Tobacco and Vapes Bill

Lord Bethell Excerpts

Committee stage
Monday 27th October 2025 Grand Committee

Someone chastised us for not mentioning health, but I am interested in improving health. The best smoking cessation tools that we have discovered recently are vapes, and the Bill barely distinguishes between vapes and tobacco, or between nicotine and tobacco, in a completely irresponsible way. If we really want to help young smokers between the ages of 18 and 24—and, by the way, there has been a dramatic decline in their smoking, largely because of the uptake in vaping—we should be liberating and promoting vaping and stopping this nonsense generational smoking ban, which is discriminatory and unlikely to help anyone.

[Lord Bethell (Con)]

My Lords, first, I declare that my wife is a non-executive director of Tesco. Secondly, I spent 10 years working at the Ministry of Sound in south London, where I came face to face with the illicit cigarette trade on a weekly basis. Christopher Upton was the name of the burly character who delivered cigarettes to the club each week; he controlled the London casual cigarette business very tightly indeed. He was a charming, if burly, individual who gave us presents at Christmas and is famous among the legal fraternity for his case, Fagomatic v HMRC, in which he argued that his shiny purple Lamborghini Countach should be deductible for VAT as a business expense, which sadly he lost in 2002. That is the face of illicit cigarette trading in the UK.

Since the days of Christopher Upton, the trade in illicit cigarettes has come down by 90%, from 15 billion sticks a year to 2 billion sticks a year. Those are the statistics that the noble Lord, Lord Bichard, rightly gave; they are different from those given by the noble Lord, Lord Scriven, which come from the KPMG report for Philip Morris, the cigarette seller, which are not figures that I feel this Committee should lean on. I can source the number, if it is helpful to noble Lords.

May I just say a word about prohibition? I have two points to make about the prohibition of cigarettes for young people. First, as the noble Baroness, Lady Fox, rightly and powerfully said, there is now a clear displacement route to vaping for anyone who wishes to take up this kind of activity. In other words, there is an alternative. Prohibitions come when there is no alternative. Secondly, I remind the Committee that, among young people, interest in smoking cigarettes has collapsed: it has gone from 23% of 18 year-olds in 2011 to 10% of 18 year-olds in 2025, and it is heading downwards. We can only encourage this move with this measure.

The amendments suggested in this group would be counterproductive and are, for that reason, extremely regrettable.

[Lord Mackinlay of Richborough (Con)]

My Lords, I support these amendments in the names of my noble friend Lord Murray and others, which concern substituting the age of 21. I do so not because I think 21 is the perfect age but because it becomes a workable solution in trying to prevent the young smoking.

I am—like many noble Lords in this Room, I suspect—a reformed smoker. It sounds like one of those AA meetings, does it not? I stopped smoking on the occurrence of my illness. I did not stop smoking because I had suddenly turned against them, morally; it is just that I now struggle to pick them up and light them. Of course, we would love to live in a world of nirvana where cigarettes and tobacco had not been invented, but I am afraid that idea is long gone; it went many hundreds of years ago.

I am sorry to say that the Bill gives this Parliament rather a bad name, because we are talking here about the complexity of age-related smoking. One needs only to look out on to today’s streets. It is pretty rare to see people smoking on the street and even rarer to see youngsters smoking on the street. As the noble Baroness, Lady Fox, and my noble friend Lord Bethell just said, 10% of youngsters smoke and, in the normal population, the number of smokers is collapsing. That is a result of cessation products, of better education and of us all, I think, being a bit more aware—if we needed to be more aware—of the dangers of smoking this smoking product, which is, by its very nature, pretty daft.

Where the public have lost us here, I think, is that they see a lot of evils on the streets of this country. They would rather we were debating banning knives on the street or banning street fentanyl, but here we are talking about banning smoking. I think people would almost laugh at us for discussing such things at length in this Parliament.

Hundreds of millions of pounds have been spent over the years on smoking cessation products via the NHS—whether patches, gums or other such things—yet the only product to have received no public subsidy, despite it being the biggest driver of reducing smoking in this country, is the vape. It has been far more successful than all those expensive products, although I share the concerns of the noble Baroness, Lady Northover, about vaping. Perversely, this is where the nanny state gets a weird outcome. We are now seeing more youngsters addicted to nicotine at a young age via a vape than I think we ever would have done had we done nothing except the usual education around how bad smoking is. We now have a generation of nicotine addicts where I do not think we would have done before.

This is not a Second Reading argument about how bad the Bill is, but we need to think carefully about the practicality of banning things. I am concerned about small shops, not so much about the trade they might lose, even though that is a factor, but the reality out there. Too often, we in Parliament try to create a nirvana but do not look at the real world. I had a decorator a few years ago and, every day on the way to my place, he was buying illicit cigarettes. He said that, on his route through the Medway towns, he knew of four shops where there were illicit cigarettes under the counter. Where is HMRC? Where are trading standards? I knew where this was going on; I even used to tell trading standards where they ought to be looking, and there was the odd raid from time to time, but it still continues.

In the same breath in this legislation, we have some ridiculous statements about snus, a Scandinavian product that probably has its place in taking people out of smoking by an alternative supply of nicotine. We are seriously going to have potentially two years’ imprisonment for the selling of snus, yet while illicit cigarettes are banned, or just not legal to be sold, on every street in every town across this country we have illegal, illicit tobacco being sold. To then overlay further a load of new regulation, hoping that it will be enforced, is, frankly, for the birds.

I will take the whole moving-age argument a bit further. We discussed the ages of 31 and 30. I pay tribute to the noble Lord, Lord Scriven, for saying what he said, which was absolutely right. I take that a bit further. A 70 year-old and a 71 year-old are living next door. The 71 year-old is going to have a very busy shopping list when he pops down to the Co-op in 2080 when he is buying cigarettes for the 70 year-old. To think that the trader is having to ask for some sort of ID, from someone who is obviously of a reasonable age, to buy cigarettes is, frankly, lunacy. That is why I support the age limit of 21 in preference to doing nothing at all.

I also have some sympathy for Amendment 16 in the names of the noble Lord, Lord Parkinson, and the noble Baroness, Lady Fox. If we are seriously considering youngsters being able to vote at 16 then why not have 16, or whatever that voting age is, as a sensible measure for doing lots of things? We do not think that 16 year-olds should be using a sunbed, but we suddenly think they should be voting.

I know that this measure was introduced, or thought about, by the outgoing Government and the previous Prime Minister, Rishi Sunak; we had discussions about this very Bill when he came to visit me in—in hospital. I nearly said “in prison”; it felt like that after six months. I gave my thoughts to him quite graphically: “Yes, it begins with a B, Prime Minister”.

