Food, Diet and Obesity Committee Report

Baroness Walmsley Excerpts

Friday 28th March 2025 Lords Chamber

Moved by

[Baroness Walmsley]

That this House takes note of the Report from the Food, Diet and Obesity Committee Recipe for health: a plan to fix our broken food system (HL Paper 19).

[Baroness Walmsley (LD)]

My Lords, I thank the members of the committee for their hard work and dedication, and our wonderful staff team: Stuart Stoner, Lucy Valsamidis, Abdullah Ahmad, Lara Orija and Kate Willett. The advice of our specialist adviser, Professor Martin White, was absolutely crucial.

Albert Einstein is said once to have said:

“Insanity is doing the same thing over and over again and expecting different results”.


Unfortunately, the Government’s response to the committee’s recommendations smacks of insanity. Why? Because we have an obesity crisis and a consequent health crisis, which the NHS is meant to clear up. Page 3 of their response accepts that this is real, urgent and caused by bad food—yet there is no commitment to do things differently.

There was outrage from food and health campaigners at the Government’s response. But the following sentence appeared in an article in The Grocer periodical:

“However, food industry bosses welcomed Streeting’s response to the inquiry”.


Well, yes, that says it all—of course they did. They are laughing all the way to the bank with their profits on making our children sick, because the Government have accepted hardly any of the recommendations in the committee’s report. All they have committed to is implementing the policies of the previous Government: reviewing the soft drinks industry levy; implementing the advertising ban on less-healthy food; and banning energy drink sales to children. However welcome these are, they are not enough. Ambition needs action, not just words. We have a new Government with a new mandate and a duty to enhance people’s lives, but all we got was obfuscation and delay.

The Food, Diet and Obesity Committee’s remit was to consider the role of foods such as ultra-processed foods and foods high in sugar, salt and saturated fat in a healthy diet and tackling obesity. We interpreted that as asking us to recommend how the Government can ensure that all our citizens get access to healthy food, real food, affordable food. The committee looked at how we got here. We heard that our food system has changed over the past 30 years: less cooking from scratch, more fast-food outlets and more ultra-processed foods. These are usually high in calories, highly palatable and high in harmful nutrients such as salt, sugar and saturated fat; they are low in fibre and vitamins, and loaded with additives. There has been a vast increase in the advertising and promotion of less-healthy foods. Only 2% of advertising spend is on fresh fruit and vegetables, while 36% is on confectionery, snacks, desserts and soft drinks.

We heard that food is an equalities issue. The poorest 20% of people would spend 45% of their family income to comply with the national dietary guidelines, rising to 70% if they have children. Therefore, they suffer the consequences in lower life expectancy and more years in poor health. On average, today’s British children consume less than half of the recommended amount of fruit and veg, but twice the amount of sugar.

The committee looked at government action over the past 30 years while overweight and obesity have rocketed. There have been 14 obesity strategies, including about 700 policies. We asked researchers which ones had worked and which ones had not—and, if not, why not? The answer was that they failed because they were piecemeal, had voluntary rather than mandatory targets and relied on personal choice in a world where many people, because of the food environment and poverty, were not free to choose healthy food. The exception was the soft drinks industry levy, which was mandatory and led to a reduction in the amount of sugar in soft drinks, as manufacturers reformulated to avoid paying the tax. That was the point of it, of course.

The committee therefore determined not to fall into the same traps, and that led to our main recommendation that the Government should develop a comprehensive and long-term strategic approach to the oversight and regulation of the food system, backed up by legislation. Despite Wes Streeting saying he would steamroller over the food industry if it did not improve, the Government are falling into the piecemeal and voluntary action trap again.

Because of the public health obesity crisis, we recommended a shift to mandatory rather than voluntary policies, such as healthier food targets, reformulation taxes on sugar and salt and a laser focus on improving the diets of babies and children—but we are not seeing any of that in this response. We regulate the oil industry, the tobacco industry, alcohol, drugs and gambling, so why not food? It is not just about the safety of food but its quality and healthiness.

