Health Bill

Lord Evans of Rainow Excerpts

Committee stage
Wednesday 11th November 2026 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, perhaps I may start by warmly welcoming the noble Baroness to the Dispatch Box. We wish her well.

This has been a valuable debate on an issue that affects millions of people across the country. While the amendments before us take different approaches, they are united by a common concern that access to NHS dentistry remains increasingly difficult to secure. I particularly wish to speak in support of the amendment in the name of my noble friend Lady Coffey. At its heart lies a simple but important principle: access to dentistry should not depend on where a person lives or what they can afford. Few would disagree that oral health is an integral part of overall health, yet for too many patients access to NHS dental services has become a postcode lottery.

The duty proposed by my noble friend would place equity at the centre of decision-making. That is a principle which this House has supported on many other occasions in many other areas of healthcare. It is surely no less important when it comes to dentistry.

The amendment from the noble Lord, Lord Hunt, and the noble Baroness, Lady Pidgeon, also raises an important issue. One frustration for Parliament and for the public is that discussions about NHS dentistry are too often conducted in the absence of clear, comprehensive and consistent information. Regular reporting on workforce pressures, access, inequalities and unmet need would provide a valuable evidence base against which future progress could be measured and Governments held to account.

The amendment from the noble Baroness, Lady Pidgeon, addresses perhaps the most visible manifestation of the current problem: so-called dental deserts. Finding an NHS dentist has become extraordinarily difficult, if not impossible, in many parts of the country. Today, three in five adults are not accessing NHS dentistry. That is not a marginal problem; it is a challenge affecting communities across the kingdom. We now have areas of the country where fewer than four in 10 adults have seen an NHS dentist in the past two years. That should concern us all. It speaks not merely of pressures within the service but to growing inequalities in access to care.

Patients are travelling significant distances for routine treatment; being forced into the private sector, despite financial pressures; or presenting at GP surgeries, walk-in centres and A&E departments because they have nowhere else to turn. These are symptoms of a system that, despite the dedication and professionalism of the dental workforce, is struggling to meet public demand.

Improving NHS dentistry requires more than warm words. Good oral health is not a luxury; it affects children’s development, educational attainment and well-being. It affects people’s ability to work, to communicate with confidence and to maintain their dignity. Increasingly, we understand its connection to wider physical health and quality of life. At a time when we are rightly focused on prevention, reducing health inequalities and delivering care closer to home, dentistry must be part of that conversation. We cannot continue to accept a situation in which access to NHS dental services depends so heavily on geography, workforce shortages or the ability to pay. These amendments offer thoughtful and constructive ways of advancing that object.

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

My Lords, I am very pleased to respond to this group, following on from these Benches from my noble friend Lady Hyde, who I am delighted to be working with on this Bill. I am very glad that she made her debut on group 1 today. We look forward to hearing more.

I am in absolutely no doubt of the challenge when it comes to dental services and dentistry. I am also deeply conscious of the situation that we started from. I will refer to some of the points about improvements and the need for further improvements, but let me turn first predominantly to the amendments before us.

On Amendment 49 from the noble Baroness, Lady Coffey, I understand the good intention behind this amendment but do not believe that it is necessary, because under Section 1 of the National Health Service Act 2006, the Secretary of State will continue to have a duty to promote a comprehensive health service in England and that includes NHS dental services.

In addition, Clause 4 strengthens the statutory framework by amending the Secretary of State’s existing duties so that they must have regard to the need to reduce inequalities in access to health services across England. As the noble Lord, Lord Patel of Bradford, rightly said, that includes coastal communities as well as others. The duty that I referred to provides a clear statutory basis for considering geographical and other inequalities in access. A dentistry-specific duty would therefore duplicate the deliberately broader framework that the Bill establishes.