There is an international dimension to this, which has been picked up on by a few speakers this afternoon. What will we do with Easyjet when you have the 18 year-old traveller coming back from Malaga or Majorca? I can only imagine, because they will be in international airspace, their complete ability to buy a carton of cigarettes on Easyjet or Ryanair or whatever other plane they are coming on, or at Malaga airport or at Dubai Airport. They will be able to bring them into the country and smoke them.

What will we do about the very real, seemingly invisible, border between the Republic of Ireland and Northern Ireland that has been discussed by my noble friend Lord Murray? Will the 18 year-olds living just over the border in Northern Ireland hop over to the tobacconist, literally just over the border, to satisfy their wishes? This just becomes within the realms of lunacy.

We have to look at what has happened elsewhere in the world. In Australia, we have seen an explosion of turf wars and an increase in illicit tobacco. There are two “illicits”: there is completely made-up tobacco, which is potentially truly dangerous, or the merely untaxed tobacco that has been imported to the UK but is the genuine product. There is huge money involved, and wherever there is big money there are turf wars, violence and problems.

It is too late to stop this legislation. I think it is daft, and we really should be addressing more pressing issues in this nation. The age limit of 21 is at least enforceable and has clarity. I have every confidence that the years of smoking in this country, because of the measures of education, peer pressure and the way we are not allowed to smoke in pubs, are being reduced almost to single figures and a diminishing number. On that basis, my noble friend Lord Murray and those amendments have my full support.

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Moved by

[Lord Bethell]

4: After Clause 1, insert the following new Clause—
“Complete prohibition of tobacco products from 2040(1) In addition to the prohibition in section 1 regarding individuals born on or after 1 January 2009, the sale of tobacco products to any person is prohibited in the United Kingdom from 1 January 2040.(2) All licences to sell tobacco and tobacco retail registrations will be invalid as of 00:01am on 1 January 2040.(3) The Secretary of State must, within 12 months of the day on which this Act is passed, lay before Parliament a strategy for—(a) implementing the complete prohibition under subsection (1),(b) supporting tobacco retailers and businesses in transitioning away from tobacco product sales,(c) strengthening enforcement mechanisms to prevent illicit trade of tobacco products, and(d) enhancing smoking cessation services to support individuals ahead of the 2040 prohibition. (4) The strategy under subsection (3) must include provision for a phased reduction in tobacco product availability beginning not later than 1 January 2030.(5) Nothing in this section affects the operation of section 1 of this Act, which applies to individuals born on or after 1 January 2009 regardless of the prohibition in subsection (1).”Member’s explanatory statement
This amendment preserves the generational approach to phasing out tobacco while establishing a backstop date of 1 January 2040 for complete prohibition. The amendment also requires the Secretary of State to develop a comprehensive implementation strategy.

[Lord Bethell (Con)]

My Lords, my amendment is grouped with Amendment 199, in the names of the noble Baronesses, Lady Northover and Lady Walmsley, and Amendment 193, in the name of my noble friend Lord Young of Cookham. I repeat my declaration of interest that my wife is a non-executive director of Tesco. I will speak to my own amendment and leave it to others to speak to theirs.

I remind noble Lords that the ambition of the Bill is nothing less than the wholesale eradication of smoking. I laid out the costs of smoking to our society in my Second Reading speech: the immense economic impact on our national finances, the relentless pressure on our health system, the toll on our human capital and the deep corporate injustice that sees tobacco companies profit while society, particularly the poorest, pays the price. I also laid out the benefits of getting rid of smoking, so I will not detain noble Lords by restating that.

The purpose of my amendment, and the opportunity presented by the growth of vaping, is a natural extension of the Bill’s intent: a logical, fair and legally robust endpoint, in 2040, to the regulatory ratchet that is already contained within the Bill. It would give clarity and confidence to consumers and industry alike, deal with the long tail of divided rights between generations and be fair to retailers, offering certainty, managed transition and guidance towards new business models.

We know that a hard stop with a long run-up can work because we have done it plenty of times before. Under John Prescott, the Asbestos (Prohibitions) (Amendment) Regulations 1999 completed a phased ban that took nearly two decades and provided industries with time-limited exemptions and sunset clauses. Today, I am pleased to say that workplace asbestos exposure has fallen by 80%. Another example of a full-stop measure was the phase out of leaded petrol, initiated in 1987 and completed in 2000, which gave manufacturers and motorists 15 years to adapt. I am pleased to say that lead levels in urban air have fallen by 94%. Thirdly, the elimination of CFCs under the Montreal protocol, signed in 1987 and implemented through UK regulations in the 1990s, relied on structured deadlines and support for innovation. I am pleased to say that global CFC consumption has dropped by 98%.

Each of those measures that tackled toxins that poisoned our society followed the same formula: clear deadlines, fair transitions and decisive action. Each was thoroughly opposed by the industry. There were warnings of economic collapse on each occasion, but none of that came to pass. Instead, we emerged with a healthier, safer and more innovative society.

Let me explain how this amendment—the “extinction 2040” amendment—might operate in practice. Proposed new subsection (1) would provide for the prohibition of the sale of tobacco products to any person in the United Kingdom from 1 January 2040, thereby establishing a complete stop date for smoking. Proposed new subsection (2) specifies that all licences to sell tobacco and tobacco retail registrations would be invalid as of midnight on 1 January 2040. In other words, the licences currently administered by local authorities under powers anticipated in Clause 58, which establishes a national tobacco licensing regime, would be ended. Local councils in Scotland already operate such schemes under the Tobacco and Primary Medical Services (Scotland) Act 2010, and similar powers will be extended to England and Wales on Royal Assent.

Proposed new subsection (3) would impose a mandatory duty on the Secretary of State. It states that, within 12 months of the Act passing, the Secretary of State would

“lay before Parliament a strategy for … implementing the complete prohibition”.

This strategy must address four elements. Proposed new subsection (4) would require

“provision for a phased reduction in tobacco product availability beginning not later than 1 January 2030”.

This would be delivered through progressive amendments to licensing regulations issued under Clause 58, reducing the number of retail authorisations by geographic area, imposing proximity restrictions near schools and health facilities and ultimately restricting sales to larger retailers with compliance infrastructure. This task would fall jointly to the Department of Health and Social Care, His Majesty’s Revenue & Customs, the Office for Health Improvement and Disparities and the National Centre for Smoking Cessation and Training.

