Fracture Liaison Services

Lord Black of Brentwood Excerpts

Wednesday 4th December 2024 Lords Chamber

Asked by

[Lord Black of Brentwood]

To ask His Majesty’s Government what progress they are making towards universal provision of fracture liaison services in England by 2030.

[Lord Black of Brentwood (Con)]

My Lords, it is a privilege to introduce this important debate, in which I declare an interest as co-chair of the All-Party Parliamentary Group on Osteoporosis and Bone Health. I am very grateful to all those taking part. I hope that, together, we will again demonstrate the strength of feeling on this issue across all parties in the House, and our determination to ensure action. It is a particular pleasure to welcome the noble Baroness, Lady Merron, to her place for her first debate on osteoporosis as Health Minister. She has always been immensely supportive on this issue, and I know how seriously she takes it. Her leadership will be crucial in advancing the cause of fracture prevention in the days ahead, and I look forward to hearing what she has to say.

Fractures caused by osteoporosis are one of the greatest threats to people living well in later life, affecting half of women and a fifth of men over 50. They are the fourth most-harmful health condition, measured by disability and premature death. They have a profound impact on those who suffer from this debilitating condition —as I saw in the case of my own mother, whose later years were blighted by it—and on those who care for them. Yet—this is perhaps the most upsetting aspect of this debate—they are entirely preventable with safe and affordable therapies.

Fractures impose devastating costs on people and the health service. The hospital episode statistics show that hip and other fractures are second and fourth on the list for total bed days lost to unplanned admissions to hospitals. Most of these patients are, on further investigation, found to have osteoporosis. Hip fractures alone cost the NHS £2 billion annually and are “heart attack-level” events that burden hospitals and our desperately overstretched social care system.

However, it need not be that way. Half of these patients had a previous fracture that could and should have flagged them as being at risk. That is where fracture liaison services—FLS—come in and why the Government’s commitment, made during the election, to making them universal was so welcome. The Secretary of State for Health and Social Care told the Daily Mail, which, alongside the Sunday Express, has been a steadfast campaigner for universal FLS—I pay tribute to them—that one of his first acts in government would be to task NHS England with developing a rollout plan so that every part of the country could access these vital services. I commend his leadership and vision.

As I said, the Minister has also been a determined campaigner. I recall her urging my noble friend Lord Kamall—whom I am delighted to see taking part this evening and who has also been extremely supportive —to acknowledge back in 2021 that two-thirds of people were not receiving the treatment they needed for osteoporosis. Three years on, that figure remains tragically unchanged. The postcode lottery for FLS means that 90,000 people are still missing out on urgently needed bone medications.

In 2021, we also learned through a freedom of information request that only half of NHS trusts in England had a fracture liaison service in place. Yet again, almost nothing has changed since. Progress should be so easy, but the truth is that we are stagnating and, in the case of broken hips, that inaction costs lives. Earlier this year, the noble Baroness who is now the Minister from the other side of the Chamber asked my noble friend Lord Markham when would the Government’s

“promise to establish more fracture liaison services actually be delivered?”.—[Official Report, 5/2/24; col. 1443.]

We need to ask that again today, because time is running out. Fracture liaison services are the proven solution to the public health crisis of preventable fractures, offering a perfect fit with the Government’s laudable focus on moving from sickness to prevention and on getting people back into work.

FLS are the world standard in this area. They ensure that, after a person suffers their first fracture, they are assessed for osteoporosis, put on treatment and helped to stay on it. That prevents this horrible disease progressing and reduces significantly the chance of further broken bones. In areas without an FLS, the story is different. Many patients who suffer their first fracture are fixed up in A&E and then forgotten about. No assessment for osteoporosis is carried out and no anti-osteoporosis medication is prescribed. Far too many therefore end up back in hospital with multiple, more severe fractures. Over a quarter of hip fracture patients die within 12 months. That is a human tragedy.

FLS are perhaps the most powerful example that we have of preventive healthcare, which is why the Government’s commitment to rolling it out to every trust by 2030 is so critical. There is strong consensus in this House that this is the right thing to do. The Government support it, the Opposition support it and the Liberal Democrats support it. I can recall few other subjects where all parties are so united. So, in the interests of patients, the NHS, the taxpayer and the wider economy, let us get on with it, and fast. While 2030 may seem far away, the scale of work required to deliver universal FLS is substantial. We cannot afford to let this critical deadline creep up on us.

