, again, is: what progress is being made with publishing the consultation on the healthy food standards? Has the department even established the parameters of the consultation?

GP practices also deliver the core childhood vaccination programme, mostly given by the practice nurses, and they are the most trusted people to answer patients’ questions. But some communities are hard to reach, leading to inequality of coverage. Reaching them costs a lot more time and money, but the benefit of doing so is felt not just by those patients but by the whole community when herd immunity levels can be reached. Dangerously, this is not being achieved, partly through lack of consistent funding. In transferring vaccination commissioning to ICBs, will the Government ensure consistent funding for outreach according to the need in the area?

Midwives, health visitors and school nurses have a role in advising patients about diet and vaccination, but all those services have experienced cuts. Many schools no longer have a school nurse, and newly qualified midwives are not able to find posts. The number of health visitors has reduced by 43% since 2015. This makes it difficult to ask them to do catch-up vaccinations in the home. Does the Minister have any results from the recent pilot on this? All these health professionals have a contribution to the preventive agenda and saving money.

We have all heard of dental deserts and community optometrist deserts. Both could save the NHS money given appropriate levels of funding. The main reason children go into hospital is to have rotten teeth removed. This is because they eat too much sugar and are unable to see a dentist. What is being done to avoid dental deserts?

In eye care, we have the workforce and infrastructure in the community, yet access depends on where you live, which pushes avoidable demand into hospitals. One in four people cannot access a local optometrist and there are 600,000 people on hospital waiting lists, many of whom could have been managed in the community. What steps are the Government taking to ensure equitable access to optometrists across England?

We have a wonderful range of community and primary care services and yet their full potential is not being used to prevent ill health because of underfunding or inconsistent funding. That is very unwise, to say the least.

Foetal Alcohol Spectrum Disorder

Baroness Walmsley Excerpts

Thursday 25th June 2026 Lords Chamber

[Baroness Merron (Lab)]

My noble friend is quite right. There are tremendous opportunities to link up work on tackling foetal alcohol spectrum disorder with other parts of our work, not least the major principle of moving from treatment of sickness to prevention. I assure my noble friend that we are working across government. We will also continue to work with all local areas so that we can address unmet need, prioritise prevention and make sure that we have improvements to alcohol treatment services. All of these will make a difference.

[Baroness Walmsley (LD)]

My Lords, according to the association for FASD, every prevented case saves over £400,000 in lifetime costs, as well as the personal tragedy. Universal antenatal alcohol history taking is recommended by NICE guidelines, but implementation remains variable. Will the Government embed NICE guidelines everywhere, alongside a national public health campaign on alcohol in pregnancy, equivalent to the effective existing smoking in pregnancy campaign?

[Baroness Merron (Lab)]

In addition to the ring-fenced funding I spoke of, we are going further on alcohol labels to get across the important points. In 2022, NICE produced and published a quality standard, which the noble Baroness referred to, so that the system can help diagnose but also support those affected by FASD. I am not aware of there being widespread difficulties with its adoption, because it is so fundamental to pre-pregnancy and pregnancy care, but, if the noble Baroness has particular examples, I would of course be pleased to look into them.

Severe Myalgic Encephalomyelitis

Baroness Walmsley Excerpts

Thursday 18th June 2026 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I congratulate my noble friend Lady Scott of Needham Market on her very moving speech. She comprehensively covered the major issues that are before patients with ME.

The prevention of future deaths report into the death of Maeve Boothby-O’Neill emphasised that there is no known cure into myalgic encephalomyelitis—not only no cure but no known cause, no known reason why some are susceptible to developing ME and no known reason why one in four sufferers develop severe problems. It was clear that despite three periods in hospital, the NHS was unable to reverse Maeve’s malnutrition and sadly she died. One might think that apart from lots more research into causes, prevention, diagnosis and effective treatment, there is nothing that can be done to care for sufferers appropriately. But there is.

I note that in a recent survey by Action for ME, just 10.8% of respondents with severe or very severe ME said they felt supported by the NHS. I began to wonder what “good” looks like, so I looked at the NICE guidelines and there it was. But I recently heard from a carer of a patient with severe ME. She said: “There is almost no help available on the NHS for patients of this severity. We waited six months for an NHS specialist appointment. The consultation lasted 10 minutes over the phone. The consultant, whose primary speciality was diabetes, reviewed blood tests, said they were normal and suggested my partner take a multivitamin. The clinic was disbanded the following day due to the consultant’s retirement, with no handover to an alternative service. Our experience with primary care has been equally concerning. Most GPs we have encountered have little understanding of severe ME, how profoundly disabling it can be or best practice for care. To give one example, a GP recently suggested to me that my partner try ‘talking therapies’ when he was unable to tolerate sound”.

My first question to the Minister is therefore: do the Government know how many ME services are implementing the NICE guidelines? If not, what is being done to find out? What is being done to support those that are not implementing the NICE guidance to do so? Obviously, we need to take several steps back from the quality of care to find out how this disease develops. Clearly, the Government should commit to accelerating biomedical research into ME, including the severe and very severe conditions. This should include targeted funding for diagnostics, biomarkers, treatment development, clinical trials and other post-infectious disease research, as my noble friend demanded. But there are also off-label, low-risk interventions, including cannabis-based medicines, which patients may be willing to try but cannot access on the NHS.

As we have just heard, ME remains significantly underresearched relative to its prevalence. Severe sufferers often cannot work from an early age. Those who are bed-bound require constant care at home, which also limits the economic activity of their carers. Improving economic evidence is important as it encourages grant-making decisions. Better cost of illness data would help demonstrate the wider social and economic impact of ME, including costs to the NHS, social care, the welfare system, families and carers, and the wider economy. State-funded research into this would pump-prime investment by charities, academics and pharmaceutical companies. It sends a message that ME matters.

The condition is increasingly being understood within the broader field of post-infectious conditions such as long Covid, but we must avoid the danger of the two conditions being confused. However, I welcome the announcement of a £1.4 million NICE research programme to explore the cost effectiveness of existing healthcare for ME and long Covid to improve the quality of care. Major UK research studies, including DecodeME, LOCOME and Sequence ME & Long Covid, are helping to build momentum. As my noble friend said, there is now an opportunity for the Government to position the UK as a leader in post-infectious disease research, with ME right at the heart of it. Is there a coherent plan for a broad range of research to cover all aspects of ME, or is it a bit here and a bit there? Are we lagging behind other countries and losing an important economic opportunity?

We will also need targeted support to translate biomedical science into commercially viable diagnostics and treatments. In this context, a recent report from your Lordships’ Science and Technology Committee into the need for more support for science-based companies trying to scale up is certainly worth a read. It is called Bleeding to Death: the Science and Technology Growth Emergency. In other situations, there has been successful repurposing of pharmaceutical interventions developed for other diseases. Dexamethasone was an example during the Covid pandemic, and it certainly saved lives. There is a new funding opportunity for an NIHR award focused on evaluating repurposed pharmaceutical interventions. I wonder whether these grants might be applied to treat post-acute infection syndromes and associated conditions, including ME. Can the Minister say whether there has been any progress on this?

We have a once-in-a-lifetime opportunity to do something for ME patients now. The sensory overload suffered by some sufferers means that they must restrict their stimulus by lying in a quiet, dark room, and their care needs to be physically gentle. This means that the environment in which care is delivered is as critical to their health outcomes as the treatment itself. The current definition of patient information in the NHS modernisation Bill risks creating a significant safety blind spot. While the single patient record is welcome and designed to consolidate a patient’s medical history, current guidance omits the contextual clinical data providing accommodations to make services accessible to all patients. Without formal, recorded and transferable data on reasonable accommodations, these patients face preventable harm, wasted clinical resources—when no sensory adjustments mean that appointments fail—and having to re-advocate for their safety needs at every new touchpoint.

By amending the definition of patient information to include reasonable accommodations, we could ensure that the SPR acts as a true safety net, not just for ME patients but for those with learning or communication difficulties. Including this provision does not merely add data; it formalises the duty of care, ensures clinical safety and embeds equity into the very architecture of the future NHS digital infrastructure. Will the Government accept an amendment to correct this omission?

--- Later in debate ---

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

My Lords, I am most grateful to the noble Baroness, Lady Scott, for securing this important debate, which matters so much to so many, and for her clear introduction to these matters. I am also grateful to all the other noble Lords who spoke for their thoughtful and probing insights. The debate has certainly underlined the profound impact that myalgic encephalomyelitis—ME/CFS—has on those living with the condition, but also on their families, friends, carers and communities.

Noble Lords have spoken very movingly about the reality, and I am grateful for the welcomes across the House for a number of government actions. I recognise what noble Lords have described, which is—to pick up a few points—a lack of awareness, variability in services, the stigma faced by those with ME/CFS and the need to go further. We recognise all of that.

The fact is that the system has not worked as it should for people. But that is why, early on, the Government prioritised publication of our final delivery plan on ME/CFS, which we published in July last year. I assure noble Lords that we work closely with those most impacted by the effects of this debilitating condition, including those with lived experience. I add my thanks to charities and campaigners for their work, because they have given voice to this subject. We want to ensure that patients are truly heard by a system that can respond to those voices, because historically that has not been the case. So the plan sets out a clear direction for improvement, and it focuses on three key ambitions: boosting research, improving understanding and education, and strengthening the care and support people receive.