In practice, phased reduction means progressive tightening of retailer licensing, initially capping licensing numbers per local authority, then applying proximity restrictions and ultimately withdrawing licences from smaller retailers, while allowing supermarkets to transition shelf space to vaping devices and alternatives—products that the Government already support as harm-reduction tools. This plan aligns with changing consumer behaviour. Smoking prevalence is falling and retailers are diversifying, as we have discussed.

On enforcement, proposed new subsection (3)(c) would require

“strengthening enforcement mechanisms to prevent illicit trade”.

This responsibility falls to HMRC under the existing powers of the Tobacco Products (Traceability and Security Features) Regulations 2019 and Schedule 23 to the Finance Act 2020, which authorises civil penalties and empowers HMRC to deactivate economic operator identification numbers. Trading standards officers provide complementary enforcement. Critically, this system already exists and is cost neutral, as penalties, duty recovery fund operations and phased withdrawal of the legal market actually reduce illicit activity by cutting demand.

Finally, proposed new subsection (3)(d) would mandate

“enhancing smoking cessation services to support individuals ahead of the 2040 prohibition”.

The Government have already committed £70 million annually to local stop smoking services, distributed to upper-tier local authorities based on smoking prevalence. This funds the National Centre for Smoking Cessation and Training and NHS community pharmacy services, which offer nicotine replacement therapy and behavioural counselling. Scaling this architecture over 15 years would ensure that, by 2040, the vast majority of current smokers would have been supported to quit, minimising enforcement costs and public backlash.

This amendment would work with the grain of existing systems, emerging technologies and declining smoking rates. It would assign clear responsibilities to established agencies: local authorities for licensing; HMRC and trading standards for enforcement; the DHSC and OHID for cessation. It would grant a 15-year transition period, ensuring fairness to industry and retailers. A complete prohibition by 2040, with phased reductions and cessation support, would generate measurable productivity gains for our economy, savings for the NHS and reduced economic inactivity, likely reducing the costs of our national debt within a decade. Crucially, this amendment could be scored by the Office for Budget Responsibility.

We stand at a crossroads. This Bill could be remembered in two ways: as a high point for incrementalism, a policy that is cautious and takes a century to work, that is not registered economically and is complex; or it could be the beginning of a more emphatic approach to regulation where Britain stops tinkering and starts deciding. I believe that we should choose the second path—the evidence supports it and so do the public. It is not my intention to push this amendment, but I urge the Minister to consider it seriously. If she cannot find a place for it in today’s Bill, could she comment on how the department might study such a measure for a future Bill?

[Lord Young of Cookham (Con)]

My Lords, Amendment 193 in my name and those of the noble Baronesses, Lady Northover and Lady Grey-Thompson, covers much of the same territory as Amendment 199. It would require the Secretary of State to publish a road map to a smoke-free country every five years. It lacks the ambition of my noble friend Lord Bethell, who provides not just a road map but a destination and a date. If we were to agree with my noble friend, that would be worthwhile progress.

This group of amendments is important because, although the Bill is a step forward in promoting public health and reducing the numbers who start to smoke, as it stands it does very little to help the 6 million smokers who are already endangering their health. The amendment reflects the latest APPG on Smoking and Health report, which calls on the Government to publish a road map to a smoke-free country. The Labour Party promised to publish such a strategy in its health mission document, Build an NHS Fit for the Future, saying it was important that no one should be left behind. It said:

“We will build on the success of the last Labour government with a roadmap to a smoke-free Britain”.


I hope this amendment will find favour with the Minister. Can the Government confirm that they have the same target as the last one, to achieve a virtually smoke-free England by 2030?

As I said, the rising age of sale will not affect current smokers but, as the legislation is progressed with, we should not forget them. Smoking is not evenly distributed across our society. There are higher rates of smoking in nearly all groups experiencing disadvantage and high rates among people with mental health conditions, those on low incomes and those living in social housing—the people most at risk of being left behind, whom the Government have rightly said they will look after. In turn, these differences fuel the gaps in healthy life expectancy between different groups in our society and undermine progress on addressing inequality.

To end this inequality, the Government need a clear plan or road map on how we can achieve a smoke-free future for all parts of society. That road map should include clear targets. For example, the APPG on Smoking and Health has called for a national target of 2 million fewer smokers by the end of this Parliament. Is that something that the Minister could sign up to? If such a reduction were achieved, the country would be on track to have less than 5% smoking two years later and could continue progress to make smoking obsolete within 20 years, within shooting range of my noble friend Lord Bethell’s target.

There should also be specific targets for vulnerable groups with high rates of smoking. Under the last Conservative Government, the target to reduce smoking among 15 year-olds was achieved. The previous Government also set a target to reduce the prevalence of smoking in pregnancy to 6% or less by the end of 2022. That target was not met, but it helped mobilise significant support for pregnant women, which has led to a reduction—it fell at the fastest ever rate last year.

The last Government also committed to other targets—for example, using the pioneering Swap to Stop scheme. It is welcome that the Government have maintained their commitment to some of these initiatives, but they should be part of an overall strategy so that we have a clear vision of where we want to go and how the various components help us reach that target. There is also a risk that, once this legislation has passed, the Government, both locally and nationally, are lulled into believing the job has been done, so we need a clear plan now and every five years until we have created a smoke-free country.

I understand the pressure on the NHS, but the astonishing decline in smoking among pregnant women was achieved by embedding support in hospitals alongside financial incentives. However, these services are now threatened with cost pressures in the NHS, seeing some ICBs reduce or decommission those vital services. Within a road map to a smoke-free country, the role of ICBs could be clearly laid out and the importance of these services in helping to reduce the incidence of smoking could be clarified.

So the Bill is ambitious. It is world leading when it comes to stopping the start, but we need the Government to have a similar ambition for supporting the current 6 million smokers in the UK to quit for good.

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[Baroness Merron (Lab)]

My Lords, I thank noble Lords for their thoughtful contributions. As they have acknowledged, the Government are taking bold action to create the first smoke-free generation. Our published modelling shows that smoking rates in England among 14 to 30 year-olds could be close to 0% as early as 2050. I make that point particularly in respect of Amendment 4, tabled by the noble Lord, Lord Bethell.

I sympathise with the intention of his amendment and with the other amendments we have debated in this group. Let me assure noble Lords that, as is consistent with best practice, we will evaluate this legislation as is appropriate and helpful, such as by monitoring smoking rates over time. We need to ensure that no one is left behind in this smoke-free UK that we seek to create.