The Royal Osteoporosis Society’s data, scrutinised by Department of Health and Social Care officials, shows that universal coverage would save 750,000 hospital bed days in just five years, prevent 74,000 fractures and save almost 9,000 lives—that is 9,000 people who are someone’s mother or grandma, husband or dad. The ROS, whose campaigning work on this issue has been exemplary, has identified six integrated care boards ready to go. They are like horses at the starting gate: eager, ready and waiting for the Minister and her colleagues to fire that starting gun. If we do that now, we can just about bring those ICBs online by April. The ROS has proposed following this with 12 more ICBs in 2026, 2027, and 2028 respectively.

This proposal is a practical and cost-effective road map to real change. If those ICBs come online as planned, by 2029, FLS will save over 300,000 hospital bed days—that is 60,000 extra elective surgeries that the NHS can deliver by the next election. Further delay is not acceptable; if those first six ICBs do not start until 2026, by 2029 FLS in England will save only half the bed days—that means 30,000 fewer surgeries. Push it back two years and the benefits get pushed back even further into the future, with more preventable fractures, more lives lost, and more pressure on the overstretched NHS.

Many health initiatives take a decade to pay off, but the department has seen the comprehensive analysis which shows that these services break even within 18 to 24 months. All that is needed is a modest pump- priming fund to cover the first two years. Then, after break-even point, the cost savings can keep them sustainable within local budgets. I understand that the former Secretary of State, Victoria Atkins, identified funds within her budget for this very purpose as part of the major conditions review before the general election. Releasing this funding now would kick-start the rollout of FLS.

While the human cost of fractures will always be the most compelling reason to act, we cannot ignore the need to help older workers stay in the labour market, an important aspect of public policy. Independent analysis shatters the stereotype that people with osteoporosis are all retired, and lays bare the cost of inaction to our economy. Each year, osteoporotic fractures in working-age adults lead to over 1.5 million work days lost due to sick leave and carer absences, costing employers £130 million annually. The OBR has identified musculoskeletal conditions, a definition that includes osteoporosis, as the second greatest driver of long-term sickness. This has to change.

When we last debated this subject in September 2023, I ended with these words:

“This is a big strategic challenge for the whole of our society. Bold, visionary leadership from the Government could change the terms of the game, improving the lives of tens of thousands, relieving pressure on our beloved NHS and saving money for the taxpayer. We have such a huge opportunity here to save and change lives. I implore the Government to take that opportunity”.—[Official Report, 14/9/23; col. GC 232.]


I make no apology for repeating those exact same words, with a new Government and a new chapter opening in the history of the NHS. Let us give people with osteoporosis back their lives and the future they deserve, and let us start now. Again, I implore the Government to act, and I beg to move.

HIV Care: Access

Lord Black of Brentwood Excerpts

Wednesday 11th September 2024 Lords Chamber

Asked by

[Lord Black of Brentwood]

To ask His Majesty’s Government what estimate they have made of the number of people with diagnosed HIV in England who are not accessing HIV care.

[Lord Black of Brentwood (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare my interest as a patron of the Terrence Higgins Trust.

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

My Lords, in 2022 England exceeded the joint United Nations programme on HIV and AIDS targets, with 98% of people diagnosed with HIV receiving treatment. The UK Health Security Agency estimates that between 6% and 15% of people living with diagnosed HIV in England did not access HIV care that year. Re-engaging people into HIV care is a priority for the current HIV plan for England and for the new plan that is in development.

[Lord Black of Brentwood (Con)]

My Lords, we know from the opt-out testing programme in A&Es introduced by the last Government that up to 15,000 people in England who are aware that they have HIV are not accessing life-saving care, with devastating personal consequences for them and profound ramifications for public health, because if you are not on medication, you can pass on the virus. Is the Minister aware of the case of a 45 year-old man, out of care for several years, who went to hospital with a headache and was found to have a CD4 count of just four. He was diagnosed with cryptococcal meningitis, an AIDS-related illness. He went blind and died three months later, one of a growing number of tragic preventable deaths. Can the Minister ensure that we get an HIV action plan as soon as possible and that this issue—with funding, if necessary—will be a key part of it, to ensure that we get those lost to care back into it?

