Tobacco and Vapes Bill

Debate between Earl Howe and Baroness Merron

Report stage
Tuesday 3rd March 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, I am sorry to disappoint the noble Baroness, Lady Walmsley, but, unless it is designed as a probing amendment, I fear I am not drawn to Amendment 123. In essence, it would tie the Government’s hands on the rules around the packaging and display of vapes. If the amendment were accepted, it would make any prior consultation and legal advice completely pointless. Measures of this depth and scope, mandating plain packaging for all vaping products and prohibiting point-of-sale display in all circumstances, would represent a major intervention in what is currently, and will certainly remain, a lawful market, and not only a lawful market but one that serves a significant therapeutic purpose in a public health context. The extent to which the powers in the Bill relating to the packaging and display of vapes need to be exercised must surely depend on decisions by Ministers following full and proper consultation with the businesses, manufacturers and retailers that would be directly affected.

Some regulation in these areas is almost certainly going to be necessary, particularly if we are to protect young people. However, regulation must be proportionate and evidence based. Vapes are not the same as tobacco, as the noble Baroness, Lady Fox, pointed out. For example, there needs to be scope for product differentiation by consumers. If consumers are denied choice, that will kill off any incentive on the part of manufacturers to pursue beneficial innovation. That consideration is important if we believe that vapes are likely to occupy an important place as a smoking cessation tool for adult smokers over the medium to long term.

On Amendments 125 and 134 from my noble friend Lord Moylan, notwithstanding the remarks of the noble Lord, Lord Darzi, I hope to hear the Minister make some positive comments. As my noble friend has argued, both today and in Committee, it is not just the flavour of a vape that gives it an appeal but the flavour that it purports to have, and we know that the flavour descriptor can affect the purchasing decisions of those inclined to use vapes as a recreational toy.

In relation to Amendment 136A, there are clearly a number of considerations that must be weighed carefully. On the one hand, higher-capacity devices may be important for some adult users who rely on vaping as a smoking cessation tool. For those individuals, practicality and product functionality can make a real difference in supporting a transition away from combustible tobacco. On the other hand, there remains a legitimate concern, which my noble friend rightly voiced, about whether larger-capacity devices could increase appeal to younger people or facilitate greater nicotine consumption, with implications for addiction.

I suggest that those are finely balanced issues. I look forward to hearing the Minister’s response on the evidence base underpinning the proposal and how the Government intend to strike the right balance.

[Baroness Merron (Lab)]

My Lords, I am grateful for the contributions in this debate. Amendment 123 was tabled by the noble Baroness, Lady Northover, and spoken to by the noble Baroness, Lady Walmsley. Clause 89, which I will refer to later as well, already gives the Secretary of State powers to regulate packaging, while Clause 13 already provides powers on display that can set requirements as to where products can be sold.

The noble Baroness, Lady Walmsley, asked about evidence. There is evidence that removing branding and standardising packaging reduces a product’s appeal to young people, as the noble Baroness alluded to, while having little impact on adults. However, I can say that we will consult on proposals before making regulations. The noble Earl, Lord Howe, has referred to this issue a number of times and I agree, because we are conscious of the need to ensure a balance between dissuading young people from taking this up while not dissuading adult smokers from quitting.

On the point about research, through the National Institute for Health and Care Research, we continue to fund high-quality research, including research on the packaging of vapes and nicotine products, and I am glad to say that that is due to conclude later this year. While I understand the intention of the noble Baroness, Lady Walmsley, to reduce the appeal and visibility of these products, and I acknowledge her concerns, her amendment does seek to set the requirements in the Bill. As the noble Earl, Lord Howe, referred to, we have a statutory duty and we would be wise to consult on these issues, because we need to ensure, as the noble Earl said, that any restrictions are proportionate and evidence based. However, I reassure the noble Baroness that these are areas on which we will be acting.

On Amendment 136A, tabled by the noble Lord, Lord Udny-Lister, under the Tobacco and Related Products Regulations 2016, vaping products, as has been referred to in this debate, are already limited to 2 millilitres for tanks and 10 millilitres for refill containers. Over recent years, some manufacturers have developed devices where multiple refill containers can be attached to a single device as a means to circumvent the legislative requirements and restrictions.

I want to assure the noble Lord that Clause 90 provides the powers to amend or place additional requirements and limits on vape tank sizes and the size of refill containers. It is vital that we undertake the necessary consultation, because we wish to make sure that our regulations are based on the best possible evidence related to tank capacity limits and that we do not have unintended consequences for adult smokers who use vapes as a quit aid, something I know is of concern, and rightly so, to noble Lords. It is therefore more appropriate for such detailed technical measures to be introduced through secondary legislation. Our recent call for evidence sought views specifically on tank sizes to better understand current market practices and we are, as I mentioned in an earlier group, currently analysing responses and will consider our proposals for consultation post Royal Assent.

Finally, I turn to Amendments 125 and 134, tabled by the noble Lord, Lord Moylan. I begin by assuring noble Lords—and the noble Lord, Lord Moylan, suggested I would do this—that Clauses 89 and 90 already provide powers for the Government to regulate information on vape devices and packaging, including flavour descriptors. I draw the attention of noble Lords particularly to Clause 89(3), which is a non-exhaustive list of the kind of provision that regulations could make, including in paragraph (b),

“the information provided on packaging or otherwise supplied with a product”.

I have listened carefully to the concerns expressed by noble Lords about potential unintended consequences of implementing flavour restrictions too rapidly or stringently, and I understand the points that noble Lords have made about the role that flavoured vapes can play in helping adult smokers quit, something the noble Baroness, Lady Fox, mentioned. Certainly, the noble Lord, Lord Moylan, did a very fine job of inviting us into the world that he has experienced in this regard. In that spirit, I can confirm the Government’s commitment to consult on regulating flavour descriptors as a first step before considering broader restrictions on flavoured ingredients. This commitment reflects our intention to adopt a proportionate approach, again as the noble Earl, Lord Howe, asked me to do, supporting adult smokers in their efforts to quit while also working to reduce the appeal of vaping products to children.

However, and on the points raised by the noble Lord, Lord Darzi, I have to be clear that it is essential that we retain the ability to go further in line with the evidence, which the noble Baroness referred to. Flavourings are added to vaping products and that can increase their appeal. Hundreds of flavoured ingredients are used in vapes and, although some are considered safe when ingested, we do not, as the noble Lord, Lord Darzi, said, know the long-term health effects when they are inhaled, particularly in respect of children. Some initial data drawn from the limited research available is concerning and indicates that certain chemicals may be harmful if inhaled. For this important reason, we must have the flexibility to restrict flavoured ingredients in the future to protect public health. We have sought further data on flavours as part of the call for evidence conducted at the end of last year and we are reviewing those responses. In addition, we are exploring commissioning further research on the health impacts of vape ingredients when inhaled.

I hope that all this reassures noble Lords that the powers in the Bill already provide a comprehensive framework to act on these issues and that our approach will remain balanced and evidence-based to strike a necessary balance between reducing youth appeal and ensuring that adult smokers continue to have access to products that may help them quit. I hope the noble Baroness, Lady Walmsley, will feel able to withdraw the amendment.

Tobacco and Vapes Bill

Debate between Earl Howe and Baroness Merron

Report stage
Tuesday 24th February 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, I thank my noble friend Lord Murray for his amendments in this group and all noble Lords for their contributions to this important and lively debate.

Reducing smoking rates and, in particular, preventing young people from taking up tobacco, with its highly damaging and pernicious consequences, are goals that I believe command broad support across the House. My noble friend’s amendments present us with an opportunity to settle in our minds the best way those goals might be achieved. From our debates in Committee and again today, we know there is a dichotomy of views on that.

My noble friend has eloquently made the case for substantially lifting the age of sale such that the legal purchase of tobacco by anyone under the age of 21 would be rendered impossible. The Government, on the other hand, have proposed the much more radical step of initiating a complete ban on tobacco sales to anyone born after 1 January 2009, thus creating, year by year, a wider and wider cohort of individuals for whom access to cigarettes and other tobacco products in shops will be legally barred.

Neither of these proposals, whether that of my noble friend or that of the Government, provides an absolute block on young would-be smokers accessing tobacco; so long as cigarettes remain a legal product, nothing could. However, if the generational ban can be made to work as intended, there can surely be no doubt that the benefits to public health over the long term will be immense. My right honourable friend the previous Prime Minister arrived at that realisation during the last Government, and the present Government have seen fit to agree with him.

There are two main arguments against the generational ban: one relates to civil liberties; the other is that of practical workability. I will not repeat the points that have been made on those themes, but I acknowledge that what is proposed in the Bill is, by any standards, without precedent in our consumer law. For the first time, a permanent legal distinction will be drawn between two adults based solely on their date of birth. One person may lawfully purchase a legal product while another, perhaps a year younger, may not. This would be not because of any difference in capacity or circumstance but purely by virtue of when they were born. The question people ask is whether in a free country that is right.

Following on from that are the questions around enforcement and general practicability. There are major questions around verification. As the years go by, shopkeepers will need to satisfy themselves that the person in front of them seeking to buy tobacco is 42 as opposed to 41, and so on. That does seem very different from a straightforward age of sale cut-off, which is a rule that everybody understands. Would shops and customers get used to this rigmarole? How easy would it be? As my noble friend rightly said, a number of countries have chosen to adopt the course that he is advocating rather than the generational ban.

I must, however, declare my hand. This Bill, as I have said, is an opportunity—an opportunity to make a transformational change in an area of public health that successive Governments have agreed is one of the two or three most important and far-reaching in our midst. Indeed, I would say that it is the most important. I do not think that the civil liberties arguments stand up to scrutiny for very long when we are talking about the chance of preventing serious ill health across millions of our population. Smoking needs to be made deeply unfashionable. My noble friend’s amendments, although entirely well meant, are unlikely to achieve that scale of health benefits nor that kind of attitudinal change.

There is uncertainty in whatever we decide to do. I am content for my noble friends on these Benches to make up their own minds on these matters. My noble friend, whom I greatly respect, will urge colleagues to join him in the Lobbies if he chooses to divide the House. At the same time, I hope he will understand that it ill behoves me, as my party’s spokesman for health and social care and as a former Health Minister, to pass up what I see as a golden opportunity to do something imaginative and radical, which is why I support the Government in their excellent ambitions.

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

My Lords, I am most grateful for the contributions to this debate. I think we can safely say that there is no unanimity of view, as a number of noble Lords have commented. I am particularly grateful for the support from both Front Benches, as has been consistent throughout. I am also grateful for the support of a number of noble Lords, including the noble Lords, Lord Pannick, Lord Young, Lord Rennard, Lord Stevens and Lord Bethell, and the noble Baroness, Lady Gerada, and others.

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[Earl Howe (Con)]

My Lords, I begin by thanking my noble friends Lord Moylan and Lord Udny-Lister for their amendments in this group. I welcome the fact that the Government have accepted my noble friend Lord Moylan’s amendments and congratulate my noble friend on pressing the point.

Turning to the amendment in the name of my noble friend Lord Udny-Lister, I will pick up the cogent points made by the noble Baroness, Lady Fox, because this brings us to the broader question of age verification. Our debates in Committee demonstrated the genuine concerns among retailers that a strict “no ID, no sale” policy could become a serious flashpoint for violence and abuse directed at shop workers—an issue that, I am sure the Minister will agree, cannot be dismissed lightly. There is also a risk of confusion among customers, particularly where different age thresholds already apply across tobacco, alcohol and other age-restricted products; any new requirement must not add to that complexity. The process for purchasing these products should remain clear and readily understood by all members of the public and, crucially, shopkeepers.

Against that background, it would be extraordinary if technology were not to play a part in making that process easier and less potentially fraught. Can the Minister tell us anything about the cost and affordability of such technology? What specific consideration was given to these concerns during the Government’s consultations, and what assessment has been made of the potential impact on retail workers of what could become a cumbersome and confusing set of procedures with, as I have said, the added risk of threats and abuse to shopkeepers? At the very least, is any guidance planned to ensure that new verification requirements do not create a patchwork of conflicting obligations at the point of sale?

[Baroness Merron (Lab)]

My Lords, I am grateful for the contributions to this short debate. I thank the noble Lord, Lord Moylan, for bringing back Amendments 3 and 12, which would change from negative to affirmative the procedure for making regulations to specify steps that may be taken to verify the age of customers.

In Committee I committed to returning with the Government’s response to the recommendations made by the Delegated Powers and Regulatory Reform Committee. We have carefully considered those recommendations and listened to the support within your Lordships’ House, and I can confirm that we are accepting the recommendations in full. Therefore, as noble Lords have observed, I have—I think we can say unusually—put my name to the amendments from the noble Lord, Lord Moylan. I can only counsel the noble Lord not to get used to it. I am very pleased to support his Amendments 3 and 12.

I have tabled government Amendment 105. For consistency, I have also tabled Amendment 110 to Clause 76, which is an equivalent amendment that provides the power to specify age-verification steps for Northern Ireland.

Amendment 26, tabled in the name of the noble Lord, Lord Udny-Lister, would require the Secretary of State to establish a financial assistance scheme for the acquisition of age-verification technology by producers and retailers of nicotine products. I absolutely understand that the noble Lord’s aim is to support retailers—something that I hope the noble Lord heard me saying on behalf of the Government—and to strengthen adherence to age restriction laws. But I say to the noble Lord and the noble Baroness, Lady Fox—it is important to clarify this point—that the Government have no plans to mandate the use of age-verification technologies to enforce age of sale.

Checking that a customer is over the age of sale is a well-established concept for retailers, and they should continue to take reasonable steps and exercise due diligence to ensure that they do not sell age-restricted products to anyone underage. To provide clarity for retailers on the types of ID that they can use, the Bill provides powers to specify in regulations the steps that may be taken to verify a customer’s age. This includes the types of digital identities that can be used.

On some of the points raised by the noble Earl, Lord Howe—I know that other noble Lords are, rightly, concerned about this—I confirm once again that the Government will work with the retail sector, as we are already doing, to publish clear, workable guidance to support it with these legislative changes. With that, I hope that the noble Lord, Lord Udny-Lister, understands the Government’s position, and I encourage noble Lords to support Amendments 3, 12, 105 and 110.

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[Earl Howe (Con)]

My Lords, I will speak to my Amendments 13A and 14A only as a means of thanking the Minister very much for her Amendments 14 and 15 in this group. As a number of us argued in Committee, including in particular my noble friend Lord Moylan, there is a strong case for saying that, in a secure mental health setting where staff often find themselves dealing with patients in a high state of agitation, a vending machine dispensing vapes or nicotine products not only would do no harm but could be of considerable benefit to the well-being of the individuals being treated, and potentially to staff as well, as a knock-on effect. I am very glad that the Minister felt able to reconsider this issue in the way that she has.

I confess I am troubled by Amendment 7 in the name of the noble Earl, Lord Russell, because, although its stated purpose is to future-proof the Bill, the signal that it sends is perhaps regrettable in the context of current public attitudes towards vaping as a means of quitting cigarettes. A substantial percentage both of the general public and of smokers mistakenly believe that vapes present a greater risk to health than smoking tobacco, extraordinary as that is. The NHS is unequivocal that vapes provide a far safer route to managing nicotine addiction than continuing to smoke. The prospect that they could at a later stage simply be swept into the same prohibition regime risks creating uncertainty, discouraging switching and undermining public health gains. We need to remember that the Bill already contains extensive regulation-making powers in respect of vaping and nicotine products—on advertising, flavours, packaging, display and sale—and those powers are wide-ranging and substantial. So adding a further power of this breadth is, I suggest, unnecessary overreach.

I am afraid that I think Amendment 16 is unnecessary as well. The Bill already contains extensive powers to regulate vaping products, from product standards and enforcement to environmental controls. The Government are already consulting widely and gathering evidence in these areas, and I am afraid I do not think there is any need for the creation of yet another statutory taskforce.

[Baroness Merron (Lab)]

My Lords, I am grateful to all noble Lords who have contributed to this debate. The Chief Medical Officer’s advice on vapes is quite clear: although vaping is less harmful than smoking and can be an effective quit aid for adult smokers, non-smokers and children should never vape. In the design of policy proposals, it is imperative, we feel, to get the balance right—I say this to noble Lords who raised this point—and we sought to get the balance right between protecting future generations from the risk of vaping and ensuring that vapes remain accessible for adult smokers. I hope the noble Baroness, Lady Fox, in particular will welcome that.

Amendment 7 from the noble Earl, Lord Russell, would add a new clause to the Bill to provide a regulation-making power that could be used to add vaping and nicotine products to the smoke-free generation provisions in England and Wales. I understand the aims of the noble Earl in bringing this forward, but I have to say—again, I hope this will be helpful to noble Lords who expressed concerns—that there is a fundamental difference in safety between vapes and tobacco products.

Tobacco is uniquely harmful. Up to two-thirds of deaths in current smokers can be attributed to smoking —so vaping, while it is not harm free, is significantly less harmful than smoking. Given the current research on health harms, the evidence base does not support extending smoke-free generation provisions to vapes or to nicotine products.

Also, to respond to the amendment, the Government should assume new powers only where there is clear justification for future regulatory change. Certainly, introducing a vape-free generation power, as suggested, would be a major step not currently supported by evidence. An age of sale restriction of 18 for vaping and nicotine products is therefore considered proportionate to protect children and young people, particularly as they may be more susceptible to the risks from nicotine use, including addiction.

On Amendment 16 from the noble Earl, Lord Russell, and to the points raised alongside this by the noble Baroness, Lady Bennett, I hope that I can provide a reassurance that the Government are already delivering a comprehensive programme to tackle youth vaping, strengthen enforcement and reduce environmental impacts, and have the relevant expertise required on these issues. It is our contention that it is not necessary to put this on a statutory footing.

The noble Earl, Lord Russell, as did the noble Baroness, Lady Bennett, asked how we would deal with the environmental impact of vapes. That is an extremely important area. What I can say is, as part of our upcoming circular economy growth plan, to which the noble Earl referred, the task force will consider circular design. That means including cross-government approaches such as would fit this Bill; it will consider regulation of product features and support increased recyclability—and I think that is the right place for it to be dealt with. We have to remember that last June we banned the sale and supply of single-use vapes, and from 1 October this year we will introduce a vaping products duty, which we know is effective at dissuading price-sensitive young people. Furthermore, we have a range of measures in this Bill that will tackle the drivers of youth vaping and allow us to take action on advertising, packaging, flavours and display. To support the development of future regulations, importantly, we have recently conducted a call for evidence to gather views on issues such as flavours, nicotine limits and tank sizes. There are differing opinions on all of these, so I think the call for evidence is the right approach.

The Bill also strengthens enforcement with powers that will enable us to introduce a licensing scheme and product registration scheme. Through our £10 million enforcement programme with National Trading Standards, which I referred to in the previous group, we will fund the vaping expert panel to provide valuable guidance for trading standards professionals on the enforcement of regulations.