I can reassure the noble Baronesses, Lady Coffey and Lady Pidgeon—because the comments that I am about to make also relate to Amendment 216 in the name of the noble Baroness, Lady Pidgeon—that we are taking practical action to tackle dental deserts. I was grateful for the comments of the noble Lord, Lord Patel of Bradford, who made the point that the definition of a dental desert is rather more complex than just miles, or indeed numbers, and that is indeed the case. The practical actions that we are taking include introducing a package of reforms to address some of the most pressing issues that dentists and dental teams have been experiencing, and therefore the knock-on effect to patients. These reforms prioritise those with the greatest need and shift care away from clinically unnecessary check-ups.

On the matter of addressing dental deserts, we have, supported by some £11 million, brought in some 50 additional dental school places on top of the existing 809. It is interesting to note that the University of Porstmouth and the University of East Anglia are where these will be provided; we are going to train more dentists in the areas that need more dentists. As we know, throughout the medical professions, when you train in an area you are more likely to stay. I add that all NHS regions now have a dental school. We also have the golden hello recruitment incentive scheme, with payments to dentists of £20,000 to work for three years in areas that need them the most. As of July this year, 159 dentists had started working in the areas that needed their services the most.

Referring back to Amendment 216 in the name of the noble Baroness, Lady Pidgeon, I make the point to a number of the comments made that since July 2024 we have sought to rebuild NHS dentistry while being in no doubt of the challenge. In 2025-26, just under 3 million additional NHS treatments were delivered compared with the previous year, and around half of those benefited children. I very much share the concerns that noble Lords have described. It is totally unacceptable that the primary reason for emergency care for children is their very poor dental health. Children’s access now exceeds pre-pandemic levels, more adults are being seen and more dentists practise in the NHS, if we compare it with 2019-20.

I absolutely agree with the noble Baronesses, Lady Finlay and Lady Pidgeon, and other noble Lords, about the key role of prevention. That is exactly why, as the noble Baroness, Lady Finlay, said, we have brought in a toothbrushing scheme for young children, as well as fluoridation. We are seeking to tackle—if noble Lords will forgive the pun—the root causes. I cannot think of another word, but perhaps noble Lords will enjoy that anyway. It is important that we prevent as well as treat, for sure.

I turn to Amendment 213, tabled by noble friend Lord Hunt. We agree that transparency and accountability are essential to a properly functioning NHS dental system. However, the amendment risks duplicating existing arrangements. For example, the annual dental statistics help to identify problems and inform policy development, and I know that nobody present would wish to divert resources away from patient services. The whole focus of the Bill is on increasing Ministers’ accountability to Parliament, so I have no doubt of that happening.

I will pick up on some of the other points that were made, in more general terms. The noble Baroness, Lady Coffey, the noble Lord, Lord Lansley, and my noble friend Lord Hunt spoke about the dental contract and expressed concerns about the focus on units of dental activity, which I understand. I agree that reforming the dental contract is a key lever, and that is why we are working with the British Dental Association and other representative bodies to do just that. In addition to that contract, we are looking at how we can better use technology and boost the number of NHS dentists, as well as all the other areas that I have spoken to.

The noble Lord, Lord Patel of Bradford, asked about funding. I can confirm that the dental budget is worth around £4 billion, net of patient charges. The Government want to ensure that the ring-fenced dental budget is spent on the patients who need it most, and we need to maximise treatments for taxpayers’ money. I am pleased to say that we reduced the NHS dentistry underspend, which was standing at £392 million in 2023-24, to £36 million in 2024-25. That will make a major change to the provision of dental services. On the question from the noble Lord, Lord Patel, about the dental framework being developed by the Chief Dental Officer, I will be pleased to write with more detail on that.

I will pick up a few points in response to the noble Lord, Lord Young; where I cannot do so at the moment, I will be pleased to write to him. As I have mentioned, 4 million urgent appointments were delivered in 2025-26; that is 8.4% more than in 2024-25, and more than in any previous year under the current contract. We have now required high street dentists to deliver a minimum amount of urgent treatment as part of their contract. On the point about fluoridation, which the noble Baroness, Lady Finlay, also spoke to in terms of prevention, we are investing £136 million over five years to maintain existing schemes across England and fund the expansion to which the noble Lord referred across the north-east of England. Some 6 million people are already benefiting from fluoridated water, and this latest intervention is expected to reach an additional 1.6 million, to reduce tooth decay and inequalities in dental health.