The noble Baroness, Lady Scott, and the noble Lord, Lord Evans, raised a number of questions about funding timelines and accountability. I confirm that the department has overall responsibility for progress against the final delivery plan, and officials are actively tracking progress. It is very much worth noticing that three-quarters of the plan’s actions have been completed or commenced or are currently ongoing. I say to the noble Lord, Lord Evans, that an update on the delivery of the final delivery plan will be communicated next month.

We know, as has been spoken about, that a lack of research has meant that those with ME/CFS have been left feeling undervalued, frustrated and overlooked. That is why the final delivery plan commits to stimulating research, including through new funding opportunities, better support for researchers and building capacity and research. We have gone beyond the actions in the final delivery plan, as all noble Lords were good enough to reference, by investing £4.75 million in SequenceME, which will create the first high-resolution genetic map for ME/CFS. I believe that this will offer new hope to patients and pave the way for better diagnostics and future treatment, which, after all, is what we need.

All noble Lords asked for further commitments. To the points I have just made, I add that the Government are investing in turbocharging clinical trials research. Key to this is enabling new treatments to get to patients faster; and the NIHR has funded projects to explore the feasibility of a clinical trial for treatments for ME/CFS and other post-acute infection conditions, as noble Lords have asked for. Of course, funding and support is available for researchers, and the Medical Research Council and the NIHR welcome funding applications for research into ME/CFS and other post-acute infection conditions. Addressing gaps in knowledge and awareness around this condition is also crucial, because people who live with ME/CFS have to be seen and feel seen. They need to be reassured, and they need evidence that they are going to be taken seriously. I am therefore glad to say that NHS England has developed an e-learning programme, which consists of four modules and seeks to improve the understanding of healthcare professionals, and to support them to provide the right care at the right time for those who need it, including those with severe ME/CFS.

Experiences of care vary widely—that should not be inevitable, but we recognise that they do—but I believe that those with ME/CFS deserve a high standard of care, no matter who they are or where they are. We will seek to improve that through the development of a new template service specification for mild and moderate ME/CFS, and that will expand to include the severe nature of the condition. The template will focus minds and demonstrate to integrated care boards the ways in which NICE guidelines can be implemented. Key here too is that it will provide good practice examples for ICBs, so they can model their own services on where it is being successful.

There is, as I said at the beginning, much more to be done. We are working at pace to implement this final delivery plan, and we will work continually with stakeholders to make sure that it meets the mark. The noble Baroness, Lady Scott, and the noble Lord, Lord McCrea, asked about interim support. We are not just committed to considering a specialised service for those with a very serious version of the condition; we are also exploring what preparatory work can be taken forward ahead of April next year. We want to progress the work at pace once the transformation in respect of NHS England has been concluded. In the meantime, we are considering a range of potential interim measures to support those with severe ME/CFS, including further promotion of the e-learning modules that I referred to, making sure they span very severe and severe ME/CFS, alongside the recommendations that have been presented to government directly by patient groups.

The noble Baroness, Lady Scott, asked about setting up an expert advisory panel. We do not currently have plans for such a panel for those with severe ME/CFS, but I assure the noble Baroness that we engage very closely with experts from NHS England, clinicians and experts in the charity sector so that we can develop a much broader approach to supporting patients with ME/CFS.

In response to the question about exploring whether a specialised service should be commissioned for very severe ME/CFS, any decision on whether this committee would be convened remains at the discretion of the Secretary of State. I say to the noble Lord, Lord Evans, that we recognise that ME is more likely to affect women and that early results in the DecodeME study have found that women with ME/CFS tend to have more symptoms and co-occurring conditions than men. That will be taken into account. Again, I am most grateful to the noble Baroness, Lady Scott, for her work and advocacy in this area.

[Baroness Walmsley (LD)]

Before the Minister sits down, I asked what support is being given to those services that are unable to fulfil the NICE guidelines, and about the Government’s attitude to including reasonable adjustments in the information on the single patient record.

[Baroness Merron (Lab)]

I would be pleased to take those two points away and look at them, particularly the second, which is a very practical suggestion. I am grateful to the noble Baroness, as ever, and I will gladly write to her.

Women’s Health Strategy

Baroness Walmsley Excerpts

Thursday 23rd April 2026 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank the Minister for tabling the Statement. I am sure that the ambitions for the renewed women’s health strategy will be supported by noble Lords from all Benches. I know that the Minister recognises that women have too often felt unheard, as conditions such as endometriosis and chronic pelvic pain go underdiagnosed.

There was emphasis in the Statement on listening to women and tackling entrenched inequalities. This is, of course, welcome. We support the focus on a shift from treatment to prevention and from hospital to community, as well as the ambition to unlock the potential of digital innovation through NHS Online. I also thank the Minister for acknowledging that these initiatives build on work undertaken by previous Governments.

However, many women will judge this strategy not by its intentions and words but by whether it leads to tangible improvements in their day-to-day experience of care. All Governments announce grand strategies, but sometimes fail to deliver. While many of these individual announcements are welcome, I hope the Minister will allow me to ask for further clarity on a few points.

First, on waiting times and access to care, it is encouraging that waiting times for overall gynaecology have begun to move in the right direction, but many women are still waiting too long for diagnosis and treatment. We know what that leads to—a range of conditions, often worsening outcomes and poor quality of life. Can the Minister tell us what the department is doing to speed up the whole pathway from when the patient first presents through to treatment? How will it ensure that there is greater transparency for patients, so that they know where they are in the queue and how long they really have to wait, rather than estimates?

Secondly, the strategy rightly places an emphasis on listening to women and acting on their experiences. I am sure that noble Lords across the House share that objective. However, experience suggests that, unless you have clear structures for accountability, good intentions do not always translate into change. How will the department ensure that any feedback gathered in a patient consultation is not just perfunctory but consistently acted upon, and that it reflects a diversity of women’s experiences? There will be a range of experiences; it will not be the same for all women, especially for those who face additional barriers to being heard.

I will give your Lordships a couple of examples from my time in the department. I wonder what progress has been made. I remember when a young official came up to me and told me about her friend, a young Black lady, who had lost her baby. When they asked for the investigation and the paperwork, it had magically disappeared. How do we make sure that that sort of incident does not happen again, that there is real accountability and that there is no gaslighting, particularly for women from ethnic minority communities?

Another example comes from when I spoke to the baby loss charity Sands. Of course, we value the work that the noble Baroness, Lady Amos, is doing on maternity care. I recently received an email from a lady whom I met at Sands, which said: “For almost three years, my case was handled by the same caseworker. Of course, sometimes I questioned their competence, but at least the caseworker knew my case and they knew about things. And, despite being advised that my complaint was at its final stages, I’ve just been told that it’s been reallocated to a new case handler. Someone has to relearn the case, but has not yet been given a date for when that case will be heard”. I wonder what the Minister’s department can do to ensure that people who have suffered terribly, and are still suffering physically and emotionally from what has happened, really get the justice that they deserve.

Let us move on to patient safety and redress. The Statement refers to unacceptable experiences of women harmed in the past. As the House will be aware, the recommendations of the Hughes report were intended to provide redress for medical interventions such as the pelvic mesh, sodium valproate and hormone pregnancy tests, but many women are still waiting for some form of redress or help. Often, they are racking up bills, such as taxi bills to go to appointments, and many of them are still in pain.

When I was in the department and I was being asked the question, in the Minister’s place, I would go back to the department and ask what we are doing about this. The first answer I would be given was that I should leave it to the responsible Minister as I was the Minister responsible for technology, innovation and life sciences. When I probed again over time, I was told by one official that the Treasury does not like to write blank cheques. That is understandable—the Treasury is the guardian of the national finances. I used to ask whether anyone was doing any work on how much this would cost so that we could then present to the Treasury the cost of providing some form of redress.

The Hughes report suggested £20,000 each for mesh victims and £100,000 for sodium valproate victims. We welcome the fact that 100 of the 10,000 women who suffered from the pelvic mesh issue have received some payout from manufacturers. What about the others? I am told that many women missed out due to limitations for civil claims. What can the Minister’s department do to help those poor women who are still suffering and make sure that more women receive redress as quickly as possible? As a result of the Hughes report, we now know that it is not a blank cheque. We know that there will be negotiations between the Department of Health and the Treasury. Can the Minister update us on those discussions so we can better understand whether these women are finally going to achieve some form of justice?

Going forward, we need not only to make up for the mistakes of the past that have occurred under all Governments but to address the outstanding issues, making sure that those women who suffered are receiving long-term support and learning the lessons so that if, sadly, this ever happens again, we know how to address those issues and give the appropriate care, compassion and redress to those who suffer.

Overall, there are a number of different issues covered by the women’s health strategy. I know some noble Lords will be concerned that, although it is wonderful to have a grand, overall strategy, what about the individual interventions that we need from the departments, clinicians and others? How do we deliver on all those various issues that women suffer from to make sure that patients across the country—whatever party they support or however they feel—particularly female patients, believe that the renewed women’s health strategy will finally deliver a safe system of health for all of them and justice for those who have suffered in the past?

[Baroness Walmsley (LD)]

My Lords, I thank the Minister and I, too, welcome the women’s health strategy, as it includes many important objectives. In communities up and down the country, we have seen the devastating toll of sustained failures to invest in and deliver better women’s health. Women’s lives, families and economic productivity are damaged when they do not receive treatment in a timely way. Indeed, this also happens when menopause difficulties are ignored. This is because vital services remain understaffed and underfunded, while women and girls go without the care they need.