We are also commissioning independent research through the National Institute for Health and Care Research. This includes a comprehensive analysis of all youth vaping studies and a five-year long living evidence review that will collate the latest research of vaping. Additionally, last year, we announced a landmark 10-year study that will include in its investigations the long-term health impacts of vaping on young people’s health. I consider that all these will greatly build on to the knowledge base and evidence base that we have.

Amendments 13A and 14A, tabled by the noble Lord, Lord Kamall, seek to exempt sales from vape vending machines in mental health hospitals for patients and staff aged 18 and over. I am very grateful to the noble Lord for raising this issue. As I am sure the noble Lord realises, we believe that the Government’s amendment covers what he is intending to achieve—and I am glad that he is indicating his agreement on that point.

I listened carefully to the concerns raised by noble Lords in Committee on patients in mental health facilities—something particularly close to my heart, as I am the Minister for Mental Health. These patients’ liberties may be restricted in terms of their being able to access vaping products to meet the public health need of helping them to quit smoking or manage nicotine addiction. Adults with a long-term mental health condition have much higher smoking prevalence rates than the general population, and this exemption takes into consideration the concerns that were raised by Peers, for which I am grateful, related to helping those people with a long-term mental health condition to quit where needed and it is appropriate.

In my reflection on these concerns, I am pleased to say that is why I have brought forward government Amendments 14 and 15, and I am very pleased to have the welcome of both Front Benches, as well as the noble Baronesses, Lady Bennett and Lady Fox. These government amendments provide an exemption from the ban on vape vending machines for adult mental health in-patient facilities in England and Wales. To be clear, the wording of the exemption has been very deliberately chosen. It is tightly defined to include only adult mental health in-patient settings and only in areas intended wholly or mainly for in-patients. By its nature, that means that staff will also be able to access these machines, but the exemption would not extend to areas that are not mainly for in-patient use, such as a visitors waiting room or a staff room. I hope that gives some indication to the noble Baroness, Lady Northover, on how this might work.

We are retaining the wider ban on vending machines to prevent young people from accessing age-restricted products, and to protect the next generation from being hooked on nicotine. I hope that this provides the necessary reassurance to the noble Earl, Lord Russell, and that he will feel able to withdraw his amendment.

Medical Training (Prioritisation) Bill

Debate between Earl Howe and Baroness Merron

Report stage
Monday 23rd February 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, I too am grateful to the noble Lord, Lord Patel, for leading the debate on his amendments, which seek to establish a new prioritisation hierarchy that puts UK medical graduates first, ahead of those in the priority group who are not UK medical graduates. I should have prefaced my speech by reminding the House of my interest as an honorary fellow of the Royal College of Physicians.

We debated this proposal in Committee, when other noble Lords, including my noble friend Lady Coffey, tabled amendments that sought to introduce a different prioritisation hierarchy. I understand fully the case that the noble Lord is making and I agree that UK medical graduates should have a much fairer crack of the whip in access to medical specialty training places. Fairness has been our primary concern throughout our scrutiny of this Bill. However, I agree also with the noble Lord, Lord Hunt of Kings Heath. The Government have had some hard choices to make.

In an ideal world, where the House had been given more time to consider these matters in the round, we might have been able to improve on the approach that Ministers are taking. For example, there is surely a place for guidance to make clear that the prioritisation process should incorporate considerations of medical and academic excellence, a point that the noble Baroness, Lady Finlay, has consistently made.

I am grateful to the noble Lord, Lord Stevens of Birmingham, for putting the decisions made by the last Government into their proper context. However, given where we are, we accept that Ministers have introduced this as urgent legislation with a specific purpose. In that context, having accepted that the Government’s approach will have the effect that they are seeking to achieve, we are satisfied that the Minister’s proposed method of prioritisation is acceptable.

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

My Lords, I am most grateful to noble Lords across the House for their considered contributions to this group of amendments and to the noble Lord, Lord Patel, for his introduction to this group. I have a third reason to be grateful—namely, for the understanding of the challenge that this Government are facing and the need to take action. I do not take that for granted. We are not able to support the amendments tabled by the noble Lord, Lord Patel, and I will go through the reasons.

In answer to the noble Baroness, Lady McIntosh, the Bill already sets clear priority groups without any further ranking within them. This is a binary system: applicants are either prioritised or they are not. It might be helpful to your Lordships House to say that the priority groups set out in the Bill have been agreed across the four Governments of the nation. They are best placed to support moving to what we all want—a sustainable workforce to meet the health needs of this population.

As I emphasised in Committee and at Second Reading, prioritisation does not mean exclusion. Non-prioritised graduates will still be able to apply, and they will be offered places if vacancies remain after prioritised applicants have received offers. For specialty training, there are likely to be opportunities in general practice, core psychiatry and internal medicine, which, historically, attract fewer applicants from the groups that we are prioritising for 2026.

Alongside UK graduates, the Bill prioritises graduates from Ireland—this reflects, as I have spoken of before in this Chamber, the special nature of our relationship with Ireland—along with graduates from Iceland, Liechtenstein, Norway and Switzerland, which reflects our obligations under international trade agreements with the European Free Trade Association countries to treat their graduates no less favourably. The amendments would mean that we would not be honouring these arrangements as we would be prioritising UK medical graduates over applicants from these countries.

The agreements with EFTA countries precede this Government. The agreement for Iceland, Norway and Liechtenstein was made in July 2021, and for Switzerland in 2019. The bottleneck issues that this Bill is designed to address were primarily driven by the removal of the resident labour market test in 2020. I know noble Lords will understand the need to uphold these international obligations, albeit we receive very low numbers of applicants from EFTA countries. As I noted in my recent letter to the noble Lord, Lord Mohammed, and to give noble Lords some idea of scale, there are a total of two applicants from EFTA countries for foundation and specialty training in 2026.

For specialty training, the amendments would mean we would be prioritising UK medical graduates over applicants with significant NHS experience. That would undermine the effective delivery of our policy intention, for which there is much sympathy in this Chamber, to prioritise applicants with significant experience working in the NHS. The Government have rightly committed to prioritising those who have made a considerable contribution to our health service because they better understand how the health service works and how to meet the needs of the UK population.

The noble Lord, Lord Patel, asked how many more students in the priority group would be able to enter specialty training. I will be pleased to write to the noble Lord on that matter.

My noble friend Lord Hunt and the noble Baroness, Lady Finlay, called for improvement of the broader approach to medical training, and that is something with which I would definitely concur. We have published phase 1 of the medical training review, which identifies the key challenges and the areas for improvement across postgraduate medical training, as noble Lords are inquiring about, and asks what is working well. Phase 2 of this work is already under way, and will focus on exploring those issues and developing options for change.

The noble Baroness, Lady Finlay, asked that I give an assurance that Oriel would, as an appointment process tool, have what she described as a more subtle way of looking at NHS experience. I can confirm that we will be engaging with stakeholders on what the best definition is and what is most appropriate for NHS experience. That will then allow us to update the system.

The noble Baroness, Lady Finlay, asked about merit-based selection and made a valid point about the quality of applicants. I assure your Lordships’ House that the Bill does not replace in any way a merit-based selection. Existing recruitment processes for foundation and specialty training already assess applicants against rigorous, merit-based criteria, including competence, performance and suitability for training, all of which I know are of concern, and rightly so, to the noble Baroness. The Bill sits alongside that process, not instead of that process.

The noble Lords, Lord Stevens and Lord Clement-Jones, asked about specialty training places. In the 10-year health plan, which the noble Lord, Lord Stevens, referred to, our commitment is to create 1,000 new specialty training posts over the next three years, focusing—importantly, in my view—on specialties where there is the greatest need. The Bill will not delay this process. There are some programmes and regions already at capacity for delivering properly supervised training posts. Expanding that training capacity will therefore need to be done gradually to ensure that placements remain of the high quality that we need and that appropriate supervision is in place to support it.

I hope that I have dealt with the main questions raised. For these reasons, I hope the noble Lord will withdraw his amendment.

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[Earl Howe (Con)]

My Lords, with these amendments, the noble Lord, Lord Mohammed, has reprised proposals he made, and which we debated, in Committee. In Committee, the Minister emphasised a point that I must say resonated particularly strongly with me. She pointed out that the delay proposed in Amendment 3 sets the Government back in their timetable to address the bottlenecks in medical training. Although I acknowledge all that the noble Lord said about fairness, I must accept that a delay of a year would set the Government back significantly in their plans. Given our support for the main principle underpinning the Bill, we cannot, I am afraid, support that amendment.

However, I reiterate that prioritisation is only part of the solution to the problem we have been talking about. It is a logical and sensible step, but the bottlenecks in medical training, which are having such a pernicious effect on the future opportunities of young doctors, will not be ameliorated until the number of training places is increased significantly. The Minister’s answer in the previous group to the question about training places posed by the noble Lord, Lord Stevens of Birmingham, was helpful. However, can she go any further and indicate whether the Government consider that the additional training places which have already been announced are likely to be sufficient, or is there a possibility that more may be announced in the coming months?

The noble Lord, Lord Mohammed, made a strong case for Amendment 7, and I endorse the powerful comments made not only by him but by the noble Lord, Lord Clement-Jones. Can the Minister provide us with further information on the Oriel system? There is a sort of fog surrounding this subject.

When we last debated this issue, I was surprised that the Minister was unable to give clarity on the number of individuals who have demonstrated an established commitment to the NHS but do not have leave to remain. It seems to me essential that we have clarity on the number of doctors that this amendment would affect. Has she had the opportunity to look into this in more detail between Committee and Report? If we are not able to get greater clarity on the issue today, will the Minister at least give a commitment to look at any cases where a doctor has demonstrated that commitment but does not have indefinite leave to remain, so that we can ensure that any injustices that may arise as a result of this emergency legislation are resolved swiftly at ministerial level?

[Baroness Merron (Lab)]

I am grateful to noble Lords on all sides of the House for their contributions today. I turn first to Amendment 3, tabled by the noble Lord, Lord Mohammed. As I explained in Committee, this is not an amendment that we are able to support. As has been emphasised, including today, a key aim of this Bill is to address the severe bottlenecks in medical training that have built up over recent years. These pressures are having real consequences, evidenced most starkly, I believe, through the most recent industrial action, where concerns about stalled career progression and training opportunities have featured and continue to feature heavily.

The noble Lord, Lord Mohammed, rightly spoke about the concerns of applicants mid-cycle, and I do recognise the concerns about this group and the impact on them, particularly where applicants did not know how prioritisation might affect them. But, although I absolutely understand the concerns, which we have discussed, these have been carefully considered and, at the end of it all, we have to make decisions about what it is we are trying to do. There will be people who are affected in ways that none of us would have chosen, but it has not been possible to make a change in legislation, particularly at this pace, without some effect on some groups. So, yes, it is a choice, and it is one that we have made. But I acknowledge of course the impact on those who are in the middle of a cycle of application.

With regard to the proposal in the amendment, I can only endorse the comments by the noble Lord Earl, Lord Howe, that another year of inaction would only deepen the frustration felt by UK-trained doctors and further destabilise the workforce. I do not think that is something that any of us want to see. So, we do believe that applying prioritisation to the 2026 intake is both necessary and justified. If we wait, as this amendment suggests, until 2027, it is projected that competition ratios will have risen even further. That would mean more UK graduates unable to progress their careers on time, with greater risk to the long-term sustainability of the NHS workforce, and protecting the long-term sustainability of the NHS workforce, protecting patients and protecting patient care and services is what this Bill is all about. That is why we are not able to accept another year’s delay, although I understand why the noble Lord put his amendment forward.

In addition, there is a difficulty in terms of the drafting in respect of this amendment, because it would create two clauses related to the prioritisation of applicants to specialty training programmes for 2027, and each would have a different approach to prioritisation. I am sure that the noble Lord would not want to create operational confusion or undermine legal certainty, but I thought it important to point that out.

I turn to Amendment 7, also tabled by the noble Lord, Lord Mohammed. First, following our conversation earlier—I am grateful for the noble Lord’s flexibility in that regard—I want to reassure him and your Lordships’ House that we are absolutely committed to recognising those who have worked in the NHS for a significant period. There is a very good reason for this: as well as it being the right thing to do, those individuals are much more likely to stay in the National Health Service for the long term, and they are much better equipped to understand how the health service works and how to meet the needs of the UK population. Again, that is a core driver in this Bill. It is our intention to prioritise those with significant NHS experience for specialty training. However, we are unable to support Amendment 7, for a number of reasons. I appreciate that the amendment was changed, but I want to refer at this stage to the points made by the noble Lord, Lord Clement-Jones; I discussed these matters with him earlier today.

While the NHS Oriel recruitment system holds some information about an applicant’s NHS experience, it cannot be used consistently or fairly for the 2026 round. The data has been collected on the basis that it would be checked by employers before appointment, not for retrospective automated assessment. It is indeed the case that applicants enter their employment history on Oriel as free text, but with no consistent format. Yes, there is a tick-box to indicate NHS experience, but I have to emphasise that it is self-declared—and that is the problem. There is no mechanism for verification to confirm that the employer listed is an NHS organisation, or any other relevant detail. That is why I spoke about this in Committee: it would require a manual review of tens of thousands of applications. That means a high risk of error, potentially delaying offers and start dates: again, nothing that any of us would wish to do. It would of course be destabilising for applicants and trusts, so it is not operationally feasible and nor would it be fair.

The noble Earl, Lord Howe, asked for more information on the Oriel system. I would welcome speaking to him at great length about it as, having looked into it in a practical sense, I can absolutely see the limitations. In my letter to the noble Lord, Lord Clement-Jones, which I have placed in the Library, more detail has been provided on the system, which may be of help to the noble Earl, Lord Howe. But if the noble Earl would like a more in-depth acquaintance with the Oriel system, he and other noble Lords are most welcome to benefit, as I have done.

The noble Baroness, Lady Finlay, spoke of voluntary experience as a possibility for being NHS-significant experience, and I understand why she raises this. On this point and also to the point about the amendment, there is currently no agreed threshold for what constitutes significant NHS experience. The fact is that views on this differ widely, as evidenced today by the noble Baroness. That is why we have committed to full engagement on this issue for future years, rather than rushing through the changes for 2026. Once we have agreed the parameters around experience, the Oriel system will be updated to ensure that data is collected in a consistent, verifiable format—that is the key—to support fair assessment in future recruitment rounds. Our aim is to have this in place in time for the next specialty training round, which will open for applications in autumn 2026.

For the current recruitment round, the Bill uses a set of carefully chosen specified immigration statuses, as this is a practical and proportionate proxy for identifying applicants most likely to have significant NHS experience. After careful consideration, we have concluded that this is the best approach for the 2026 recruitment round.

On the question from the noble Earl, Lord Howe, about the potential for additional training places and the likelihood that the ones I referred to earlier will be sufficient, we are keeping the numbers under review, as we always do. The noble Earl asked me to look at particular cases, and I am always happy to do that. We should bear in mind that it is often difficult to comment on very specific individual cases, but I am pleased to look at the broad point that he makes.

On the basis of the reasons I have outlined, I hope the noble Lord will withdraw his amendment.

Medical Training (Prioritisation) Bill

Debate between Earl Howe and Baroness Merron

Committee stage
Thursday 12th February 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, the noble Lord, Lord Patel, deserves our thanks for opening our Committee debate in a cogent and powerful way. He is absolutely right: in this country, we train some of the very best doctors in the world—at great expense to them and to the taxpayer—but too many are choosing to leave the training process because in the now expanded competitive scrum they cannot access the training places they require. Each year many remain unemployed. That is a serious policy challenge, and Ministers are right to seek to address it. We need a long-term and fair solution.

The noble Lord, Lord Patel, is seeking to ensure that UK medical graduates are prioritised for training places first before those in the priority group are offered places. There would then be a third tier of prioritisation for any other eligible applicants. This would put UK medical graduates, as defined by Clause 4, ahead in the queue for training places. I do not think we can fault the noble Lord for his logic. If we believe there is currently a massive and disproportionate injustice being meted out to UK medical graduates, we owe them the best chance we can give them to enter further training pathways in this country.

However, I have two questions for the Minister. First, the Explanatory Notes confirm that those who have trained in Ireland, Iceland, Liechtenstein and Norway have been included in the priority group because

“existing agreements require us to recognise their qualifications and offer parity in access to the profession”.

Can the Minister please confirm whether the reordering of prioritisation, as proposed by the noble Lord, Lord Patel, would cut across the existing agreements that the UK Government are bound by?

Secondly, I think many of us agree that emergency legislation should be avoided as far as possible, but where it is necessary, it should be simple and straightforward. On the face of it, the amendments from the noble Lord, Lord Patel, would make the Bill a bit more complicated by adding a further tier of prioritisation. If that is so, I am sure he would argue that the extra complexity is well worth it. It would be helpful if the Minister could tell us whether such an additional tier of prioritisation would make the process more complex to manage.

Amendment 2 in the name of my noble friend Lady Coffey would prioritise UK medical graduates who are British citizens first, then those persons in the priority group and then UK medical graduates who are not British citizens. The category of other eligible applicants is not included. Perhaps it is an inadvertent omission; I do not know. Again, this would create a three-tier prioritisation process, where the Government are currently proposing two tiers, with the added dimension of drawing a distinction between different categories of UK medical graduates. Like the noble Lord, Lord Clement-Jones, I am uncomfortable with that as a matter of policy. On the face of it, the amendment presents a more complex set of arrangements than those proposed by the noble Lord, Lord Patel, so it would be helpful to hear from the Minister how the Government view my noble friend’s suggestions, including their ready workability.

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

My Lords, I am most grateful to all noble Lords for their helpful contributions to this debate. Amendments 1, 3, 6 to 8 and 12 to 14, tabled by the noble Lord, Lord Patel, seek to create tiered categories of prioritisation for the UK foundation programme and specialty programmes. Taken together, they would require places to be allocated to UK medical graduates in the first instance, and then to applicants in the other prioritised categories specified in the Bill. As noble Lords have observed, the Bill sets clear priority groups, but it does not make rankings within these groups, and that is what we are looking at.

I welcome my noble friend Lord Darzi, not least because the review that he undertook for the Government in 2024 recommended that we should prioritise medical training, for all the reasons given by the noble Lords who support it. I will return to this whole area when we debate a later group, but on the point made by the noble Lord, Lord Darzi—this will perhaps also be helpful to the noble Earl, Lord Howe—alongside UK graduates, we are prioritising in the Bill graduates from Ireland and the EFTA countries. This reflects the special nature of our relationship with Ireland—specifically, our reciprocal rights of movement and employment—and our obligations under international trade agreements with the EFTA countries, which the noble Earl, Lord Howe, referred to, that require consistent treatment of these graduates in access to medical training. The amendments that we are looking at would mean that we could not honour these agreements. That, by its nature and definition, would create huge difficulties.

On specialty training, these amendments would also mean that we could not effectively deliver on our policy intention to prioritise applicants with significant NHS experience who understand how the health service works and how to meet the needs of the UK population. It might be helpful if I summarise this by saying that the Bill sets out what I would regard as a binary system where applicants are either prioritised or not. Clearly, once that prioritisation has happened, the normal processes will apply to establish who the appointable applicants are, to fill the posts, and so on.