However, I say to the noble Lord, Lord Bethell, that we do not believe that an outright ban would be the most effective or proportionate way of encouraging current smokers to quit. As he knows, we are taking an evidence-based approach to supporting current smokers to quit and have invested an additional £70 million both last year and this year to support local authority-led stop-smoking services in England. We are continuing our national smoke-free pregnancy incentive scheme to support pregnant smokers to quit, which the noble Lord, Lord Young of Cookham, referred to.

I turn to Amendment 193, tabled by the noble Lord, Lord Young of Cookham. I aspire to be as mindful as I know he is of the importance of parliamentary scrutiny of the implementation of legislation. As I mentioned, we will assess the implementation of the Act, which is consistent. For measures implemented by secondary legislation, we will publish post-implementation reviews as appropriate. I can also commit to publishing a report on the Bill before Parliament, in line with our requirements, so we do not feel that it is necessary to outline this in the Bill. There are no plans to develop a report on specific targets or to publish a road map at this time, because we are focusing our attention and total ambition on making sure that we can deliver the Bill and work on the regulations that will follow.

The noble Lord, Lord Young, asked about a retained target to have a smoke-free England by 2030. We are going even further than the Smokefree 2030 target. As I have mentioned throughout, our ambition is for a smoke-free UK and creating the first smoke-free generation.

Finally, I turn to Amendment 199, tabled by the noble Baroness, Lady Northover. The Government are committed to ensuring the successful implementation of all measures in the Bill, as I am sure she appreciates. We will ensure that the public, retailers, enforcement bodies and other relevant groups are aware of all measures and their associated commencement date. We will publish clear guidance in advance to aid a smooth transition. The noble Baroness’s amendment also seeks to include measures to raise public awareness. That is absolutely key, as the noble Baroness, Lady Walmsley, also said.

I say to noble Lords that we run successful public health campaigns to support smokers to quit and to inform the public on the harms of tobacco. Indeed, this month is our annual Stoptober campaign. I therefore reassure the noble Baroness that my officials are working to ensure that everyone will be informed about the smoke-free generation policy and the benefits of quitting and continuing that route.

To the point made by the noble Baroness, Lady Walmsley, about social media campaigns, earlier this year we launched the first ever campaign to inform young people about the health risks of vaping. The campaign featured on social media and paid media used by young people, and the noble Baroness will be delighted to know that that included working with trusted influencers to speak directly to—how might I put it?—a younger audience.

On the comments by the noble Lord, Lord Harlech, the matter of which tobacco products are in scope will be covered in detail in group 16, and I look forward to discussing that.

On the basis of those responses, I hope the noble Lords will feel able not to press their amendments.

[Lord Bethell (Con)]

My Lords, I thank the Minister for her concluding remarks, which were thoughtful, detailed and thorough. I congratulate the Government on pursuing these measures with the energy and determination that Rishi Sunak brought to it when he was Prime Minister. They still enjoy widespread support in all corners of the House—not unanimous support, but widespread.

I am grateful for the Minister’s commitment to the £70 million cessation budget and to the smoke-free pregnancy programme that my noble friend Lord Young of Cookham mentioned. I am grateful for her commitment to evaluation and assessment and to a post-implementation review. These are standard. I hope very much that she has taken on board the comments about the need for a clear road map and for accountability, and I am grateful for everything that she said on that.

I also emphasise the importance of a public health campaign—whether it should use influencers and Kardashians, I am not quite sure—and I pay tribute to the DHSC and the NHS for their public health campaigns, which have proved to be effective: they are good curators of the nation’s health when it comes to campaigning. I emphasise to the Minister the critical importance of getting both the guidance and the communication right. We do not legislate in order to communicate, but the communication of good legislation is very important.

I also stand by the Minister’s comments on cigars and other tobacco products. I thought my noble friend Lord Harlech made extremely clear and persuasive points. I totally take on board everything he said on my 2040 extinction proposal and would very much like to talk to him about that in future, and how it might be shaped.

With that in mind, I beg leave to withdraw my amendment.

Amendment 4 withdrawn.

Alzheimer’s Disease

Lord Bethell Excerpts

Monday 13th October 2025 Lords Chamber

[Baroness Merron (Lab)]

In our development of the modern service framework for frailty and dementia we are engaging with a wide group of partners, because we need to understand what should be included to ensure the best outcomes. I hope my noble friend will welcome that we are going to be considering what interventions should be supported to improve diagnosis waiting times—which are, I certainly agree, too long in many areas. In addition, we are considering all the options to help reduce variation, including reviewing metrics and targets, as my noble friend refers to.

[Lord Bethell (Con)]

My Lords, having had the analysis of the results of incredibly extensive clinical trials on the use of GLP-1s to treat dementia, particularly Alzheimer’s disease, this is an incredibly exciting potential development. Will the Minister please share with the House what the Government are doing to prepare diagnosis for Alzheimer’s disease, so that those with the disease can be ready for this exciting treatment?

[Baroness Merron (Lab)]

The noble Lord is right to identify what are exciting developments in this area. We are investing in dementia research across all areas. That includes causes and diagnosis, as well as prevention, treatment, care and support, including for carers—I think it is important to identify the wide range. In preparation, we are ensuring that clinical trials are maximised and that reductions in waiting times happen. As I said, through the modern service framework we will be looking at the arrangements as a whole, which will give the useful range of direction that we need to address the point that the noble Lord made.

Prostate Cancer

Lord Bethell Excerpts

Wednesday 3rd September 2025 Lords Chamber

[Lord Bethell (Con)]

My Lords, I give huge thanks to my noble friend Lord Mott for this important debate, and thanks also to the noble Lord, Lord Patel, for pointing out that we need better diagnostics with better specificity and sensitivity. We all aspire to a new generation of diagnostics, but we have to live with what we have today. My noble friend Lord Dobbs pointed out that timely assessment is the most urgent thing if you are developing prostate cancer. That is why I would like to address the question of risk aversion: a culture that, I am afraid to say, holds back timely intervention.

The evidence suggests that, too often, doctors’ intolerance of uncertainty is directly associated with diagnostic delays and errors, sidelining informed choices for patients and instead favouring the psychological comfort of clinicians. The NHS culture too often infantilises patients. In modern life, we are used to making 35,000 decisions a day, so the suggestion that patients cannot handle the complexity of modern tests, the idea that diagnoses may be reversed, or the pressure of diagnosis is, frankly, absurd. Yet studies reveal wild variations in PSA testing between GP surgeries, driven often by individual bias, not by science. This lottery is completely unacceptable.