In 2022, we had the previous women’s health strategy, which had similar important goals to this one with similar delivery mechanisms and the same reliance on local systems to make it happen. Yet four years on, the problems remain stubbornly in place, with half a million women suffering long waits for gynaecology, patchy access to services, women reporting that they are not listened to, women not being given pain relief when they need it and serious conditions diagnosed too late. These facts must give the Government pause for thought that perhaps things need to be done differently this time.

Medical misogyny is still a perverse and unacceptable norm in the health service and that requires a culture change, which is notoriously difficult to achieve. How does the Minister’s department plan to go about it?

This strategy is being implemented when the NHS is already stretched and ICBs are facing cuts while, at the same time, taking on some of the responsibilities of the disappearing NHS England. Now we also have soaring inflation, due to Trump’s war in Iran. In this climate, can we reasonably expect the strategy to deliver meaningful change? I really hope so.

Although the issues affecting women’s health generally are numerous, the NHS failures in maternity services are the most widely reported and deeply shocking. Review after review has uncovered the same failures across the country: a failure to listen to women, a lack of time for training, inadequate staffing levels leading to staff burnout, a lack of proper assessment, poor management of risk and a failure to learn lessons when things go wrong. All this is leading to a rise in perinatal mortality, with the figures showing inequality between different groups, such as those on lower incomes and some ethnic minority groups. How will that be tackled by the strategy?

That is why the Liberal Democrats recently launched our maternity secure package to make Britain the safest place in the world to give birth. We want every maternity unit in the country brought up to a good or outstanding level of safety. That could be done by guaranteeing one-to-one midwifery and specialist doctors on every unit. Will the Minister consider incorporating these proposals into the new strategy?

On medical misinformation, many people now get their health advice online, particularly via social media. Long waits for NHS services and GP appointments are pushing people into getting their so-called information this way, but advice on those platforms does not adhere to clinical standards or guidelines, which is leading to rampant medical disinformation, with sometimes disastrous results. There is some evidence that this is a particular issue in women’s health, where gaps in scientific knowledge and public awareness are being exploited. Does the Minister have any plans to tackle that?

It is possible to fight back. In order to be helpful, we are calling for the following for the Minister’s consideration. The first is a new kitemark for health apps and digital tools that are clinically proven to help people to lead healthier lives, regulated by the GMC. The second is a big effort by the NHS, with a ring-fenced budget, to dominate the health advice social media ecosystem and algorithms, with clinically approved information in plain English. That could improve patient care and save staff time and costs. The third is a new verification requirement for any social media account claiming to be written by a medical professional.

I have a few more questions before I finish. In line with the 10-year health plan’s objective to make care more local, is the Minister confident that women in every area will benefit from a family health hub, as promised, without the threat of closure or cuts, especially in this time of reduced resources for ICBs?

How will the new system linking feedback from patients to provider funding work? Will the results for each unit be made public? Will improved staffing be funded to achieve the promise that women no longer face long waits for diagnosis for conditions such as endometriosis? Will we be able to hear from the Minister in the education department about the promised menstrual education programme to ensure that girls are better equipped to recognise the difference between healthy and unhealthy periods, and will the programme be evaluated by the girls receiving it? Finally and most importantly, will women themselves be involved in developing the implementation plans for the new measures in the strategy and coproduction of their communication with other women?

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

I thank the noble Lord and the noble Baroness on the Front Benches for their warm welcome for this renewed women’s health strategy. It represents a major shift in this country and, as the noble Lord, Lord Kamall, said, it recognises the fact that women’s voices have not been heard. It is shocking, although sadly not surprising, to know that some eight out of 10 women report not having been listened to. The noble Baroness, Lady Walmsley, talks about a culture change. The biggest culture change that we can make is to embed women’s voices into women’s healthcare, and that is exactly what we will do.

This strategy gives women and girls voice, choice and power over how they receive their healthcare. When we say that we are transforming care as part of the 10-year health plan, we mean it. I absolutely agree with the noble Lord that strategy is one thing, but delivery is another.

I was asked why this is different from the 2022 strategy. Let me first acknowledge the importance of the 2022 strategy: it was the first time we had a women’s health strategy. I spoke to the women’s health ambassador, Dame Lesley Regan, about this, and she told me that, with this renewal, we have embedded women’s healthcare in the NHS in a way that has never happened before. I have been moved and struck by the responses I have had from stakeholders, women, parliamentarians—the list goes on—because their voices were heard.

I will pick up some of the points; I am sure that a number of the points raised will come up. The matter of waiting times is key. They have improved, as the noble Lord, Lord Kamall, said—the number of patients on gynaecology waiting lists is down by over 25,000 in the same period—but there is much more to do. If I had to make just one point about this women’s health strategy, it would be that this is not the end of it but the start of the continuum of work we have been doing. How will we drive down waiting lists? I am very excited to say that, when we launch the NHS online hospital next year, we will prioritise gynaecology pathways. It is one of the limited number of pathways that there will be.

We are prioritising gynaecology for treatment in surgical hubs. We are piloting gynaecology pathways in clinical diagnostic centres, which are now in place up and down the country. We are increasing relative funding to incentivise more gynaecology procedures, as and when they are clinically appropriate. Those things are very practical and, alongside shorter waits and more convenient gynaecological care for patients, they will make that shift not only in practice but in culture.

One way in which this strategy is different from the 2022 strategy is in its considerable emphasis on measuring impact, which noble Lords have asked for. If we cannot measure something, we do not know what it is. There are three overarching measures of success: reversing the decline in healthy life expectancy, which was seen to decline in the 2010s; improving healthy life expectancy in the poorest regions to at least 61 years of age; and reducing the time that women spend in poor health, particularly for women experiencing the greatest health inequalities. That will be measured in the short, medium and longer terms. I would be happy to provide further information if required.

Women’s voices are a key focus, again in both practice and culture. We are establishing a women’s voices partnership, which means that women’s organisations, particularly those representing the more marginalised, will be able to influence national decision-making. We have described it as a direct line to Whitehall; in other words, this is not the end of the conversation. We have consulted very widely and will build on what was done with the 10-year health plan—that will continue. This has been welcomed.

In particular, we are introducing patient power payments as a trial. We will see how this goes, and I look forward to monitoring it. It will link provider funding to women’s experiences, particularly in gynaecology services, and whether a service is found wanting. The noble Lord asked about including those who are often excluded, and I absolutely agree with him. Again, culturally—to the noble Baroness’s point—women will not just have to come forward with a complaint. They will be asked, “What is your experience of care?” That is crucial. It may be that the care was excellent but the experience was terrible, and I think many of us will know about that. If that is the case, the provider will have money withheld. As I said to a former Health Minister, how do you make real change? You do it through finance, funding and systems. The money will be withheld, but it will come back into the improvement of those services. So women will not lose out, but that provider will have its feet held to the financial fire.

On the important matter of redress, we are carefully considering the work done by the Patient Safety Commissioner, and I am glad that she welcomed the women’s health strategy. I re-emphasise my deep sympathy with those who have been harmed, and I recognise the harm to those individuals and the families. We continue to look at the recommendations for redress and, as soon as we are able to make a comment, we will of course do that. In view of the time, I will just say that reducing inequalities is hard-wired throughout the women’s health strategy.

Cancer Outcomes in the UK

Baroness Walmsley Excerpts

Tuesday 21st April 2026 Grand Committee

[Baroness Walmsley (LD)]

My Lords, I am very grateful to the noble Lord, Lord Patel, for giving us the opportunity to talk about cancer today, because I am a very lucky woman: like the noble Baroness, Lady Ritchie, I am a cancer survivor. My cancer was picked up by routine screening, so I am just as much of a fan as the noble Lord, Lord Stevens, of routine screening.

I am delighted to be able to talk about the National Cancer Plan, which covers improvements in targets for prevention, diagnosis, treatment, care and research. Yet, of course, all these are underpinned by a sufficient, properly trained workforce—with ongoing CPD, since the science is constantly changing. The Government have promised the NHS workforce plan by this spring, yet, despite the sunshine outside, for the Government, spring has not yet quite sprung. Will the Minister be able to confirm when we will get it, and can she say whether it will deal with not just clinicians but technicians, and not just initial training but a reliable system of CPD to keep practitioners up to date, as the noble Baroness, Lady Watkins, has also requested?

There are many areas where efficient workforce planning is vital for achievement of not just the cancer plan but the 10-year health plan, including, as it does, moving from hospital to community, and many examples have been raised by speakers today.

A couple of hours ago, I raised an Oral Question about the issue of newly qualified midwives being without a post despite the issues of unsafe staffing levels in maternity services. In Wales, paramedic students are being told there are no posts for them in Wales when they qualify; they will have to go and work somewhere else. The number of posts for health visitors has been halved over 10 years, leading to some having enormous case loads, which were highlighted in the media this week. These are just a few examples of poor workforce planning in the general NHS workforce, but I recognise that this is not easy.

There are of course many examples of shortages in the cancer workforce, including of GPs, as the noble Baroness, Lady Gerada, just told us. They are all vital to early diagnosis, which we know leads to better outcomes. Yet the role of some groups is underestimated: last week, I went to my local dentist for a check-up; she checked me for oral cancer, and for any swellings in the lymph nodes in my neck, which might indicate cancer. Thousands of people cannot get an NHS dentist and cannot afford to pay, as I did, and therefore do not get these cancer checks, as well as having their teeth fall out. Dentists also part of the cancer workforce.