The noble Lord, Lord Kakkar, talked about bringing together datasets to understand the impact of dentistry on broader health, which is a point I take. I will be pleased to look into that and write to him.

Tobacco and Vapes Act 2026 (Display of Tobacco Products) (Consequential Amendments) Regulations 2026

Lord Evans of Rainow Excerpts

Tuesday 10th November 2026 Grand Committee

[Lord Rennard (LD)]

My Lords, these two statutory instruments are essential stepping stones towards a historic milestone in public health. They will help to enable the smoke-free generation policy to come into legal effect on 1 January 2027. They are not about reopening the principle of the rising age of sale, which both Houses voted decisively in favour of. We now need to implement the policy as effectively as possible.

I was a strong supporter of previous legislation prohibiting retail stores from displaying tobacco products openly to the public. As the Minister said, tobacco products can be shown only once a customer’s age has been verified as being 18 or over. I agree with her that the instrument before us sensibly updates those rules to reflect the forthcoming changes to the age of sale. They will help to ensure that lethal products are never displayed to anyone who cannot legally be sold them.

The Government are also proposing point of sale restrictions for nicotine products such as vapes and nicotine pouches. For too long, we have seen brightly coloured nicotine products, designed to be attractive to young people, displayed at child height near shop counters. The indiscriminate promotion of these products must stop. I welcome the proposal to store nicotine products separately, so that the customers buying them are not inadvertently exposed to tobacco displays.

As we seek to promote switching from smoking tobacco to vapes instead, we need to recognise the problem of perception. Action on Smoking Health has shown that 54% of UK adults and 52% of smokers mistakenly believe that vaping is as harmful or more harmful than smoking tobacco. Most significantly, that figure rises to 61% among smokers who have never tried vaping. I was a very early supporter of legislation promoting vapes, or e-cigarettes as they were then called, as a means of quitting tobacco. But now, we have to balance very carefully how vapes are promoted. We want to clamp down on their appeal to young people and at the same time ensure that these restrictions on promoting vapes do not inadvertently worsen misconceptions among adult smokers.

We need smokers, most of whom want to quit, to understand that switching to vaping can really help them and that vaping products are less harmful. So, I would be grateful if the Minister could explain how nicotine product point of sale restrictions will be designed so that they do not entrench dangerous misconceptions about their relative harm compared to tobacco products. Can she also say whether there will be scope for improved public health messaging, such as Swap to Stop, on covered retail units?

The second instrument concerns the legal defences available to retailers when verifying a customer’s age. It provides clarity by accepting both physical and digital forms of identification. Responsible retailers, who know their regular customers, can continue to serve them without unnecessary friction.

Data from ASH shows that 41% of 11 to 17 year-old smokers and 47% of children who vape purchase the products directly from retail shops. Furthermore, it shows that 71% of retailers in England and Wales actively support mandatory age verification, with only 20% opposed to it. Tighter verification is urgently needed. Responsible retailers want to do the right thing. What detailed guidance will be published to explain what these defence changes mean in practice for shopkeepers operating Challenge 25 schemes?

As we approach 1 January, leadership and clear communication from central government will be decisive in making the policy work and helping us to move further towards the smoke-free generation that we are seeking. Retailers and local councils are doing their part. Perhaps the Minister can tell us more about the Government’s national public awareness campaign and when it will launch. If we combine clear regulations, evidence-led public health messaging and dedicated support for our front-line retailers, we can ensure that 1 January 2027 marks the true beginning of the end for the tobacco epidemic in this country.