I find it sad that this is despite the Government being elected on some very worthwhile promises—first, to have the healthiest generation of children ever. However, there is no commitment to reviewing the school food standards and the eligibility for and value of free school meals. There is no commitment to increase healthy start payments or to address the deluge of advertising of junk food to teenagers or the poor regulation of foods advertised for infants and toddlers. Will the Government start by implementing all the recommendations of the CMA report on formula milk, and then tackle the shocking and harmful content and misleading advertising and labelling of food for young children?

Secondly, there is the Government’s health mission, to move from treatment to prevention. What has happened? The only tangible initiative on obesity has been treatment through expensive anti-obesity jabs—which would cripple the NHS budget according to NESTA—rather than primary prevention by ensuring everyone can get a healthy diet. I do not deny jabs can be appropriate and successful, but prevention is cheaper.

Thirdly, the Government promised to save the NHS, where the cost of treating obesity-related illness is £18 billion per year. However, the Government seem content for the taxpayer to pay for the NHS to foot the bill for obesity, rather than the food industry that caused it.

Fourthly, the new national food strategy shows no sign of getting to grips with the food industry, the sector that has caused the obesity crisis in the first place. Last week, the membership of the advisory board for this strategy was announced. Although there are several very good people on the board, the majority are from the food industry, and so is the secretariat—talk about the fox in the hen coop. It includes a major supermarket which refused to give the committee evidence in public, but instead offered us a private meeting with researchers that it funds—we rightly refused on transparency grounds. I wish the advisory board and the food strategy well, but I fear it is already in danger of going in the wrong direction.

Finally, there is the Government’s growth objective. We have almost 3 million people of working age out of the workplace because of preventable illnesses caused by obesity. Sick people cannot work. They do not pay taxes, but they qualify for benefits, adding £4 billion per year to the Government’s existential economic problems, according to Frontier Economics. But it is not the patient’s fault; it is the fault of our broken food system, and the Government could fix it if they wanted to.

Wes Streeting said recently,

“Our sick society is holding back our economy, and that is why we should act”.—[Official Report, Commons, 26/11/24; col. 685.]


The committee heartily agreed, because the annual economic cost of overweight and obesity is £98 billion. Professor Susan Jebb, chair of the FSA, has pointed out:

“At a time when government is looking closely at public expenditure, it’s important to remember that costs of inaction far outweigh the investment needed to deliver a safe, healthier, and more sustainable supply of food for all”.


The OBR has warned that many older workers are leaving the workforce because of obesity-related health issues. On the plus side, investors told us that there are billions of pounds waiting to be invested in companies that produce healthy food, but they wanted to see a clear direction of travel from government and a level playing field on regulation.

The case for bold action is made, and it is in line with the Government’s own objectives and the public’s wishes. Some 68% of those polled support the committee’s recommendation for a sugar and salt reformulation tax. Indeed, our recommendations could have been written precisely to enable the Government to achieve their objectives—but that means that they must get a grip on the food industry, with measures well beyond the last Government’s proposed restrictions.

And then there is lobbying. The committee recommended that the Government should establish their food policies independently of companies that rely mainly on sales of less healthy foods but should engage on implementation. After all, the Government’s objective should be public health, while the industry’s legitimate objective is making profit. In many cases, these two objectives are incompatible, but the Government have given a majority on the food strategy advisory board to the food industry. I ask the Minister: are the Government deliberately misrepresenting our recommendation, or are they responding to the vigorous lobbying of the industry?

Those few food industry witnesses who were prepared to give evidence in public wanted one thing. Like the investors, they want a level playing field: regulation that applies to all industry players, so that the good guys doing the right thing are not undercut by the bad guys who do not care who pays for the health consequences, as long as it is not them. The Government say they will continue

“to review the balance between mandatory and voluntary measures”,

but the voluntary target of reducing sugar by 20% resulted in a measly 3.5% reduction. Are the Government serious about saving the NHS, improving children’s health and growing the economy?

I am afraid I paint a very disappointing picture, and yet there is much to celebrate. So, here’s to those who produce and sell good healthy food, the food banks and redistributors, and the chefs and restaurants who serve good, healthy local food. Here’s to the food campaigners who never give up—and I hope they never will—and the parents and carers who try their best to feed their families healthy meals. Here’s to the health professionals who treat the consequences of bad diets, and here’s to the many witnesses who shared their experience and expertise with the committee. I thank all of them.