Amendment 2, tabled by the noble Baroness, Lady Coffey, seeks to create tiered categories of prioritisation for the UK foundation programme and to prioritise UK medical graduates who are British citizens above all other applicants. The Bill as drafted prioritises all UK medical graduates who meet the criteria, regardless of their citizenship status. It might be helpful to the noble Lords, Lord Mohammed and Lord Clement-Jones, to restate that what matters is where a doctor is trained, not where they are born. UK-trained medical graduates have undertaken curricula, clinical placements and assessment standards aligned to the NHS, and are therefore best prepared to move directly into NHS practice.

The Government are committed to prioritising those doctors who have already spent a significant part of their education within the NHS and understand how the health service works and how to meet the needs of the UK population, not least because—this is an issue that we have discussed many times—these doctors are more likely to remain in the NHS for longer, supporting the sustainable medical workforce for the future that we are all looking at.

As I set out in relation to the previous set of amendments tabled by the noble Lord, Lord Patel, this amendment would also mean that we would not be honouring the special nature of our relationship with Ireland and obligations under trade agreements with EFTA countries. I emphasise again in the Chamber today that prioritisation does not mean exclusion. All eligible applicants will still be able to apply and will be offered places if vacancies remain after prioritised applicants have received offers, which we expect to be the case particularly in certain areas.

My noble friend Lord Winston raised a question about the Bill in respect of highly skilled overseas doctors and particularly referenced clinical academics. As I have said, it is not exclusion from applying—it is prioritisation. It may be helpful more broadly for me to emphasise that there are likely to be opportunities in specialties such as general practice, core psychiatry and internal medicine, because historically they attract fewer applicants from the groups that we are prioritising for 2026. I understand the point that my noble friend is making, but we have to focus on the core purpose of the Bill. With that, I hope that noble Lords will feel able not to press their amendments.

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[Earl Howe (Con)]

My Lords, I shall speak to my Amendments 20 and 21 and in support of the other amendments in this group.

My amendments are intended to work together and to return us to one of the salient themes of our debates at Second Reading, a theme which has been persuasively developed today by the noble Baroness, Lady Gerada, the noble Lord, Lord Forbes, and other speakers. At the heart of their concerns is why the Government have chosen to adopt a definition that threatens to undermine high-quality workforce capacity in the NHS, that jeopardises the sustainability of medical education delivered overseas by UK institutions, and that runs completely counter to the Government’s stated ambitions on promoting British standards of education internationally.

The Bill prioritises graduates based on strict geographic criteria, rather than on the provenance of their qualifications. UK academic institutions such as Queen Mary University of London and Newcastle University have campuses respectively on Malta and in Malaysia which train doctors to GMC-approved standards, using the same curriculum and the same assessments as those employed on their campuses in the UK.

The noble Baroness, Lady Gerada, has eloquently made the case for Maltese-trained students. I can add little to that. The noble Lords, Lord Clement-Jones, Lord Mendelsohn, and Lord Forbes have also spoken very powerfully on the same theme. The amendments of the noble Baroness, Lady Gerada, speak of the two qualifications—in other words that gained in Malta and that gained in London—as being identical in character. The amendment from the noble Lord, Lord Forbes, uses the word “equivalent”. I would go further by saying that the degree issued by the Queen Mary University of London Malta campus is not merely equivalent to a UK degree: it is a UK degree.

Not only that, but Queen Mary University is able to state that cohorts of its students trained in Malta frequently outperform their contemporaries who have studied and trained on the London campus. The intervention from the noble Lord, Lord Winston, has confirmed that that is not an isolated claim. The same claim could be made of many graduates of Newcastle University’s campus in Malaysia. These are excellent doctors, so there is not an issue of quality here.

Nor should there be an issue around numbers. In total, as we have heard, the number of these overseas-trained graduates is modest in comparison to the overall NHS training intake in a given year. The numbers really ought to be treated as de minimis. We have heard from Ministers that, if they were to flex the rules in the way that I and others are proposing, there would be no way for them in the future to control the total numbers of eligible applicants from these sources. My question is: why? It would seem perfectly possible to grant Ministers a power to cap total numbers at a figure corresponding to recent experience. It would then be up to the relevant universities concerned to collaborate year by year to ensure that the cap was not exceeded. That is what my Amendment 21 is intended to do.

Finally, we return to the issue of legitimate expectations. For all the reasons that I have given, students trained on overseas campuses of UK institutions have never dreamed of questioning whether the status of their qualification would differ in the slightest from the status of the qualification gained by their student colleagues in London. They are, in consequence, not to put too fine a point in it, appalled that, through this Bill, they are suddenly to be regarded as less deserving of a medical career in the NHS. I ask the Minister to think again.

[Baroness Merron (Lab)]

My Lords, I am grateful for this debate, as I have been grateful for the time that noble Lords have given to discussing their concerns about various aspects of the Bill in advance of today. I can say to both the noble Earl, Lord Howe, and the noble Lord, Lord Mohammed, that I always reflect on what they and other noble Lords say. Indeed, I reflect on what every noble Lord says—it is true that I may listen to some more than others, but that would be telling. I am genuinely grateful. In my view, it really does assist the passage of legislation and I take it very seriously. I will of course reflect, as I have before, not just on what is said in the Chamber but on what we have discussed outside.

The noble Earl, Lord Howe, said previously that people will be watching and reading this debate, and I absolutely agree and am glad that they do. So I must emphasise the point that this is not about excluding people from their applications; it is about prioritising. The reason we are in this position is the removal of the resident labour market test in 2020, which changed the whole landscape. In 2019, there were 12,000 applicants; now, there are nearly 40,000 applicants, which means four resident doctors for every specialist training post. I believe that noble Lords understand the scale. Internationally trained doctors make a huge contribution and will continue to do so. We are aiming to bring forward those internationally trained doctors who have significant NHS experience for training posts in the future, which I think is absolutely right.

Let me turn to the amendments in this group: Amendments 15 and 16, tabled by the noble Baroness, Lady Gerada; Amendment 17, tabled by my noble friend Lord Forbes; and Amendments 20 and 21, tabled by the noble Earl, Lord Howe. Each of these amendments seeks to ensure that graduates of overseas campuses of UK medical schools are prioritised for foundation and specialty training. I understand why this is being raised, and it is quite right to probe this whole area, in my view. While I appreciate the intention behind these amendments, and the manner in which they have come through, the Government are unable to accept them.

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[Earl Howe (Con)]

My Lords, I am grateful to the noble Lord, Lord Mohammed, for his amendment and his very helpful introduction. From these Benches, we have consistently raised our concerns about the downsides of emergency legislation. The Constitution Committee chairman, my noble friend Lord Strathclyde, wrote in his letter to the Minister that the Constitution Committee has

“repeatedly raised concerns about the fast-tracking of legislation, highlighting in particular the need to ensure that effective parliamentary scrutiny is maintained”.

We are all of us, I hope, doing our utmost in the short time available to scrutinise the Bill fully, but, with such a short period of time available, we cannot discount the possibility that this legislation will have unintended consequences. The noble Lord, Lord Clement-Jones, posited one particular example in his speech during the last debate.

It is true that the Delegated Powers and Regulatory Reform Committee has not brought anything in the Bill to the attention of the House. However, in the light of the fact that the Bill has been fast-tracked through Parliament, there is, I believe, a case for making all regulations under this Act subject to the affirmative procedure, allowing for additional future scrutiny. Like the noble Lord, Lord Mohammed, I look forward to hearing the Minister’s reply.

[Baroness Merron (Lab)]

My Lords, I am grateful not just for this brief debate but for the efforts of noble Lords to expedite this legislation. I acknowledge the short timeframe—it is not as short as in the other place but, nevertheless, noble Lords have been most co-operative, and I value that.

Amendment 23, tabled by the noble Lord, Lord Mohammed, seeks to require that all regulations made under the Act are subject to the affirmative procedure. This is an amendment we are not able to accept. To reiterate our intention, the Bill sets out the groups of people who are to be prioritised for specialty training from 2027 onwards. I reassure the noble Lord that the delegated power is limited to adding to this list by reference to significant experience working as a doctor in the health service or immigration status.

Similarly, we have set out in the Bill specialty training programmes excluded from the prioritisation scheme. The delegated power is limited to amend this list, and it gives necessary operational flexibility to respond to future changes in recruitment, training and workforce needs—something that I know noble Lords are very attuned to the need for.

I am sympathetic to the desire for parliamentary scrutiny and I always try to ensure that it is provided but, because of the limited scope of these powers, we believe that the negative procedure is appropriate. As the noble Earl, Lord Howe, just referred to, the Bill has been assessed by the Delegated Powers and Regulatory Reform Committee, and no suggestion has been made that the negative procedure was inappropriate for this regulation.

I have spoken in a previous group to why we are dealing with emergency legislation. I hear what is said about the downsides, but we have to balance that with the scale of the problem and the urgency that it demands. That is why we decided to introduce emergency legislation.

The noble Earl spoke about the Constitutional Committee letter. We will be responding formally to the committee to address its concern. With that, I hope the noble Lord feels able to withdraw his amendment.

Terminally Ill Adults (End of Life) Bill

Debate between Earl Howe and Baroness Merron

Committee stage
Friday 6th February 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, before the Minister rises to speak, I have a question for her about workability arising from one of the amendments included in this debate. In his Amendment 581A, my noble friend Lord Sandhurst posed a specific question on capacity at the moment when a person is given the substances with which they will take their own life. He is surely right that at that critical moment appropriate safeguards are needed where, for any reason at all, there is doubt about the person’s capacity—for example, where there is a history of fluctuating capacity. The doctor should clearly know how to respond to that situation. Can the Minister say whether she believes that the situation that my noble friend has described would require specific guidance to be issued by the Government over and above guidance already issued under the Mental Capacity Act?

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions on mental capacity and eligibility. As usual, I will keep my comments limited to those amendments on which the Government have major legal, technical or operational workability concerns. Indeed, if I do not refer to an amendment, clearly that is not the case, as was just suggested.

I wish to make a point to the noble Baroness, Lady O’Loan, who asked about consideration about compliance with ECHR. It is probably helpful for me to re-establish the consideration about that. It is the role of the Government—this is what I am doing—to highlight where there is a risk of issues in respect of the ECHR. However, it is for the House to decide whether policy choices might create a risk and whether that amount of risk is acceptable or not. The other thing, if it is helpful to the noble Baroness, is that, if it is found that primary legislation is incompatible, there could of course be a declaration of that incompatibility. It would not invalidate legislation. That is probably the main point that I want to emphasise, but this is ultimately a matter for decision by the House.

Amendments 117 and 892, in the name of the noble Baroness, Lady Hollins, would remove Clause 3 and insert a new clause requiring the Secretary of State to make regulations that establish an alternative framework for assessing and determining capacity, based on a psychological assessment, rather than reliance on the Mental Capacity Act. How to make that assessment on capacity—noble Lords have referred to this—is a policy choice and is therefore a matter for Parliament. However, as drafted, Amendment 117 uses a number of undefined terms such as “validated, standardised instruments” and “evidence-based methodology”, which, without further clarification or definition, are likely to create workability concerns. Amendment 892 would mean that the majority of provisions under the Bill could not come into force until the regulations under Clause 3 were made. This would make the backstop provision in Clause 58(4) ineffective.

I turn to Amendment 108, tabled by my noble friend Lord Hunt of Kings Heath. It would introduce a departure from the MCA framework by linking a lack of capacity in one area, to consent to care and treatment arrangements that amount to a confinement, to lack of capacity around another decision, the decision to end one’s life. This could create confusion and require additional guidance and training for practitioners.

It appears that Amendment 119 in the name of the noble Baroness, Lady Grey-Thomspon, would introduce a separate specialist capacity assessment process for adults with a learning disability. This departs from the MCA framework, which requires proportionate, decision-specific assessments, rather than separate processes for particular groups. Operationally, this could create significant training and resource demands, as specialist assessors would need to be identified. The Committee may wish to note that the amendment restricts any publicly funded provider from undertaking the mental capacity assessment, which would mean that individuals with learning disabilities would have to self-fund the assessment from a private sector provider. There are also technical drafting issues, including a lack of definition for “learning disability” and other terms such as “relevant professional regulator”, which could lead to uncertainty in how the legislation is applied.

Amendments 117, 892, 108 and 119 would all involve introducing differential treatment, by treating different groups of people differently. As such, they could give rise to legal challenge on the basis of ECHR obligations, specifically Article 14, which prohibits discrimination when read with Article 8. Any differential treatment, as I said more broadly earlier, would need to be objectively and reasonably justified in order to comply with ECHR obligations.

I turn to Amendment 235 in the name of the noble Lord, Lord Moylan. The effect of this amendment is that certain groups of people would not be able to make a valid first declaration, as the noble Lord said. This could exclude people with learning disabilities, mental disorders, as per Section 1 of the Mental Health Act 1983, and autism from accessing assisted dying. An individual who may experience substantial difficulty in understanding processes or communicating their views, wishes or feelings would also be excluded under this amendment from accessing assisted dying. The definition of “mental disorder” in the Mental Health Act is extremely broad and will include those with conditions such as ADHD, dyslexia, anxiety and sleep disorders. The Committee may wish to note that these groups would be excluded, even if their condition had no impact on their ability to fully understand the relevant information.

Terminally Ill Adults (End of Life) Bill

Debate between Earl Howe and Baroness Merron

Committee stage
Friday 30th January 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, in the interests of time I do not propose to summarise the many points and questions that have been raised in this debate. However, I wish to speak briefly to Amendment 320A in the name of my noble friend Lord Wolfson. The amendment seeks to set the presumption that the first assessment by the co-ordinating doctor

“must be undertaken in person, except in circumstances where this is not reasonably practicable”.

It is plain from everything that we have heard in the debate that the first assessment is a pivotal moment in the process set out in the Bill. It is the point at which a co-ordinating doctor must satisfy themselves not only of the diagnosis and prognosis but of the patient’s capacity and will and, crucially, the absence of coercion or pressure, as set out in Clause 10. These are human judgments that depend not simply on what a patient says but on the way that they say it, on physical cues and on the broader context in which the conversation takes place.

I listened carefully to the noble Baroness, Lady Finlay, in particular, as I did to other noble Lords, and an in-person assessment undoubtedly allows a clinician to observe matters that may not be apparent on a screen—for example, who else is present in the room, whether the individual appears comfortable speaking freely or whether there are signs, however subtle, of hesitation or external influence. At the same time, I suggest that we need to be patient-focused as well as doctor-focused, which is why my noble friend’s amendment seeks to recognise practical realities. There will surely, from time to time, be circumstances, perhaps in late-stage illness when a person may be in acute distress, where an in-person assessment is genuinely not possible. The reasons for that could be several, but in those cases we need to ask ourselves whether a live video and audio link would be preferable to a delay, or even a complete exclusion from the process.

I emphasise that the amendment is a probing one. If we decide that provision should be made for certain cases then that would surely be a classic area for guidance or codes of practice, but the key test in every instance would be what is reasonable in the circumstances. My noble friend wants to be clear that this amendment is about setting the right default for arguably the most consequential clinical judgment in the entire scheme of the Bill, while preserving professional discretion in response to the needs of the patient where circumstances require flexibility.

I have deliberately spoken in general terms when talking about what might not be reasonably practicable. The question is really the one posed by the noble Baroness, Lady Hayman: how rigid do we wish the Bill to be in prescribing how the system should work? I hope the noble and learned Lord, Lord Falconer, could set out his vision of how this mechanism will work in practice and how he will ensure that the safeguards that we all want to see can still be maintained if an in-person assessment is not possible.

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

My Lords, I am grateful to all noble Lords for their contributions to this debate. As ever, I will limit my comments to amendments on which the Government have major legal, technical or operational workability concerns.

First, I draw the attention of the Committee to operational workability concerns about Amendments 60 and 65. Under Amendment 60, professionals delivering the service would be responsible for checking whether the person was in England or Wales on multiple occasions before carrying out their duties, even if it had been confirmed that the person was ordinarily resident in England or Wales. That would place a significant burden on professionals delivering an assisted dying service.

Terminally Ill Adults (End of Life) Bill

Debate between Earl Howe and Baroness Merron

Committee stage
Friday 12th December 2025 Lords Chamber

[Earl Howe (Con)]

My Lords, this group of amendments covers two distinct but connected questions. The first question, posed by Amendment 17, is, in my judgment, a very helpful one, because the answer will clarify the role—or lack of role—played by a person’s GP in the process being pursued by that person in seeking an assisted death. It seems to me, from reading the Bill’s provisions, that the involvement of a person’s GP in that process, although very likely, is not legally necessary provided that the patient fulfils all the conditions set out in Clause 1(1). Clarification from the noble and learned Lord would be very helpful.

The second question, posed by my noble friend Lady Fraser’s Amendment 62, is also one that I hope can be answered very simply by the noble and learned Lord. Am I correct that it is implicit in Clause 5 that the preliminary discussion between the patient and the registered medical practitioner need not involve a doctor physically situated in England and Wales and need not be face to face? Equally, am I correct that it is unnecessary to state in Clause 1(3)(b) that the steps set out in Clauses 8 and 19 must be taken

“by persons in England or Wales”,

because Clauses 8 and 19 already explicitly provide for this?

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their contributions to this debate. As I have said, I will keep my comments limited to the amendments on which the Government have major legal, technical or operational workability concerns.

On Amendments 17 and 309A, in the name of the noble Lord, Lord Beith, and introduced by the noble Baroness, Lady Fraser, Amendment 17 is a probing amendment that seeks to establish whether people who are registered with a GP in Scotland but live in England would be excluded from eligibility for an assisted death under the Bill. Noble Lords may wish to note that Amendment 17 would have limited effect as it amends only Clause 1, which is largely descriptive. Without further amendments to Clauses 10 and 17, which contain duties to assess eligibility criteria, Amendment 17 would not impact those criteria and would introduce conflicting provisions.

Amendment 309A would amend the corresponding eligibility criteria in Clause 10 to include a person registered as a patient with a general medical practice in England, Wales or Scotland. It would not amend Clause 17, which contains the assessment by the panel. Therefore, Amendments 17 and 309A would require further consequential amendments to ensure that the Bill is coherent. This would include amendments to ensure that data recording obligations and the associated criminal offences apply to Scottish GPs. These consequential amendments would likely require consultation with the Scottish Government, as the noble Baroness, Lady Fraser, referred to, in line with the guidance for Private Members’ Bills.

I thank the noble Baroness, Lady Fraser, for tabling Amendment 62. The purpose of this amendment is to establish why the Bill requires only the actions set out in Clauses 10 and 11 to be undertaken by people in England or Wales, and not the preliminary discussion under Clause 5. Our understanding is that the reference to the preliminary discussion in Clause 5 is not mentioned in Clause 1(3) because Clause 5(3) already requires that a person wanting to have a preliminary discussion must be in England and Wales. Amendment 62 would require steps under Clauses 8 and 19 to be taken by persons in England or Wales. As drafted, the Bill requires that most of the steps in Clauses 8, 10, 11 and 19 will already have to take place in England and Wales.

