Learning Disabilities: Health and Social Care Access

Earl of Effingham Excerpts

Thursday 26th March 2026 Grand Committee

[The Earl of Effingham (Con)]

My Lords, I thank all noble Lords for their valuable contributions, including the noble Lord, Lord Scriven, and the noble Baroness, Lady Ramsey, for their lived experience of this important issue. Ensuring that people who live with learning disabilities are able to access safe and effective health and social care is a fundamental test of the fairness of our system. Reasonable adjustments are essential to ensuring patient safety and equitable care. However, we know that, regrettably, people with learning disabilities continue to experience poorer health outcomes and face avoidable barriers when accessing services. This is a matter of both access and safety. Where reasonable adjustments are not properly understood or implemented, the consequences can be severe.

When in government, we took important steps to try to address these issues as best we could. The Health and Care Act 2022 placed a clear requirement on providers to ensure that staff receive training in learning disability and autism. The Oliver McGowan code of practice established a consistent standard for training across health and social care. The NHS Long Term Workforce Plan set out ambitious goals to increase learning disability nursing training places by 46% by 2029. The noble Baroness, Lady Hollins, made some constructive challenges of our proposals, and I of course respect the views of an acknowledged expert, as the noble Baroness is.

However, it is now the responsibility of this Government to make good on our previous commitments and push through the further social care reforms that are needed. The Government published guidance last year stating that any adult social care providers arranging staff training between April 2025 and March 2026 would be reimbursed. Will the Minister update the Committee on how many adult social care providers have participated in this scheme and what steps the Government took to ensure that social care providers were aware of the funding available?

Pressing workforce challenges also threaten effective access to social care. Faced with falling student numbers, some universities have been forced to close learning disability nursing courses. In the south-east of England, there is no learning disability nursing course available. Nursing in Practice reported that the domestic supply of learning disability nurse specialists could run out by 2028. While the Conservative’s workforce plan set ambitious targets, the most recent data shows a negligible increase in the number of learning disability nurses of 4% between 2024 and 2025. The Government have committed to publishing a revised NHS workforce plan by spring 2026, so can the Minister now provide a publication date? Are the Government confident that the existing targets remain achievable?

We also have concerns regarding accountability. The removal of the quality and outcomes framework indicator relating to learning disability registers raises important questions. If only a proportion of those with a learning disability are currently captured on the registers, how exactly will the department ensure that all patients are properly identified and supported as they should be?

Finally, I turn to the issue of safety. The insights of the learning from life and death programme are invaluable in understanding the causes of mortality and identifying areas for improvement. The most recent report’s issue with the integrity of its data and delays was most unfortunate. The noble Lords, Lord Scriven and Lord Crisp, mentioned LeDeR. His Majesty’s loyal Opposition suggest that it is fair and reasonable to ask why the Government have not placed the programme on a statutory footing. Through what process will the Government ensure that the report’s findings are consistently translated into improvements in care at a local level?

It appears that many noble Lords are in broad agreement on the importance of this issue. The framework for improvement exists; the challenge now lies in ensuring effective implementation. The noble Baroness, Lady Hollins, highlight this very clearly. We hope the Minister will provide clarity on how the Government intend to bridge the gap between policy and practice to ensure that those with learning disabilities receive the safe and equitable care they deserve.

Terminally Ill Adults (End of Life) Bill

Earl of Effingham Excerpts

Committee stage
Friday 20th March 2026 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, I have Amendments 172, 322, 322A and 406 in this group, which address the requirements of accessibility, BSL and Braille.

In speaking to her amendments, the noble Baroness, Lady Fraser of Craigmaddie, raised a number of issues. While I tabled all my amendments before the start of Committee, her speech showed some of the areas where there is still some cause for concern—certainly, around things such as programmable text and the way that it is used.

My noble friend Lady Campbell of Surbiton is not able to be in her place today, but she raised the issues faced by Lucinda Ritchie, who, as a woman who used communication aids, had to go to a care home. The nurses were not able to set up the communication aids, and she, in essence, became voiceless.

As the debate today has highlighted—in the words of the noble Baroness, Lady Nicholson—if this Chamber cannot provide reasonable adjustments for Members, that reflects a bigger problem that exists outside in terms of whether people can really understand what is going on.

The Bill takes its foundation from the Mental Capacity Act. We have to get to grips with whether someone can understand, retain and use information. I am against the process of assisted suicide being called treatment. If we cannot communicate with people properly, the individual might be confused about what they are being told.