[Baroness Merron (Lab)]

My Lords, Ministers have already commissioned officials for advice on how to progress the development of a new HIV action plan. On the very tragic case that the noble Lord refers to, he will be aware that since April 2022, NHS England has funded emergency departments in London, and in areas of very high diagnosed HIV prevalence, to provide routine blood-borne virus testing for HIV as well as for hepatitis B and hepatitis C in everyone aged over 16. That attention at the point of contact is crucial in this area.

NHS: Fracture Liaison Services

Lord Black of Brentwood Excerpts

Monday 5th February 2024 Lords Chamber

Asked by

[Lord Black of Brentwood]

To ask His Majesty’s Government what plans they have to invest in NHS Fracture Liaison Services in England.

[Lord Black of Brentwood (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I declare my interest as co-chairman of the APPG on Osteoporosis.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government recognise the value of the quality-assured secondary fracture prevention services, including the fracture liaison services, or FLS. More than 500,000 fragility fractures occur annually in the UK, and up to 40% of fracture patients will suffer from another. FLS are commissioned by integrated care boards, which are well placed to make decisions according to local need. The Major Conditions Strategy: A Case for Change and Strategic Framework outlines that, with NHS England, we will explore supporting the additional provision of FLS.

[Lord Black of Brentwood (Con)]

My Lords, I thank my noble friend for that Answer, but all we ever seem to get are warm words and then broken promises. We were promised money for FLS in the elective recovery plan by the Chancellor himself, with announcements on FLS before the end of last year. A package of measures was promised in the Autumn Statement, as well as a national specialty adviser on osteoporosis. None of those promises has been kept.

To go back to basics, can my noble friend tell me whether he accepts that the 90,000 people who need anti-osteoporosis medication are missing out on it because of no access to FLS; that universal coverage of FLS in England could prevent 31,000 hip fractures over five years; and that investment in FLS would pay for itself in just 18 months? If he does accept those points, can he tell us why on earth these promises have not been honoured, and why the needless suffering of tens of thousands of people has not been brought to an end? When will words finally become deeds?

[Lord Markham (Con)]

First, I thank my noble friend for his tireless campaigning in this space. I agree that there is a very good case to be made. Many of us will know the advantage of the fracture liaison services. A lot of studies show that you are at least 10% less likely to suffer from another fracture, so it is a vital part of the prevention programme. There is a very strong case behind it, and my noble friend can rest assured that it is something that we are really looking to progress.

Sexually Transmitted Infections

Lord Black of Brentwood Excerpts

Tuesday 5th December 2023 Lords Chamber

Asked by

[Lord Black of Brentwood]

To ask His Majesty’s Government what steps they are taking to tackle the increasing rates of sexually transmitted infections in England.

[Lord Black of Brentwood (Con)]

My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I declare an interest as a patron of the Terrence Higgins Trust.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

We remain committed to improving sexual health in England. The UK Health Security Agency conducts comprehensive surveillance of sexually transmitted infections and supports local areas to use this data to inform sexual health services delivery. We are working with it and other key delivery stakeholders to explore options for the best use of both existing and innovative preventive interventions, as well as strengthening messages to the public on how to reduce the transmission of STIs.

[Lord Black of Brentwood (Con)]

My Lords, PrEP has been a game-changer in the fight against HIV, and making sure that as many people at risk of infection as possible have access to it is fundamental to meeting the target of ending new HIV cases by 2030, but at the moment we are failing to ensure that access because of the immense pressure on sexual health services. Nearly 60% of people are forced to wait more than three months to access PrEP through that route. Does my noble friend agree that one way to deal with this problem is to make PrEP available through pharmacists, as contraception now is—an initiative backed by the Royal Pharmaceutical Society—and does he recognise that such a policy, in line with the ambition of Pharmacy First, would not just relieve pressure on sexual health services but encourage uptake among women, who make up 31% of people accessing HIV care but represent only 2% of PrEP users?

[Lord Markham (Con)]

I thank my noble friend for all the work he does in this space and absolutely agree that we are world leaders in the use of PrEP. We have 86,000 people currently using it. It is a key prevention tool and something that we want to expand as widely as possible. There is an excellent pilot happening in Brighton at the moment, where you can get PrEP online, and I absolutely agree that we should look at Pharmacy First as a way to expand that even further.