This is a system-wide problem involving not just prostate cancer. Early detection of disease is vital if we are to turn around our national health disaster. We need risk-based screening, mandatory GP engagement and accountability for delays. Therapeutic privilege should be dead and buried; patients deserve informed choices and agency.

Tobacco and Vapes Bill

Lord Bethell Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

[Lord Bethell (Con)]

My Lords, I thank the Minister for bringing the Bill to this House so thoughtfully and clearly. I also declare my interest as a consultant to Oviva, an obesity treatment company, and my wife’s role as a non-executive director at Tesco and Diageo.

It is a great honour to be so far down the list, because this has been a very rich debate and we have heard some very touching and powerful testimony. As the noble Lord, Lord Griffiths, put it, we have heard some particularly personal stories, particularly from the noble Lord, Lord Rennard, and the noble Baroness, Lady Morgan of Drefelin, of people who were brought up with smoking and who either were orphaned or had their lives devastated by it. These stories should move us, and it is very powerful that they were brought to the House in this way.

We have also heard a lot of depressing talk of violence, gangs, the diminution of civil rights, the breakdown of societal values and a complete collapse of market mechanisms because of the unintended consequences of the Bill. I will spend a moment to talk about some of the other unintended consequences, which are the huge benefits that the Bill might bring to our economy, society and national security.

We are really blessed to live in a time when modern medicine is delivering miracles that can keep us alive well into our 70s, 80s and 90s, but the things that hold us back are the bad habits and pollutions which mean that chronic disease in this country is exploding. The projection is of 40 million people with a chronic disease by 2040, according to the Health Foundation. The reason for that is junk food, inactivity, bad air, filth on the internet that gives us mental health issues, and smoking. That kind of pollutant is causing immense harm to our families, our communities and our economy.

I welcome the Bill’s emphatic intervention. It is not a half-measure protecting big tobacco’s grip on our lives. Let us have no more Treasury nihilism or medical fatalism, and no more free market complacency. I like the Bill because it will ultimately get rid of smoking forever, and I celebrate that decisive step towards a healthier, more prosperous Britain. The unintended consequence will be a massively more prosperous life.

My only regret is that the Bill does not go further and faster. I hear very clearly the reservations people have about the Bill and I do not want to give the impression that I do not understand the practical restrictions on the Government. However, there are two measures that could make a big difference, and one more on vaping.

First, there is an opportunity to integrate the Khan review’s recommendations more emphatically by increasing funding to cessation programmes and tightening market controls even further, and moving towards a complete smoking extinction target of 2040. By that, I mean completely eradicating smoking in the UK. In other words, I mean upgrading the Bill from a transition measure towards gradual reduction to an absolute and total eradication, saving lives, reducing inequality and setting a global precedent.

If we did that, we would give clarity to the industry, which I hope many in the Chamber would welcome. It would recognise and answer many of the concerns about the extended generational nature of the Bill that creates potentially ludicrous scenarios a long time in the future. I hope the noble Lords, Lord Moylan, Lord Sharpe, Lord Brady, Lord Murray and Lord Scriven, the noble Earl, Lord Leicester, and the noble Baroness, Lady Meyer, will think about supporting this measure when I bring it to the House as an amendment, in order to answer their concerns on that point.

Secondly, I strongly back the introduction of a profit-based levy, as the noble Lord, Lord Young of Cookham, referred to. This measure, with 79% public approval, would ensure that the industry contributes fully to cessation programmes and our overstretched public health.

On vaping, I welcome the thoughtful debate we have had already. The question for me is: what kind of vaping industry do we want? Do we want a small, tightly controlled market selling vapes to former smokers, turning over around £1 billion, which is where it is at the moment, or something bigger? My instincts are that a sprawling, £10 billion industry that leaves our children to pay for the potential long-term health consequences is something that we should try to avoid.

This Bill is a huge opportunity. Let us not allow exaggerated concerns from the tobacco industry playbook to hold us back. Instead, let us lean in.

Food, Diet and Obesity Committee Report

Lord Bethell Excerpts

Friday 28th March 2025 Lords Chamber

[Lord Bethell (Con)]

My Lords, it is a great honour to follow my noble friend Lady Jenkin who has been talking on these issues way before it became so fashionable and drew me into this debate in the first place. I would like to say thanks to the noble Baroness, Lady Walmsley, and all those who sat on this committee, who have done an incredible job and made a very persuasive case. I also draw attention to my role as adviser to Oviva, a company that provides treatment to those with obesity, and the role of my wife, who is a non-executive director of Tesco, the British retailer.

Others have spoken about the impact of obesity on our health, including the noble Baroness, Lady Browning, the noble Lord, Lord Brooke, and my noble friend Lady Meyer. As a moment of personal testimony, I saw how we, as a country, suffered during the pandemic because 64% of adults were carrying too much weight and their bodies were weakened and could not fight the virus properly. The ONS study on obesity and mortality found emphatic evidence that the risk of death from coronavirus was double for those who had obesity. That is true in other realms of health and it is an observation that plays out in every hospital, every GP surgery and every morgue in the country, every day of the week.

Others, including the noble Lord, Lord Krebs, the noble Baroness, Lady Boycott, and my noble friend Lord Caithness have talked about how all this damages our economy. The evidence is absolutely overwhelming; I will not go over it all, but I will mention the correspondence I had with the OBR—emphatic and clear arbiters of our future financial security. It wrote that the rising tide of chronic health conditions linked to obesity is increasing the years that people spend in ill-health, and that is having a material impact on our ability to sustain the national debt. The Army cannot recruit fit soldiers; our businesses cannot find a fit workforce; and our communities are struggling to cope with obesity-related poor health—we simply cannot go on like this.

The response from the Government is particularly disappointing given that the political mood on this issue has completely changed. Polling evidence overwhelmingly points to strong support for government interventions. National newspapers have become health conscious, campaigning on issues such as fast food outlets near schools. Major civic organisations like children’s charities and the health champions are clamouring for action. Directors for public health, local authority chiefs and NHS chiefs published compelling evidence of harm, thoughtful recommendations for change and alarm about the cost of exciting but expensive obesity treatments. Countries such as Norway, Portugal, Mexico, Canada and Chile are leading the way by clamping down on junk food advertising and, most strikingly, in America, the popular End Chronic Disease movement has expressed popular anger towards the junk food industry. That was seen in the influence of Robert Kennedy on the presidential election. His appointment at Secretary of State for Health, while quite a strange event in world history, has shown how popular anger about our declining health is boiling over into the mainstream.