The Government plan for 28 more radiotherapy machines, which—as the noble Baroness, Lady Redfern, said—are probably enough only to replace the outdated ones. My party has proposed that the ambition should be more like 200, but we are aware that this would have to go alongside training more technicians. Is there a plan to do so across the health service?

This brings me to diagnosis and the question of investment in haematology, pathology and several other sectors which noble Lords have mentioned. Many years ago, I worked as a cytologist in the pathology lab of a major cancer hospital in Manchester. I was screening cervical smears for cancer and pre-cancer cells so that patients could have further examination and timely treatment. Since then, productivity has vastly improved with mechanisation of slide preparation and AI-assisted interpretation of samples. There is even more potential for this sort of improved productivity today, so that patients can get their results quickly and proceed to treatment. The noble Lord, Lord Kakkar, talked about the importance of doing this kind of investment when we have a cash shortage.

However, while this requires some investment, it is certainly cost-effective, as indicated by many studies. Waiting for test results is very stressful for patients—as I am sure has been experienced by several noble Lords at some points in their lives—and can be dangerous, as mentioned by the noble Baroness, Lady Redfern. Consultants need these test results to aid early diagnosis, but most areas are unfortunately well behind the targets.

Turning to prevention, there are three major areas I will mention. First, there is a long list of cancers that could be prevented by lifestyle changes. Smoking tobacco has long been the most common cause of cancer, and we are grateful to the noble Baroness, Lady Ramsey of Wall Heath, for her speech on this. Over recent years we have had legislation which has helped to reduce smoking and secondary smoking, the most recent of which was the Tobacco and Vapes Bill which finally went through your Lordships’ House yesterday. I congratulate the Minister and the Government on this legislation, which will certainly protect young people from taking up smoking and increase the opportunity for smokers who wish to quit to get help, thereby reducing their risk of getting lung and mouth cancer.

However, it is vital that community-based stop-smoking services have sufficient resources to be able to offer the full range of help. For example, most do not have the funding to afford prescriptions for the drugs which are proven to help smokers for whom other methods have failed. Vapes have proved to be a very effective quitting tool and should be widely available as such, including on prescription. However, I am pleased that the Government have taken powers to restrict the opportunity of manufacturers to attract, through advertising and marketing, children and non-smokers to start vaping, and I look forward to the regulations to put these into practice. We do not yet have enough information about any long-term dangers of vaping, especially on young and developing lungs.

The second lifestyle factor is diet. In addition to diabetes and musculoskeletal problems associated with overweight, there is a very long list of cancers caused by bad diet and obesity. In response to an inquiry in your Lordships’ House in 2024, which I had the honour to chair, the Government have put a number of our recommendations in place—thank you very much—but a great deal more needs to be done, and more quickly. The effect on the economy of the lost years of life and the lost working years due to illness caused by obesity has been well documented. It is tempting for some to suggest that it is all down to willpower, but that is not the case. We make our decisions on diet in an obesogenic environment, and many people cannot afford a healthy diet, so they are susceptible to a whole list of cancers. My committee proposed a comprehensive cross-government, long-term strategy to improve the nation’s diet.

Last year, the Government set up a national food strategy led by Defra, but we are not hearing much about it. It should cover a whole raft of government departments, so can the Minister say how her department is contributing to that? It really affects the budget of the NHS in the long term. Legislation on healthy food is undoubtedly required, and the Government will no doubt soon hear proposals for a healthy food Bill in the debate on the King’s Speech.

Having formerly worked in the area of cervical cancer, I was thrilled when a vaccine against the human papillomavirus was developed. It is offered free to teenagers as part of the school-based vaccination programme. As chair of your Lordships’ current ad hoc committee on childhood vaccination rates in England, I have heard evidence that the uptake of the HPV vaccine has fallen from 90% when it was first offered to only 72% now, and this puts the Government’s objective of eliminating cervical cancer by 2040 in great danger—the noble Baroness, Lady Nargund, mentioned that. Therefore, what is the Minister’s department doing about that, and how is she working with the Department for Education to improve the situation? I am hearing that some schools are refusing to work with the vaccination services offered to their pupils, and some find getting parental consent very time-consuming. Perhaps the Minister will write to me about that when she has spoken to her colleague.

Finally, on research, as I mentioned, vaccines have already been developed to prevent or treat cancer, and there will be more. Only yesterday, the media reported a vaccine that considerably extends the survival of patients with pancreatic cancer. This raises the question as to what the Government are doing to enable more of this sort of work and the clinical trials that are basic to it, as mentioned by the noble Baronesses, Lady Bottomley and Lady Paul. Clinical trials are absolutely vital in order to bring treatments to patients, and we need to make them easier.

I served on another of your Lordships’ committees—the Science and Technology Committee—with the noble Lord, Lord Drayson, who mentioned some of the findings of one of its most recent reports. But, in addition to the report on the difficulties of scaling up small businesses in this country, including life science businesses and other scientific businesses, the committee wrote an urgent letter to the Secretary of State for Health about the missed opportunity of attracting more researchers from the United States to come here if they are unhappy with the situation there. I am hearing that it would cost an American researcher £18,000 to come with a spouse and one child, to get visas and to pay the NHS charge in advance. This is more of a barrier than an encouragement. The committee heard that other countries are being much more opportunistic than us on this matter. Why are we lagging behind, when other countries have managed to strengthen their cancer research workforce? We need to get good people from wherever they are willing to come to us. Let us stop pussyfooting around and get on with it.

Midwives: Graduate Guarantee

Baroness Walmsley Excerpts

Tuesday 21st April 2026 Lords Chamber

Asked by

[Baroness Walmsley]

To ask His Majesty’s Government what progress they have made towards achieving the graduate guarantee for newly qualified midwives.

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

My Lords, the graduate guarantee creates additional temporary registered midwife roles and enables newly qualified midwives to apply to join the NHS workforce. This supports the transition from education to employment. Since September, over 850 of these roles have been created, backed by £8 million. This includes part-time and full-time jobs. NHS England is working closely with universities and employers to align graduate numbers with vacancies through improved workforce planning, enhanced support for students and co-ordinated local recruitment.

[Baroness Walmsley (LD)]

I thank the Minister for her Answer. The graduate guarantee is very welcome but, already, 31% of newly qualified midwives do not have a job or are on fixed-term contracts. First, how will the Government ensure that workforce planning is aligned to the number of posts available so that the skills of newly qualified cohorts are not wasted? Secondly, given the concerns about unsafe workloads in midwifery and maternity services, how will midwives have the time to discuss with their clients health issues such as diet and vaccination?

[Baroness Merron (Lab)]

On the second point, the noble Baroness is quite right: it is important that midwives have that time. That is what we anticipate will be the case—I refer her to the forthcoming workforce plan, which will improve the situation. With regard to the position that the noble Baroness describes, I agree that this needs sorting out, and I recognise the figures that she has shared. That is why we have brought in the graduate guarantee scheme—so that we can get people from their training and education into the NHS and can ensure that midwives are recruited on the basis of looking to the future rather than of the existing headcount. So we are future-proofing this.

Tobacco and Vapes Bill

Baroness Walmsley Excerpts

Report stage
Tuesday 3rd March 2026 Lords Chamber

[Baroness Merron (Lab)]

My Lords, in an earlier group I spoke about the importance of fixed penalty notices in the Bill, as they provide trading standards officers with an additional enforcement tool to bring retailers into compliance without taking up court resource. I have carefully considered the points raised by noble Lords in Committee about the proceeds of fixed penalty notices issued for licensing offences, including those made by the noble Baroness, Lady Walmsley.

I am therefore pleased to have tabled these government amendments because they will allow local authorities in England and Wales to retain all the proceeds from the £2,500 licensing fixed penalty notices for enforcement purposes, rather than having to return proceeds to the Consolidated Fund. That will enable local authorities to reinvest proceeds into strengthening the enforcement of tobacco and vape legislation—something that noble Lords have asked for.

In addition, we are investing up to £10 million of new funding in trading standards annually until 2028-29 to tackle the illicit and underage sale of tobacco and vapes, and to help to enforce the law. This funding is being used to boost the trading standards workforce by hiring 120 apprentices across England, and we will continue to provide funding to support the apprentices over the next three years as they complete their training.

Trading standards plays an essential role in ensuring compliance with tobacco and vape legislation. The enforcement provisions in the Bill, further strengthened by this amendment, will give them the tools they need to carry out that role. Proper enforcement of the law will protect the public from potential health harms and help to realise public health outcomes from policies in the Bill and other tobacco and vape legislation. For these reasons, I hope that noble Lords will feel able to support the government amendments in this group. I beg to move.

[Baroness Walmsley (LD)]

My Lords, I will speak to Amendments 66 and 68 in my name. These provide that the money collected by trading standards in small fines imposed by fixed penalty notices for offences other than those related to the licensing regulations should go towards smoking cessation services provided by the relevant local authority. The Liberal Democrats have been calling for this since the Bill was first introduced to Parliament.

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[Lord Mawson (CB)]

My Lords, I support the amendment from the noble Lord, Lord Young. Supporting a smoke-free society is the right direction of travel, in my view, but I also worry about contact with reality.

A road map should also include the potential unintended consequences of cannabis smoking in a smoke-free country, with real targets and interventions. Walk across London and other towns and cities and smell the cannabis smoking on every street corner. People are breaking the law, with the police doing virtually nothing about it.

Cannabis has profound long-term health implications in the young. Some of us have worked in this space and have to deal with them. What are the unintended consequences of the Bill for the uptake of cannabis smoking among the next generation? I ask the Minister: what work have the Government done on the unintended consequences of this policy, and what do they plan to do about the potential uptake and increase in cannabis smoking, and the increase in illicit dealing on our streets?