In addition, Amendment 62 would have the effect that, when the Secretary of State makes regulations under Clause 19, the Secretary of State must be in England and Wales at the moment they sign the regulations. This could lead to the regulations being improperly made and challenged should the Secretary of State not physically be in England or Wales at the time of signing the regulations. This raises a practical issue of workability, as I am sure the noble Baroness understands.

On the points raised by the noble Baroness, Lady Fraser, and the noble Lord, Lord Shinkwin, relating to Scotland and guidance that the Government have provided to the sponsor, as I am sure noble Lords will understand, and I have reiterated, we are providing technical and workability support to the sponsor on devolution issues, including those that have been raised. This is an evolving situation that will continue throughout the passage of the Bill.

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[Earl Howe (Con)]

My Lords, the noble and learned Lord has already been very helpful in the undertakings and clarificatory comments that he made earlier in the debate, so I shall be very brief. In following up those comments, I will return to the question that I raised on the previous group. The Bill seems consciously to steer clear of insisting that a person’s GP must always be involved in the process being pursued by that person in seeking an assisted death, other than the GP having a duty to note in the patient record that the preliminary discussion has taken place. The entire process, in other words, could be conducted by the patient in conjunction with hospital-based medical consultants.

Do I understand correctly that the noble and learned Lord is willing to look closely at ways of making sure, by whatever means, that the crucial judgments made by clinicians about a patient’s capacity, about coercion and about that person’s settled wish to end their life are firmly and soundly based? The route to achieving that may well be the GP practice and the multidisciplinary team within it, but, as we have heard, that source of information may not be practical or useful in every case. Will the noble and learned Lord therefore ensure that he will consider more generally in the round possible safeguards that will forestall the possibility of superficial or cursory assessments being made—especially, perhaps, assessments by hospital consultants, who may have enjoyed only a brief acquaintance with the patient?

[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their contributions on proposed safeguards relating to general practice. I will keep my comments limited to the amendments on which the Government have major legal, technical or operational workability concerns. On that basis, I draw noble Lords’ attention to the operational workability concerns in relation to Amendments 19, 20, 21, 29, 30B, 265A and 443A.

Tobacco and Vapes Bill

Debate between Earl Howe and Baroness Merron

Committee stage
Wednesday 26th November 2025 Grand Committee

[Earl Howe (Con)]

My Lords, my noble friends Lord Howard of Rising and Lord Udny-Lister, who is unfortunately not in his place, are to be thanked for enabling us to focus on the issues around the use of heated tobacco. We have touched on this subject at earlier stages but, when previously discussing heated tobacco, the Minister promised to write to noble Lords about the evidence that her department possesses of the harms caused by heated tobacco. I am sure that is high on her agenda, but the question is crucial in the context of these amendments since, whatever the answer is, it will have a direct bearing on the use of the Secretary of State’s powers to designate locations as heated tobacco-free.

There are various published studies, as she will know. A study published by UCL found that people who switched from cigarettes to heated tobacco had lower levels of exposure to harmful chemicals than those who kept smoking, but higher levels of these toxins than those who stopped using tobacco altogether, which I guess is not a surprising finding. Other studies state that it is too soon to know how using heat—not burn—products will affect someone’s health in the long term, since research looking at these tobacco products is still, I understand, in its early stages and, in the main, funded by the tobacco industry. We therefore need clear evidence, born of independent research, on both the relative harm of heated tobacco compared to burning tobacco, as well as the absolute levels of harm that result from its use.

I am a non-smoker. I understand the concern that heated tobacco should not be a loophole for large tobacco firms to get around the law, but I am also concerned that in the absence of long-term evidence, portraying heated tobacco as being in the same category as cigarettes carries the risk of failing to reduce harm for that small percentage of smokers who wish to quit but have not taken to vapes for one reason or another.

Pending fresh research findings, I think, alongside my noble friends, that there remains a legitimate question about how the Government intend to treat spaces, both indoors and outdoors, where heated tobacco is used, and about whether they believe there is a clear proven case for including heated tobacco in the generational ban. In particular, does the Minister consider uncovered outdoor areas to be different in this context from enclosed spaces, in terms of both health risk and social behaviour? As she knows, the hospitality industry has concerns about extending the indoor smoking ban to outdoor hospitality areas such as pub gardens, and I welcome the assurance she gave on that a few minutes ago. The indication from the Government thus far is that hospitality areas will not be caught by any outdoor ban, but if that is true of smoke tobacco, can the Minister confirm that there is no similar intention as regards the outdoor use of heated tobacco?

[Baroness Merron (Lab)]

My Lords, the amendments in this group relate to limiting the Government’s ability to create heated tobacco-free places in England. I am grateful for all the contributions to the debate.

The noble Lord, Lord Udny-Lister, opposes Clause 139 standing part of the Bill. Clause 139 provides the power to designate certain places and vehicles in England as heated tobacco-free. Places can be designated heated tobacco-free only if they are smoke-free. As I have mentioned, we plan to consult on making heated tobacco-free all indoor places that are currently smoke-free. We also plan to consult on making certain outdoor spaces heated tobacco-free. As with smoke-free places, the consultation will cover children’s playgrounds, the outdoor areas of schools and early years settings, and areas outside healthcare settings where medically vulnerable people may be present.

The noble Earl, Lord Howe, asked an important question about evidence, and I will write with more detail as soon as possible. However, I reiterate what I said in debates on previous groups and elsewhere: there is no safe level of tobacco consumption and all tobacco products are harmful, including heated tobacco products. I am grateful to the noble Baronesses, Lady Bennett and Lady Walmsley, for their supportive comments. Laboratory studies show evidence of toxicity from heated tobacco and that the aerosol generated by heated tobacco devices, like other forms of tobacco, contains carcinogenic compounds. Recent evidence has also indicated that exposure to second-hand emissions from heated tobacco products is associated with significant respiratory and cardiovascular abnormalities in bystanders.

The noble Lord, Lord Udny-Lister, also tabled Amendment 185. The noble Earl, Lord Howe, asked me to repeat—I am glad to do so—that, as I have made clear, we are not planning to consult on making outdoor hospitality settings in England heated tobacco-free.

Amendment 184A tabled by the noble Lord, Lord Howard of Rising, seeks to exempt areas where it would be reasonable to expect that only over-18s are present from any future restrictions on heated tobacco places. This amendment is similar to the one already discussed in relation to vape-free places, which would mean that some indoor areas, for example nightclubs, could not be made heated tobacco-free.

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[Baroness Merron (Lab)]

My Lords, I am most grateful for this discussion. I say at the outset that, although I do not support accepting the amendments, I have a lot of sympathy with a number of the points made, which I will come on to. However, while I completely understand the pressure on small retailers—I will come on to that—I struggle to accept that the Bill is the fount of all evil, which I feel is the direction we are going in. I certainly agree with the noble Baroness, Lady Bennett, who spoke about the need to see the Bill in its overall context. I associate myself with those comments.

I absolutely agree with the intention behind Amendment 191, tabled by the noble Lord, Lord Kamall, and introduced by the noble Earl, Lord Howe. I hope I can reassure noble Lords that the Government are committed to supporting businesses to implement the measures in the Bill, which much of this discussion has been about. As I have said previously, we will continue —it is a continuing thing that is not in the past—to work closely with retail bodies such as the British Retail Consortium and the Association of Convenience Stores on the implementation of the measures, which will include the development of guidance.

I heard the concern of noble Lords about what guidance will be given. Again, I understand those points but, to say it in other words, we will support retailers through this transition. As the noble Baroness, Lady Walmsley, mentioned, what is being asked of retailers is not unusual for them; they are very familiar with age verification. I will come back to that later. The measures in the Tobacco and Vapes Bill will come into force across a range of dates and therefore it is important that the associated guidance is available at the appropriate time. In other words, there will be time to make this transition and there will be support for that. We are firmly committed to publishing the guidance in a timely manner.

Turning to Amendment 188, tabled by the noble Lord, Lord Kamall, I say to nearly all noble Lords who have spoken that, although I understand the intention of the amendment, it is unnecessary. As noble Lords have acknowledged, the Government are already taking action to tackle the absolutely unacceptable rise in retail crime. The Government will not stand for violence and abuse of any kind against shop workers. Everybody has a right to feel safe at their place of work and we have long championed specific protections for retail workers.

To protect the hardworking and dedicated staff who work in stores, the Crime and Policing Bill introduces a new offence of assaulting a retail worker, which the noble Baroness, Lady Fox, referred to. The Bill also removes legislation which makes shop theft of goods to the value of £200 or below a summary-only offence. That sends a clear message that any level of shop theft is illegal and will be taken seriously. I hope that that is helpful to the noble Lord, Lord Howard.

Alongside legislative action, we are also providing over £7 million over the next three years to support multiple policing bodies to help to tackle retail crime. As I have mentioned, we will continue to work closely with retailers and will utilise the lead-in time to best support them in preparing for and implementing the measures in the Bill. This will include government communications and information campaigns to inform both the public and retail workers.

The noble Baroness, Lady Fox, asked what assessment the Government have made of the impact on small businesses. Page 82 of the impact assessment specifically addresses this. As noble Lords are aware, an impact assessment should be expected and is required for any Bill. That means that the Regulatory Policy Committee also took a view; it published an opinion on the impact assessment and provided a fit-for-purpose rating. This included a green rating for the assessments of small and micro businesses’ assessments. I hope that will be useful.

I turn to Amendment 200A, tabled by the noble Lord, Lord Howard. This would require the Government to create a financial assistance scheme specifically to subsidise the cost of purchasing age-verification technology to enforce on the sale of nicotine products. I heard the comments of the noble Baronesses, Lady Walmsley and Lady Bennett, who spoke against that amendment.

There are no plans to mandate the use of age-verification technologies to enforce the age of sale of nicotine products. It will be for businesses to decide how they ensure that they sell only to people 18 years or over, including whether to use age-verification technology to support them in this. As I mentioned earlier, as did the noble Baroness, Lady Walmsley, checking that a customer is over a certain age is a well-established and well-trodden path for retailers. They should continue to take reasonable steps and exercise due diligence to ensure that they do not sell products to anyone underage. Most retailers already follow recommended practice, and I am grateful to them; they regularly ask for identification from customers to verify their age.

To provide clarity for retailers on the types of ID that can be used, the Bill provides powers to specify in regulations the steps that may be taken to verify a customer’s age and satisfy the age of sale defence. This will include the types of digital identities that can be used, and work will continue with the Department for Science, Innovation and Technology, which is leading on this work. I emphasise that the Government are absolutely committed to supporting retailers through the changes brought in by this legislation, including through the publication of clear guidance in which they will be fully involved.

I hope that I have provided helpful reassurances and that the noble Lord will feel able to withdraw the amendment.

[Earl Howe (Con)]

My Lords, I am grateful to all noble Lords who have spoken in this short debate, including the Minister for her reply. Perhaps I could repeat that my amendment was intended as a probe to raise a set of general concerns surrounding the retail sector. I was reassured by the Minister’s reply, including her references to the provisions of the Crime and Policing Bill. But we need to bear in mind, as we debate the Bill, that retailers are not the source of the problem that the Bill seeks to address—yet they will be the ones to lose out.

The Bill is projected to cost retailers more than £1 billion in profits over the next 30 years, plus what I am sure will be a considerable amount more from the reduced footfall that many will see over time. The noble Baroness, Lady Fox, was right: there is considerable worry in the sector, which is exacerbated by the uncertainty surrounding the timetable for the Bill’s implementation. It would be helpful, perhaps when we reach the next stage of the Bill, for the Minister to give us an idea of how the Government intend to proceed as regards the processes of consultation—consideration of submissions, as well as the actual implementation—and what the outline timetable will look like. The transition needs to be as inclusive and smooth as possible, and practical guidance and support will be essential, especially for small retailing businesses. I have no doubt that the Government have this in mind, but we may need to return to it on Report, just to underline the point. Meanwhile, I beg leave to withdraw the amendment.

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[Earl Howe (Con)]

My Lords, the Committee will be grateful to my noble friend, with his considerable experience in health policy, for the clear and cogent way in which he introduced his amendment. I am very supportive of the principles behind the amendment, as it seeks to ensure that decisions taken after the passage of the Bill are informed by robust, independent evidence and that Parliament is equipped with the relevant and authoritative information it needs to provide proper oversight of the regime for vaping and nicotine products, information that is constantly updated as the body of evidence evolves.

Critically, this principle applies equally to the Government. Proposed new subsection (5) in the amendment would require Ministers, when making regulations under the Act, to have regard to the proposed panel’s reports and recommendations. That is a sensible idea. My noble friend Lord Young of Cookham was right to remind us that there has for some time been a gap in the public health mechanisms regarding the production of such reports. If we were to recreate a mechanism of the kind suggested, the regulatory frame- work would evolve in response to the realities of science and the market rather than outdated information.

It is also important to recognise, as the amendment implicitly does, that although our primary concern here is health, regulation in this space cannot be viewed in isolation from the wider economy. When sales of currently legal products are restricted or prohibited, this inevitably impacts businesses, consumers and, sometimes, wider society, and those economic effects can themselves have unintended consequences for public health and people’s lives. There is also plenty of evidence of unintended consequences and the effectiveness of previous episodes of prohibition. The risk of a rise in consumption of illicit products is an obvious example, as is misinformation propounded on social media. The Government should make and review decisions with as clear a view as possible about those sorts of trade-offs.

For those reasons, I hope the Government will take on board the very sensible suggestion contained in this amendment.

[Baroness Merron (Lab)]

My Lords, I am most grateful for this debate, which concludes the work of the Committee. As I have said before, I certainly share the intention of the noble Lord, Lord Lansley, who tabled this amendment, to ensure that regulations are based on the best available evidence. I appreciate the consideration he has given to the amendment and the reason he put it forward.

I say in response that we continue to monitor emerging evidence, which we have much discussed, on vapes and nicotine products, including commissioning independent research through the National Institute for Health and Care Research. For example, we commissioned a comprehensive analysis of all youth vaping studies—referred to in the debate—which was published recently, and a five-year-long living evidence review that will collate the latest and most robust research into the health impact of vaping. This living evidence review is accompanied by a scientific advisory panel, which includes independent experts, appointed independently from the Government on merit, who the Government can call on for advice on the latest evidence. Further, as the noble Lord, Lord Young, mentioned, earlier this year we announced a landmark 10-year study that will include in its investigations the long-term health effects of vaping on young people’s health.

I agree with the noble Lord, Lord Lansley, that misperception of the harms of vaping is of concern; I take that point. Vaping absolutely can play a role in helping adult smokers to quit, as we have discussed, but children should not be vaping and nor should non-smokers. We are committed to carefully considering the scope of restrictions, to avoid unintended consequences and the misperception of harms, which is an area for further work.

We also fund a vaping expert panel, which provides valuable guidance for trading standards professionals on the enforcement of regulations. Under many of the powers in the Bill there is a requirement to consult before making regulations and, on 8 October, we published a call for evidence on issues where more evidence is needed before we can consult on specific proposals. We will monitor the impacts of measures brought in by the Bill and subsequent regulations. We will also be able to update regulations in future to ensure that policy is responsive to evolving evidence, should this be necessary.

It is our view that we have access to appropriate expert advice, which I know is the noble Lord’s intention, and we will consider the best available evidence in making regulations. I hope that he will feel able to withdraw his amendment.

Tobacco and Vapes Bill

Debate between Earl Howe and Baroness Merron

Committee stage
Monday 17th November 2025 Grand Committee

[Earl Howe (Con)]

My Lords, in this group of amendments we have seen a logical continuation of our debate on the previous group, since in their various ways these amendments pose the question of what are the appropriate constraints to place around products that are of considerably less concern in a health context than tobacco products. We are back in the realm of deciding what is proportionate and how to secure better clarity and consistency in the operation of the Bill’s advertising and design provisions.

Although he has not been here to speak to it, my noble friend Lord Udny-Lister’s Amendment 161A struck me as a point worth raising. It would protect designers and creative professionals from being criminally liable based on mere suspicion or indirect association because it would work to raise the threshold of proof of intent. One could imagine that in some cases it could be difficult to prove that someone designing an advertisement had reason to suspect that it would be published. In any event, is it right that someone who has been asked by their employer to design a vape advertisement should be criminalised because they know or believe it may be used in some context? I am afraid that the word “draconian” comes to mind.

On my noble friend’s Amendment 161B a very similar thought came to mind. Are the Government really saying that the offence of designing an advertisement for a vape merits a prison sentence? There are mixed messages coming out of the Government at the moment. How should the sentencing provisions in this part of the Bill be read alongside the provisions of the Government’s Sentencing Bill? What is the overall message? The Sentencing Bill will require almost all sentences of less than 12 months to be suspended. On the one hand, the Government are creating imprisonable offences, and on the other, they are saying that people should not actually go to prison, even if they are sentenced to it. At the very least, the Minister needs to explain to the Committee why the sentence on summary conviction is to be different in Scotland than in Northern Ireland, which might have been a point my noble friend Lord Udny-Lister would have made.

Turning to my Amendment 167 and the very well worded amendment, if I may say so, from the Liberal Democrats, the underlying purpose of each is the same, which is to urge the Government to regulate, rather than ban, vape advertisements so that in narrow clinical contexts, such as smoking cessation clinics, they can be deployed for public health purposes. Amendment 168A in the name of my noble friend Lord Howard of Rising has a very similar purpose.

In Amendment 169 I am asking the Government to consider a further exemption for advertisements located discretely in specialist vaping shops. Why not allow that? As my noble friend Lord Moylan has asked in his Amendment 170, why prohibit such specialist shops providing information online subject to suitable age-gating checks? That in turn raises a further question from my noble friend in his Amendment 168. In adult-only environments, why should displaying an advertisement for a vaping product be against the law given that, as we need to keep reminding ourselves, vapes are and will remain legally available for purchase by anyone aged 18 or over? Why are the Government treating vape advertising in exactly the same way as tobacco advertising? What is the justification? Amendment 170A from my noble friend Lord Howard asks that question in a different form. Why should we not allow factual product information to be provided at point of sale in an age-restricted area in suitably licensed premises?

Finally, Amendment 172A from my noble friend Lord Udny-Lister would prevent overreach. It would ensure that brand restrictions target only genuine attempts to promote nicotine or tobacco, not completely unrelated products such as clothing or other merchandise. I think my noble friend has identified an issue that requires clarification from the Government, and I would welcome the Minister’s comments.

[Baroness Merron (Lab)]

I am most grateful to noble Lords for bringing forward this group of amendments, which reference Part 6 provisions, and for the contributions that have been made.

I will start with Amendments 161A and 161B, which are tabled in the name of the noble Lord, Lord Udny-Lister. The current drafting of Clause 114 makes it an offence, when acting in the course of business, to design an advert that would promote a relevant product and be published in the UK. If an organisation knows or has reason to suspect their advert has a promotional purpose or effect and will be published in the UK, it has committed an offence by designing the advert.