We have reached a point where the junk food industry can no longer be regarded as a constructive contributor to our national interest, or a benign employer of our people, or a supplier of nutritious sustenance to feed our people. Companies such as Nestlé, Mondelēz, Coca-Cola, Mars, Ferrero and others are making billions of pounds of profits. Their CEOs make tens of millions of pounds each year. Meanwhile, our children face a life of poor health and addiction; the NHS is running nearly 100 child obesity clinics, at great expense; and the UK workforce is quitting employment because of the cardiovascular, MSK and consequential mental health problems associated with obesity. The junk food giants should be regarded as a leech on our public finances; free riders that are not paying for the externalities that they create; and a threat to both our national security and our public finances. That is why the Government’s response is so disappointing. It calls for “co-ordination and collaboration”, which they say is essential. I just do not agree.

We need hard, regulatory guard-rails. We need to put health promotion at the centre of the Food Standards Agency priorities. We need fiscal intervention, starting with the sugar tax. We need a monopoly investigation by the CMA. We need to start taking the junk food industry out of the conversation, as we have done with the tobacco industry and should do with the pornography industry. The points made by the noble Baroness, Lady Boycott, on that really resonated.

If we have learned anything, it is that the micro-intervention approach does not work. It did not work with tobacco, despite what the noble Lord, Lord Krebs, said. Some 80 years after it was proven that cigarettes kill, 13% of the country still smokes. The micro-intervention approach does not work for businesses, which have a fiduciary obligation to maximise profits. As a result, they waste huge amounts of shareholder value and creative energy battling fines and red tape. It is not working for our NHS, our economy or our national security. Instead, we need a clear and emphatic approach that protects the consumer and allows the industry to survive. Collaboration with today’s junk food industry just will not get us there.

Health: Quad-demic

Lord Bethell Excerpts

Tuesday 10th December 2024 Lords Chamber

[Baroness Merron (Lab)]

I listened carefully to the noble Lord. The JCVI considered that there was less certainty about how well the RSV vaccine works in people aged 80 and over when the programme was introduced in 2023, and that is because, as the noble Lord said, there were insufficient people aged 80 and older in the clinical trials. The JCVI continues to keep this under review, including looking at data from clinical trials and evidence in other countries, and there will shortly be an update to your Lordships’ House in respect of research and clinical trials.

[Lord Bethell (Con)]

The Minister says that we are determined to learn the lessons of Covid. During Covid we had vaccination rates of 90% but, as she said, only 16 million—just 25%—of our citizens have had the flu jab and vaccination rates among children are also deteriorating at a rate. I say this with some personal interest because there was an outbreak of the quad-demic in my own household at 2 am today. There are three times as many people in hospital today with flu than in this week last year. Can the Minister please explain what she is doing to increase vaccination rates, particularly among children?

Vaping Products: Usage by Children

Lord Bethell Excerpts

Monday 2nd September 2024 Lords Chamber

[Lord Bethell (Con)]

The noble Lord, Lord Winston, may be right that vaping has been around for longer than we think, but the current boom came out of a deliberate exercise by two academics at Stanford University, Adam Bowen and James Monsees, in 2005, to find a medical technology that would give people a route out of smoking which would give them the same social interaction—the smoking, the fiddling and the what have you. They deliberately sought to find a device that would help people give up smoking. In this endeavour they succeeded fantastically well. The business that span out of their work in Stanford became Juul, the big success story in the American vape industry, sold in 2017 for billions. In that respect, it is a wonderful success story of how medical technology can be used to crack one of the big, difficult knots in our medical challenges.

We should be honest with ourselves. In the UK, smoking cessation has completely stalled. There are still 50 million cigarettes smoked every day by around 15% of the country. There is no way that we will hit the 2030 smoke-free objective that we have set for ourselves on the current trajectory. In some demographics—the poorer demographics—we will not get there until 2050, if at all.

Vapes are a really promising opportunity—a way out. This is innovation at its best. However, vapes also present us with a classic but horrible public health dilemma: in seeking to forestall one deadly epidemic, we might accidentally be creating another one. Clearly, the vape companies, now largely owned by the tobacco companies, are targeting children. My noble friend Lord Storey put it really well. The statistics are plain. They have created a £1.5 billion nicotine addiction industry here in the UK, which is mostly made up of young people who have never smoked and never intended to smoke. I find that extremely uncomfortable.

As noble Lords have pointed out, current regulation is completely failing to prevent young people taking up vaping. I say this with due consideration of and respect for the efforts of those concerned, but the truth is that trading standards officers, HMRC inspectors, MHRA officials and local authorities are tripping over each other to try to find a way to control this. But the business moves more quickly than regulators can adapt, and, frankly, it is a bit of a mess. I have little hope that the various piecemeal ideas that are being proffered will be an effective answer.

This state of confusion is compounded, as the noble Lord, Lord Winston, quite rightly pointed out, by the ambiguity around the long-term health implications of vaping. I am a lay person, not a clinician, but I think I would be right to summarise by saying that although there is not conclusive evidence today that vaping is bad for you, there is enough on the books to make us worry that there is a fair chance of significant consequences sometime in the future.

What we end up with is a debate around whether we should have flavours, but we should be honest: the debate around flavours is a bit of a legislative displacement exercise. Flavours are intrinsic to the attraction of vapes, both to adults and to children, but the real dilemma facing us as legislators is how comfortable we feel about this industry growing in size. Are we comfortable with the number of vapers in the UK rising from 5% of the country to 15% or 25%? Are we comfortable with the industry being worth £3 billion or £5 billion, or maybe more? Are we comfortable with it attracting largely a poorer consumer group, for vapes to be used largely by young people and children, and for it to store up a potentially massive healthcare liability for the future? Those are the key questions. Or are we so worried that our smoking cessation tool may become a backdoor for another nicotine addiction sector that has dangerous health effects that cost our society another fortune, just like the tobacco industry did, that we should close the whole thing down, as many other countries have done or are trying to do? Is there a way of using regulation to walk the line between these two vivid and quite different choices?

This is the dilemma facing many areas of consumer medical advance. There is a wonderful revolution in the world of medicinal innovation. We must work much harder on the edge cases to make this bountiful for our taxpayers and our patients. This is true in nutrition, medtech, social media and many other fields. Let me give three quick examples.

There is mounting evidence that hallucinogenics might offer treatment for the horrible effects of PTSD. We should probably be encouraging more investment and research, but we will need a regulatory regime that prevents misuse of these potent drugs. After 10 years at the Ministry of Sound, I can testify that they can have both wonderful and devastating effects on one’s psyche.