In New Zealand, as has already been raised, people have to ring a phone number. Dr Jeanne Snelling said that it is completely inappropriate. A deaf person cannot ring a phone number, so they might not be able to access the service that they want.

I have amendments on reporting mechanisms, but I am keen to understand what issues also might be highlighted from these discussions and whether one impairment group is disproportionately affected in accessing this service. That is why Amendment 406 says that we need to record when people’s accessibility needs are not met. Clause 39(1)(d) gives a power to the Secretary of State to introduce codes. I hope that the breadth and depth of debate in this group will inform that.

The National Down Syndrome Policy Group, as already mentioned, said that it is essential that people are able to understand what is going on, but the Easyread document from the NHS on the Mental Capacity Act is 28 pages long and is complicated. It is difficult to get true consent when we know that people with Down syndrome are already suggestible and potentially eager to please others. We know that people with learning disabilities and deaf people already have lower health outcomes than others. There was the tragic case of Adrian Poulton, a man with Down syndrome and dementia, who starved to death in a British hospital because the doctors put “nil by mouth” above his bed. He was not able to communicate, and the staff were not listening when he asked for food. They just looked at the “nil by mouth” and assumed that he did not know what he was talking about.

The equality impact assessment has identified that there are some areas of concern. It should be noted, too, that British Sign Language is not a direct translation of English. We missed a trick, when we were doing that legislation, in not going into greater depth with it, but we have to be clear about how we provide appropriate translation.

The noble Baroness, Lady Fraser, raised speaking difficulties. I met someone for the first time recently. We had no issues communicating at all. It was only after about 10 minutes that they mentioned to me that they had had a stroke, and they felt that they were struggling to speak and find the right words. You could easily make an assumption that someone’s communication skills are very good, when indeed they are not.

One of the issues is that we do not have enough people who are able to use British Sign Language. I accept that Makaton is not a language and should in no way be confused with BSL, but about 100,000 people use it as a communication aid. There are 1,200 licensed tutors, and they train about 20,000 people annually. I should have probably made it clear in the amendment that Makaton and BSL are not interchangeable. In a different context, we certainly should not replace Québécois with French, or Swiss German with German.

We talked earlier about Wales. I am Welsh, and I think it is important that we discuss these issues. I grew up in a semi-fluent household, and my mother spoke very colloquial Welsh. Depending on who speaks to me, I can understand quite a lot, but what one takes from a conversation can be very different. That is why I am concerned about this group of amendments.

My noble friend Lady O’Loan raised the issue of translation. In 2017, I did a piece of work for the then Government on duty of care in sport, and the word “safeguarding” is not translatable into other languages. Even where it is translatable, its meaning can be very different, and we need to be concerned by that.

A survey by the Royal National Institute for Deaf People found that 77% of BSL users had difficulty communicating with hospital staff, and that 33% left consultations with their family doctor feeling unsure about instructions or taking the correct doses of medication. We have seen in the media that a deaf man was wrongly told that he had HIV after the hospital failed to provide an interpreter. There is the case of Derlyn Roberts, an American woman who famously pretended to be a sign language interpreter at a high-profile news conference in Tampa, Florida, where the police were announcing the arrest of a serial killer. She could not sign at all, and experts described her interpretation as gibberish. Members of the deaf community were very upset, and the deaf mother of one of the victims of the serial killer was present and was relying on the interpretation. Just think how distressing that is. However, there are good examples. At the St Helena Hospice, people who prefer to use BSL can communicate with nurses by clicking the BSL live button. Deaf patients or visitors can choose to use that service, so it is possible to provide appropriate translation.

We should not presume that the person with the communication barrier is the patient. It might be that the doctor has some challenges in translating, understanding or, indeed, communicating. I am delighted to learn that doctors are now getting much better training in how to communicate with patients, but this could be improved. The GMC guidance says that steps must be taken to meet the needs of individuals, but each stage of the process relies on an open choice. If discussions are not accessible because of a language or communication barrier, any perceived safeguards in the Bill are simply worthless. The noble and learned Lord has said many times that everyone should have equal access to the process, but for deaf or disabled people and for those who have a combination of impairments, it is really important that they are given genuinely equal access to the process and that they understand every step of the pathway.

[The Earl of Effingham (Con)]

My Lords, before I speak to the substance of the amendments in this group, I pay tribute to the noble Baronesses, Lady Nicholson, Lady Berridge, Lady Fraser of Craigmaddie, Lady Grey-Thompson, Lady Hollins and Lady O’Loan, and the right reverend Prelate the Bishop of Newcastle. They have all stood up for a particularly vulnerable group of people, and they are absolutely right to do so. I am sure that the noble and learned Lord, Lord Falconer, is listening most carefully to their arguments.