Finally, I want to share the concerns of the noble Lord, Lord Young of Cookham, when it comes to the relationship between tobacco companies and C-Talk and the Protect Your Store campaign. The tobacco industry often uses proxies to circumvent restrictions that are in place to prevent it from influencing health policy. But those restrictions are there for a very good reason. Retailers should stand ready to implement this important, life-saving policy, and evidence shows that when consumers spend their money on things other than tobacco it is good for the UK economy. I look forward to the Minister’s response.

[Lord Evans of Rainow (Con)]

My Lords, I thank the Minister for introducing this SI and for turning up this morning. She is clearly under the weather; perhaps she should have a hot toddy and take a rest for the rest of the day, given that she will be in her place at the Dispatch Box tomorrow evening for Committee on the Health Bill.

Protecting young people from the harms of smoking and vaping is the principle underpinning both these measures, but it is essential that the regulations implementing these changes are practical and properly scrutinised. The first instrument I will address today concerns the display of tobacco products, aligning existing exemptions with the new generational ban. At first glance, this appears to be a straightforward change, but it raises wider questions about the cumulative burden being placed on retailers.

The Government’s own impact assessment estimates that the changes to vape displays could cost retailers £26 million. The Association of Convenience Stores has suggested that the costs of a full display ban could actually exceed £160 million for convenience stores alone. These figures demonstrate the substantial financial pressures facing businesses as a result of these reforms. Can the Minister therefore clarify what assessment has been made of the specific costs associated with implementing this instrument, particularly for small independent retailers? What assurances can she provide that businesses will receive sufficient time and guidance to adapt?

The second instrument sets out the steps that retailers must take to check a customer’s age when selling tobacco or vaping products so that they can demonstrate that they have followed the law if an underage sale takes place. These provisions follow on from the fact that the generational ban introduces a fundamentally different approach to age verification. Rather than simply establishing whether someone is over 18, retailers will need to determine whether customers were born before a particular date: namely, before 2009.

This creates additional complexity for shopkeepers and their employees, who will be expected to understand and enforce the law. The Government must ensure that those acting responsibly are not inadvertently exposed to prosecution because of unclear requirements. Can the Minister explain how the Government will ensure that retailers can reliably check whether a customer is legally entitled to buy tobacco, particularly as the age limit will change each year? What expectations are there for people to carry identification as they get older?

During the passage of the Tobacco and Vapes Act, concerns were raised about the extensive powers given to the Secretary of State. Concerns have been repeatedly raised about the breadth of the Government’s regulation-making powers and the importance of parliamentary scrutiny. It is therefore vital that these powers are exercised transparently, with clear evidence supporting the measures introduced. Can the Minister tell us how the Government expect trading standards officers to enforce these additional requirements without providing them the resources to do so?

As my noble friend Dr Caroline Johnson highlighted in the other place, these powers could allow the Government to extend smoke-free restrictions to a wide range of places with limited parliamentary oversight. While these SIs deal particularly with tobacco displays and age verification, the wider concern about scrutiny remains. Can the Minister reassure the Committee that future regulations will be subject to proper consultation and parliamentary scrutiny, and that the Government will clearly explain why further restrictions are necessary?

I hope the Minister will address these concerns and reassure the Committee that these regulations will be implemented fairly and scrutinised properly.

[Baroness Merron (Lab)]

My Lords, I am most grateful to all noble Lords who have contributed to this debate and grateful for the support for the measures that we are taking. I know that many noble Lords who have spoken today have long been active campaigners, and I am extremely grateful. In particular, the noble Lord, Lord Young, welcomed the various steps across government, which speaks to the fact that this is not just a matter for health; there are other actions that we can take. I am also glad that the noble Lord, Lord Rennard, welcomed the clarity that these regulations will provide. He referred to avoiding unnecessary friction. That was very much part of our discussions during the passage of the Bill, and it is one of the concerns of the noble Lord, Lord Evans, which we share.

In just seven weeks’ time, the smoke-free generation will become a reality in this country, and that is something to celebrate. The first young people born in 2009 will turn 18, the law will change and those young people will enjoy a life that is free from the harms of tobacco that have plagued successive generations before them. These two sets of regulations are important steps in making sure that retailers are ready—I take on board the concerns raised—that the law is consistent and that the new age of sale is implemented successfully from 1 January. That is what these regulations seek to do.