[Baroness Walmsley (LD)]

My Lords, I thank the noble Lord, Lord Young, for tabling Amendment 202, to which I have added my name. It would require the Government to publish, every five years, a road map to a smoke-free country: in other words, a plan for the event rather than a review after it.

There are two essential components to achieving a smoke-free country. The first is that no one should start smoking at all. I hope that the Bill will successfully achieve that over time; the Government have shown great ambition in this area. The second component is that all current smokers are supported to quit, so that everyone stops. On this second part, the Government have been a little quieter, until recently. We have heard about the recent success of targets met for the number of pregnant women smoking at the time of delivery: I think it has gone down by half. However, the rates for other groups remain stubbornly high and we are not seeing the same targeting interventions. We need to ensure that we have this type of focus, energy and commitment with other groups, where we know that smoking rates are higher. Plans for these groups could be located in the road map being proposed.

For example, mental health is a key priority area for the Liberal Democrats. There is a dual causal relationship between smoking and mental health: if you smoke, it increases your chances of developing mental health conditions and, if you already have a mental health condition, you are more likely to smoke. Nearly half of those with a serious mental illness in England smoke, alongside a quarter of people with depression or anxiety, compared with 11.6% of the general population. High rates of smoking in this population have a disastrous impact on physical health, particularly for those with a serious mental health illness who, on average, live 15 to 20 years less than someone without. It is estimated that smoking accounts for about two-thirds of this reduced life expectancy.

The pervasive false narrative that smoking somehow alleviates mental health symptoms urgently needs to be addressed, as it creates so many challenges when we are trying to support these smokers to quit. If the Government are going to publish a strategy, a dedicated section on how they will bring down smoking rates in this group would be extremely welcome and needed. I welcome the Government’s concession that vaping vending machines should be allowed in secure adult mental health settings; this should certainly help this population to quit.

Amendment 206, tabled by the noble Lord, Lord Lansley, would require the Government to publish a review of the Bill. I welcome government Amendment 205, which does something similar but with a lot less granularity. However, would the Minister give us a little more information about where the Government will get their evidence to underpin the review? Can she assure the House that that evidence will be independent and not influenced by any lobbying or so-called evidence put before the Government by big tobacco, or anybody else who would benefit from slowing down the elimination of smoking in the UK?

The intent of this review should be to support the legislation. As several noble Lords have said, the smoke-free generation is a novel policy and we need to demonstrate the impact and evaluate implementation to encourage other countries to follow. There are also many regulations on the way, along with those from other government departments, on nicotine products. A clear analysis of how these policies will work together would be very welcome.

However, the review must not be viewed as a sunset on the smoke-free generation, and I would welcome comments from the Minister on what, at this point, we know will not be in the Government’s review. For example, the Bill’s impact assessment notes that many of the health impacts of the rising age of sale will not be seen for 10 years, so we should be mindful that this part of the Bill is playing a very long game. There may be early data that we are on the right track and the review will perhaps be able to look at compliance, retailer feedback and all the other things that the noble Baroness, Lady Fox, mentioned. I feel that much of this falls into the scope of her Amendment 207.

Finally, Amendments 91, 120, 201 and 216, tabled by the noble Baroness, Lady Hoey, raise concerns about the Bill’s implementation in Northern Ireland. I have been reassured by the Government’s response to the TRIS process, which lays out in some detail their response to the concerns raised, but, as the noble Lord, Lord Forbes of Newcastle, mentioned, the legal opinion published in the Daily Mail was commissioned by the Tobacco Manufacturers’ Association. Without seeing it, I cannot really comment other than to say it is not surprising that the industry is laying the ground for future legal challenges. It is, as we know, highly litigious and wants to chill the appetite for tobacco control globally. It all goes to show, I suppose, that if you put two lawyers into a room, you get three opinions. There are, as we have heard from the Minister on other occasions, other legal opinions out there that say that the Bill is compatible, but I leave the noble Baroness to answer for those concerns. However, I support the Government to press on with this vital public health legislation, and to plan it and review it as required.

[Earl Howe (Con)]

My Lords, this has been a very useful debate with some powerful contributions, but I should like to turn first to the amendments tabled by the noble Baroness, Lady Hoey. It was reported last week in the Times that seven EU member states have formally expressed concern that the Government’s proposed generational smoking ban might breach the Windsor Framework. The Minister said last week that the provisions of the Bill intended to apply to Northern Ireland are compatible with the United Kingdom’s obligations under the Windsor Framework. However, these external concerns plainly have not gone away.

In a previous meeting, I was grateful to the noble Baroness and her officials for discussing the Technical Regulations Information System—or TRIS—procedure in respect of liaising with the European Commission and those EU countries that have raised objections. She explained that, in the Government’s opinion, the TRIS procedure is about consultation and will not lead to any decisions that would be binding on the UK Government. Can the Minister clarify if my understanding of the Government’s position is correct in that regard? Will she also update the House on discussions with the European Commission and with representatives of member states that have raised their concerns? Can she also say whether any formal objections have been lodged through the Windsor Framework structures, including the joint committee?

In general on this issue, we see a rather polarised position, with the tobacco industry on one side and ASH and the Government on the other, so I would be grateful if the Minister could clarify whether the Government have sought or obtained any independent external legal advice on compatibility and whether they are confident that the measures would withstand a challenge in the event of infraction proceedings or dispute resolution. Following on from that, what contingency planning, if any, has been undertaken should a divergence issue arise in relation to Northern Ireland?

Let me turn to Amendments 202, 205 and 206, which relate, in their several ways, to reviewing the effects and outcomes of the Bill as an Act. I am supportive of them but especially grateful for Amendment 205, which responds to the plea put forward by a number of noble Lords in Committee that this far-reaching Bill, whose real-life effects on the health of the population must inevitably lie in the realm of uncertainty, merits close review at a point when we are in a position to assess those effects realistically. Hence, I particularly welcome subsection (2) of the new clause proposed by the amendment, which refers to assessing the impact of the Act. As my noble friend Lord Lansley argued persuasively, the review needs to drill down into the granular detail and the substance of how smokers and non-smokers are behaving in response to the implementation of the different strands of policy.

Having said that, I very much support the ideas contained in my noble friend Lord Young’s Amendment 202, for all the reasons that he gave. A review within four to seven years, as the Government have proposed, considering both economic and health outcomes and involving the devolved Governments, is a sensible safeguard as far as it goes. However, a road map and milestones, which both government and Parliament could follow and monitor along the way, would add considerable value. I am sorry that it appears that this is not an idea that the Government are willing to take further.

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Moved by

[Baroness Walmsley]

123: Clause 89, page 50, line 17, at end insert—
“(2A) Provision made by the regulations must ensure that—(a) vaping products are sold in plain packaging;(b) vaping products are not displayed at the point of sale in the usual course of business, including promotional or marketing materials used at the point of sale, such as imagery, wording, branding, or promotional offers;(c) a person who fails to comply with the requirements imposed by the regulations under this section commits an offence and is liable to a fine not exceeding level 4 on the standard scale.(2B) In subsection (2A)—“plain packaging” means packaging that does not include branding, logos, imagery, or colours designed to make the product attractive;“point of sale” means any location within retail premises where vaping products are available for purchase.”

[Baroness Walmsley (LD)]

My Lords, Amendment 123 is in my name and that of my noble friend Lady Northover. When in Committee my noble friend tabled an amendment to prevent companies advertising vapes in a way that attracted children, the Minister’s response was that this was not necessary because advertising of vapes would be banned under the Bill except for public health purposes as a smoking cessation tool. In that case they would not be allowed to be advertised in a way that attracted children, and our amendment was therefore not necessary.

Having accepted the Minister’s point, we turned our attention to the packaging itself and point of sale display materials, because we know that the companies trying to sell vapes to people who have never smoked before will stop at nothing to hook people into nicotine addiction. That is why we have proposed that vapes must be sold in plain packaging like cigarettes and not displayed with attractive materials at point of sale. A recent UCL study showed that implementing plain packaging for vapes reduced their appeal to young people but did not affect how harmful adults perceive vapes to be compared with cigarettes. In particular, the paper noted that:

“Packaging is a primary marketing tool for vape companies”,


and that

“it is commonplace for brands to also use youth-appealing elements, such as images, cartoon characters, stylised fonts, and novel brand and flavour names on vapes and e-liquid packaging”.

We therefore felt it worth exploring the Government’s plans with regard to consultation and regulations about the packaging and point of sale of vapes. Vapes were on the market for quite a few years before the big uptick in youth vaping around 2021. That coincided with cheap, colourful, ergonomic disposables flooding the market. We need to make vapes a dull cessation tool again. Regulating packaging can and should be done quickly because vapes are being more aggressively marketed, partly through displays in stores. This is having an effect. Action on Smoking and Health’s latest youth vaping survey found that awareness of vaping promotion grew among 11 to 17 year-olds between 2022 and 2025. There was a significant increase in awareness of promotion of vapes over that period, particularly in shops: 37% in 2022 compared with 55% last year.