Individuals with speech, language and hearing difficulties are particularly vulnerable, and it is imperative that they fully understand the process, their rights and the terms of the Bill before they can access the provisions made within it. My noble friend Lord Blencathra said that we really need to know that an individual understands what they are doing, and the noble Baroness, Lady O’Loan, used the phrase “crystal clear”. They are both absolutely right.

Surely how society cares for the most vulnerable of its citizens is an unmovable benchmark. Society must protect people with communication difficulties. The noble Baroness, Lady Berridge, specifically questioned the Government, and His Majesty’s Loyal Opposition believe that it is fair and reasonable to ask the Minister what specific work officials and Ministers have undertaken to establish the core risks posed by the Bill to those with hearing, speech and language impediments. In the view of His Majesty’s Government, how effective are the safeguards currently in place? Can the Bill be improved from a neutral perspective of workability to ensure that no one who faces the challenges we have discussed in this group ends their life without being given the obvious support that they need to fully understand the life-changing decision on which they are embarking?

As the noble Lord, Lord Winston, referenced in the previous group, during the course of the Bill, noble Lords have debated detailed provisions and addressed complex moral issues with a laser focus. However, the question at hand is not a complex one. Those who are not able to understand the situation without proper support must be provided that support if they are to take the decision to end their life. Surely that is non-negotiable.

The noble Lord, Lord Shinkwin, said that we have to think differently and challenged the noble and learned Lord, Lord Falconer, to lead by example. The right reverend Prelate the Bishop of Southwark took the words out of my mouth when he said that he remains hopeful that the noble and learned Lord will agree with this line of thought and commit to engaging collaboratively with all noble Lords whose amendments in this group aim to implement the right and appropriate protections for this vulnerable body of individuals.

[Baroness Merron (Lab)]

My Lords, I am most grateful for the debate that we have had today. In keeping my comments limited to amendments on which the Government have major legal, technical or operational workability concerns, I turn first to Amendments 171A and 174A, tabled by the noble Baroness, Lady Nicholson. The duty outlined within these amendments may prove difficult for doctors to discharge as they are ambiguously drafted and use undefined terms such as “religious, cultural or sex-based” barriers. It is also a mandatory duty that does not afford discretion to the doctor to refuse unreasonable requests.

The duty to appoint an advocate conflicts with Clause 22. It is unclear how these proposed advocates would be appointed or trained, or what their role or responsibilities would be. Furthermore, your Lordships’ Committee may note that where a person has religious, cultural or sex-based barriers, the amendment would also require such a person to be provided with an advocate who has training in and experience of relevant safeguarding issues and must be the same sex as the person seeking assistance. Introducing a more extensive mandatory duty for the provision of adjustments, including an advocate, may give rise to workability issues, as the cohort of advocates meeting these criteria could be very limited and may result in a person being delayed or unable to take part in a preliminary discussion.

--- Later in debate ---

[Baroness Lawlor (Con)]

My Lords, my noble friend Lord Moylan and the noble Lord, Lord Carlile, have told us about the uncertainty of the statistical evidence, and indeed the unreliability. That points to a flaw at the heart of the Bill, for which a condition for eligibility is that death must be reasonably expected within six months in consequence of that illness. What then is at the heart of the Bill, if I may develop the point a bit, is a process for managing assisted suicide in consequence of something which is not at all certain.

I have to say that, in the areas we know about where the state has a process for providing a service, particularly in education, we see that a state service is not geared to the individual case. One of the points that my noble friend Lord Moylan explained was the individual case, and most noble Lords agree with this. How are we going to have a state service, as is proposed by the sponsor’s Bill, for a general cohort, and not the specific individual case, that is reliable for individuals? We see in education and other areas that exceptions continue to have to be made—for instance, for children with special educational needs, particularly autistic children. These are exceptional cases which do not fit the general application of a state service.

[The Earl of Effingham (Con)]

My Lords, it is a hallmark of the noble Lord, Lord Moylan, to make valuable contributions to debates in your Lordships’ House, and today is no different. The noble Lord is living proof that an average, median or mean life expectancy is incredibly difficult to predict, as is the third standard deviation of the bell curve, which he rightly referenced.

I believe that the noble Baroness, Lady Finlay, said that she never gives prognoses due to the complexity of the answer. Other noble Lords touched on the way a prognosis is calculated in previous debates. Taking such a monumental decision of life or death based on a medical prognosis derived from a median life expectancy raises questions. That said, it is difficult to see what other measure should be used as the test for eligibility.