I turn to the points raised. The noble Lords, Lord Young and Lord Rennard, raised questions about the tobacco industry’s influence and input into consultations. I remind the Committee that our consultation on proposals to reduce the appeal of tobacco, vaping and nicotine products closed on 2 October. The consultation spoke to aligning the display of vaping products, nicotine products, cigarette papers and heated tobacco devices with display restrictions—in other words, removing them from display and moving them away from the eyes of children and young people. We are currently considering the responses.

Concerns were raised about interference. We have robust controls in place to prevent the manipulation of public consultations. These controls certainly worked effectively in our past consultation, where we set out the case to create a smoke-free generation. I assure noble Lords that we remain alert to the kind of interference raised by the noble Lord, Lord Young, in particular, and we will not be deterred from doing what is necessary to promote healthier living and to protect children and young people.

The noble Lord, Lord Young, asked about a road map. Of course, we very much share the ambition to further drive down smoking rates; we are far from complacent. I know how pleased the Chief Medical Officer was recently at the historic low in smoking rates, but we do not stop there; we will continue. Our immediate priority is delivering the Tobacco and Vapes Act and the comprehensive programme of secondary legislation that sits behind it. With the investment in stop smoking services and enforcement, these measures will form our programme for delivering a smoke-free UK.

It might be helpful if I remind the Committee that the Act includes a requirement for the Secretary of State to review the operation of the Act within four to seven years of Royal Assent and to lay a report before Parliament concluding the findings of this review. I assure noble Lords that we remain open to evaluating the impact of the Act and to being held to account on that. I remember the conversation about what the right length of time was. This is our feeling on the right length of time, so we can give the Act time to make an impact and be realistic with Parliament about what has been achieved.

Health Bill

Lord Evans of Rainow Excerpts

Committee stage
Monday 9th November 2026 Lords Chamber

[Lord Patel (CB)]

My Lords, I have put my name to several of these amendments. Much has been said already, so I will try to be brief. I will focus on two or three main things. One is where the developments are likely to lead us, which will complicate the issues even more than what we are talking about today.

Let me come to cancer outcomes first. It has rightly been pointed out where England stands internationally in terms of cancer outcomes. Cancer outcomes are the ultimate truth: the truth in terms of one-year and five-year survival rates of any cancer. They are often what we use for international comparisons, but there is a system-wide reflection to be had. Poor survival outcomes are, often, a failure of several other processes, including when the diagnosis was made, the aggressive nature of the tumour—the later it is identified, the more aggressive it is likely to be—and whether the treatment was given at the right time. As was mentioned, delayed treatment increases the risk of mortality.

Although the outcome, survival-wise, is an important parameter, there are other issues that need to be considered when assessing cancer outcomes, and they often relate to the processes. The balance metrics of measuring cancer outcomes may well include process indicators; operational timelines, in terms of how many days’ treatment the patient has; patient-centred outcomes, which are not often mentioned; and risk-adjusted clinical outcomes, based on the nature of the cancer. The core outcomes that are reported should include not only survival rates, but mortality rates, stage of diagnosis and operational and access metrics. The purpose of reporting—that is the important part for commissioning issues—is that accountability be taken into consideration. It should hold regional health services and Governments responsible for funding allocations and clinical performance, highlighting the gaps, and guiding policies and clinical improvements. Unless we have these measurements of outcomes, measuring survival rates only will not be enough.