National Health Service: Major Conditions Strategy

Lord Black of Brentwood Excerpts

Monday 18th September 2023 Lords Chamber

[Lord Markham (Con)]

AI is a key point. Take stroke, which is one of these conditions. I saw a very good example in the Royal Berkshire the other day of what we all know as the golden hour, and the results from it. The Royal Berkshire has AI scans that go straight to the responsible physician, who can say straightaway whether a thrombectomy, for instance, is needed, the timing of which is critical. That is now being used in that cluster of hospitals and will be one of the six key technologies, the roll out of which we will encourage across the board to others.

[Lord Black of Brentwood (Con)]

My Lords, osteoporosis must surely be included in the major conditions strategy, as fractures are the fourth-worst cause of premature death and disability in the UK, with as many people dying of fracture-related causes as lung cancer and diabetes. Does my noble friend agree that the inclusion of osteoporosis in the strategy would need to be backed up by investment in fracture liaison services to make it effective? Would not a two-year transformation budget of just £54 million to pump-prime universal coverage of FLS in England, which would quickly pay for itself, be a game-changer for patients, the NHS and the taxpayer?

[Lord Markham (Con)]

I thank my noble friend. I think that is covered by musculoskeletal conditions, which is one of the six major conditions we are looking at. Key to pathways is moving treatment away from individual silos to patient-based treatment that looks across the board. We know that 55 year-olds have, on average, at least one condition, and that 80% of those over 85 will have one, two or three of these conditions. We need to ensure that we look at this across the board, rather than in silos.

Osteoporosis: Early Detection

Lord Black of Brentwood Excerpts

Thursday 19th January 2023 Lords Chamber

Asked by

[Lord Black of Brentwood]

To ask His Majesty’s Government what steps they are taking to improve rates of early detection of osteoporosis.

[Lord Black of Brentwood (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and declare my interest as co-chairman of the APPG on Osteoporosis and Bone Health.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government are committed to improving outcomes for those living with osteoporosis. NHS England, through its Getting It Right First Time programme, is exploring how best to support integrated care systems in the detection and management of osteoporosis. This includes a focus on improving provision of and equity of access to high-quality secondary fracture prevention services, such as fracture liaison services that help to identify those most at risk and offer preventive support.

[Lord Black of Brentwood (Con)]

My Lords, osteoporosis affects half of women and a fifth of men over the age of 50, but all too frequently its late diagnosis means broken bones, pain, reduced independence and, sometimes, life-changing disability. Yet there is no excuse for that, because we have it in our power to identify those most at risk. Is my noble friend aware that almost two-thirds of people with one of three major risk factors have never received a bone health assessment, while a simple and cheap assessment tool proven to prevent hip fractures can be used in five minutes in a GP’s surgery? As the costs of helping people recover from fractures are far higher than the costs of identifying and treating those at risk, should the National Screening Committee not urgently reconsider the case for a targeted national screening programme, so that as a country we invest just millions of pounds in preventing harm rather than billions in managing failure?

[Lord Markham (Con)]

I agree with my noble friend that prevention is always better than cure. The beauty of these processes is that I get to swot up, and I learned that the second largest bed-intake cause is actually a fractured femur from osteoporosis, so he is correct. We have a target that 95% of patients will get a check within six weeks by March 2025. It is good that musculoskeletal services are now part of the national improvement programme, but we clearly need to make sure we are on top of that.

Health: Pancreatic Cancer

Lord Black of Brentwood Excerpts

Monday 21st November 2022 Lords Chamber

Asked by

[Lord Black of Brentwood]

To ask His Majesty’s Government what steps they are taking to improve survival rates for pancreatic cancer.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

Improving early diagnosis is incredibly important to help boost cancer survival, and the Government are committed to the NHS Long Term Plan ambition of diagnosing 75% of cancers at stage 1 or 2 by 2028. Pancreatic cancer is difficult to diagnose due its unspecific symptoms. To help diagnose these cancers, we have opened 91 community diagnostic centres and 96 non-specific symptoms pathways which are transforming the way those with symptoms not specific to one cancer are diagnosed.