Human Medicines (Amendment) Regulations 2026

Earl of Effingham Excerpts

Monday 9th March 2026 Grand Committee

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank the Minister for her clear and comprehensive introduction to this statutory instrument, and I express Green Party support for it. I echo the comments of the Minister in the House of Commons, who said that,

“after clean water, vaccination is the most effective public health intervention for saving lives and promoting good health”.—[Official Report, Commons, Second Delegated Legislation Committee, 3/3/26; col. 8.]

We need to say that and keep saying it, particularly in the current era. I am glad that, through this SI, the Government are making sure that we prepare ourselves for the next pandemic, because we know there will be one. I shall speak briefly about the vaccination situation and some of the changes relating to vaccination that occurred in our health system during the Covid pandemic. I have a question for the Minister; if she cannot answer it now, I will entirely understand and appreciate a reply in writing.

In her introduction, the Minister said that we are no longer in a Covid pandemic, but we are still seeing the extensive spread of the Covid disease. I declare an interest as someone who has the financial wherewithal and ability to have had—and will continue to have—regular vaccinations against Covid, although I am not in one of the Government’s target groups. I want to address this because we saw the development of a great deal more private medicine during the pandemic. Private clinics were set up, running Covid tests and offering vaccinations. We have seen a profound change in the ecology of the vaccination system.

In the context of this SI, I have looked at NHS travel vaccines. Typically, the NHS offers vaccination against hepatitis A, typhoid fever, diphtheria, tetanus and polio, if not previously received, and cholera. These are available for certain destinations, but a number of travel vaccines are not covered by the NHS, including for yellow fever, hepatitis B, Japanese encephalitis, rabies and meningitis ACWY. Many noble Lords will have seen the recent tragic case of travel-acquired rabies—the most hideous disease—acquired from the lick of a puppy on a beach, I believe.

My question is about vaccination as we move increasingly into an ecology where some people are able to afford to protect themselves against a wide range of risks, for travelling but also even if they are not travelling. I randomly selected a provider and saw that there is a huge range in prices. Vaccination against dengue fever and Japanese encephalitis costs £125 for each, and for typhoid it costs £40. I wonder whether the Government are taking into consideration the availability of these crucial health measures. Some people are able to afford a broad range of protection but some may not be able to afford or have access to protections that could keep them healthy and, eventually, save the NHS a great deal of money.

Through this SI, we are making sure that we are able to react quickly in crisis situations, but it would be interesting and important to hear from the Minister about whether we are looking at the broader ecology of all this. What are we are doing for public health in the new, increasingly privatised medical arrangements that we are seeing?

[The Earl of Effingham (Con)]

My Lords, I thank the Minister for introducing these regulations. Vaccination remains one of the most effective public health interventions available to us all. The flexibilities introduced during the pandemic enabled the rapid deployment of both Covid-19 and influenza vaccines at scale. It is understandable that the Government now seek to make certain arrangements permanent and extend them to other infectious diseases.

His Majesty’s loyal Opposition support a vaccination system that is resilient, agile and capable of responding to future public health requirements. Expanding the role of community pharmacies and broadening the vaccinator workforce may well assist in that aim, provided that safeguards are robust. However, it would be wrong to wave this past without scrutiny, as temporary powers become permanent.

The introduction of a permanent vaccine group direction mechanism is a significant change. Flexibility must be matched by clarity. If a patient experiences a serious adverse reaction following vaccination under a vaccine group direction, where does the ultimate legal and clinical responsibility lie? Is it with the authorising body, the supervising clinician, the employer or the individual vaccinator? It would be helpful to have that clearly set out by the Government.

On workforce scope, the regulations expand the occupational health vaccinator provisions and align them with professions able to operate under a patient group direction. Can the Minister clarify the criteria used to determine inclusion? Were decisions based on professional registration, competence in administrating injectable medicines, workforce capacity or other considerations? I am sure all noble Lords agree that consistency and safety are paramount.

On public confidence and uptake, greater flexibility does not automatically mean higher vaccination rates, so how will the Government ensure that these changes actually translate into improved uptake among eligible and vulnerable groups? What benchmark will the Government use to evaluate the success of the measures?

A full impact assessment has not been produced. Although the stated impact may be minimal, these are system-wide changes. Reporting under the Medicines and Medical Devices Act occurs on a two-year cycle. Does the Minister consider that sufficient, or will interim data on safety, workforce, deployment and uptake be made available?