As I come to the end of this rather depressing analysis, I would like to quote from page 17 of the Government’s response. They said that they

“will consider whether further action is needed”.

You bet it is, my Lords. I beg to move.

--- Later in debate ---

[Baroness Walmsley (LD)]

My Lords, I thank the Minister for her response, and I will come back to some of her comments in just a moment.

Time does not allow me to thank everyone and pick up points from all the fantastic speeches we have heard today. However, the hard-hitting speech by the noble Baroness, Lady Freeman of Steventon, reminded me that I was remiss at the beginning of my introduction to not thank her. She had the clever idea of producing a podcast to disseminate more widely the fantastic evidence that we received. I thank her for the many hours of her—absolutely free—professional advice and work. Noble Lords might be interested to know that, next week, our digital department is going to publish a short YouTube video about this debate and the Government’s response. I am going to film some of it next Tuesday.

In response to the noble Baroness, Lady Coffey, I say that regulation is needed because voluntary action has failed. If the food industry does not like it, they have only themselves to blame, because they did not come up trumps when it came to voluntary targets. However, I agree that it is not the only thing that is needed and thank her for the FDTP; its work is really needed to get the metrics for measuring the achievement of mandatory health targets, which we recommended.

The noble Lord, Lord Bethell, mentioned a lot of food companies. He might be interested to know that the majority of them were invited to give us evidence and refused to do so.

I agree with the noble Baroness, Lady Meyer, about markets. I spoke recently to Sadiq Khan’s health adviser, Professor Everington, who is a long-standing GP in London. He was very keen on markets because, through them, people on low incomes can get healthy food for the same price that they might pay for unhealthy food in the supermarket. That was a very good point.

I say to the noble Lord, Lord McColl, on UPF, that the committee came down in the middle ground. We asked the Government to fund more research and to really take notice of what it comes up with. We also suggested that it would be appropriate, in dietary guidelines, to warn people that it could be dangerous to have too much UPF in their whole dietary pattern, because it pushes out wholefoods.

We had very hard-hitting speeches about children’s food from the noble Baronesses, Lady Brown of Silvertown and Lady Suttie, the noble Lord, Lord Rennard, and others. I say to the Minister that nobody can criticise a Government which do stuff to improve the diet of children, so they should go ahead and do as much as they can on that. They will not get any criticism or push-back from the population.

I say to the noble Baroness, Lady Batters, that I regret that we did not have the opportunity or time to talk about food waste—she is absolutely right about that. We had only eight months and we could not look at education, sustainable production, food security or food waste; I only wish we could have done so. However, the Minister has given me some hope. The last Government showed that you can legislate and then give time for implementation to be prepared for—the advertising ban is one of those things, although I do not think it should have taken three and a half years. I also point out to her that the IGD, which is the secretariat of the advisory committee for the food strategy, is an element of the food industry.

I am very pleased to hear that the Minister intends to keep some of our recommendations under review, and I assure her that many people in this Chamber today will also be keeping an eye on her and the Government. We will follow up in detail how many of the things that we are proposing are put into place by the Government. So it really is encouraging to hear some of the things that she has said, but there are some things that we need to watch very carefully.

I say to the Government that, if they get to the end of their five-year term of office and have not done something to improve the healthiness of the food in this country, they will suffer at the ballot box, because this is what people want. Their Food, Farming and Countryside Commission has done a lot of polling on this, and it is very clear that it is what people want, so, if the Government want to win the next election, they need to do something about it. The best advice I can give the Minister has already been given by the noble Baroness, Lady Jenkin: listen to Tony Blair and be bold.

Motion agreed.

Soft Drinks Industry Levy

Baroness Walmsley Excerpts

Tuesday 18th March 2025 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Lord for that point. He will know that the Defra-led food strategy will assist us across government in tackling this.

[Baroness Walmsley (LD)]

My Lords, I will follow up on the question from the noble Baroness, Lady Bennett of Manor Castle, about the regulation of foods for babies and toddlers. Is the Minister aware that some of the fruit and vegetable pouches marketed for babies from four months onwards—despite the advice that they should not be weaned until they are six months old—contain more sugar per 100 millilitres than Coca-Cola? Some toddlers’ teeth are being rotted as they emerge from their gums. When will the Minister take action on this?