I say to the noble Earl, Lord Howe, that the inclusion of “has reason to suspect” is deliberate, not least because it mirrors the approach taken in the existing Tobacco Advertising and Promotion Act. This wording is designed to avoid loopholes and to ensure that those who are involved in the design of ads cannot evade responsibility by claiming ignorance where it is clear from the evidence that they had reason to suspect what they were designing an advert for. I hope the noble Earl will understand that we will, therefore, not seek to weaken existing legislation or allow any uncertainty that could be exploited.

I turn to Amendment 161B. I sympathise with the intention to align penalties across the UK but, of course, it is important that we respect Scotland has a separate criminal justice system. There are maximum penalties for this type of offence; they are fixed in line with the criminal justice system in each jurisdiction. I hope that that is helpful to the noble Earl, Lord Howe.

I turn to Amendment 172A, which was also tabled by the noble Lord, Lord Udny-Lister. It seeks to restrict the scope of the offence of brand sharing. Brand sharing, also known as brand stretching, is a form of indirect advertising and should be seen as such, not least because it promotes the use of a service or product by putting its branding on other products or services or vice versa. The clause is drafted in a manner that already limits the offence that could be created under this power to cases where the purpose or effect is to promote a relevant product. Brand sharing, as defined in the Bill, would be unlikely to capture the types of case about which the noble Lord is concerned in his amendment; it is our view, therefore, that this amendment, as it stands, would introduce unnecessary complexity.

I turn to Amendment 168 in the name of the noble Lord, Lord Moylan. The Bill as drafted takes decisive action to ban the advertising and sponsorship of all vapes and nicotine products, delivering on our clear manifesto commitment to stop vapes being advertised to children—something on which the noble Baroness, Lady Northover, spoke. The ban is essential to creating what we seek: a strong, consistent regulatory environment; and to provide clarity for businesses and enforcement bodies. I can say to the noble Baroness, Lady Walmsley, that guidance will be produced on advertising.

This Bill already includes defences for the limited circumstances in which advertising would be appropriate. As I have said in our debates on earlier groups, we are not considering any other exemptions for adult-only spaces, not least because of the risk of loopholes; these were referred to by the noble Baroness, Lady Northover. However, I take this opportunity to correct a statement that was made in the other place: this prohibition will apply to all advertisements for relevant products, not just those for specific products. In practice, this means that anyone acting in the course of business could commit an offence if they promote a relevant product, whether that is a generic product, a category of products or a specific branded product.

Tobacco and Vapes Bill

Debate between Earl Howe and Baroness Merron

Committee stage
Thursday 13th November 2025 Grand Committee

[Earl Howe (Con)]

My Lords, through these amendments my noble friend has issued a challenge to the Government which I think is extremely welcome. The challenge is to explain why the objectives the Government are seeking to achieve through Clauses 89 and 93 are achievable only via the heavy hand of prescriptive regulation rather than by less burdensome means. Is there a role for guidance as a substitute for regulation, and might there be merit in challenging manufacturers and others in the supply chain to take direct responsibility for the design of their packaging within certain parameters?

The Minister will probably say when it comes to the tobacco giants—whose ways, alas, we know from of old—that that kind of aspiration is a somewhat forlorn hope. But what if regulation, instead of being enacted willy-nilly, were used by the Government as a sword of Damocles hanging over the various arms of industry? Has anyone actually spoken to manufacturers of nicotine products or vapes to see whether they would entertain the idea of avoiding regulation by agreeing a responsibility deal with the Government whereby, in designing their packaging, they did so ethically, in a way that avoided including imagery of obvious appeal to young people, or colours and fonts that serve to glamourise the product contained inside? That idea sounds a whole lot less complicated than drafting regulations in inevitably minute detail, which could easily become quite a difficult exercise. A certain amount of commercial freedom would thereby be retained by manufacturers, along with some scope for market competition, which would be another incentive for playing by the agreed rules.

My noble friend’s amendments return us to themes we have touched on already during Committee: questions of proportionality, consultation and the need to ensure that the framework we create is both evidence-based and appropriately targeted. I am particularly supportive of Amendment 140E, which again highlights the importance of engaging with retailers and manufacturers before new provisions are introduced. It is an amendment which reminds us that we are not dealing with a single homogenous group of products. There is a wide spectrum here, from combustible cigarettes through to heated tobacco, vapes and other nicotine products, and as each of them carries a different level of relative harm, those differences should be recognised, both in consultation and in how the law ultimately treats each one of those products.

I therefore hope that the Government will give serious consideration to the intent behind these amendments, and that the Minister can set out how the Government are meeting the challenge my noble friend has issued: the need to explore whether we can achieve a set of desired ends by the least burdensome route, by proper engagement with stakeholders and by recognising the distinctions between products that the Bill has chosen—rather too often, I am afraid—to lump together.

[Baroness Merron (Lab)]

My Lords, I start by thanking the noble Lord, Lord Udny-Lister, for bringing these amendments forward, and I thank all noble Lords for their contributions today.

I should start by providing clarification that I hope will be helpful to the Committee. The Secretary of State is already able to issue guidance in these areas. However—I particularly make this point to the noble Earl, Lord Howe, who I listened to closely—here is the problem. Guidance is not enforceable, as he is aware. Instead, we would have a voluntary system that industry could choose whether to comply with. I am also grateful to the noble Baroness, Lady Northover, for her support in the arguments I am about to make.

The reality is that industry is already able to choose to package its products in a way that does not appeal to children; it could already be doing that now. There are some companies that are to be credited for following this line of not appealing to children, but the fact is, as the noble Baroness, Lady Northover, said, that we see far too many vapes marketed alongside cartoons and other imagery that can only be described as focused on young people. It is therefore appropriate and necessary for the power to make regulations to remain.

The noble Lord, Lord Udny-Lister, referred to heated tobacco. We had an extensive debate on the tobacco products in scope, including heated tobacco, on a previous day in Committee, so I will not take up any more of the Committee’s time on that.

As for consultation, Clause 109 already requires the Secretary of State to consult before making any regulations in Part 5. I can assure the noble Baroness, Lady Northover, that we intend to consult on introducing restrictions on tobacco, vaping, which she spoke of, and nicotine product packaging as soon as possible next year. The consultation will be open to all, and we will listen very carefully to the views and evidence put forward by stakeholders.

Amendment 147B is also not needed. Clause 93, on non-compliant images, is intended to stop images being published of products that do not meet the packaging and product design requirements that could be specified under Clauses 89 and 90 respectively. Those clauses already allow the Secretary of State to restrict the use of imagery such as cartoons and images that would appeal to young people. There is therefore no need to amend Clause 93, on non-compliant images. I hope that the noble Lord feels able to withdraw his amendment.

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[Earl Howe (Con)]

My Lords, I cannot put it better than the noble Baroness, Lady Walmsley, has just done in relation to the recommendations about Allen Carr’s Easyway, which has been warmly endorsed by NICE in its guidelines. This is one of the four interventions that NICE recommends. The content of those guidelines should now be underlined for NHS smoking cessation clinics, to ensure that, exactly as the noble Baroness said, there is an option for those who do not want to remain addicted to nicotine when they elect to stop smoking.

I hope that the Minister will take this amendment away with her; I am grateful to my noble friend Lord Moylan for raising this issue. I say to him that there is probably another dimension to his amendment, if one takes literally the wording around what constitutes an appropriate level of nicotine in vapes. We have heard from the Minister that there is a power to regulate this in the Bill. However, again, we have a tension here: on the one hand, there are obvious arguments in favour of limiting the strength of nicotine in vapes that are used recreationally; on the other hand, we want vape dosages of nicotine to be strong enough to satisfy the addictive craving of someone who is hooked on smoking tobacco and who does not wish to go down the Allen Carr route. If you make the dosage too weak, the patient will simply revert to their former harmful habits.

My noble friend’s amendment is also useful in the sense that it would enable us to hear from the Minister how the Government propose to reconcile those dual objectives and the potential difficulties that face policymakers in attempting to regulate nicotine strengths. This short debate has brought us to an interesting point in the smoking cessation arguments. I look forward to what the Minister has to say.

[Baroness Merron (Lab)]

I thank the noble Lord, Lord Moylan, for bringing forward Amendment 147 and thank noble Lords for their reflections on this amendment.

I start by giving the reassurance that the Bill will allow the Secretary of State to continue making provisions about the amount and nature of substances that may be released into the body by vaping and nicotine products. Regulations made under this power will apply to products sold on the market and to those provided through stop smoking services. We will consult before making regulations and will consider restrictions carefully to avoid any unintended consequences on smoking cessation, which I know is of great concern to noble Lords.

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[Earl Howe (Con)]

That is a very helpful clarification; I am grateful to my noble friend. There is a good parallel with the Portman Group, which is recognised, as he said, in statute and has a well-understood relationship with government. That is an appropriate parallel for the Government to consider.

In the same vein, Amendment 198, tabled by my noble friend Lord Moylan and the noble Baroness, Lady Fox of Buckley, seeks to establish an industry forum. The bringing together of Ministers, supply chain representatives and officials would ensure that policies are based on not only principle but real-world experience. I return to the theme of evidence-based policy and there is a parallel here too. As the Minister knows, there are already industry forums for pharmaceuticals and for medical technology, each of which I used to chair as a Minister. Each provides a mechanism for government and officials to engage with those who work day-to-day in the vape and nicotine industries. For the vaping and nicotine industries, it would be a very effective way of making sure that the real world was reflected in future policy-making.

[Baroness Merron (Lab)]

I thank the noble Lords, Lord Lansley and Lord Moylan, for tabling these amendments, and other noble Lords for their considerations today.

Turning first to Amendments 154 and 154A, tabled by the noble Lord, Lord Lansley, I understand the noble Lord’s intention and the comments that he and the noble Earl, Lord Howe, made. I heard the noble Lord, Lord Lansley, clarify that he is talking about co-regulation. I understand his intent, but as I have said on a number of occasions—other noble Lords, including the noble Baroness, Lady Northover, have supported this—the industry has failed to self-regulate. Vapes are branded and advertised to appeal to children and rates have more than doubled in the last five years, with one in five 11 to 17 year-olds having tried vaping.

In addition to Part 5, the requirements set out in regulations are the best way to stop future generations from becoming hooked on nicotine. As I have previously said, we will consult on regulations where they are made under Part 5. The vaping industry and other bodies are welcome to respond to this consultation. We will return to advertising in more detail when we reach a later group, but despite existing restrictions on vape advertisements and the opportunities that the industry has had to self-regulate, evidence shows that vape advertising continues to appeal to young people. It is unacceptable that, in too many cases, vapes are being deliberately promoted and advertised to children.

Tobacco and Vapes Bill

Debate between Earl Howe and Baroness Merron

Committee stage
Tuesday 11th November 2025 Grand Committee

[Earl Howe (Con)]

My Lords, taken together, this group of amendments focuses on the question of how the new fixed penalty notice regime will operate in practice, how enforcement will be resourced and how local authorities will be supported in carrying out their duties under the Bill. Those are all important themes.

Amendment 74 in the name of my noble friend Lord Udny-Lister proposes a stepped approach to fixed penalty notices reflecting the number of times a person has been issued with a notice. That makes a lot of sense to me. The first time somebody commits an offence should surely be treated differently from the fourth or fifth time. I hope that enforcement officials will want to do this anyway, but such an approach would help strike a balance between giving people the benefit of the doubt—particularly as this will be, at the beginning, a complex new framework of rules—and ensuring that repeated non-compliance is dealt with properly.

That spirit of proportion and fairness also underpins Amendment 77, which would give local enforcement authorities the discretion to issue a formal warning notice to first-time offenders in lieu of a fixed penalty. I hope that the Minister will recognise the constructive intent behind both proposals.

I turn to the series of amendments tabled by my noble friend Lord Lansley, which seek to ensure that the proceeds of fixed penalty notices arising from offences under Clauses 17 and 20 are used to support trading standards teams directly, rather than being absorbed into the Consolidated Fund. Like my noble friend, I can see no real reason why the proceeds of fixed penalty notices arising from those breaches should not be treated in exactly the same way as the proceeds of other fixed penalty notices or fines. Trading standards officers are at the forefront of enforcing the Bill’s provisions.

There is, perhaps, a debate to be had about whether hypothecation along those lines creates an incentive for enforcement officers not to exercise the kind of discretion favoured by my noble friend Lord Udny-Lister. However—I admit that this is entirely guesswork on my part; I hope the Minister can illuminate us further— I do not think we should expect the yield from fixed penalty notices to be all that great in the scheme of things. This means that the incentive for overzealousness is likely to be more theoretical than real, so on balance I can identify with my noble friend’s argument that the resources generated by enforcement officers through their activity should be reinvested to strengthen their own capacity.

Amendments 81 and 83 from the noble Baroness, Lady Walmsley, would instead direct the revenue from fixed penalty notices towards local public health projects. This idea has considerable merit. There are some practical considerations because such a funding stream would, by definition, be inherently unreliable—and, in the context of a local authority budget, it would probably be very small beer—but, in any case, as the noble Baroness said, we hope that the number of penalty notices issued under this part of the Bill will start at a low level then decline even further as we go along.

Nevertheless, the noble Baroness asked an important question about how enforcement and public health objectives can be more closely aligned. I would be grateful if the Minister could set out how the Government see the relationship between enforcement activity and public health outcomes—specifically, how enforcement might be used not only to punish but to deter and to prevent the behaviours that lead to such offences in the first place. If the Minister can convincingly join the dots, as it were, I will have a better basis for assessing the merits of the noble Baroness’s amendment.

Finally, I turn to Amendment 204 tabled by my noble friend Lord Udny-Lister. This is a welcome and sensible amendment. It highlights the central role of local authorities in delivering and enforcing the provisions of the Bill. It is no secret that local authorities are already under significant financial strain, as has been said, and yet this Bill leans heavily on them for its success. I think it is fair that they are given certainty that the additional duties and regulations imposed on them will not leave them further out of pocket. With that, I look forward to what the Minister has to say.

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

My Lords, I am very grateful for the debate we have had on this group of amendments, which address the issues relating to penalties and enforcement of the Bill. Let me start with Amendments 74 and 77 in the name of the noble Lord, Lord Udny-Lister, which relate to penalties. I understand the noble Lord’s interest in providing tougher deterrents for repeat offenders and in taking a proportionate approach to first-time offenders in relation to certain measures in the Bill. However, I feel that the Bill already strikes the balance in this regard and has taken this into account.

The noble Earl, Lord Howe, and the noble Baroness, Lady Walmsley, made some good points about fixed penalty notices and their literal value. I can agree with the noble Lord, Lord Johnson, that we have focused, as we did on an early group, on supporting those who carry out their business legally and correctly, which is most people. We want to make that possible and streamlined, and we want to crack down on the illegal. This brings us to the point about how in an ideal world we would not be seeing fixed penalty notices because everyone would be playing by the rules. That is an ambition, but what I am trying to say is that it will not be a good measure if we are issuing so many fixed penalty notices without a decline. I think that is what noble Lords are saying, and I certainly share that view. I think that is a very helpful and practical point about how we see the proceeds from fixed penalty notices.

When enforcing tobacco and vape legislation, local trading standards already take a proportionate approach. They choose appropriate action to achieve compliance, and in many cases this already involves the issuing of warning notices, which can be effective in achieving compliance without the need to escalate to harsher penalties. Enforcement authorities will continue to use warning notices where appropriate.

Amendment 74 would increase the values of fixed penalty notices introduced by the Bill, with the highest penalties for repeat offenders. I understand why the noble Lord is putting that forward. The Bill is introducing fixed penalty notices in England and Wales to complement our existing sanctions and to strengthen what is already available to trading standards officers. I know noble Lords are aware—I hope it is obvious, but it is worth restating—that we have been in close conversation and will continue to be so to ensure that any concerns or points that trading standards officers wish to raise in respect of the Bill are heard.

On the point about complementing existing sanctions and strengthening the toolkit that is already available, that is something that trading standards has called for, because it wants to be able to take swift action, as we all want it to, to fine rogue retailers that breach certain regulations. Setting the fine at £200 is believed to be proportionate and the most popular level for the penalty that came through in the 2023 consultation on creating a smoke-free generation. It is also in line with the current fixed penalty notices in Scotland and is similar to the situation in Northern Ireland.

--- Later in debate ---

[Earl Howe (Con)]

My Lords, in Amendment 114A, my noble friend Lord Jackson of Peterborough rightly highlighted the need for any regulations in this part of the Bill to be underpinned by evidence drawn from the real-world experience of retailers, manufacturers and consumers. It is a point very well made, and I hope that, even if the Minister has an issue about consulting tobacco manufacturers, which I expect she will say she does, she will see the good sense of consulting others in the supply chain to make sure that the regulations stand the best chance of being fit for purpose and avoid unintended adverse consequences.

My noble friend Lord Jackson focused much of his speech on heated tobacco, as did my noble friend Lord Sharpe of Epsom just now. One of the other main concerns about regulation, which we have already touched on in an earlier debate, is the cost of the licence fee for a small business alongside the administrative burden for existing businesses to transition across to the new system. It is important that local authorities allow enough time for applications to be considered and processed and for the operational challenges faced by retailers implementing the system to be addressed. Both retailers and consumers need to be made aware of the new regulatory regime well before it goes live.

The noble Baroness, Lady Fox, amplified that proposal in her Amendment 114C by focusing specifically on the socioeconomic impact of the generational ban on retailers. She is absolutely right to be concerned about that, but I would like to talk about a different strand of the argument from that which she focused on.

In the consultation exercise conducted two years ago by the last Government, the Association of Convenience Stores, which represents more than 50,000 retail outlets across the UK, did not object to the generational ban as a policy. However, when the current Government published this Bill, shop owners expressed immediate concern about the powers contained in it around the licensing system. The biggest worry for them is the power given to a local authority to take a decision to refuse the granting of a licence to sell tobacco and vapes based on the density of other businesses operating in a specific area, or because of that business’s proximity to a school.

We debated this issue briefly last week, but the worry persists on what the effect of these provisions will be. First and foremost, how will this affect existing businesses? Might a well-established retailer selling tobacco and vapes suddenly find that it can no longer do so? Might a new business wishing to set up in a particular area be denied that ability? The ACS has rightly asked what the evidential framework will be for deciding that the density of outlets is too high. How will the threshold be set, and how can fairness be achieved between businesses in an urban area compared to those located in rural areas? Will small shops be treated in the same way as large shops? We simply do not have answers to those questions—and they are questions that are particularly pertinent to small, family-run businesses operating on sometimes tight margins. When will guidance be published to provide the answers? If the Minister cannot reply in detail today, I shall be very grateful if she would do so in writing between now and Report.