These are important questions to answer, and His Majesty’s loyal Opposition do indeed support a framework that is safe, proportionate and future-proofed, but one which has been properly stress-tested.

[Baroness Merron (Lab)]

My Lords, I am most grateful to noble Lords for participating in this debate. I appreciate the welcome for these measures and the acknowledgement of their importance from the Opposition Front Bench and the noble Baroness, Lady Bennett. I will turn to some of the questions. I will, of course, be very pleased to write to noble Lords on anything I am unable to answer.

The noble Baroness, Lady Bennett, raised the issue of provision of Covid-19 vaccinations and remarked that Covid is still very much with us; I am not quoting her directly but that is what I took from what she said. In answer to that, this is a big change, but it is now a relatively mild disease—I stress relatively—for, I stress again, most people. It can still be unpleasant, but I am glad to say that the rates of hospitalisation and death have reduced significantly since the pandemic. These proposals, as I mentioned in my opening remarks, are very much about building on the successes that we saw in the Covid-19 and the flu vaccination programmes. As I mentioned, they are about taking that best practice and ensuring that we have a vaccination system in the future.

The noble Baroness also asked about private vaccination services. It is still the case, of course, that the NHS offer of vaccination is there for all those who are at higher risk of serious outcomes; there are a number of such people and we want to ensure they are properly looked after. Private provision is also available, as the noble Baroness said, as with some other vaccines. The availability and price of any vaccines provided through the private market is a matter for the private sector and not something that we seek to regulate.

On travel vaccines, as I am sure the noble Baroness is aware, a number of such vaccines are available free on the NHS through GP surgeries. These are against polio, typhoid, hepatitis A and cholera. These vaccines are free because they protect the public against those diseases that are thought to carry the greatest risk if they were to be brought into this country.

Rare Cancers Bill

Earl of Effingham Excerpts

3rd reading
Friday 27th February 2026 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I spoke to this excellent little Bill at Second Reading and said that I wanted to table an amendment to put the Royal Marsden hospital front and centre in new subsection (3)(b) inserted by Clause 2(b), which states,

“ensure that a person (to be known as ‘the National Specialty Lead for Rare Cancers’) is appointed with a job description that includes promoting and facilitating research into rare cancers by … providing advice in relation to the design and planning of research, and … facilitating collaboration between interested persons”.

I did not table such an amendment because the Bill would not then have cleared our parliamentary timetable. However, I press the Minister on the essential need, in my opinion, to have the Royal Marsden involved in that section; either it should have the national specialty lead or the job description of that person must involve the Marsden.

The Royal Marsden is the greatest rare cancer specialist hospital in Europe and in the top four in the whole world. Since Second Reading on 16 January, the Royal Marsden has announced on 10 February a new £1 billion expansion of its world-leading cancer hub, together with the Institute of Cancer Research. It will be the largest cancer treatment and research facility anywhere in the world, and it is just three miles away from this place. If we want the Bill to succeed, I ask the Minister to please put the world’s best people in charge.

[The Earl of Effingham (Con)]

My Lords, I thank the noble Baroness, Lady Elliott of Whitburn Bay, for the skill and care with which she has steered this Bill through your Lordships’ House. This is a measured and important piece of legislation that has attracted cross-party support. It addresses an area of clear and long-standing need, and it does so in a way that reflects the lived experience of patients and families, particularly those affected by rarer and less well-understood cancers, who too often feel overlooked within the system.

Throughout the Bill’s stages, we have heard moving contributions from noble Lords with personal experience of these issues. We congratulate the daughter of the noble Baroness, Lady Elliott, on braving a skydive to raise money for her teacher’s charity. Every individual contribution from people who work tirelessly to combat cancer and support those living with its impact makes a real difference.

His Majesty’s loyal Opposition support the noble Baroness, Lady Elliott, Dr Scott Arthur and the Bill itself, and we look forward to seeing it receive Royal Assent.

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

My Lords, I am delighted to reaffirm government support for this important Bill. It will make a real difference for rare cancer patients and, as my noble friend Lady Elliott said, it stands as a real tribute and an amount of change to the memory of those we have lost, including our noble friends Baroness McDonagh and Baroness Jowell.

I have been touched to hear that charities have referred to this as a Bill of hope, and I hope that is what it will be. It aligns with our ambition to strengthen the UK’s research landscape and improve outcomes for all those affected by a rare cancer. It also complements the recently published national cancer plan, which will drive improvements in prevention, diagnosis, treatment and research across the country.