Food and Feed (Regulated Products) (Amendment, Revocation, Consequential and Transitional Provision) Regulations 2025

Baroness Walmsley Excerpts

Monday 10th March 2025 Grand Committee

[Baroness Bennett of Manor Castle (GP)]

My Lords, in following the noble Baroness, Lady McIntosh, I echo her concerns about the labelling of GMOs, and I look forward to the Minister’s answer on that. I am afraid that I somewhat disagree with the noble Baroness, Lady Coffey, regarding the rights of the nations of these islands. They surely should have the right and ability to say that they want healthier food and the right to set higher standards for food than England may choose to.

Coming to the general point, I find it a little surprising that we have heard considerable celebration about reductions in red tape at a time when there are grave concerns among the public about the safety of our food supply, particularly the impacts of ultra-processed foods, which contain many of the substances that will be covered by these regulations, and in a society that has huge problems with the overall level of public health. Surely it is better to have so-called red tape than for people to become ill as a result of the food that they buy without knowingly putting themselves at risk.

As the Minister set out so clearly—I thank her for that—there are two chief changes here. The first is to remove the requirement for reauthorisation for certain products every 10 years. These are products that have previously been identified as high risk, which is why they are on the list: feed additives, and food and feed containing GMOs or smoke flavourings. We are taking away actions to monitor products that have been regarded as high risk. Secondly, as the noble Baroness, Lady McIntosh, said, we are removing parliamentary scrutiny by not requiring SIs. Building on what she said, will there be an accessible list somewhere that can easily be found by Members of the House and members of the public?

When we do not have the automatic 10-year authorisation, what will happen when an issue arises? I do not think that this has been covered very clearly at all. How will the Government alert the House to that issue? We have seen this happen in many areas before, and I expect that NGOs and researchers in universities would come to an individual Member of the House and they would have to batter away at trying to establish the issue, how big it is and what is happening. However, we and the NGOs have only limited capacity. How will the Government keep us and the public informed about what is happening when this starts to be an issue?

I thank the Secondary Legislation Scrutiny Committee for a very comprehensive piece of work on this SI. It is seven pages of quite detailed scrutiny, which contain a considerable number of expressions of concern. The committee is concerned that the Explanatory Memorandum did not fully explain the mechanisms to detect and monitor the risks in absence of a renewal process, which essentially addresses the issue I just raised about how we know.

Some of the discussion is about what happens in the testing of products if technology and our understanding change. We are in a period of rapid, massive change in our understanding of the operations and the biology of the human body. I have talked in other contexts about microbiotoxicity, where products impact on the human microbiome. That is a sentence that would not have made any sense 10 years ago, which reflects how fast our understanding of human biology has changed. We are just starting to get into understanding the virome—I recently hosted an event on phages—the bacteria and fungi in our body and how they interact with viruses and food. It is a very complicated and fast-moving area.

I have focused on the Food Standards Agency, which has a total of 1,582 members of staff in England, Wales and Northern Ireland. As the Minister has said, it is struggling with the number of applications that it is getting and, essentially, it does not have enough staff. If that is the case and there is this flood of new applications, how can we be reassured that attention will be given to things in that “Already done, don’t really have to think about it” pile, particularly when there are so many other biosecurity risks facing our country?

I declare that my comments have been informed by Beyond GM. It highlights that the Government Chemist, which is part of DSIT and hosted by the Laboratory of the Government Chemist—which is now, curiously, a privatised organisation—

“expressed the view that the renewals process”

needs to make sure that it has

“necessary scientific checks on the currency of validation methods”.

This is not just the biology changing but the understanding of our testing.

Finally, I offer a reflection on what we have seen happen in so many areas of public safety related to chemicals. Teflon is not a food additive, although it is an additive that has been unintentionally put in our food. PFAS were discovered in the 1930s; by the 1970s, companies including DuPont and 3M were aware of the risks and hid them. It was only in the 1990s that regulators and the public started to become aware of them. We have to be aware that we cannot trust giant multinational companies to declare to the Government and identify when a problem first starts to emerge. This has to be done by people acting for public good, not for private profit.