Ketamine technology is being offered as a new treatment for unlocking psychological challenges, and I know many people who swear by it. However, I read with anger, as other noble Lords might have, about the death of Matthew Perry, the “Friends” star who died when his cynical doctor overprescribed the drug in exchange for hundreds of thousands of dollars in fees.

Cannabinoid medicines are another case. They offer treatment for those with epilepsy. Campaigners have argued very persuasively for more investment and research, and that they have been held back by arcane attitudes and laws about drug control. Recreational users of cannabinoids argue that edible highs are a healthy alternative to booze. I have grave concerns about the legalisation of cannabis, but, with global attitudes changing quickly, it is surely a possibility that this could happen here in the UK. Too many countries have already legalised marijuana without enough thought; they have not done the boring but important regulatory work around taxation, packaging, sanctions and transparency that encourages responsible behaviours.

We used to live in a binary world where medicines were for doctors, narcotics were for the police and there was a duty for the taxman to collect. But now we are in a more complex world of vapes, hallucinogenic treatments and cannabinoid edibles, where there is a leisure industry, a cosmetics industry and a nutrition industry all with one foot squarely in the medical world and aggressively trying to bend the rules to their advantage. Quite rightly, these industries are making claims that their products can help promote healthiness and fight disease. They have a point: we cannot rely on hospital treatment of disease alone to make Britain healthy. But this shambles around vaping flavours demonstrates what happens if the regulators are fragmented and decision-making does not keep up with innovation. That is why I encourage the Minister to really get stuck into the detail; to bring the various regulators together; to assign responsibility; to insist on much clearer data and reporting from the industry; to set deadlines for changes; to timetable reviews; to move quickly to close gaps; and to identify ingredients—as the noble Lord, Lord Winston, rightly pointed out.

We have a huge opportunity to apply exciting innovations to help the health of the nation and to build valuable businesses, but that is not going to work if our regulators are heavy-handed and move so slowly. Thesequasi-medical industries depend on an unremittingly activist approach to regulation and I ask the Minister to commit to more agile supervision than we have shown around vapes to date; to be prepared to close down bad behaviours when they are explicit; to put in place strict descriptions of what vapes can contain; to look very seriously at the licensing regime, as the noble Lord, Lord Storey, recommended; to look closely at advertising restrictions that get round many of the restrictions that we have on tobacco; and, if necessary, to act firmly in order to protect the vulnerable.

NHS: Long-term Sustainability

Lord Bethell Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Bethell (Con)]

My Lords, it is a great privilege to speak after the noble Baroness, Lady Warwick. I thank my good friend, the noble Lord, Lord Patel, for bringing about this important debate. I declare my interests as a research fellow on public health at the Milken Institute School of Public Health and a research fellow on biodefence at King’s College London, and as chairman of Business for Health, a community interest company which advocates for greater involvement in health by businesses.

There have been so many powerful words about the importance of investing in our healthcare system. I saw at first hand the incredible power of our national health system during the pandemic. I love the system and what it does for our society. However, we cannot duck two particularly important problems when debating this key issue.

One is the unbelievably heavy cost to society of our healthcare system. The deputy chair of the NHS, Wol Kolade, whom many will know, put this very bluntly; when he joined the board it was £100 billion a year, and it is now edging towards £200 billion a year. He asks:

“Where the hell is it going to stop?”


That is a pertinent question for this debate. We cannot treat our way into good health. We have to look at the underlying health of the country and at how we prevent disease.

We also have to think about the return on investment of our healthcare system. If we want to sustain it and to have it in a secure financial position, we have to ask whether it is giving a return on investment. We have 2.8 million people who are long-term ill at the moment and half a million extra who have left active employment. The OBR predicts that there is no hope that they will return, and there may well be another half a million on the way out in the next year or so. If the economic and spiritual prosperity of the country is not being underpinned by our healthcare system, we have to wonder whether, as a number of noble Lords have pointed out, we need a bit of a rethink.

That is why, alongside the noble Lord, Lord Filkin, and other colleagues, I launched Health is Wealth: A Fast Start for a Covenant for Health. We prioritised five areas of prevention which I believe are achievable and affordable and will yield a massive economic benefit. First, we have to scale up and deliver on our ability to detect and address the risk factors of disease. I am grateful to my noble friend Lady Blackwood for her words on genomics. Secondly, we have to strive for a smoke-free Britain. We should all celebrate this week’s achievement on the smoke-free generation legislation, but there is so much more we can do in the next 10 years to reduce the 5 million people who already smoke. Thirdly, we need to build a much stronger focus on healthy eating, making it affordable for all and helping us reverse the upward trend in obesity. Fourthly, we must focus on the health of our children, ensuring that healthy habits are ingrained from an early age. I emphasise mental health here, in particular the role of the digital world in provoking a mental health challenge for our young people. Finally, we need to ensure that no area is left behind and look at helping those who live in areas with the worst health to live longer. That includes the underlying environment in which they live—the dirty air, the mouldy homes and online and toxic workplaces.

The moral argument for this prevention and upstream focus is very strong, but the economic argument is overwhelming. We cannot keep pouring increasing amounts of money into more hospitals, doctors, nurses and medicines in the hope that we can treat our way out of this problem. We have to address the determinants of health. Can the Minister say what more can be done in this space from a position of ambition for the NHS? We cannot keep scapegoating the NHS for the poor health of our country. We have to look upstream and focus on the determinants of health.

Anaesthesia Associates and Physician Associates Order 2024

Lord Bethell Excerpts

Monday 26th February 2024 Lords Chamber

[Baroness Harding of Winscombe (Con)]

My Lords, I support this Motion and, not for the first time in a debate on health, I find myself in almost complete agreement with the noble Lord, Lord Hunt, and the remarks he made earlier in an extremely powerful speech. We are exemplifying the right debate here, in that this is a subtle and important issue.

I do not wish to suggest that I challenge the esteemed clinicians from a number of the different clinical tribes who have spoken this evening. I speak as a non-expert, as a manager of people, and as a patient. Non-experts in healthcare would find it completely baffling that we have 3,000 people working day in, day out in clinical roles who are currently unregulated. It cannot be right, and I have not heard any argument this evening that suggests that anyone in the Chamber thinks it is right. I think we are all united in our agreement that these hard-working, brilliant people need proper professional statutory regulation.

I hope that, therefore, the order, as it stands, passes. But it is worth dwelling on why this has created so much controversy. Fundamentally, it is because change is hard—and people change is hard and scary. There is a real danger that we underestimate how important it is to look after the people who care for us, and that what we are really hearing from a number of the different clinical tribes is fear, frustration and hurt that they are not being looked after. The real tragedy is that, as the noble Lord, Lord Hunt, said, in the process we have made 3,000 more people feel hurt, unloved and uncared for in the awful debate out in the Twittersphere or X-sphere or whatever it is called.