Finally, my noble friend Lord Johnson of Lainston has raised an important issue around the need for transitional provisions covering specialist tobacconists located in Northern Ireland. We will be debating specialist tobacconists more broadly in a later group of amendments, and I do not propose to anticipate that debate now. However, in the light of what my noble friend has said, it would be helpful to hear from the Minister whether she agrees that there is a strong case for what are commonly called grandfather rights for these particular specialist outlets.

[Baroness Merron (Lab)]

I am most grateful to noble Lords for this group of amendments and the contributions to the debate. I am grateful for the support of the noble Baroness, Lady Northover, and thank her for that.

The noble Lord, Lord Jackson, who has tabled the amendment, and the noble Baroness, Lady Fox, who has tabled Amendment 114C, I hope will be pleased to hear that I absolutely agree with the premise of their amendments. I have been consistent on this. It is crucial that the Government carefully consider the impact of any legislation and carry out appropriate consultation. That is why in 2023, a UK-wide consultation, which the noble Earl, Lord Howe, referred to, was published on creating a smoke-free generation. It is also why this Government, as I mentioned in the earlier group, completed and published an impact assessment for the Bill, which was deemed fit for purpose by the Regulatory Policy Committee, and this included the impact that this policy will have on retailers. Indeed, that is important.

However, I can also confirm that we will consult, in compliance with our statutory obligations under this Bill, before making regulations under Part 1 implementing significant policy changes. For example, Clauses 13 and 14, relating to the in-store displays of relevant products, already contain a duty to consult, and impact assessments will be conducted for future regulations, as required. I also want to reassure noble Lords, as I have done previously, that we regularly engage with retailers and enforcement agencies, and remain committed to supporting retailers in the implementation of new requirements. We will, as requested, provide appropriate guidance to aid this transition.

The noble Lords, Lord Jackson and Lord Sharpe, raised questions about heated tobacco being in scope. To that I say that laboratory studies show evidence of toxicity from heated tobacco. As I mentioned in the previous group, like other forms of tobacco, the aerosol generated by heated tobacco devices contains carcinogenic compounds. There is very limited evidence that this is effective for smoking cessation. I am glad to hear of the interest in smoking cessation but, clearly, we have other products that are evidenced as working rather more definitely.

The noble Lord, Lord Jackson, and the noble Baroness, Lady Fox, raised points about the illicit market. Let me say to that point that history shows that when we have introduced targeted tobacco control measures, they have had a positive impact on tackling the problems of illicit tobacco. For example, when the age of sale was raised from 16 to 18 in 2007, the number of illicit cigarettes consumed fell by 25% from 10 billion in 2005-6 to 7.5 billion in 2007-8. Most of the evidence that suggests that heated tobacco products are somehow less harmful than smoke tobacco is not independent and often comes from the manufacturers themselves.

Tobacco and Vapes Bill

Debate between Earl Howe and Baroness Merron

Committee stage
Thursday 30th October 2025 Grand Committee

[Earl Howe (Con)]

It certainly could be—it sounds a very interesting way forward. I did not take it that the noble Earl was suggesting introducing a levy as a substitute for tobacco duty but as an addition to it, so, in the nature of things, if this were accepted, that is the mix we would get.

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

My Lords, I am most grateful for the debate today on this group of amendments, which seek to impose regulatory obligations on the tobacco industry. Although in general I would certainly say that I have sympathy for the aims behind these proposals, I suggest that, for the reasons I will go on to outline, they are not necessary in respect of the Bill.

Amendment 192, tabled by the noble Lord, Lord Young of Cookham, seeks to require the Secretary of State to consult on proposals for regulating the prices and profits of, and to raise funds from, tobacco manufacturers and importers. Similarly, Amendment 194 from the noble Earl, Lord Russell, seeks to require the Secretary of State to introduce regulations to raise funds from tobacco manufacturers and retailers.

The noble Earl, Lord Howe, made the first point that I was intending to make. I feel that in many ways —I know not all noble Lords will share this view—we already have a “polluter pays” tax on tobacco, which comes in the form of tobacco duties, as the noble Earl outlined. Overall, throughout, I am very focused on what impact will be made on improving public health and driving down rates of smoking, as I know we all are. I also appreciate that there are different opinions as to how that might be done. It has been pointed out regularly to the Government that the UK has some of the highest tobacco taxes in the world. Duty rates on all tobacco products were increased by 2% above inflation in the Autumn Budget last year, with an additional increase for hand-rolling tobacco to reduce the gap with cigarettes, and this duty raises about £8 billion a year.

I am aware that the noble Lords, Lord Bourne and Lord Scriven, in addition to other noble Lords, are very supportive of these amendments. I am sure that noble Lords who have quoted me accurately today will probably say I should have looked at this before, but I refer back to, as the previous Government will be aware, a previous consultation in 2014, which showed that going down this road would not raise the significant amounts being referred to when you take into account lost duties.

I have spent quite a lot of time with officials and others going through the detail of all this, not least because of my previous comments. Certainly, having had the chance to review the detailed government advice and all that comes with it, which I now have access to as a Minister, I think that the way to reduce the profits of the tobacco industry is to reduce the use of tobacco—I believe I said that on day one in Committee—and by creating a smoke-free generation. That is not just a prize in itself but will have a great impact, in the way I think noble Lords seek, on the industry. It is unclear to me how an additional levy on tobacco industry profits could be implemented without the costs being passed on to consumers—again, there was some concern about that in this debate—or without regulating prices.

The noble Lord, Lord Young, referred to a price cap on tobacco products. Certainly, my investigation into this shows that regulating pricing would be extremely complicated to design and implement, and difficult to shield from abuse and challenge by the global tobacco industry. Therefore, given that, as I just said, our focus is on implementing our smoke-free generation, our judgment is that the benefits do not outweigh the costs.

Therefore, at this stage, to do the job that I believe most people—not everybody, I know—is focused on, our preference would be to continue with what is a proven, effective and understood model of increasing tobacco duties. This approach provides an incentive to those who currently smoke. It incentivises them to quit, which is what we want to focus on, as well as generating revenue to be put back into a full range of public services, including public health and the National Health Service.

I say to the noble Lord, Lord Crisp, who I know is extremely well aware that I am about to say this, that of course tobacco taxation is a matter for His Majesty’s Treasury, and decisions on taxes are reserved for fiscal events. I would be extremely unwise, in my position, to speculate in advance of a forthcoming Budget.

Moving on to Amendment 12—

--- Later in debate ---

[Baroness Merron (Lab)]

I appreciate the clarification that the noble Earl has made. If that is the case, though, I have to say that that would send a complex pricing message to people, and we are not seeking to add complexity to where we are going. I am not sure I agree with the analysis but I am happy to look at the point that he is making.

Perhaps it will be helpful if I reassure the noble Earl that we are already acting to pick up the point that he rightly raised and which the noble Baroness, Lady Walmsley, was keen to emphasise, which is to ensure that vapes are not sold for pocket-money prices. Indeed, the Chancellor has confirmed the introduction of a vaping products duty from 1 October 2026. That will set out a single flat rate of £2.20 per 10 millilitres on all vaping liquids, and it will be accompanied by a simultaneous one-off increase in the rate for tobacco duties.

The noble Earl, Lord Russell, raised a number of points about the environmental damage done by vapes. I will be pleased to hear and respond to the debate in the next group about single-use vaping.

The noble Baroness, Lady Walmsley, asked about vapes being prescribed as a quit aid. We have a world-first scheme here, Swap to Stop, to help adults to ditch cigarettes as part of a 12-week programme of support, as I highlighted earlier in response to the noble Lord, Lord Moylan.

Amendment 28, tabled by the noble Baroness, Lady Northover, would prohibit businesses from providing free samples of tobacco and vaping products. The noble Baroness said herself that Clause 15 already bans the free distribution of any product or coupon that has the purpose or effect of promoting a tobacco, herbal smoking, vaping or nicotine product as well as cigarette papers, and that includes free samples. It should never have been the case that addictive nicotine and vaping products could have been legally handed out for free, and I am glad to say that the Bill closes that loophole. Clause 15 also states that products cannot be sold at a substantial discount, which will ensure that businesses cannot heavily discount products to the point where the price is no longer such a relevant factor for a prospective purchaser. So the noble Baroness is quite right to seek to close that loophole, and I am grateful to her for raising the issue, but I can confirm that the Bill already achieves her intention.

[Earl Howe (Con)]

To pick up on that, I ask the Minister to clarify the issue that was left slightly in the air earlier about the derivation of nicotine. While nicotine can be synthetically produced, it is derived from tobacco, but the point made by definition in the Bill is that a vaping product is a distinct product from a tobacco product. So the advertisement seen by the noble Baroness, Lady Northover, which I agree is highly regrettable, may be accurate in saying that the product is derived from tobacco but is not a tobacco product. Is that correct?

--- Later in debate ---

[Earl Howe (Con)]

My Lords, the first amendment in this group, in the name of the noble Earl, Lord Russell, and the noble Baronesses, Lady Grey-Thompson and Lady Walmsley, shines a spotlight on a fascinating question: when is a reusable vape not a reusable vape? The ban on single-use vapes came into force on 1 June this year, as we have heard. Single-use or disposable vapes are clearly defined in the guidance: they are vapes which are not designed or not intended to be reused. For all the reasons given by the noble Earl, especially the environmental reasons, that ban is soundly based. A reusable vape is one that possesses two key features: it must have a battery which can be recharged and the e-liquid container—that is, the cartridge or the pod—can be either refilled or replaced with a separately sold item, which is where the amendment comes in.

The regulation explicitly states that a device is not refillable or reusable if it has a single-use container, such as a pre-filled pod, that you cannot buy separately and replace. In other words, the law at present tries to capture in the definition of a disposable vape all devices that look and function like a disposable vape. So far, I hope, so clear, but as we have heard from the noble Earl, this leads on the ground to some grey areas of interpretation. A vaping device may be packaged in such a way as to claim that it is intended to work with replaceable pods—and hence that it should be classed as refillable and reusable. In practice, however, that claim can sometimes be a fiction. If, in reality, the replacement pods are not readily available for purchase separately, the device is at risk of falling foul of the legal description of a reusable vape. Enforcement authorities will also check whether the battery is genuinely rechargeable and whether a replaceable heating coil is genuinely replaceable.

More and more reports suggest that in some shops, replacement pods are either not available at all or are in very short supply. Furthermore, so-called reusable devices are priced similarly to the former disposable vapes. The net effect is that the user is tacitly encouraged to throw away the entire device, including the battery and the pod, once they have finished using it. Functionally, the supposed reusable vape has become a disposable vape.

The question therefore is: is there a need to change the definition of what counts as a disposable vape? The noble Earl suggests in his amendment that part of the answer is to ban pre-filled single-use vaping pods. The problem with that suggestion is that some vaping devices properly classified as reusable devices genuinely depend on the supply of replacement single-use pods and are thereby genuinely reusable. Banning all single-use pods would mean removing those types of reusable vaping devices from the market, a step which, on the face of things, appears rather severe.

What, therefore, is to be done? If it is true that many devices currently on the market technically tick the box of being refillable or reusable but in practice behave like disposables, how are we to address that loophole? Is the answer to reframe the regulations, or does the answer lie in intelligent enforcement by local authorities and trading standards? I will be interested to hear the Minister’s reply.

That point links neatly to the second amendment in this group, Amendment 145, tabled by the noble Baroness, Lady Fox of Buckley, which I think makes a sensible and pragmatic case, pace the noble Baroness, Lady Carberry, to whom I listened very carefully. In introducing further regulations in this area, we would be well advised to take stock of the prohibitions that have already been introduced and examine their impact in practice. The single-use vape ban that came into force on 1 June provides us with an opportunity to do that. We will no doubt debate at later stages the regulation-making powers designed to control flavours, and so on. I align myself with the noble Baroness, Lady Fox, in wanting to tread cautiously, reflecting on how the single-use ban came in as quickly as it did and whether some unintended consequences have ensued from it.

[Baroness Merron (Lab)]

My Lords, I am most grateful to noble Lords for the debate on this group of amendments. I will start with Amendment 22, tabled by the noble Earl, Lord Russell, which seeks to ban all “pre-filled single-use vaping pods”.

We understand the concerns being raised about the environmental harms of single-use products. The ban that was introduced by Defra came into force on 1 June, which was not so long ago. Under that ban, vapes must be rechargeable and refillable, while any coil must be replaceable. A vape is not considered refillable if it has a single-use container, such as a pre-filled pod, that you cannot buy separately and replace. Pre-filled pods that can be replaced are therefore not captured, to the points raised by a number of noble Lords, as the ban focuses on tackling the greatest environmental harms. Those are posed by batteries and the surrounding elements contained in the vapes. I acknowledge that vaping creates waste; that is true when users fill up a tank or pod themselves using refill bottles, as the noble Earl described, as well as when pre-filled pods are used.

However, to minimise the environmental impact, since April 2024 it has been compulsory for all businesses selling vapes and vape products, including pods, to provide their customers with a recycling bin and to arrange for these products to be collected by a verified recycling service. I hope that makes a helpful contribution in answering the points raised by the noble Earl, Lord Howe. Since this obligation came into force, some 10,500 vape takeback bins have been introduced into stores. I say to the noble Earl, Lord Russell, that Defra is monitoring the impact of its regulations and will consider the environmental impact of any new vaping regulations brought in using the powers in this Bill.

I hear the concerns about the appeal of single-use pods to children. The Bill contains powers to regulate vape devices. Importantly, we have recently launched a call for evidence that seeks information on the role that different sizes, shapes and features of devices play in the appeal of vaping to young audiences. As part of that, we would welcome evidence on any types of vaping device that particularly appeal to children. I assure the Committee that we will use the evidence to inform future proposals on potential restrictions to devices.

Amendment 145, tabled by the noble Baroness, Lady Fox, seeks to place additional requirements on the Secretary of State before regulations can be made on contents and flavour. I note that part of these requirements involves evaluating the impacts of the ban on single-use vapes, which came into force on 1 June. Defra is monitoring the impact of its regulations and a post-implementation review will be undertaken in line with statutory obligations.

Turning to the impact of future restrictions on contents and flavour, we recognise that vape flavours are an important consideration for smokers seeking to quit. We will therefore consider the scope of restrictions very carefully to avoid any unintended consequences on smoking rates. I am grateful to my noble friend Lady Carberry for her contribution on this group.

As I said, to support all this, the call for evidence was launched on 8 October. It includes questions about the role of flavours, their contents and the associated risks. I assure noble Lords that before any restrictions are introduced on contents and flavours, we will conduct an impact assessment. We will also undertake a consultation on our policy proposals, and Parliament will have the opportunity to scrutinise the regulations. I hope that this response allows noble Lords not to press their amendments.

Tobacco and Vapes Bill

Debate between Earl Howe and Baroness Merron

Committee stage
Monday 27th October 2025 Grand Committee

[Earl Howe (Con)]

My Lords, I turn next to my noble friend Lord Lansley’s amendments, which would introduce requirements and provide enabling powers for age-verification technology to be built into vaping devices themselves. This proposal opens up all sorts of interesting avenues of thought. The idea of age-gating devices, using technology to prevent use by those who are underage, is innovative by any standards. As we heard from my noble friend, there is already at least one technology that would facilitate this; like him, I am led by the manufacturers to understand that it has been successfully trialled in the United States.

There could be distinct advantages to such a system: it would close a loophole that rogue sellers currently exploit; it would be more effective as a way of reducing the incidence of underage vaping; it could avoid unpleasant confrontations in retail stores, about which we know retailers are very worried; and, as my noble friend said, it would not affect the way in which adults use vapes as a way of quitting smoking. From the Government’s point of view, an amendment along the lines of my noble friend’s would act as a form of future-proofing the Bill, because it would enable them to regulate the technology in devices or packaging— a power that this Bill does not currently give them. Can the Minister tell us whether the Government have considered systems of this kind and whether officials are aware of developments in this field?

I turn to the amendment in the name of the noble Viscount, Lord Hanworth, which calls for a review of age-verification methods. The Committee will be grateful to him for raising this idea; it links into my noble friend Lord Lansley’s amendment, but it also speaks to the crucial principle that we must remain properly informed about how these measures will work in practice. This Bill introduces a major new regulatory framework, so it has to be monitored and tested against real-world evidence. Age verification will, as I have said, be central to the Bill’s success, so we need credible and accurate systems to facilitate it. The noble Viscount is therefore right to emphasise the need to engage directly with those on the front line: the retailers who will have to implement these rules every day. Their experience will be one of the best indicators of whether the system is working as intended.

I turn to the amendments in the name of the noble Lord, Lord Davies of Brixton, introduced by the noble Baroness, Lady Northover, which seek to place a statutory requirement on businesses to operate age-verification policies in England and Wales. These are well-intentioned amendments, and we share entirely the objective of preventing underage sales. However, as I read it, the Bill as drafted already makes it an offence to sell tobacco or vaping products to anyone below the legal age and provides for a due diligence defence for retailers who have taken all reasonable precautions. In practice, that means having and enforcing an age-verification policy, which is the very outcome that these amendments seek to achieve. The familiar Challenge 25 model is already a well-established part of a range of retailer compliance. So, although we understand and respect the motivation behind these amendments, we do not believe that it is necessary to restate these duties in the Bill.

I welcome the amendment from my noble friend Lord Young of Cookham, which would prohibit the online sale of tobacco products. This raises serious and timely questions around enforcement, fairness and the protection of legitimate retailers. My noble friend put his case very well. Online sales prevent a potential route for illicit or underage trade; as purchasing habits continue to shift online, that risk will surely only increase. We therefore see every benefit in exploring whether a prohibition or stricter control of online sales is appropriate.

If I were to voice a caveat, which I am sure my noble friend would not object to, it would be that we must always ensure that law-abiding retailers—those who comply with the law and operate responsibly—are not disadvantaged. Any new regulation has to be clear, enforceable and fair. The central question here is: has the Minister given any thought to this issue? If so, what capacity do the Government have to enforce a measure such as the one suggested by my noble friend? What mechanisms exist to distinguish legitimate traders from those operating illicitly? Can we control online sales in the way we would like to do? I am sure that the Minister will be the first to recognise that, if unregulated online trade becomes a loophole—indeed, it already is—it will seriously undermine the objectives of the Bill.

[Baroness Merron (Lab)]

My Lords, this group of amendments addresses the important topics of age verification and online sales. I am grateful to all noble Lords for not just their contributions but the intent behind these amendments—an intent that I have heard as being presented to assist the Bill. I am grateful for noble Lords’ considerations; I have certainly heard the support given by the noble Lord, Lord Bourne, to a number of these amendments.

I turn to Amendments 24 and 25 tabled by my noble friend Lord Davies of Brixton, who is not able to be in his place. We wish him well. I thank the noble Baroness, Lady Northover, for presenting these amendments, which would introduce a requirement for a person carrying on a business selling tobacco, herbal smoking, vaping or nicotine products, in England or Wales, to operate an age-verification policy. I certainly welcome the intention to prevent underage sales and to express a view—as I have heard not just from the noble Baroness but from other noble Lords—about supporting retailers to do the job that we are asking of them. I associate myself with that, but we believe that the Bill’s current provisions are sufficient in this regard.