I will briefly mention genomics and radiotherapy. On radiotherapy, I get a daily, or sometimes weekly, bulletin from a medical oncology consultant whom I know extremely well; I will not name her. The important point has already been mentioned: it is not that we do not have the expertise in clinical capabilities, as Cancer Research UK has mentioned in its report; it is that bottlenecks occur in the processes afterwards. The surgery might be good, but there are bottlenecks in other forms of treatment. On radiotherapy, we have already mentioned the unmet needs, waiting times, regional disparities and workforce and equipment pressures. They will multiply with the advances that are coming in radiotherapy, which not all centres in England have implemented. It is good that NHS England announced a major rollout of stereotactic ablative radiotherapy, which reduced treatments for prostate cancers, for instance, from 20 to five. However, only a few centres now use advanced technology and AI together to further assist the planning of radiotherapy treatments, which can sometimes take days.

There are developments occurring in radiotherapy that will put further pressures on patient access. With FLASH radiotherapy, for instance, radiotherapy is given in a concentrated way in a millisecond—not minutes, not hours, not days, but in a millisecond. Through biologically guided radiotherapy, integrated PET scanners, mentioned by the noble Baroness, Lady Finlay, are combined with linear accelerator scanners. They can immediately diagnose the nature of the cancer and deliver the appropriate therapy on the spot. Through generative AI adoption, AI is used while the patient is on the treatment table to identify the nature of the tumour and whether it can take higher-dose radiotherapy. There is also radiogenomics, whereby personalised genomics are associated with the behaviour of the tissue and the machine can decide whether it can give a higher dosage at a concentrated level. All these developments will put further pressure on our capacity to deliver to cancer patients, which needs to be addressed.

There are lots of issues to be addressed but, finally and briefly, the Science and Technology Committee is about to produce a report on AI, genomics and personalised medicine, which identifies the role of genomics not only in cancer but in other areas too. Cancer, in particular, will require the rapid genomic analysis that the noble Baroness, Lady Finlay, mentioned. It is good that NHS England established seven genetic hubs that now do mutation screening and genomic screening, looking at the mutations in each and every cancer to see whether it will react to a particular treatment or not. They are building up a library, and it is important to continue building that library.

Importantly, the only way to develop personalised medicine vaccines for delivery to individual patients is to do the genomics mutation study as rapidly as we can. The cancer genomics 10-year plan has identified all the issues, but it has not identified a way forward for implementation. This debate has emphasised that we need to know how we are going to deal with all the developments, deliver the cancer treatments and improve outcomes globally.

[Lord Evans of Rainow (Con)]

My Lords—

[Lord Stevens of Birmingham (CB)]

My Lords, I declare my interest as chair of Cancer Research UK and wholeheartedly endorse all the previous contributions on this group, which have been outstanding. The purpose of these probing amendments is simply to make sure that cancer remains very firmly on the Government’s agenda. The cancer plan, published in February, has a range of really welcome proposals, but the key thing will be putting them in place. In the cancer plan, there was a commitment to delivering the cancer waiting time standards by 2029. It would be fantastic if the Minister could confirm at the Dispatch Box that that remains the game plan the Government and the NHS have embarked on.

In doing so, can the Minister briefly comment, in the context of the three headline cancer waiting times targets, on the faster diagnosis standard for urgent referral of 28 days? We are seeing a bit of a bifurcation opening up between the faster experience that patients who do not have cancer are having—with cancer being ruled out for 79% of people, against an 80% target, which is great—and maybe only 55% of people who actually have cancer getting their diagnosis within that 28-day period. If we are interested in the outcomes improvement that will come from early diagnosis, it will be crucial to keep a beady eye on the waiting times for diagnosis for people who actually have cancer.

[Lord Tarassenko (CB)]

My Lords, I will speak very briefly in support of Amendment 250 in the name of the noble Baroness, Lady Finlay, to which I have added my name. I come to this debate as the husband of a cancer survivor. My wife was diagnosed with Hodgkin’s lymphoma 30 years ago, and I am very glad to say that she was successfully treated with radiotherapy.

I realise that, for lymphoma, the role of radiotherapy has decreased as chemotherapy has improved. But for some cancers, as we have heard, radiotherapy remains the treatment of choice. Chemoradiotherapy for cancer of the larynx cures patients while, very importantly, preserving their voice. For anal cancer, it has replaced an operation that once meant a permanent colostomy for every patient. For locally advanced cervical cancer and early lung cancer in patients too frail for surgery, it is the curative option.