[Baroness Walmsley (LD)]

My Lords, as the Minister said, this SI does two things. It removes the requirement for 10-yearly renewals of regulated product authorisations and removes the requirement for regulated product authorisations to be prescribed in secondary legislation, instead allowing them to come into effect following a ministerial decision, presumably based on appropriate advice from the FSA.

As is not unusual, and as has been mentioned before, the Secondary Legislation Scrutiny Committee, in its 17th report of this Session, was critical of the Explanatory Memorandum. The efforts of this hard-working committee, which I admire very much, have filled in many of the gaps; however, I feel that it should not have been necessary for it to do this had the department provided a fuller and more helpful explanation of the protections. Is it not for officials to predict the concerns that might arise about new regulations, explain why the Government feel that they have been addressed and put that in the Explanatory Memorandum?

The Government assure us that the changes are intended to simplify the authorisation process and would create

“a more streamlined and effective regulatory regime”.

They cover three regulated product regimes: feed additives; food or feed containing, consisting of or produced from genetically modified organisms; and smoke flavourings. I believe that all these product groups may be subject to new evidence of health or environmental effects—either benefits or dangers—as time goes by. The FSA and the FSS have responded that they

“would continue to assess products at initial application stage to authorise them as safe to be placed on the market, and would maintain their powers to carry out safety reviews of authorised products already on the market at any time if new evidence or risks emerge”.

The words “at any time” are key, because they mean that those organisations do not have to wait 10 years to spot and assess a problem. This is reassuring.

However, as we have heard, Beyond GM was concerned that, in future,

“greater emphasis would be placed on the FSA’s post-market monitoring activities to ensure new evidence and risks are detected before harm occurs”.

I am familiar with the FSA system of horizon scanning in another context. It is thorough, gathering intelligence from international regulators, global networks and its own scientific advisory committee for horizon scanning. It also keeps abreast of analytical methodology and has a well-used incident reporting mechanism. As we speak, revocations of authorisations due to safety concerns reported through this mechanism have generally been actioned outside of the renewal process—in other words, it has not had to wait for 10 years. Can the Minister assure us that the FSA has sufficient resources to keep up this level of horizon scanning and subsequent action? I am clearly not the only Member of this Committee with concerns about this; the same submission from Beyond GM had concerns about it as well, in the light of recent budget cuts and staff shortages.

The FSA responded:

“An evidence-based review system will ensure already authorised products are reviewed based on risk and new evidence, rather than on a fixed timetable”.


This new risk-based system may well be a response to budget cuts, but it could also be justified by the fact that there is no point in wasting precious staff time on reassessing products that have consistently been found to be safe—and I mean “consistently”; one reassessment may not be enough in this field. Can the Minister tell us which of those two options it is? Of course, we might not have needed the Minister’s explanation if the EM had been more helpful.

There were submissions suggesting that GMOs should not have been treated in the same way as other products. The SLSC’s report contains the FSA’s explanation of the additional measures that are in place when GMOs are authorised initially and of how monitoring occurs post market approval. This includes the responsibility of the businesses—the producers, or the people putting the food together—to supply annual reports to the FSA and the FSS about environmental and any other risks that were not predicted at the start of the authorisation. Is the Minister confident that these reports are always sent and are complete? There may be vested interests in not having them complete.

There was a response from the Government Chemist, as we have heard, which was interesting. It considers that the renewals process, which is now being removed, provides important and necessary scientific checks on whether laboratory-based validation methods for GMOs remain current. In other words, it was not about the dangers of GMOs themselves but confidence in the laboratory procedures which assess them. The FSA response says that it will be relying on businesses, which will continue to be required to notify the FSA and the FSS if they have any new information which might affect the suitability of a validation method. Can we rely on businesses to know that and to report any concerns? Given that science is developing so fast in the world of biotechnology, is the Minister confident that we have a regular means of ensuring that we have the best, most up-to-date and accurate methodology, without having to rely on businesses telling us or on this being looked at every 10 years?