Mental Health Bill [HL]

Debate between Earl Howe and Baroness Merron

Report stage
Monday 31st March 2025 Lords Chamber

[Earl Howe (Con)]

My Lords, this is Report and I do not propose to do more than underscore all that is been said by noble Lords who have spoken, particularly my noble friend Lady Berridge. Approved mental health professionals carry with them a huge responsibility for the well-being of those whose interests they are called upon to protect. When a child or young person suffers a mental health crisis, it is the job of the AMHP to make the right assessments, take the right decisions and follow the right procedures under the law to ensure that the young person is looked after appropriately and swiftly. To do that, he or she needs a clear set of ground rules to follow.

We need to imagine a situation, such as the one posited by my noble friend, in which a child’s mental and emotional condition is such that they lack decision-making competence. An AMHP is then called in. In that situation, when it comes to appointing a nominated person for the child, the scope for confusion and indeed delay is enormous. Who should be appointed? Is it the mother or the father, or is there someone else who should take precedence?

The Minister has acknowledged through the government amendments before us that, when there is a care order for the child, the AMHP should have no choice but to appoint the local authority as the nominated person for the child. That is a welcome step forward but, as my noble friend has rightly said, what if there is a special guardianship order or child arrangement order issued by the court under the terms of the Children Act? In those circumstances, too, the AMHP should be relieved of the obligation of making a decision that, if it is the wrong one, could leave them open to legal challenge. I very much hope the Minister will be receptive to the powerful arguments that my noble friend and the noble and learned Baroness, Lady Butler-Sloss, have advanced on these significant issues.

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for their contributions in this important area, and I thank the noble and learned Baroness, Lady Butler-Sloss, for Amendment 2.

On that point, I can say that a copy of the report made following a care and treatment review must be sent to those who have a legal duty to have regard to the review recommendations, so that they are implemented appropriately. We agree that parents play an important role. However, it may not be appropriate for the report to be sent to parents in every case: for example, where safeguarding concerns have been raised. Inappropriate sharing of information could result in the patient withdrawing their consent to the review. So we will provide statutory guidance on the role of the parent to assist the responsible commissioner in considering who to involve in care and treatment reviews.

On Amendment 25, also tabled by the noble and learned Baroness, Lady Butler-Sloss, the Bill already allows anyone involved in the patient’s care or welfare, which includes parents, to apply to the county court to terminate the appointment of a nominated person. I can assure the noble and learned Baroness that we will make this clear in the code of practice and the Explanatory Notes for the Bill, as she has raised an important point.

To address Amendment 27, we are concerned that making it a requirement for parents always to be consulted when a nominated person is chosen could put undue pressure on a child to choose a parent. However, we agree that the witness should consider the views of parents and others who may have insight into the suitability of a nomination. I can tell the House that we will therefore set out in the statutory code of practice how the views of the family and others should be fed into the witnessing process.

I have also heard the concern of the noble Baroness, Lady Berridge, about the nominated person regarding children who lack competence. In response to this, as she acknowledged, I have tabled Amendments 29 to 33 to make it clear who an approved mental health professional must appoint in certain circumstances. For an over-18 lacking capacity, an approved mental health professional must appoint a competent lasting power of attorney or Court of Protection deputy, if they have one. For all under-18s lacking capacity or competence, where there is a care order, they must appoint a local authority which has parental responsibility for them or, if relevant, a competent Court of Protection deputy. Where there is no care order, the approved mental health professional can appoint a person who does not have parental responsibility for 16 and 17 year-olds. This allows for suitable alternative arrangements, for example, informal kinship arrangements for young people who live independently. I hope that this reassurance and commitment on my behalf provides the further clarity for which the noble Baroness has been advocating.

Finally, in response to Amendment 34, we agree that in the vast majority of cases we would expect a parent, or whoever has parental responsibility, to be appointed. This would include consideration of special guardians and child arrangement orders. As I have set out before, we do not agree that a person with residual parental responsibility should always be blocked from being a nominated person. A child arrangement order or special guardianship may be in place for reasons other than the parent being a risk to the child. For example, the parent might struggle with their own health issues but could still be an effective nominated person.

The situation is different in the case of a care order because the local authority is being given lead parental responsibility. We have engaged with the Children’s Commissioner on this point. As I believe the noble Baroness may be aware, I recently met the Children’s Commissioner on a range of issues, including discussions about the Mental Health Act.

If there are no relevant people, approved mental health professionals must follow the patient’s past and present wishes and feelings when deciding who to appoint. We do not believe that the eldest person should be given preference, as this represents an outdated assignment of responsibility. I assure the noble Baroness, Lady Berridge, that I have been advised that my officials met the chair—but I understand that the term is lead—of the AMHP Leads Network last November.

I can make a further commitment, which I hope will be helpful to your Lordships’ House. I am committing to establishing an expert taskforce to support the development of the statutory code of practice to provide clear guidance for professionals involved in the nominated person appointment process for children and young people. Views will be very much welcomed on who should be part of this; I have already invited the noble Baroness, Lady Berridge, and the noble and learned Baroness, Lady Butler-Sloss, to make suggestions about that. With these reasons, I hope that noble Lords can support our amendments and will not press their amendments.

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[Earl Howe (Con)]

My Lords, I will speak briefly to the amendments in this group tabled by my noble friend Lady Berridge, supported by the noble Lord, Lord Meston, and the noble and learned Baroness, Lady Butler-Sloss, whose last suggestion I hope will be listened to by the Minister.

I must commend my noble friend for her tenacity with this issue. As she has outlined, there is a significant concern that the use of the county courts to decide on matters pertaining to the termination of nominated persons is not the most appropriate process. I do hope that the Minister will give my noble friend words to her comfort.

[Baroness Merron (Lab)]

My Lords, I thank the noble Baroness, Lady Berridge, for her Amendments 24, 28 and 35. They would mean that the mental health tribunal, rather than the county court, handled the termination of appointment of the nominated person. The county court already has a role in displacing the nearest relative. It has the expertise, procedural tools and legal framework to handle sensitive disputes involving external parties, such as conflicts of interest or allegations of abuse. The First-tier Tribunal (Mental Health) in England and the Mental Health Review Tribunal for Wales are focused on reviewing detention under the Mental Health Act. This would add an additional burden on the tribunal, risking undermining its core function and delaying detention reviews.

The noble Baroness, Lady Berridge, raised the issue of legal aid. County court mental health cases are largely limited to applications for the displacement of a nearest relative. Legal aid is currently available to a person seeking the displacement of the nearest relative, except where the person bringing that application is doing so in a professional capacity and to the nearest relative themselves. That would also apply for the nominated person, which will replace the nearest relative.

Legal representation is available where the applicant meets the means test, unless they are under 18, and the relevant merits criteria. If there are any further points of clarification, I will be pleased to make them to any noble Lords who have raised points today, including the noble Baroness.

As we do not feel that the mental health tribunal is the right place for what I was referring to before I went on to legal aid, I ask the noble Baroness to withdraw the amendment.

Mental Health Bill [HL]

Debate between Earl Howe and Baroness Merron

Committee stage
Monday 24th February 2025 Lords Chamber

[Earl Howe (Con)]

My Lords, I will keep this brief since I can do no more than back the noble Baroness, Lady Tyler, in every word that she has said in support of these two amendments. We are dealing here with a Henry VIII clause that is surely far too permissive given the great sensitivity of the Bill’s entire subject matter and, as the noble Baroness said so well, its momentous significance for the health and well-being of very vulnerable people.

The absolute minimum that Parliament can expect is that Parliament be consulted in the exercise of these powers. The affirmative procedure is therefore entirely appropriate for any statutory instruments made under this clause and I hope the Minister will not disagree with what is proposed.

[Baroness Merron (Lab)]

My Lords, I thank the noble Lord, Lord Scriven, for tabling Amendments 160C and 160D, which were introduced by the noble Baroness, Lady Tyler, and spoken to by the noble Earl, Lord Howe.

The proposal in the amendment, as was referred to, was a recommendation in the report from the Delegated Powers and Regulatory Reform Committee. I hope that your Lordships’ Committee will welcome that we are actively considering this proposal and will publish our response to the committee’s recommendation ahead of Report.

Mental Health Bill [HL]

Debate between Earl Howe and Baroness Merron

Committee stage
Monday 24th February 2025 Lords Chamber

[Earl Howe (Con)]

My Lords, I am right behind the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler, in their Amendment 130. We know, and I believe that by and large we accept, that the Bill is not intended by the Government to hold out the prospect of instantaneous changes to the delivery of mental health care. It offers a series of measures that, over a period of years, should make a material difference to the well-being of a wide range of mentally ill people who require treatment, whether in a secure mental health setting or in the community.

The Minister has spoken of the need to view these measures in the broader context of the NHS 10-year plan and, certainly from the Government’s point of view, that is a perfectly reasonable position to take. However, if that is the Government’s policy, it begs a whole mass of questions around implementation and funding. For example, what do the Government see as the immediate high-priority measures that they wish to introduce? Which measures do they propose to defer, and for how long? What are the costs associated with these changes, both to the NHS and, as the noble Baroness, Lady Tyler, pointed out, to the justice system and local government? Bearing in mind Treasury constraints, when realistically do they believe a clear timeline for change will emerge? We have the impact assessment, but how far can we rely on that?

If those questions for the time being have to remain hanging in the air, as I suspect they will, I share the view of the noble Baroness, Lady Tyler, that Parliament, in the not-too-distant future, needs to be given an account of what the longer-term future looks like in a way that reflects not only the Government’s current thinking but, as time goes on, how their thinking evolves, as it surely will. There is therefore a strong case for a report to Parliament sometime in the next few months and on an annual basis thereafter, making clear both the timeline of ambition and the timeline of what in reality is being delivered.

I am conscious that we all need to keep our remarks succinct and to the point, so I will comment only briefly on the other amendments in this group. I am afraid I cannot support Amendment 153 in the name of the noble Baroness, Lady Bennett. I have always believed that what matters most in healthcare is not whether a service is delivered by a public or a private organisation but rather the quality of care to patients and whether good outcomes are achieved at acceptable cost.

Finally, my noble friend Lord Kamall has added his name to Amendments 163 and 164. These amendments stand absolutely four-square with the theme of Amendment 130, and on my noble friend’s behalf I express my warm support for them. The noble Lord, Lord Stevens, has said it all.

Just as we accept that we will not get any instant changes arising from the Bill, by a corresponding token, the Government cannot take that as a free pass from Parliament to defer implementing its provisions sine die. We cannot have a situation in which, prior to implementing the provisions, the principle of parity of esteem is quietly put to one side. I hope the Minister will have reassuring words to say on those very important points of principle.

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

My Lords, I am most grateful to noble Lords for their contributions to this first debate today, and I start by saying how glad I am—I am sure other noble Lords will say this too—to see the noble Baroness, Lady Hollins, in her rightful place. I certainly heard her support for the amendments that we are discussing.

Before I turn to the amendments, it may be helpful to your Lordships’ Committee if I briefly set out some of the high-level plans for implementation of these reforms. I am grateful for the understanding—the noble Earl, Lord Howe, made this point—that time is required. I also understand the emphasis that noble Lords are putting on pace and, of course, we try to match those two things together, but I know we are all agreed on the need to get the Bill in the right place and the Act delivering.

The first priority after Royal Assent will be to draft and consult on the code of practice, and we will be engaging with people with lived experience and their families and carers, staff and professional groups, commissioners, providers and others to do this. The code will be laid before Parliament before final publication, and I am committed to working with noble Lords to ensure that we get this crucial piece of work absolutely right. We expect that this process will take at least a year.

Alongside the code, we will be developing secondary legislation, which will also be laid before Parliament, with more detail on areas such as statutory care and treatment plans. We will then need time to train the existing workforce on the new Act, the regulations and the code. This will likely be in 2026 and 2027, and we intend to commence the first major phase of reforms in 2027.

Of course, some reforms are going to take longer, as noble Lords will appreciate. The noble Baroness, Lady Neuberger, tempted me to go even further than five years, and I thank her for the temptation, but I know I will not be able to please her on this occasion. Of course, it takes time to train new second opinion appointed doctors, judges and approved clinicians, so, as set out in the impact assessment, we believe it will take 10 years to fully implement the reforms, but I emphasise that these timelines are indicative, and we will iterate these plans as we get more certainty on future funding and the wider workforce plans. Of course, I fully appreciate the importance of parliamentary scrutiny and accountability of this work, which is crucial, and I am committed to updating the House throughout the implementation period.

Turning to the amendments, I will start with Amendment 130 in the name of the noble Lord, Lord Scriven, kindly introduced by the noble Baroness, Lady Tyler. I say in response that any implementation plan, as proposed in the amendment, which would be published four months after Royal Assent, would be very unlikely to contain any more detail than is already in the impact assessment. It is important to prioritise drafting the new code and the secondary regulations after Royal Assent. I also confirm to your Lordships’ Committee that we will commission an independent evaluation of the reforms, alongside existing monitoring and reporting by the CQC.

As I have said, I fully expect to update the House during the planning and delivery of the reforms. However, a requirement in primary legislation to publish annually, and within four months of Royal Assent, would be premature.

Amendment 153, tabled by the noble Baroness, Lady Bennett, would prohibit for-profit companies from delivering provisions of the Act. I listened closely to the concerns raised by the noble Baroness, but I do not share the view that a ban on for-profit providers is the right approach, for the reasons that were set out by the noble Earl, Lord Howe, and the noble Baroness, Lady Fox. Our focus should indeed be on ensuring that we have high-quality and good value-for-money services. However, I assure the noble Baroness, Lady Bennett, that we are already investing in a significant quality transformation programme and piloting new models of care to ensure that care is focused on the individual, with maximum therapeutic benefit. That is where our priority lies and for that reason we are resisting this amendment.

Turning to Amendment 163, I am grateful to the noble Lords, Lord Stevens and Lord Kamall, and the noble Baronesses, Lady Tyler and Lady Neuberger, for bringing this issue before the Committee. As I said in my opening remarks, I too want to see the benefits of these reforms coming into play quickly and effectively. We intend to commence the reforms in phases, because some can be implemented more quickly than others, which need more time. This is not just about money but about building system and workforce capacity. For example, the impact assessment estimates that we need over 400 additional second opinion appointed doctors and over 300 additional approved clinicians. Many of these will be consultant psychiatrists, who would already need to have commenced training prior to the legislation for us to fully implement the Bill within five years, as required by this amendment. Rather than having a fixed deadline, as is proposed, we intend to monitor the impact of investment and test readiness to commence new powers on an ongoing basis, commencing each phase when we are confident that it is safe and effective to do so.

Finally, I turn to Amendment 164, tabled by the noble Lord, Lord Stevens, and supported by the noble Lord, Lord Kamall, and the noble Baronesses, Lady Tyler of Enfield and Lady Neuberger. I associate myself with the comments about the commitment to treating physical and mental health equally, in line with this Government’s manifesto commitments. The mental health investment standard requires ICB spending on mental health to grow at least in line with overall recurrent funding allocations. Based on total planned spend for 2024-25, we expect all ICBs to meet the standard in this financial year.

There are already mechanisms to ensure that spending on mental health is prioritised. I refer noble Lords to Section 12F of the NHS Act 2006, which requires the Secretary of State for Health and Social Care to lay before Parliament an annual document setting out whether they expect NHS England and ICB spending on mental health to increase in the next year. The Secretary of State will publish this statement before the end of this financial year.

As several noble Lords said, funding for mental health spend goes beyond the scope of the Mental Health Act, which aims to improve the care and treatment of individuals who have a mental illness and need to be detained in hospital or subject to restrictions in the community. Therefore, I respectfully suggest that the Act is not the appropriate mechanism for holding the Government to account on mental health spend. I ask the noble Baroness to withdraw the amendment.

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[Baroness Merron (Lab)]

I understand that point, and the noble Baroness makes it very well. I simply refer her to the points that I made about needing to look at evidence, the outcomes and the value of those reviews, and whether that is the right approach for everyone. I take on board her point, but my comments probably tell the Committee that we feel that there is more work to be done in this area.

[Earl Howe (Con)]

My Lords, once again, I express my appreciation to all noble Lords who have contributed to this debate. I highlight in particular the speech of the noble Baroness, Lady Hollins, which I found extremely powerful and persuasive, as did other noble Lords.

It strikes me that this is an especially appropriate grouping of amendments. The overuse of restraint in mental health settings and the use of completely untherapeutic long-term segregation are equally pressing and emotive concerns.

The noble Baroness, Lady Barker, pulled me up slightly on the issue of protection for those undergoing gender reassignment. The concern that I had in drafting the amendment was to cover protected characteristics across the piece, but she has drawn my attention to a lacuna, and I am very grateful.

I was somewhat disappointed with the Minister’s reply on the issue of restraint applied to mental health patients, which, as the noble Baroness, Lady Barker, pointed out, is an issue affecting adult patients as well as children. The amendment was drafted with precisely that in mind. The point that I sought to make was that, despite the statute law to which the Minister referred, the incidence of restraint on children in particular has rocketed, which raises questions about clinical practice, staffing and training around the code of practice. To my mind, it was a pity that the Minister had little to say about those possible areas for practical follow-up.

I shall read again what the Minister said about my amendment between now and Report. For now, I beg leave to withdraw the amendment.

Mental Health Treatment: Waiting Times

Debate between Earl Howe and Baroness Merron

Monday 3rd February 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord makes a very important point. This is one of the many areas where long waiting lists and delays in people receiving the necessary service are creating additional pressures on the individual, communities and the NHS. We are doing work in a number of areas, such as ensuring that NHS 111 can provide for those in crisis, or those concerned about a family member or loved one, so they can speak to a trained mental health professional. We are constantly looking at and providing new ways for people to get more instant access.

[Earl Howe (Con)]

My Lords, do the Government see a role for employers in promoting the mental health of their respective workforces?

[Baroness Merron (Lab)]

I certainly do, and with the NHS being such a large employer, that is one of the areas that we will be attending to. The long-term workforce plan will provide its report around the summer of this year and there will be much detail on how the workforce will be but also on the ways that we can improve its health and retention as well as recruitment.

Mental Health Bill [HL]

Debate between Earl Howe and Baroness Merron

Committee stage
Monday 27th January 2025 Lords Chamber

[Earl Howe (Con)]

My Lords, I believe we would all accept—and, personally, I am in no doubt—that my noble friend Lady Browning possesses a breadth and depth of experience in matters relating to autism and learning disability. By that, I mean that she has not just a familiarity with the day-to-day challenges of life for individuals with one or more of these conditions but a knowledge of the practical frustrations and hurdles that often have to be overcome if the best interests of such individuals are to be properly defended.

It is amply clear from what my noble friend has said that, if this amendment were inserted into the Bill, it would have the potential to make a material and beneficial difference to the process of discharging certain patients from a secure mental health unit in particular types of situations. As my noble friend said, and as we all know, there have been many instances where autistic patients have been detained inappropriately and for long periods under the Mental Health Act and where families have struggled to secure their relatives’ release.