In 2022, 56% of 11 to 17 year-olds who were aware of vapes reported that they were exposed to some form of vape promotion. In 2022, 11% of young people who were aware of vapes reported seeing vape displays every time or most times they went into supermarkets. Last year that figure had risen to 27%, so there is a pressing need to do something about this. I accept that plain packaging and display rules for tobacco products were implemented, following consultation, through secondary legislation. I therefore ask the Minister what research has been carried out on the potential effect of plain packaging and point of sale for vapes, whether it would deter young people who do not smoke from taking up vaping and whether it has been shown that there would be any deterrent effect on adults who wish to quit by using vapes to help them to do so. Frankly, I would be very surprised if someone who wishes to quit would be deterred from buying a vape just because it was not in a shiny, colourful, attractive package on a shiny, colourful, attractive display, like the ones I currently see all over the place.

I do not support Amendments 125 and 134 tabled by the noble Lord, Lord Moylan. I felt we had a balanced debate in Committee about the role that flavours play in smoking cessation, and I was reassured by the Minister’s comments at that time. Clearly, regulation of flavour descriptors is easier to do and may give us the desired outcomes, meaning that we do not need to regulate flavours themselves. However, it is important that the Government retain the right to regulate flavours in case evidence emerges about particular flavours that require action.

On Amendment 136A tabled by the noble Lord, Lord Udny-Lister, the limit on vape size is currently 2 millilitres, but I know there are concerns regarding products that attach to vapes to increase this. I urge caution in this area. While it might seem likely that larger tanks increase consumption, there is not yet evidence of this being the case, and concerns regarding big-puff products may be unfounded. We need to find out. Indeed, the rise in youth vaping in Britain since 2020 appears to have been primarily driven by 2-millilitre, colourful, single-use vapes, not larger-capacity products. It is possible that larger-volume products could have benefits in satisfying consumer demand for longer-lasting products, reducing littering—which would be a good thing—and increasing the price point of initial purchase without unduly raising the price per puff for those using them to quit smoking. I look forward to comments from the Minister on the broad point regarding attachments. I know that both these issues were included in the recent call for evidence, so she may have some early insights for us in the light of that. I beg to move.

[Lord Moylan (Con)]

My Lords, I will speak to my Amendments 125 and 134 in this group. I am grateful to the noble Baroness, Lady Fox of Buckley, for the support that she has indicated for them. On the speech just made by the noble Baroness, Lady Walmsley, I am obviously distressed that she has been exposed needlessly to the sight of shiny vapes in her local supermarket, petrol station or whatever it is. We can sympathise with her on that, but she seems to have ignored entirely the context of Clause 89. This gives the Government the most extensive powers, at least in relation to packaging, which, as far as I can see, could very easily lead to the equivalent of plain packaging, but she made no reference to it.

My amendments would increase the powers that the Government have in Clause 89. I will first explain the rationale for what I am proposing. There is a great deal of agreement—there has been throughout Report—between the Minister and me; I hope that we can continue that in the course of this debate. We agree, crucially, on the importance of how the flavours are described and presented to the public in attracting buyers to vapes.

However, that cuts two ways. We know, on the one hand, that vapes can have what I call “flavour descriptors” on them. These are deliberately designed to appeal to children and young people in a way that we are all opposed to. We do not wish to see vapes marketed in such a way as to seduce children and young people into taking them up. When we see flavour descriptors such as “cotton candy” and “gummy bear” on the side of a vape, we can all agree that that sort of thing should have a stop put to it because we know the market that it is intended to reach. On the other hand, as I think the Minister has acknowledged, for vapes to be an effective cessation tool for adults it is important to have a range of flavours available to them. As I said, I think the Government have acknowledged that.

Where in the Bill is the power that the Government need to regulate flavour descriptors? It is the flavour descriptor—the “gummy bear”, the “cotton candy”—that the Government need a clear power to be able to eliminate. We discussed this in Committee. The Minister very kindly wrote to me afterwards and said that the Government would rely on Clause 89, which relates to retail packaging. This gives the Government a certain number of powers to make regulations concerning packaging, but it does not at any point, as far as I can see, specify the flavour descriptor that appears on the packaging as something that the Government have a direct power to regulate.

The Government may rely on Clause 89, and it may be possible that its scope could be stretched to cover their point. It would ultimately, I suppose, be a matter for the courts to decide. My Amendment 125, fairly straightforwardly, would give the Government that power explicitly. It would add to the list in Clause 89(3), currently running from paragraph (a) to paragraph (k), of the things that the Government can regulate. It would add a further thing: the flavour descriptor that appears on the packaging. I do not think the Government would necessarily want to reject this amendment. It would give them a power that could be very useful; even if they feel that they have this power already, making it explicit would make matters somewhat easier.

To complement that, there is in Clause 91, which relates to contents and flavours, a power for the Government to make regulations concerning the “flavour of relevant products”. Here I want to make a point which I made in Committee and which is of the utmost importance; I speak as somebody who uses vapes. My point is that, in practice—I say this especially for the benefit of noble Lords who do not use vapes—the flavour descriptor on the vape has almost no relationship to the flavour of the vape.

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[Baroness Walmsley (LD)]

My Lords, I thank the Minister for her response and, in particular, the words—and I hope I quote them correctly—these are areas on which we are planning to act. I reassure the noble Lord, Lord Moylan, that I looked very carefully at Clause 89, as my earlier comments in earlier debates on how they might affect specialist tobacconists might have proved to him, but I point out that it talks only about packaging and not about display materials—that appears in a different part of the Bill.

I also say to the noble Baroness, Lady Fox of Buckley, that, even if my amendment was put word for word into the Bill, it would not prevent information about the products being provided on the packaging or the display to people who wanted to buy them. That would be fine. My intention—and I know the Minister understands this—is to do everything possible to reduce the attractiveness of vaping to stop it being taken up by young children who have never smoked. Vapes are and should remain a cessation tool.

I am particularly grateful to the Minister, because we have discussed this issue outside the Chamber. She has given me what I want in that she has clarified that the Government have the powers in the Bill to regulate both packaging and display and has said the Government intend to act in these areas. I am very grateful for that. Having been given what I want, I will withdraw my amendment.

Amendment 123 withdrawn.

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[Baroness Walmsley (LD)]

My Lords, despite the comments of the previous two speakers, I will speak to Amendment 199, the purpose of which is simple: to make every future and renewed pavement licence issued by local authorities smoke-free.

Your Lordships will recall that pavement licences first appeared during the pandemic, when indoor hospitality was restricted. They gave cafés, pubs and restaurants a lifeline. It seemed obvious that these spaces should follow the same rules as indoors: no smoking. The LGA supported this, saying that

“it sets a level playing field for hospitality venues across the country and has a public health benefit of protecting people from unwanted second-hand smoke”.

It welcomed this national policy because it stopped the stupid situation of allowing people to smoke in a pub pavement area on one side of the road but not on the other if a local authority boundary ran down the middle of the road and they had different policies. Since then, pavement licences have become a permanent fixture. However, after some lobbying from some parts of the hospitality industry, the requirement for smoke-free was removed without proper consultation of health authorities.

In 2021, this House supported an amendment from the noble Lord, Lord Faulkner of Worcester, noting the missed opportunity to make all licences smoke-free. Amendment 199 seeks to honour that vote and ensure that this health-protecting measure is applied consistently.

There is currently a requirement for some seating to be smoke-free, but the distinction means very little when you talk about a very small bit of pavement. More than 10 councils have made smoke-free a condition of obtaining a pavement licence, including Liverpool, Manchester, Newcastle, Northumberland County Council and Durham—not outstandingly liberal authorities, as far as I can tell. Feedback shows that customers and businesses welcome the change. In Liverpool, a survey of premises found that 74% of those asked expressed support for the scheme, including many smokers. Councils also aim to reduce cigarette litter with this initiative, which would make outdoor seating areas cleaner, more welcoming environments.

Second-hand smoke is harmful at any level. It worsens asthma and other respiratory conditions, and contributes to heart disease, stroke and lung cancer. Smoke-free spaces are also popular with the public. Polling from ASH shows that 59% of people support banning smoking in outdoor areas of pubs, cafés and restaurants; indeed, 40% said that they would be more likely to visit these venues if smoking were banned outside. That is more than double the number of people who say that they would go less often, debunking the idea that smoke-free means customer-free. Making outdoor areas smoke-free is not only sensible but what the public want.

I regret that this issue is not covered by the recent consultation on smoke-free places. It is a shame that the Government felt that they were not able to include hospitality in that consultation at all and that they fell into this false narrative that smoke-free is somehow an economic threat to hospitality.

Less than 12% of the population smoke, so the financial viability of the hospitality industry is clearly not dependent on the continued consumption of tobacco, including outdoors. Indoor smoke-free legislation was a far more drastic intervention, and we heard many of these arguments from those opposed then. However, a survey in 2012 of nearly 5,000 pub customers reported that more than one in five visited the pub more often than before smoke-free legislation. I do hope that the Minister will, in future, consider looking at the pilots for smoke-free pavement licences to assess the economic relationship between the hospitality sector and smoking. As prevalence continues to fall, we must be at a tipping point soon, where these spaces will naturally become smoke-free.

This brings me to Amendment 196, tabled by the noble Lord, Lord Sharpe of Epsom. I think we may disagree on the potential impact any restrictions will have on hospitality, but in any case, the Government would consult on any use of smoke-free powers as they are doing currently.

Moving on, I welcome Amendment 194A from the noble Lord, Lord Kamall, and the noble Earl, Lord Howe. There is no doubt that the public are keen to see more places where smoking and vaping are prohibited. However, this policy must be pursued not merely to cater to the things that people dislike, but also to ensure that it is addressing matters that are harmful to the public. Clearly, reducing children’s exposure to second-hand smoke passes that test. While the evidence of exposure to second-hand vapour remains unclear, I think we can agree that reducing any possible risks around children must be prioritised, following careful consultation.