I am pleased to confirm to the noble Lord, Lord Blencathra, that the new brain tumour research consortium will be led by the Royal Marsden hospitals, as well as working with hospitals all across the country. It is certainly expected that they will be consulted when we are looking for the person who will be the specialty lead.

I am most grateful to all those who contributed throughout the passage of this Bill, in particular to my noble friend Lady Elliott for her committed leadership and sensitivity to this matter in bringing this important legislation forward. Many noble Lords engaged so constructively at Second Reading and I wish to thank them all, as well as those advocates in the other place, including Dr Scott Arthur, who led on the Bill. This Government are determined to go further for everyone diagnosed with a rare cancer. I am delighted that we are supporting this Bill and that it has been so strongly supported across Parliament, both in the other place and in your Lordships’ House.

Medical Training (Prioritisation) Bill

Earl of Effingham Excerpts

2nd reading
Wednesday 4th February 2026 Lords Chamber

[The Earl of Effingham (Con)]

My Lords, I thank all noble Lords who have made such valuable contributions to this debate. I greatly enjoyed hearing the maiden speech of the noble Lord, Lord Roe of West Wickham. He mentioned ham, egg and chips, and I can assure him that he will enjoy himself very much in your Lordships’ House, but it is the staff in this House who are amazing. I know they are going to look after him as well. They do an incredible job, and they are part of the package; they will do everything they can to make his experience an enjoyable one. He mentioned that he had served over half his life in the fire brigade, which is an incredible achievement, as well as his Army service. I think when he referenced boxing, it was incredibly appropriate, because fitness, discipline and mutual respect will greatly assist him in making a real difference in your Lordships’ House, and we are really looking forward to hearing his future contributions.

I must say the same for the noble Lord, Lord Duvall. It was most interesting to hear his background. The noble Lord is obviously an expert in local and regional politics. He was made in Woolwich. He then went on to lead Greenwich council, and I think the noble Baroness, Lady Thornton, was entirely correct when she said, back in the 1980s, that Len was going places. I think it is a huge testament to the NHS that the noble Lord, Lord Duvall, has had a double bypass and he is standing before us, fighting fit. He is going to enjoy constructively challenging His Majesty’s Government —and, I am sure, His Majesty’s loyal Opposition—and we are very much looking forward to hearing his contributions as well.

As many noble Lords have put it so well, there is a great deal to think about in this Bill, and there are a number of areas where His Majesty’s loyal Opposition and other noble Lords will wish to press the Government further. The Bill is intended to address a situation that is universally recognised as both serious and unsustainable, and precisely because there is such broad agreement on the problem, it is all the more important that your Lordships’ House scrutinises the Bill with a laser focus to ensure that the final proposals will be hallmarked as best market practice.

The interventions thus far have already highlighted the value of that scrutiny, with noble Lords identifying a number of areas that would benefit from further consideration. The noble Baroness, Lady Finlay—who is, of course, widely respected in this area of legislation—the noble Baroness, Lady Gerada, and the noble Lord, Lord Mohammed of Tinsley, all spoke about unintended consequences. In attempting to solve the problem, there may always be unintended consequences. Our desire is to stress-test the potential outcomes to resolve that the end result is indeed beneficial for those who need the help and does not formulate a situation where more harm is done than good.

The noble Baroness, Lady Coffey, referenced the fact that this is a pressing issue and time sensitive, but that is no excuse for poorly drafted legislation, which may have serious ramifications for both questions of fairness and trusted relationships with our international allies.

His Majesty’s loyal Opposition support the core principle and intended purpose of the Bill but are clear that there are areas that would benefit from constructive challenge and a moulded consensus as we progress. We have had the opportunity today to discuss some of the practical effects that the Bill will create. Certain groups will, for a variety of reasons, fall outside the mainstream. The noble Lord, Lord Clement-Jones, said that the situation Malta was a “manifest absurdity”. The noble Baroness, Lady Finlay, rightly recognised that routes for overseas doctors to train here have multiple ancillary benefits. The noble Lord, Lord Patel, likened this situation to being “thrown to the wolves”. So those studying on accredited programmes as part of agreements with third countries, and British citizens who have done the majority of their training abroad for legitimate reasons such as military service, are two examples where we need further scrutiny.