[Lord Black of Brentwood (Con)]

My Lords, this is Pancreatic Cancer Awareness Month, a time to remember those who have died prematurely of this cruel and unforgiving disease, but also a time angrily to reflect on the shocking statistics that surround this least-survivable and quickest-killing cancer: three in five pancreatic cancers are diagnosed at a late stage—worse than any other cancer; half of those diagnosed die within three months—worse than any other cancer; almost 60% of people are diagnosed in A&E—worse than any other cancer. These statistics are shameful. Would my noble friend tell us what has happened to the 10-year cancer plan, which is so vital in this area, and commit to a strategy within it to ensure early diagnosis of pancreatic cancer patients within 21 days of presenting with symptoms? Will he explain why there is so little investment in research in this area—just 3% of the total UK cancer research budget—when we vitally need a test to stop this horrible disease in its tracks?

[Lord Markham (Con)]

My noble friend is correct: pancreatic is probably one of the cruellest of cancers. We have a 10-year cancer plan; to answer his question, we are going through 5,000 responses, and we are analysing them and will report back shortly. On research, we are performing over 70 different pancreatic cancer studies. Key to all of this is not just early diagnosis; more important than ever, in this awareness month, is making sure that people are aware and go to their doctors early if they have any concerns at all.

Health and Care Bill

Lord Black of Brentwood Excerpts

Committee stage
Thursday 20th January 2022 Lords Chamber

Moved by

[Lord Black of Brentwood (Con)]

50: Clause 16, page 14, line 4, at end insert—
“(j) fracture liaison services to identify people at increased risk of fragility fractures and prevent future fractures.”Member’s explanatory statement
This amendment ensures equity of access to Fracture Liaison Services for people with osteoporosis.

[Lord Black of Brentwood (Con)]

My Lords, Amendment 50 is supported by the noble Lords, Lord Hunt of Kings Heath and Lord Rennard, and the noble Baroness, Lady Masham, underlining the cross-party interest in and support for this vital issue. I am grateful to them. I note my interest as co-chairman of the APPG on Osteoporosis and Bone Health. I also support Amendment 101B in this group, on mental health, and much look forward to the debate on the other amendments.

Amendment 50 is, at heart, about equality of access to services for people with osteoporosis. If accepted, it would end the current appalling postcode lottery which means that so many people are suffering unnecessarily from the pain and distress of avoidable broken bones. It will do this by making the provision of fracture liaison services—FLS—one of the core services that an integrated care board must consider for the people for whom it has responsibility, alongside dental and ophthalmic services and others.

--- Later in debate ---

I regret that the Government cannot accept these amendments. I hope I have given noble Lords some assurance on the issues where I have sensed the strength of the House’s feeling. I hope we can continue these conversations. In that spirit, I hope that noble Lords will not press their amendments.

[Lord Black of Brentwood (Con)]

My Lords, even by the standards of your Lordships’ House, this has been an exceptional debate. The noble Baroness, Lady Pitkeathley, said that this is a really important set of amendments which go right to the heart of the Bill. They cover a remarkable range of issues. I, for one, am profoundly grateful to all the speakers who have taken part.

I think we all have some sympathy for my noble friend the Minister. He will have heard a number of messages loud and clear. I would like to mention the powerful contribution from the noble Baroness, Lady Masham, with her very important personal insights on the issue of fractures and the problems in rural communities. The noble Baroness, Lady Hollins, gave us a comprehensive view of the integration of services. It certainly struck a chord with me, as I am currently grappling with the problems faced by an elderly friend who is seriously ill and for whom these issues are very real and distressing. My noble friend Lady McIntosh told her own story of osteopenia, which underlined how vital early diagnosis and treatment are.

I thank the Minister for his comprehensive response. I think we all welcome his comments on data and digitisation. These are obviously good, but it is not just about data or monitoring, nor about building blocks, however important they are. It is about structures and obligations, and about effective integration being written into the Bill.

I am afraid that the elephant in the room, identified by the noble Lord, Lord Scriven, is still sitting out there. The Minister will have seen the strength of feeling of the House. As he said, there should be further conversations, which I think everybody would welcome. Otherwise, these issues will come back on Report.