In that respect, I do not support Amendments 194 and 195 from the noble Lord, Lord Udny-Lister, which would remove these powers altogether. However, there is a challenge in all of this. Given the high level of public misunderstanding about the difference in harms between vaping and smoking, as the noble Baroness, Lady Fox of Buckley, has said—and she is quite right —how do we ensure that in creating vape-free places we do not exacerbate those misconceptions? I talked to a young man the other day who asked me, “What are you doing in the House of Lords?” I explained about this Bill, and he said, “Oh, all my friends vape”. He said, “I think it is just as harmful as smoking, isn’t it?” QED. Of course it is not.

I welcome the commitment in the published consultation to treat vaping differently from smoking where it is providing support to smokers to quit. I am on the same side as the noble Baroness, Lady Fox, on that score. Will the Minister say more about how this policy will be communicated to improve public understanding that vaping is less harmful than smoking? How will any exemptions to indoor vaping regulations be used to best effect to encourage more smokers to see vaping as quitting aids?

It is disappointing to see only council-run playgrounds included in the ban on smoking in playgrounds. Why should children playing in settings not run by councils not be similarly protected? There are also other places, such as transport hubs, where the public and workers are regularly exposed to other people’s smoke, so are the Government planning to commit to look at these too?

Amendment 192A from the noble Earl, Lord Howe, is very interesting, but we do not think actors should have to smoke at work. I think it was pointed out in Committee that there are alternative products that can depict smoking for artistic purposes; in particular, I believe that the National Theatre has such a device. If it is good enough for that theatre, it is good enough for me. Moreover, Wales does not have this exemption in place, and it has not harmed Welsh theatres.

We do not think that Amendment 193 is appropriate either: most venues are vape- free anyway, and the law is just really catching up.

On Amendments 197 and 198, I do not think that heated tobacco should have special exemptions at all. Only 1% of the population use it and it is not recommended by NICE for cessation. However, I do have a couple of questions for the Minister about heated tobacco devices, because I have had a letter expressing some concern that the law is not terribly clear. The advertising offence in the Bill applies to any advert,

“whose purpose or effect is to promote … a tobacco product”.

So can the Minister confirm that heated tobacco devices—not just sticks—will be caught under this definition, as advertisement of the device might constitute promotion of the tobacco product?

I see that in Clause 132 the Government explicitly take the power to extend provisions in Part 6 to tobacco- related devices. I understand that this is to future-proof the advertising restrictions against any innovation in this space, as we know the tobacco industry is likely to use any loopholes. I ask the Minister: why are heated tobacco devices explicitly included in Clause 132? Is it because of the difficulties they have had recently with two big supermarkets advertising heated tobacco products? Is it just the devices they are advertising, or are they simply breaking the law about advertising the tobacco sticks themselves? A little clarification would be most welcome if the Minister could provide it, please.

[Baroness Merron (Lab)]

My Lords, I am grateful to noble Lords for their contributions on this last group of amendments. It may be helpful if I remind your Lordships’ House that, on 13 February, the Government published their consultation on free-from places. We are consulting on making outdoor public places, including children’s playgrounds, hospitals and schools, smoke-free and heated tobacco-free. Additionally, we are consulting on making outside playgrounds and schools vape-free.

With regard to indoor spaces that are currently smoke-free, we are consulting on also making these heated tobacco-free and vape-free. I want to emphasise—and I hear different opinions on this within your Lordships’ House—that the consultation does not consider extending these proposals to outdoor hospitality. I hope that this addresses the concerns raised under Amendments 194 and 197, tabled by the noble Lord, Lord Udny-Lister, as well as Amendment 196 from the noble Lord, Lord Sharpe.

With regard to Amendment 193 from the noble Lord, Lord Udny-Lister, the vast majority of people—around 90% of those over 16—do not currently vape. Just because someone is present in an over-18 setting does not mean that they are content to be exposed to second-hand harms. This would be of particular concern to those who are medically vulnerable, whose conditions may not always be visible.

Additionally, under the proposals put forward in the consultation, those who wish to vape would still be able to do so in outdoor hospitality settings. I should say that we have been pleased to meet various stakeholders, including UKHospitality and the British Beer and Pub Association, and we have welcomed their input.

Furthermore, a number of establishments, as I am sure we are all aware, have already introduced their own policies restricting vaping indoors. These proposals provide consistency and clarity for the public and businesses, and that is crucial if we are thinking about legislation.

I turn to the evidence. Amendments 195 and 198 in the name of the noble Lord, Lord Udny-Lister, question the need for the vape-free places and heated tobacco-free places clauses. I also refer to Amendment 194A in the name of the noble Lord, Lord Kamall.

We have already published a draft impact assessment alongside the consultation on free-from places. To the points made by the noble Earl, Lord Howe, this sets out the evidence base for the proposed policies. I encourage noble Lords to review the document, which is thorough, if they have not had the chance to do so already. I can say that we will reassess the evidence after the consultation is closed, and we will consider any additional evidence identified before deciding on final policy positions and publishing a final stage impact assessment alongside regulations.

Under-16s Energy Drinks Ban

Baroness Walmsley Excerpts

Tuesday 10th February 2026 Lords Chamber

Asked by

[Baroness Walmsley]

To ask His Majesty’s Government when they expect to publish a timeline for legislation banning the sale of energy drinks to under-16s.

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

My Lords, we are taking decisive action on obesity, easing the strain on our NHS and creating the healthiest generation of children ever. As part of this, we will fulfil our commitment to ban the sale of high-caffeine energy drinks to children aged under 16, introducing the ban within this Parliament. Our consultation has closed. We are analysing the responses and will set out further information on our timelines in due course.

[Baroness Walmsley (LD)]

My Lords, the Government promised to ban the sale of energy drinks in this Session. The consultation has ended but we have not seen the results yet. When will the responses be published and when will the Government publish the regulations? Will the ban extend to all under-18s and all retailers, including vending machines and schools? There is still time to pass the regulations before Prorogation. Will the Government get on with it? Otherwise, it will be a promise made but a promise broken.

Better Start Longitudinal Programmes

Baroness Walmsley Excerpts

Tuesday 10th February 2026 Lords Chamber

[Baroness Merron (Lab)]

It is an important point that the noble Lord raises. This is being dealt with by the Government’s proposal to have a three-month consultation, so that we get it right in terms of acknowledging the concerns and challenges of screen time for children. So, I take the point that the noble Lord has made. This is of course a matter for DSIT. I will ensure that it is aware of the noble Lord’s comments, as well as the relevant departments—my department and the Department for Education—in respect of the programme that we are talking about.

[Baroness Walmsley (LD)]

My Lords, while I welcome today’s announcement about protecting special educational needs funding, I would like to ask about support for very young children with special needs and those with physical disabilities. Parents often find it difficult to find an early-years place or childcare suitable for these special children. Can the Minister point them towards any real, properly funded, properly resourced help from people with the right training looking after these special children?

[Baroness Merron (Lab)]

I hope I can be helpful to the noble Baroness. In the Best Start for Life strategy, we committed that each Best Start Family Hub will have a children and family services practitioner to support children and families who have additional needs. I feel that this new offer will help parents to understand their child’s development and identify emerging needs sooner. Importantly, it will also support vital join-up across the services, keeping children who have particular needs at the very centre.

National Cancer Plan

Baroness Walmsley Excerpts

Monday 9th February 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, I begin by welcoming the publication of the national cancer plan and make it clear we fully share the Government’s desire to tackle cancer and to succeed in the fight against a condition that has affected almost every family in the country in one way or another. The Government have set out a clear ambition in this area, and we support them in that endeavour. It is appropriate for me also to pay tribute to all those who have contributed to the development of the plan, particularly those with lived experience with cancer and those close to them. Their willingness to share their experiences with such openness—and in many cases, courage—has, I am sure, been invaluable in shaping the finished result, and they deserve our thanks and recognition.

The national cancer plan sets out a number of significant commitments, including improving early diagnosis, restoring performance against cancer waiting time standards, accelerating the set-up of clinical trials and rolling out targeted lung screening nationally. It also places a strong emphasis on modernising services through technology and innovation.

These are all laudable aims and, indeed, Cancer Research UK has said that there is “much to welcome” in the plan. However, it has also rightly noted that delivery, funding and accountability will ultimately determine whether patients see real change. It is easy to put ambitious plans down on paper, but what matter in the end are clear delivery milestones and accountability. In that respect, this plan echoes many of the ambitions of the 10-year NHS plan, which was strong on aspiration but lighter on detail about how improvements would be delivered on the ground. My first question is, therefore, straightforward. When will the Government publish clear, fully funded milestones setting out how and when patients can expect to see tangible improvements over the next year or two?

It is also clear that the success of the plan will depend on having a sufficient workforce of cancer nurses, radiographers, pathologists and oncologists to deliver its aims. Can the Minister say whether we will shortly see a fully funded long-term workforce plan to support the staffing required to expand diagnostic and treatment capacity, not just in NHS trust settings but within neighbourhood health centres? In particular, can the Government explain clearly who will staff these services and how they will be funded? Blood Cancer UK has highlighted the importance of ensuring that blood cancers are properly recognised in workforce and service planning, and that patients receive consistent support from the point of diagnosis, including access to a named healthcare professional. Staff also need to know that they will be supported in delivering this plan, given current strains on capacity. In that context, we hear anecdotally of the difficulties involved in ensuring that staffing by doctors is adequate in all parts of the country. Some doctors, especially doctors in training, make up their minds that they will not be sent to work in an area that is not to their liking, perhaps because it would locate them far from friends and family. Will the welcome announcement of more training places in rural areas be enough to get sufficient doctors working in those areas?