In light of the potential unintended consequences of the Bill, where Parliament has had a limited opportunity for detailed analysis both in your Lordships’ House and particularly in the other place, it is vital that it contains robust mechanisms for review and accountability. Clear duties to review and report on the operational and “lived experiences” impact of this legislation will provide a pivotal safeguard, ensuring that Parliament retains a meaningful and proactive role in holding the Government to account as this framework is implemented. This would seem an entirely proportionate and sensible approach, allowing the Bill to work effectively while minimising potential unforced errors. We are confident that noble Lords will be keen to embed such provisions in the Bill.

Workplace confidence and consistency were mentioned. The noble Lord, Lord Clement-Jones, said that the execution is “flawed”, and the noble Baroness, Lady Hollins, said that there is a great risk of undermining confidence. So we must address the question of confidence among individuals for whom this legislation contains far-reaching consequences and whom it directly affects. Doctors make long-term, often irreversible, decisions about their training, specialisation and careers. Those decisions are shaped not only by pay or conditions but by their confidence that the system is fair, predictable and stable. They need to know what the rules of engagement are and that their career paths will be, within reason, clear, coherent and consistently applied.

No one likes uncertainty and, whether for government, business or relationships, everyone needs stability. Doctors are no different. Knowing that the goalposts will not shift unexpectedly part way through training is a must-have. Where legislation is rushed or where its effects are uncertain, that very confidence can be undermined. Even reforms that are well intentioned can have negative knock-on consequences if doctors feel that eligibility criteria are opaque, that established pathways may suddenly be reclassified or that decisions affecting their future are taken without sufficient forethought or scrutiny.

That matters because confidence and morale are central to retention in every aspect of life. If talented doctors harbour doubts that the system they are held to may not treat them fairly, or doubts about whether their own significant investment in training, as mentioned by many noble Lords, will be recognised, they may choose to take their skill set elsewhere—not because they lack commitment to our National Health Service but because they lack confidence in the framework governing their progression. A lack of confidence in any system will lead to pitfalls.

This is precisely why the detail of the Bill matters so much. Getting it right is not simply a technical or procedural exercise; it goes right to the heart of whether doctors feel valued, supported and willing to commit their careers to the National Health Service. An open and transparent workflow of prioritisation will only strengthen confidence. A rushed or overly rigid one risks doing the opposite.

Many former Members of the other place would suggest that helping health and social care in some small way is critical because it provides a unique opportunity to do the right thing through debate and constructive challenge, which should result and positive outcomes for everyone living in the United Kingdom. Our National Health Service, while not perfect—indeed, nothing is—remains based on the founding principle of providing universal care that is free at the point of use, and our doctors are at the heart of that premise.

This Bill aims to make provision about the prioritisation of graduates from medical schools in the United Kingdom, and His Majesty’s loyal Opposition look forward to working constructively with the Government and all noble Lords in facilitating that desired outcome.

Baby Milk Powder: Cereulide

Earl of Effingham Excerpts

Wednesday 4th February 2026 Lords Chamber

[Baroness Merron (Lab)]

In my preparation for this Question, which is an important one, I asked a similar question to officials, particularly those from the FSA, and they assured me that testing shows we are meeting the right standards. They also made the point that this is all covered by the Food Safety Act. In their opinion, they have the tools to do the job. I am not aware that there has been something wrong in the management of this live incident, but I am aware that the FSA and the UK Health Security Agency are liaising very closely with the manufacturers to establish the root cause of the possible presence of this toxin. But I can also reassure your Lordships’ House that it is confined to certain batches. That is the information that is going out.

[The Earl of Effingham (Con)]

My Lords, providing the best nutrition for children of all ages is surely a “must have”. So, why do the Government allow ultra-processed foods to constitute between two-thirds and three-quarters of calories in UK school meals? They are high in fat, sugar and salt. That is not a good combination.

[Baroness Merron (Lab)]

The noble Earl has moved from food safety to what is in food. Food standards applicable to school meals are both monitored and in place. As he knows, the general advice from the NHS on processed foods is that we would all benefit from eating less of the foods that are high-fat, high-salt and high-sugar. But those foods are not presenting the immediate safety concerns. I make that distinction as we are looking here at toxins in products.

NHS: Corridor Care

Earl of Effingham Excerpts

Wednesday 4th February 2026 Lords Chamber

[Baroness Merron (Lab)]

We very much appreciate the role that GPs play. Corridor care is related to a whole range of factors, not only the position of GPs. I have heard what the noble Baroness has said and will gladly relate it to my ministerial colleague.

[The Earl of Effingham (Con)]

My Lords, the Minister referenced data collection in her previous responses. In November, hospitals carried out 10% fewer operations than in October, but the Government claim the waiting list went down. Is that because the Government are paying hospitals £3 million per month in a process known as “validation”, and so it appears that the health service is treating more patients than it actually is? Is that the real reason that corridor care numbers are up?