It is essential that we tackle the issue of bone health and, as the noble Lord, Lord Rennard, said, this Bill is the right place to do it. The noble Lord, Lord Hunt of Kings Heath, summed it up superbly. We have known the benefits of proper prevention for a very long time, but progress has been at a snail’s pace. There was no answer to that point. In purely economic terms, as well as for the care of individuals, this is—in the vernacular—a no-brainer. If we do not make progress, we are letting down patients, taxpayers and the NHS.

I hope we can make further progress on all the points that have been raised by noble Lords in this extraordinary debate. In the meantime, I beg leave to withdraw my amendment.

Amendment 50 withdrawn.

NHS: Fracture Liaison Services

Lord Black of Brentwood Excerpts

Monday 8th November 2021 Lords Chamber

Asked by

[Lord Black of Brentwood]

To ask Her Majesty’s Government what support, if any, they intend to provide to the National Health Service to ensure full coverage of Fracture Liaison Services throughout England.

[Lord Black of Brentwood (Con)]

I beg leave to ask the Question standing in my name on the Order Paper and note my interest as co-chairman of the APPG on Osteoporosis.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

I thank my noble friend for raising this issue and for the work he has done as part of the all-party group. I look forward to reading the report it is writing on this important service. The NHS has prioritised the fracture liaison service as a key part of its elective recovery plans, after this was a recommendation from the best musculoskeletal health pathway improvement programme. NHS England is working closely with integrated care systems to support the implementation of this and other services.

[Lord Black of Brentwood (Con)]

I thank my noble friend for that Answer. He will be aware that fracture liaison services are vital for the identification and treatment of osteoporosis. That silent disease, as it is known, causes over half a million broken bones each year—one every minute—and as many deaths, resulting from fractures, as lung cancer and diabetes. The FLS is the world standard for fracture prevention, yet too many suffering from osteoporosis are unable to access the service. Is my noble friend aware that, when the Royal Osteoporosis Society surveyed NHS trusts in England, only 51% confirmed they provided the service and many of those are underfunded? Can he tell us what action the Government will take to reduce such clear health inequalities and make sure that fracture liaison services are available to all?

[Lord Kamall (Con)]

I thank my noble friend for highlighting the importance of this issue. There are MSK leads in local regions who have the ability to focus on what is best for their local region, with the incorporation of key performance indicators related to the FLS within the national clinical audit. NHS England has also convened a group of key clinical opinion leaders to develop an evidence-informed integrated secondary fracture prevention pathway for sharing with integrated care systems. There are many other issues that I could mention, and I would be happy to write to my noble friend.

Virginity Testing

Lord Black of Brentwood Excerpts

Tuesday 12th October 2021 Lords Chamber

[Lord Kamall (Con)]

I give the noble Baroness the assurance that I agree—I do not think anyone disagrees—that we should try to ban both these practices as soon as possible. The issue is that although I do not personally consider it a cosmetic procedure, legally it is considered as such, and that is why we have to be a little more careful about how we address the issue in legal terms, and the exact drafting of the ban. Of course, any medical professional who carries out these procedures following a ban will be breaking the law, and that is absolutely right. The other issue we then have to consider is what penalty those who break the law in this way will face.

[Lord Black of Brentwood (Con)]

My Lords, I welcome the Government’s renewed commitment to making virginity testing illegal, but I hope the fate of similar commitments in the health and care sector does not befall it. It is now four years since the Government made a similar pledge to end another degrading and cruel practice, that of so-called gay conversion therapy, and we are no nearer action to making it illegal than we were in 2017. Does my noble friend understand the frustration of those who want to see this repulsive practice banned but are having to wait for endless consultations and a failure to find parliamentary time? Is not the Health and Care Bill the perfect vehicle to fulfil this long-standing government commitment?

[Lord Kamall (Con)]

I thank my noble friend for that question. I think we all agree, as he said, that conversion therapy is an awful practice and should be outlawed. The Government have made a commitment to outlaw it. There is an interesting thing, when we talk about the history of various commitments from the Front Bench and whether they were implemented: around Christmas time, we often see advertisements saying, “A dog—or a puppy—is for life, not just for Christmas”. As we know, with ministerial life, it is the opposite: a ministerial portfolio is for Christmas, not for life. However, when I look back at my time, I would ask people to judge me on my actions.