I will not talk for very long. I just want to register that this has been far too long unfixed, that 20 years is too long for people to be practising without regulation, and that other countries around the world are far ahead of us on this. We should be discussing how we properly define the scope of practice and how we then extend that scope of practice, with the appropriate training for prescribing rights and the ability to order X-rays, just as happens in many other countries in the world. We are all in this Chamber rightly proud of the NHS, but we must not stick our heads in the sand and convince ourselves we are brilliant when others fixed this issue 20-plus years ago.

I finish by saying that regulation is clearly not enough. I completely agree with the noble Baroness, Lady Finlay: we have to recognise that our health and care workers feel unloved and uncared for. There are far too many stories of people unable to get a hot meal when they are working night shifts or having to cancel their own wedding because they are not rostered to be allowed to take the time off. None of that requires professional regulation; that requires professional management. We need both of those.

[Lord Bethell (Con)]

My Lords, I hope that my noble friend the Minister will not mind if I say that I am very grateful to the noble Baronesses, Lady Bennett, Lady Brinton and Lady Finlay, for the regret amendments and this debate today. Secondary legislation comes through the House and too often we overlook it. Every now and again we need to put a spotlight on some of the important measures that go through.

I regret two things. I deeply regret the way in which the professions of associate physician and associate anaesthetist have been denigrated in the press, in the lobbying material that has been sent around, and, frankly, in aspects of this debate. I agree with my noble friend Lady Harding and the noble Lord, Lord Hunt, that the feelings and sentiment of these hard-working contributors to our healthcare system have been overlooked. I was sent a very robust briefing by the BMA. I replied: “Is there nothing positive you can say about these hard-working healthcare professionals?” The reply came back—the noble Baroness, Lady Finlay, was copied in on it—that there was not: there was nothing positive it could say about them. I greatly regret that tone, and wish it had not happened.

I am not a clinician and I do not have anything to rival some of the comments made by the clinicians. However, I point out that our hard-working healthcare professionals are incredibly stretched. Take GPs, for instance: 350 million appointments were conducted in primary care last year, 160 million of which were by GPs themselves. That was 50 million more than in 2019, so 44 more appointments per practice. That trend is going up. Britain is getting less healthy, and there is a large amount of immigration. The number of full-time equivalent GPs—although the number of GPs has gone up, a lot of them are working fewer hours—has decreased from 28,000 in September 2015 to 27,000 in October 2023. The complexity of many people turning up to these appointments is very high.

We have to find people from somewhere to do some of these appointments, and there are going to be people who have a lot to contribute who do not necessarily go through the 10 years of qualification to become a GP. We should be embracing them. That is what is happening in every other professional walk of life—it is happening with the astronauts who fly to the moon, the people who fly our planes, and the lawyers who run our courts. The modernisation of workforces is happening everywhere; we should embrace that. My noble friend the Minister alluded to 12,000 AAs and PAs by 2036; that would be just 8% of the number of doctors. That is not a revolution or a threat that the doctors of Britain should be worried about.

If these regulations do not go through—the noble Baroness, Lady Bennett, has said that they will—then it would be difficult to enforce standards, there would be years of delay to regulate the professions, there would be a reduction in the number of healthcare professionals to support our healthcare system, and training programmes would be on hold. I support the passage of this legislation, so that we can modernise the workforce, increase primary care capacity, improve the lot of our hard-pressed GPs and make it easier for a wide range of talents to make a difference to the British healthcare system.

[Baroness Bloomfield of Hinton Waldrist (Con)]

My Lords, I will speak very briefly in favour of these regulations. I am absolutely in favour of any way in which we can leverage the ability of our doctors to concentrate on what they want to do, and what they have been highly and expensively trained to do, which is to take responsibility for seeing, diagnosing and treating patients who are ill and in need of medical help. I am also in favour of trying to reduce the exorbitant cost of locum GPs, which bleed resources from the National Health Service—resources which could be much better spent elsewhere. Some of the Government’s initiatives, such as allowing pharmacists greater and more extensive advisory and prescribing powers, are also very welcome.

I have no philosophical objection to the concept of physicians or anaesthetists being supported by assistants, whether they are senior nursing staff or others, but I share the concern that the very term “associate” implies a greater degree of qualification than is actually the case. Two years’ training post a science degree does not a doctor make. Of course they should be regulated by an organisation which enjoys public confidence, so long as that in itself does not imply a greater medical qualification.

It is easier to prevent overreach in a hospital environment, where supervision in anaesthesia should be routine, but it is much harder in general practice. The reason I rise now is because my husband was seen by a physician associate when his throat failed to heal weeks after he burned it with a hot cup of coffee. After the young man had taken a photograph and disappeared up the corridor with his phone, allegedly to see a GP, he reappeared with an ominous pamphlet entitled “Suspected throat cancer” and suggested an urgent appointment at the John Radcliffe Hospital. I am pretty sure he was not trained to be the bearer of such bad news. So undoubtedly physician associates need to be regulated, though I acknowledge it was better this way round than ignoring something and saying that there was no issue to be dealt with when there might have been.

We have 14 GPs in our local practice, in a small town in Oxfordshire: 11 work three days per week, none of them works full-time and one of them works one day per week. Perhaps we should also address the loss of 40 working days per week from any similar team, as well as putting in place things that make doctors’ working lives more rewarding and meaningful. If physician associates are part of that then I am fully supportive, so long as they are properly regulated. The Faculty of Physician Associates code of conduct, produced with the GMC, says that physician associates will always work under the supervision of a designated senior medical practitioner and that they must work within the limits of their experience. Let us make sure that these regulations will help make that happen.

Premature Deaths: Heart and Circulatory Conditions

Lord Bethell Excerpts

Tuesday 6th February 2024 Lords Chamber

[Lord Markham (Con)]

Absolutely. These are all key parts of a good, healthy lifestyle for mind and body—for mental health as well. Social prescribing is important for all this as well.

[Lord Bethell (Con)]

My Lords, following the appointment last year of Professor John Deanfield as the champion for personalised care, can my noble friend the Minister please update the House on the progress of his report on radical approaches to prevent life-threatening cardio- vascular disease?

[Lord Markham (Con)]

I will need to come back in writing to my noble friend on this. I take this opportunity to thank him for his work on the Times Health Commission and for generally pushing forward the whole prevention agenda.