I cannot see a logical reason why a mental health tribunal should not be placed on an equal legal footing with the Court of Protection in this very limited respect. I hope the Minister will agree.

[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 Browning, for tabling Amendment 128 and for her contribution, along with that of the noble Earl, Lord Howe.

On the proposals in Amendment 128, I can tell your Lordships that, under the current tribunal procedure rules, the tribunal can direct responsible authorities, which could be a local authority or an NHS body, to provide evidence. The practice directions that apply in mental health cases place a requirement on the responsible authority to provide reports and records relating to the patient’s detention treatment and any after-care plans. The tribunal can use these reports to decide whether the detention criteria are being met. Therefore, it appears that the tribunal has extensive powers to require responsible authorities to provide the information to support its decision on whether to discharge a patient. I hope that the noble Baroness will be satisfied with this response and will withdraw her amendment.

Mental Health Bill [HL]

Debate between Earl Howe and Baroness Merron

Committee stage
Monday 27th January 2025 Lords Chamber

[Earl Howe (Con)]

My Lords, in this group of amendments my noble friend Lady Berridge has raised an armada of issues which I think it is clear to all of us cannot be ducked. These issues, as she said, were examined at length both during the independent review and by the Joint Committee, but it has to be said that in both instances it proved too much of a challenge to identify a satisfactory resolution to them. For that reason, as we observed in our debate on the previous group, the weight of these matters now rests on the shoulders of this Committee and of the Government.

In summary, we need arrangements that are robust enough to ensure that a nominated person’s appointment can be effectively challenged, and that, in certain circumstances, where necessary, the exercise of their powers can be legally contested and blocked. Without those measures, we shall leave an unacceptable lacuna in the law and, more pertinently, run a high risk of exposing children to personal danger.

My noble friend is to be thanked for assisting this Committee’s deliberations with the clear way in which she has set out the challenge, and I hope and trust that the Minister will wish to grip the challenge with her usual vigour.

[Baroness Merron (Lab)]

My Lords, like the noble Earl, Lord Howe, I am most grateful to the noble Baroness, Lady Berridge, for introducing an appropriately wide range of scenarios, questions and testing. That is important for the Committee but also for our ongoing work. As the noble Baroness, Lady Tyler, said, to describe this area as complex is to use too small a word, and I think we are all wrestling with that to get it in the right place. I know that noble Lords are aware that the work is ongoing, and I thank them for their engagement and interest in this issue. As I said previously, I very much understand the need for a robust process to keep children and young people safe and ensure that only appropriate individuals can take on the role of nominated person, while giving children and young people that right to choose.

I will respond collectively to the amendments put forward in this group. As I set out earlier, we agree that in the vast majority of cases there is an expectation that a parent or whoever has parental responsibility would take on this role, and that would include consideration of special guardians and child arrangement orders. We also agree that, where parental responsibility has been removed due to care proceedings, in the vast majority of cases it is unlikely to be appropriate for such a person to take up this role. My reference to this being a complicated area—

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[Baroness Merron (Lab)]

I would be very glad to share the date if I could put a date on it. It will be after Royal Assent, and I will keep noble Lords updated.

[Earl Howe (Con)]

My Lords, I very much appreciate the support from around the Committee for my Amendment 115. I support all the other amendments in this group, each of which is designed to bolster the rigour and thoroughness of the advance choice document process.

It is good to hear from the Minister that the code of practice will include guidance on how information on ACDs will be made known to relevant would-be patients. I shall need to reflect on this, but I confess I retain a worry in this area. The CQC in its annual report of 2020-21 on monitoring the Mental Health Act reported that many patients do not have their rights explained to them during their treatment. This is despite the existing requirement in the Mental Health Act code of practice for hospital managers to provide information both orally and in writing. Clearly, if someone without an existing ACD is admitted to a mental health unit for treatment, it will be too late for them to execute a valid ACD during that episode of care. The time to be informed that an ACD could be an appropriate thing for them to draw up is once they are discharged, to cater for possible future contingencies.

I suggest that the CQCs finding is still relevant, its point being that the NHS is not all that good at providing information to patients in a timely or appropriate way. Therefore, I think that creating a duty to do so would add value—perhaps not in the precise terms I have used in the amendment, but in similar language. That could, incidentally, be achieved quite easily if mental health patients were automatically invited to complete a debriefing report following discharge from hospital in the way that I suggested in an earlier amendment.

The prize, let us remember, could be significant. I refer noble Lords back to remarks by the noble Baroness, Lady Murphy, in an earlier debate, where she indicated that independent advocates have been proved as central to the success of advance choice documents—a facilitator, in other words. She referred to a study in North Carolina that showed that providing a facilitator in the form of an independent advocate increased the number of people making a psychiatric advance directive from 3% to 60%. That is a very powerful set of figures.

I hope the Minister will be open to further discussion on this and the other amendments in the group between now and Report. Meanwhile, I beg leave to withdraw my Amendment 115.

Mental Health Bill [HL]

Debate between Earl Howe and Baroness Merron

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Baroness Merron (Lab)]

I would be very pleased to look into it further, but, as I have described, this is a rolling programme. I emphasise that the CQC has that duty both to monitor but also to make the relevant bodies subject to sanctions if needed—in other words, more immediately. So I am concerned that through this amendment we could be creating a structure which is actually less flexible and responsive than the one we have now.

Amendment 148, tabled by the noble Lord, Lord Crisp, and the noble Baroness, Lady Hollins, would impose on integrated care boards—ICBs—a legally binding duty to provide local, in-person, specialist withdrawal treatments for patients on psychiatric medication prescribed during the course of their treatment by services under the Mental Health Act. In addition, there would be a duty on each ICB to send to the Secretary of State an annual report on the availability, uptake and outcomes of this support. Under this amendment, the Secretary of State would be obliged to lay these reports before Parliament. ICBs would also be subject to a requirement to provide a 24-hour helpline and online platform to support patients to receive withdrawal treatment.

Let me say at the outset that I recognise the difficulties that withdrawal can pose. I recall that the noble Lord, Lord Crisp, spoke on this very point in the Chamber last month and was also good enough to speak directly to me. It is, I agree, an issue that will not go away and, per the noble Lord’s request, I would be happy to arrange a meeting. I feel there is a whole area here to which we today, considering amendments, cannot do justice, so I would be pleased to do that. To the noble Lord, Lord Mawson, who has tabled Written Questions, I say that I look forward to answering them, and I hope that he will look forward to reading my Answers.

Where relevant, we would expect the patient’s statutory care and treatment plan to include a tapering plan and put in place whatever additional support is needed to enable a patient’s recovery and effective discharge. On the requirement to provide support in the community and report on availability, this is the responsibility of local health commissioners. In 2023, NHSE published a framework for ICBs and primary care boards on how to optimise personalised care for patients prescribed medicines associated with dependence or withdrawal symptoms. With regard to the requirement in the amendment for a 24-hour helpline, this would not seem proportionate, given the relatively low numbers of people who might need this service, who should already have a support plan in place, including access to relevant local support services.

Finally, Amendment 154, tabled by the noble Baroness, Lady Bennett, would allow the Secretary of State to make regulations giving people detained in hospital and those subject to community treatment or guardianship orders the ability to have certain care and treatment matters considered by a mental health tribunal.

This is a very complex area, as I am sure the noble Baroness is aware. The amendment seems to draw on the recommendation made by the independent review to give patients a new right of appeal to a single judge of the mental health tribunal regarding compulsory treatment. I recall that the previous Government publicly consulted on this new right, and the majority of respondents raised major concerns in this regard. The consultation was followed by further long and careful consideration with stakeholders, which led the then Government to the conclusion that this safeguard is just not viable. A solution could not be found that provided an efficient and effective route of appeal for patients while avoiding the risks of the tribunal intervening in clinical decision-making, alongside significant resource burdens. Many of these concerns were reflected in the report of the pre-legislative scrutiny committee, which also acknowledged the complexity of the issue.

We believe that the other provisions in the Bill will better achieve the same objectives of providing patient choice and autonomy, so while we do not support introducing a new role for the tribunal, I assure your Lordships that the emphasis on therapeutic benefit within the detention criteria will mean that whether care and treatment are proving effective will play a role in the tribunal’s consideration of whether or not detention should continue to be upheld. With these explanations, I hope that the noble Earl feels able to withdraw his amendment.

[Earl Howe (Con)]

My Lords, I am very grateful to all noble Lords who have contributed to this debate in such compelling ways, and I think we can see that when it comes to the experiences of children and young people in mental health units, we are dealing with a story that is a lot more substantial than mere anecdote. From briefing I have received, I am afraid I have been left in no doubt that the therapeutic environment in a number of mental health hospitals around the country—not all, of course—is, to put it mildly, a lot less than optimal.

Clearly, it is unacceptable for any patient, of whatever age, to be detained compulsorily without being offered treatment. It is unacceptable that drugs or restraint should be used as punishments. Challenging behaviour can be difficult to deal with, but staff should be trained to deal with it in a way that demonstrates that they understand the root causes of the behaviour. Those causes can be extremely complex.

To pick up another strand of the debate, I am in no doubt that medication has a place in mental health therapy. It can often be the treatment of choice. It is one tool in the toolbox. However, I very much agree with what the noble Lord, Lord Crisp, and the noble Baroness, Lady Tyler, had to say about social prescribing. It can not only be clinically effective but save costs if it is delivered, for example, by local charities that work in the fields of music, drama or art. Incidentally, it can help budding musicians, actors and artists in their downtime to train as music, art or drama therapists, which is an added bonus.

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[Earl Howe (Con)]

There are two answers to that. First, it is generally unthinkable for a Government to lay regulations without first having consulted the relevant parties. Secondly, if we are honest, putting something on the face of a Bill is not the whole story; there would need to be proper clinical guidance published alongside that for practical purposes for hospitals and elsewhere.

[Baroness Merron (Lab)]

My Lords, I thank all noble Lords for examining the important issues that have been raised in this group of amendments.

Amendment 55, in the name of the noble Baroness, Lady Tyler, supported by the noble Lord, Lord Scriven, seeks to change the Mental Capacity Act to allow young people aged 16 or 17 the ability to make a binding advance decision to refuse medical treatment for mental disorder. I shall set out some concerns about the amendment that may be helpful.

First, the amendment would mean that a young person who is not detained under the Mental Health Act could refuse a mental health treatment, even if it was life-sustaining. While the Mental Health Act and the Bill currently provide safeguards that enable a person’s advance decision to be overruled, detention under the Act may not always be appropriate. For example, if a 16 year-old is left very unwell following an attempted suicide, then currently they may be given treatment on the basis of what is in their best interests, under the Mental Capacity Act, if they lack capacity to consent at the time. However, under the amendment, if the 16 year-old had made an advance decision to refuse treatment necessary for their recovery or to sustain their life, then they might need to be detained under the Mental Health Act simply so that their advance decision could be overruled. This is important in terms of timely access to treatment and to avoid loss of life, of course.

Mental Health Bill [HL]

Debate between Earl Howe and Baroness Merron

Committee stage
Monday 20th January 2025 Lords Chamber

[Earl Howe (Con)]

My Lords, I shall be very brief, because other noble Lords have already eloquently articulated the arguments that are almost self-evident about the importance of services for people with autism or a learning disability and, in particular, the importance of training all staff who may find themselves working in those fields. I agree very much with the remarks of my noble friend Lady Browning and the noble Lord, Lord Scriven, and I was particularly interested in the research mentioned by the noble Baroness, Lady Bennett of Manor Castle, which brings us into a whole new dimension, I think, in this debate.

The need to train all healthcare staff, no matter what role they perform or which part of the health service they serve in, should surely be taken as read. This should be training both in the initial identification of those with autism or a learning disability and in the skills needed to handle such individuals with the necessary sensitivity and insight. I was interested in what the noble Baroness, Lady Barker, had to say about that. The behaviour of a person who is on the autistic spectrum can be baffling to anyone who has had no experience of it, and because of that it can be open to misinterpretation. A situation of that kind carries dangers, which is why it is so necessary for healthcare staff to know how to react in a way that will make the situation better and not worse.

This is not the first time that we have debated this important topic. I believe we may be told by the Minister that mandatory training in these areas is already provided for in Section 20 of the Health and Social Care Act 2008. The provision reads:

“Regulations under this section must require service providers to ensure that each person working for the purpose of the regulated activities carried on by them receives training on learning disability and autism which is appropriate to the person’s role”.


That broad provision was inserted into the 2008 Act thanks to an amendment which your Lordships approved three years ago, during our debates on the Health and Care Act 2022.

So, a provision on training is already enshrined in law; the problem is that we have no way of knowing the extent to which it is being implemented in practice. Hence, Amendment 145 would require the Secretary of State to publish a review on mandatory training for all persons who treat patients with learning disabilities and autism under the 1983 Act and consult as necessary to determine the extent to which health service staff are actually in receipt of such training. I see this amendment as perhaps a logical partner to Amendment 152 in the name of the noble Baroness, Lady Bennett, and indeed, in his absence, to the amendment of the noble Lord, Lord Adebowale.

While the vast majority of people who provide care to people with learning disabilities and autism do so with compassion and professionalism, we have seen a number of failings in care for people with those conditions. At the same time, detention will continue to be necessary in some cases where a patient with autism or a learning disability is suffering from a separate mental health condition. In all those cases, regardless of the context in which a person presents, we need to have confidence that the people providing care have the training they need to deliver that care sensitively, and above all, capably. I would venture to say that the people who need to have most confidence in the system apart from the person receiving the care are the parents or nearest relatives of that person. Hence, I believe we need more transparency on how well the system is working than we have currently.

Incidentally, one of the things that could come out of a review of training is an opportunity to look at the current processes for whistleblowing. An important aspect of improving standards of care is to have a system of accountability that includes listening to everyone in the sector, from the most senior staff to the most junior. No one should be afraid to speak up when they see something going on that does not look right, and I should be very grateful to hear what the Minister has to say on this whole theme and on the other important issues that noble Lords have raised.

[Baroness Merron (Lab)]

My Lords, I express my gratitude to noble Lords, not just for their amendments but for the way in which this debate has been conducted. I appreciate much of what lies behind the contributions and amendments today.

I first turn to Amendment 33, tabled by the noble Lord, Lord Scriven, and supported by the noble Baroness, Lady Hollins, and also Amendment 150 in the name of the noble Lord, Lord Adebowale. All of these were spoken to throughout this group, including by the noble Baronesses, Lady Tyler and Lady Murphy. I noticed that Amendment 150 was particularly referred to by the noble Lord, Lord Patel, and the noble Earl, Lord Howe.

On the matter of data collection, I absolutely share my noble friend Lord Beamish’s view on its importance, the need for the visibility of data and the need to find out what is behind detention. However, I can give the reassurance that the data and statistics that were referred to are being collected and published. They will continue to be monitored and published monthly in the assuring transformation statistics for learning disability and autistic people, and I hope that will be helpful to my noble friend.

The amendments I am referring to, which the noble Lord, Lord Scriven, introduced, require the Secretary of State to publish plans within a specified timeframe, outlining the Government’s plan to allocate sufficient resources for the commissioning of services for the detention and treatment of autistic people and people with a learning disability, as well as costed plans which show how integrated care boards and local authorities will ensure provision of adequate community services for these groups.

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[Earl Howe (Con)]

My Lords, there is little for me to do following the persuasive speech of my noble friend Lady May, other than to say how much I support her in putting forward her amendments. I hope that the Minister will approach the proposals my noble friend has made in a receptive and constructive way.

I was struck by the case put forward by my noble friend Lady Buscombe about how technology could assist in the handling of mental health incidents. I hope equally that the Minister will wish to follow up on my noble friend’s suggestions.

The question of whether police officers, and only police officers, should exercise the powers under the Act to remove a person suffering from a mental health crisis to a place of safety is one that, as my noble friend Lady May said, has been simmering in the Home Office and the Department of Health and Social Care for a decade or more. Extending those powers to suitably trained healthcare professionals would be a change that I suggest goes with the grain of this Bill as regards the emphasis that it places on looking after mental health patients in the best possible way. That is not a criticism of the police in any sense. The police do a magnificent job in tackling anything that they are called upon to do, but, as we have heard, the police themselves say that the vast majority of instances in which they are called upon to deal with a mental health incident do not require a policing response.

The issue of risk is important to consider. Statistically, as my noble friend said, most mental health incidents present no risk whatever to the police attending. Admittedly, it is not always possible to tell in advance how risky a particular encounter is likely to be, but I agree with my noble friend that, provided that a paramedic is suitably trained and equipped, they will have the necessary skill set to deal with any risk to their own safety, bearing in mind that if a police presence turns out to be necessary, they can always call for one.

I very much hope that, between now and Report, the Minister will agree to meet my noble friend, if that is what she wishes, to map out a way forward that will lead to a broadening of the Sections 135 and 136 powers.

[Baroness Merron (Lab)]

My Lords, this has been an interesting debate, with much agreement across the Committee. I noted the support from both the other Front Benches, from the noble Earl, Lord Howe, and the noble Baroness, Lady Tyler, for much of what has been said.

Let me first discuss Amendments 37B, 38C, 42C, 42F and 128B in the name of the noble Baroness, Lady May, along with Amendment 158 in the name of my noble friend Lord Davies of Brixton. I am most grateful to the noble Baroness and my noble friend for bringing this issue before the Committee today. Amendments 37B, 38C, 42C and 42F would add a new category of authorised persons and would provide that police constables and such authorised persons may detain a person under Sections 2, 3 and 5 of the Act.

I share the recognition from the noble Baroness, Lady Barker, of the noble Baroness, Lady May, who I commend for her work to pave the way and dramatically reduce the use of police cells as a place of safety for those who are experiencing a mental health crisis. I listened carefully to the noble Baroness’s words of advice to all government Ministers; all I can say is that I cannot think how much better we could be advised than by a former Home Secretary and Prime Minister.

I thank the noble Baroness, Lady Watkins, for what I might call her notes of caution in respect of extending provisions, and the noble Lord, Lord Meston, for sharing his first-hand experience to add to the debate today.

We understand the broad intention of these amendments and of Amendment 128B, also in the noble Baroness’s name, to reduce police involvement in mental health cases for all the reasons that were said, including the extra distress that an officer may—inadvertently, of course—bring to a very delicate crisis situation.

The noble Baroness, Lady May, asked how the Bill will ensure that pressure is not placed unduly on police resource. I understand that that is very much a driving consideration, so let me say a few things on that matter. We recognise the pressure on the police, who are responding to a very large volume of mental health-related incidents, although—this is not to dismiss the point—detentions under Section 136 have decreased this year by 10%, and we are removing police cells as a place of safety to reduce some of this burden. We recognise, in particular, that police time in health settings should be reduced. I give an assurance that we have committed to look at this issue and to update the code of practice to clarify the handover process between police and health, including in A&E, which the noble Baroness, Lady Tyler, spoke about. We recognise the confusion around the application of the legal framework that can tie up police time when it would be lawful for them to leave a patient with health staff.