Alongside the important question of staffing levels sits the Government’s ambition to invest in up-to-date capital equipment and cutting-edge technology. Investment in this often expensive technology is best and most efficiently met through capital budgets managed centrally. That leads me to a question about accountability for delivery, and where such accountability will lie. With the planned absorption of NHS England into the department, can the Minister give a sense of how the national cancer plan as a whole will be steered and monitored, not only centrally but regionally?

One specific aspect of the plan that I would like to welcome is the dedicated chapter for children, teenagers and young adults. This has been described by the Teenage Cancer Trust as a crucial step and an important acknowledgement that teenagers and young people deserve care designed around them and not as an afterthought. The work that the Government have done in recognising this is welcome. One point that the Teenage Cancer Trust has made particularly clearly is the importance of involving young people at the policy development stage. Can the Minister set out how young people with cancer were engaged in the development of this plan and how their voices were reflected in its content? Looking ahead, what steps will the Government take to ensure this becomes an ongoing process: listening to young people with cancer and systematically taking their feedback into account as the plan is implemented and reviewed?

Another point that charities and campaigners have consistently emphasised is the importance of clearly distinguishing between children and young people. The needs and challenges facing a three year-old child are self-evidently different from those of a 17 year-old young person, and it is important that this distinction is properly recognised in both policy and practice. I would therefore be grateful if the Minister could set out for the House how these different groups within the broader category of children and young people are engaged with. In particular, it would be helpful to understand how mental health support is tailored to different age groups and how the impact of a cancer diagnosis at different stages of a young person’s educational journey is reflected in their treatment and support pathways. If the noble Baroness could confirm that this distinction is one which the Government actively make and which will be taken into account in future policy development, I should be most grateful.

Let me conclude by reiterating my support for this plan and for the ambitions it sets out. In particular, there are some welcome and promising commitments around improving access to clinical trials and speeding up diagnosis. As the Minister knows, we need to do better in both those areas, and we share the Government’s ambitions to do so. For our part, we will continue to play our role in opposition by scrutinising delivery closely to ensure that ambition is matched by action and that the Government’s very laudable commitments translate into tangible improvement on the ground for patients.

[Baroness Walmsley (LD)]

My Lords, from these Benches, we very much welcome the national cancer plan and support its ambitions—and it is very ambitious. Many organisations and committees have called for an integrated, long-term plan, so it is very good that the Government have listened and, in particular, have taken note of the views of patients and their families—the people with lived experience of all these problems. However, may I reiterate Cancer Research UK’s response to the plan? It said:

“The key question that patients and their loved ones will ask, however, is how quickly will they see progress in cancer survival and outcomes? The improvements they are waiting for will depend on how this plan translates into delivery. Funding must match the ambition of what has been promised, or the NHS will struggle to expand its diagnostic capacity or introduce innovation at scale. And clear leadership and accountability are also crucial”.


Many of those points have also been mentioned by the noble Earl, Lord Howe, just now.

We know that outcomes in England have lagged behind comparable countries for decades, so it is positive to see improving cancer survival at the centre of the plan. However, it is going to be tough to achieve and will require much faster progress than what we have heard so far indicates. The key, of course, is improved diagnosis at an early stage, so I welcome the renewed commitment to earlier diagnosis and to meeting all cancer waiting time targets by 2029. It is outrageous that 92% of trusts do not reach the target for starting treatment. I welcome the full rollout of lung screening by 2030 and increasing the sensitivity of the tests used in bowel screening by 2028. However, what about breast screening? There have been problems in some parts of the country in getting that done. Can the Minister say whether these plans will be fully resourced? There is no point in doing the screening and tests unless an expert is there to interpret them. There are bold promises, but will they be matched with the resources and training required?

The plan talks about AI tools and liquid biopsy tests, which could certainly hold real potential for increasing productivity. However, before they are introduced, they must be robustly tested so that only safe and effective innovations reach patients and those that do not work can be dropped.

While there is a focus on diagnosis and treatment, I was pleased to see that the plan includes a commitment to increase action on lifestyle factors which we know cause cancer. Smoking tobacco, being overweight or obese, alcohol and UV exposure still cause many cancers that could be prevented. Fortunately, the Tobacco and Vapes Bill should certainly have a positive effect over the coming years in stopping people smoking in the first place. It is also positive to see action to strengthen protections on sunbed use and measures to drive HPV vaccination uptake, particularly in underserved groups. The new ad hoc committee on childhood vaccine rates is, I hope, going to contribute to that.

More action is needed to drive the shift from sickness to prevention, which is one of the Government’s core objectives in their 10-year health plan. There is still more to do to help millions of existing smokers quit smoking and to prevent someone becoming overweight or obese in the first place. Tightening regulation on alcohol through introducing minimum unit pricing, as implemented in Scotland and Wales, was a missed opportunity. Will the Government reconsider?

Rare cancers make up about 24% of cancers diagnosed in the UK and the EU every year. This includes cancers of children and young people, because they are less likely to suffer from the cancers caused by the lifestyle issues I have just mentioned. This is where research comes in, and the ability to implement research findings into the NHS. It is a sad fact that the NHS has been slow in the past to implement new cutting-edge treatments, so it is welcome that the plan has some important commitments in that respect. However, as with other aspects of the plan, the devil is in the detail.

The focus on ending delays in cancer treatment is a step forward, but funding 28 new radiotherapy machines is not enough when the treatment is so cost-effective and successful. We need to end the radiotherapy deserts. Will the Minister extend her ambition to the 200 extra radiotherapy machines that the Liberal Democrats have proposed? Another 28 will probably only replace the old machines that need to be replaced anyway—it will not take us forward. Can the Minister tell us about the plan to train the operatives for these new machines? Resources, training and accountability are at the heart of this. We have not had a lot of detail yet, so I look forward to getting more.

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

My Lords, I am grateful for the warm welcome from both Front Benches for the national cancer plan. This is a moment when we transform our cancer care and we make it personalised—we wrap it around the person instead of expecting it to be the other way around. The 62-day treatment standard has not been met since 2015, and outcomes, as we have talked about a lot in this Chamber, continue to lag behind those of comparable countries. That is what has driven us to this point to ensure that, by 2035, three in four people diagnosed with cancer will be alive five years later, whereas at present, the figure is three in five. That represents 320,000 more lives saved, with all the effects on their friends, families and communities, as well as themselves. That will be the fastest improvement in cancer survival this country has ever seen.

I will try to deal with some of the Front-Bench questions. I agree with much of what has been raised, including the recognition of all those, including those with lived experience, who contributed to what is, in my view and experience, a very bold 10-year strategy that actually sets out how we will do this. Both the noble Earl, Lord Howe, and the noble Baroness, Lady Walmsley, asked about clear milestones. I am glad to say that those are set out at the end of each chapter, with dates and the responsible organisations for all key actions and commitments.

The noble Earl raised the workforce plan. It will be published in the spring and will set out guidance—this goes to the point raised by the noble Baroness—not just on expanding numbers but on ensuring that staff are properly trained and supported. This will require a multidisciplinary team approach. We will use training directly as a lever to prioritise training places in trusts, often in the rural and coastal areas that the noble Earl asked about, as it is indeed the case that vacancy rates are higher and performance is lower. Training doctors of course takes time, but this is about long-term sustainable change and about turning around the whole of the cancer pathway. It is the exact opposite of us tinkering here and there. We are working with the royal colleges to boost the numbers of doctors specialising in clinical and medical oncology.

The noble Earl asked about bringing NHS England into the department. I see that as a great opportunity. Within the plan, we have set out a reformed national cancer board. It will be comprised of cancer experts, and it will be accountable—this is so important, as the noble Baroness said—for the overall delivery of the plan. Regionally, we will keep and strengthen the role of cancer alliances, which will work hand in glove with NHS regions to deliver cancer improvements.

The noble Earl asked how young people are being engaged. We worked with the Children and Young People Cancer Taskforce to ensure their voices were heard through its patient experience panel. Importantly, we will appoint a lead for children and young people with cancer to be part of the revamped national cancer board. We want their voices to continue to be heard. We definitely recognise the distinction between children and young people; they have different needs. For example, the plan highlights the importance of play for children, as well as the role of youth support co-ordinators in providing educational, emotional and fertility support for teenagers and young people. I agree with the noble Earl that cancer has a profound psychological impact on all patients and those supporting them. The plan sets out how that support must be standardised for children and young people, including the provision of longer-term support.

The noble Baroness asked about improving early diagnosis. We are providing £2.3 billion of investment in diagnostics to deliver 9.5 million additional tests by 2029 across screening and symptomatic diagnosis. The noble Baroness asked about seeing change; I say go to a community diagnostic centre. That epitomises where we are going with our National Health Service. We will also spend more than £650 million to complete the rollout of lung cancer screening by 2030, which is one of the things that can make the biggest difference in more disadvantaged areas, as well in prevention.

On radiotherapy machines, the responsibility lies at a local level. We expect local systems to continue to invest in new machines to meet the ambitious targets. Through the spending review, providers have been allocated with £15 billion in operational capital for local priorities and £5 billion to support a return to constitutional standards, including for radiotherapy machines.