Prostate Cancer: National Screening Programme

Baroness Walmsley Excerpts

Thursday 27th February 2025 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I am glad to hear that the right reverend Prelate had such good care in the NHS. His comments are appreciated, and we are very pleased that things have out turned so well for him. The issue, as I know he will he understand, is that we cannot offer an inaccurate test to high-risk groups, not least because that increases the risk of adverse effects, unnecessary treatment and misdiagnosis. We are not yet in a scientifically and evidence-based position to offer the national screening programme, and that is why we are taking the action that I outlined in my Answer.

[Baroness Walmsley (LD)]

My Lords, while we wait for a more reliable screening tool, what are the Government doing to inform men about the very clear risk factors that are known about? To that I would add that maintaining a healthy weight reduces the risk. Additionally, what can the Minister do to reassure men that, if they are in any way worried about any symptom, they are not wasting their GP’s time if they go along and get it checked out?

[Baroness Merron (Lab)]

The noble Baroness is absolutely right. I encourage everyone, men and women, to be aware of any changes in their bodies. They are not wasting the time of their GP. That is exactly what they should do. As she says, men are disproportionately affected by a number of health conditions, including some cancers, heart disease and type 2 diabetes. As part of addressing this, the Secretary of State has announced that we are developing a men’s health strategy, not least because we know that men are less likely to come forward to deal with health matters.

Young Disabled People: Social Care Services

Baroness Walmsley Excerpts

Tuesday 28th January 2025 Lords Chamber

[Baroness Merron (Lab)]

I understand and am sympathetic to the points that the noble Baroness makes about Cameron and his family. I listened very closely to the concerns that she raised. As I mentioned in my Answer, we are very aware and absolutely accept that the services are not in the places they need to be. That is why I made the commitment to work closely with the relevant department.

Looking to the future, as recently as November we published what I regard as a very ambitious and wide-ranging whole-system plan, called Keeping Children Safe, Helping Families Thrive. It seeks to break the cycle of crisis intervention and to rebalance the system back towards earlier help for families, which I hope would have been helpful in the situation the noble Baroness describes. All local authorities, including Somerset, have to set out the support available for those with special educational needs and disabilities as they move into adulthood.

[Baroness Walmsley (LD)]

My Lords, the duty of local authorities to carry out a transition assessment includes whether the child, or their carer, is likely to have needs for care and support after the child in question becomes 18. In the light of that, what resources and guidance are the Government giving to local authorities about the needs of the carers of those transitioning to adulthood? Does the complexity of this whole issue not indicate the need for care co-ordination?

[Baroness Merron (Lab)]

It certainly does. The noble Baroness has been positive about the plans that we have for the independent commission, led by the noble Baroness, Lady Casey, to resolve once and for all, on a cross-party basis, adult social care. The noble Baroness makes a very good point about the role of carers. Indeed, when we think of a young carer particularly, it is crucial that their needs are considered and that support is given. It is part of the whole way in which we support someone who needs social care, no matter what their age.

Puberty-suppressing Hormones

Baroness Walmsley Excerpts

Monday 16th December 2024 Lords Chamber

[Lord Kamall (Con)]

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

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

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

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

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

[Baroness Walmsley (LD)]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Baroness Walmsley (LD)]

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

[Baroness Merron (Lab)]

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

Bread and Flour Regulations 1998

Baroness Walmsley Excerpts

Wednesday 11th December 2024 Lords Chamber

[Baroness Merron (Lab)]

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

[Baroness Walmsley (LD)]

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

[Baroness Merron (Lab)]

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

Bread and Flour Regulations 1998

Baroness Walmsley Excerpts

Wednesday 11th September 2024 Lords Chamber

[Baroness Merron (Lab)]

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

[Baroness Walmsley (LD)]

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

[Baroness Merron (Lab)]

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

NHS: Breast Screening Programme

Baroness Walmsley Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Merron (Lab)]

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

[Baroness Walmsley (LD)]

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

[Baroness Merron (Lab)]

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

Vaping Products: Usage by Children

Baroness Walmsley Excerpts

Monday 2nd September 2024 Lords Chamber

[Baroness Walmsley (LD)]

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

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

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

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

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

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

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

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

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