[Baroness Merron (Lab)]

No. I hope that the noble Lord would welcome a greater level of activity in this area. The waiting lists are going down. We have delivered, for example, 5.2 million extra appointments since we came into government, when we had promised just 2 million. Waiting lists are going down, and I am very happy to provide the data again to the noble Lord so that he can investigate that.

Breast Cancer

Earl of Effingham Excerpts

Monday 15th December 2025 Lords Chamber

[Baroness Merron (Lab)]

My noble friend makes a very powerful case; I am grateful to her for doing so. The UK National Screening Committee continuously monitors emerging evidence through horizon scanning and maintains active engagement with international peers. Should robust evidence regarding the extension of breast screening age thresholds become available, the committee will look at it right away. In the meantime, a suite of public-facing information communicates to women aged 71 and over that they can have screening every three years if they wish. I realise that does not quite meet my noble friend’s request, but I hope it indicates movement to support women aged 71 and over.

[The Earl of Effingham (Con)]

My Lords, women over the age of 70 are entitled to receive free breast screening every three years. However, for those who are digitally excluded, both awareness of this and the practical process of making an appointment can present real barriers. What steps is the NHS taking to ensure that women over 70 are aware of this right, and how is access to screening being made easier for those who struggle with digital access?

[Baroness Merron (Lab)]

Part of the 10-year plan, as we move from analogue to digital, will be ensuring that digital exclusion will not be a barrier. As I mentioned in response to my noble friend, it is indeed the case that women aged 71 and over can have screening every three years, and that can happen by women calling their local breast screening service to ask for an appointment. In other words, analogue is still possible, not just digital.

Emergency Adrenaline

Earl of Effingham Excerpts

Monday 15th December 2025 Lords Chamber

[Baroness Merron (Lab)]

I very much understand my noble friend’s personal involvement in this area. I congratulate her on her work in promoting the availability of needle-free delivery of adrenaline, and I too welcome its approval. It is down to local area prescribing committees to provide advice to integrated care systems on whether to include new products such as nasal adrenaline and whether they should be included in local formularies. This takes into account available evidence, as well as any relevant guidance. Following this Question from my noble friend, I will seek a view from NICE as to whether it is considering developing guidance in this area, as I know she would find that helpful.

[The Earl of Effingham (Con)]

My Lords, it has been four years since the Commission on Human Medicines first examined widening public access to adrenaline auto-injectors. It is an excellent initiative, but it requires national co-ordination. What progress have the Government made in establishing a national lead for allergy—which some refer to as an allergy tsar—given their previous support for the idea?

[Baroness Merron (Lab)]

We have been focusing our efforts, as I said, on whether changes to the law are required to allow wider access to, for example, adrenaline nasal sprays, which are a welcome development. Our focus is on that, rather than on the appointment of a tsar, to which the noble Earl referred. We will be establishing national clinical directors, and I am sure that this will be considered in that regard.

Alzheimer’s Disease

Earl of Effingham Excerpts

Monday 13th October 2025 Lords Chamber

[Baroness Merron (Lab)]

As the noble Baroness says, diagnosis is absolutely crucial. I feel our health system has struggled somewhat to support those with complex needs, including those with dementia. That is why I emphasise the role of the modern service framework in this area; it is the first time we have had one and it takes a whole view, which I think has been sorely lacking. It will be informed by the independent commission on social care next year—so we are looking at next year, not waiting for years. The final point I make is about the dementia diagnosis rate for patients aged 65-plus. The Government are committed to recovering that to the national ambition of 66.7%; at the end of August, it was 66.1%.

[The Earl of Effingham (Con)]

My Lords, the evidence is clear across the board: eating healthily and staying active helps brain health and the prevention of Alzheimer’s. Is it not a huge concern to the Government that more than half the calories the average person in the UK eats and drinks come from ultra-processed foods and fewer than 25% of adults in the age groups most prone to Alzheimer’s are not meeting the Chief Medical Officer’s guidelines for aerobic and muscle-strengthening exercise?

[Baroness Merron (Lab)]

I think the valid points that the noble Earl raises refer to a whole range of health conditions. I refer particularly to our health service’s struggle to support those with complex needs. Clearly, prevention of ill health—one of the pillars of the 10-year plan—is going to be crucial, and that will include good diet and a good exercise and movement programme. I cannot comment on the specific link with dementia. There is so much more work to be done, which is why we are investing so much in research and development.