Radiotherapy, of course, also works in partnership with other treatments. A study of more than half a million cancer survivors in England found that three-quarters of five-year breast cancer survivors and two-thirds of head and neck survivors had received radiotherapy. In the ProtecT trial, led by my Oxford colleague Professor Freddie Hamdy, which followed more than 1,600 men with localised prostate cancer for 15 years, radiotherapy matched surgery on survival but fewer men were left with long-term incontinence.

So, the problem is not the evidence but delivery. As the noble Baroness, Lady Finlay, has said, only four in 10 patients start radiotherapy within the 62-day standard against a target of 85%—far behind surgery and chemotherapy. More than half of cancer patients would benefit from radiotherapy, yet in England only around a third receive it. Some 60,000 patients a year miss out, and that is often because of where they live.

That is why a national delivery programme is important. First, we should think about equipment: the linear accelerators which generate the high-energy radiation of radiotherapy last around 10 years. A national programme can plan a replacement as a rolling cycle and buy at scale instead of trusts bidding for capital one machine at a time. In May 2025, the Government invested in 28 new machines, which is very welcome, but a plan is needed to go beyond one-off funding. Secondly, satellite centres such as Oxford’s, at Swindon’s Great Western Hospital, bring treatment closer to the patient’s home, but they need to be planned nationally once the gaps have been identified. Thirdly, a national programme can collect national data, including performance data, and have a co-ordinator responsible for delivery.

Radiotherapy is curative, cost effective and preserves organs. Patients deserve timely access to it wherever they live.

[Lord Evans of Rainow (Con)]

My Lords, I apologise for interrupting the noble Lord; the House always enjoys hearing from him. I am speaking in an incredibly important and delicate debate. I thank all the noble Baronesses for tabling such amendments which address some of the most pressing challenges facing cancer patients and their families. Cancer is a disease for which time is so often the difference between life and death. Too many patients face delays in diagnosis, uncertainty over treatment and unacceptable inequalities in access to care. These amendments speak to a fundamental principle: improving cancer outcomes must remain a clear and measurable national priority.

I welcome the amendments tabled by the noble Baroness, Lady Pidgeon, particularly Amendment 41, which seeks to ensure that cancer outcomes, including survival, remain a priority for the Secretary of State. Removing the existing statutory requirement risks weakening accountability at precisely the moment we need greater ambition.

That ambition must extend to cancers with the poorest survival rates. I was encouraged to hear last week from the noble Baroness, Lady Merron, that the Government have commissioned an expert review into brain cancer research and that findings will be expected within just three months. This is welcome, but patients and families have heard promises before. What will be different this time? Can the Minister explain how the review will translate into tangible improvements in research funding, clinical trials and, ultimately, survival?

The Government have also released a national cancer plan to support new clinical trials and increase research participation, coupled with an ambition to reduce clinical trial set-up times to 150 days by March 2026. These are positive steps, but they must be matched by the capacity to deliver them. Does the NHS have the workforce, infrastructure and resource necessary to turn this ambition into concrete results for patients? Research is essential, but so is timely treatment. What targeted funding do the Government further envisage for clinical trials?

I will now address the amendment from the noble Baroness, Lady Pidgeon, which would strengthen patients’ rights to begin cancer treatment within 62 days of referral. This should be a reliable standard. Can the Minister explain why this target is not being met and what steps they are taking to do so?

The urgency is particularly apparent in radiotherapy. As the noble Baroness, Lady Finlay, powerfully highlighted, radiotherapy is one of the worst performing cancer treatments. Only 62% of radiotherapy patients begin treatment in 62 days in comparison to 71% for surgery and 67% for chemotherapy—all fall short of the target of 85%. These figures should concern us all. Delays and geographical inequalities continue to undermine access to treatment. Can the Minister tell us whether the Government have begun to design a nationally co-ordinated programme addressing workforce shortages, equipment capacity and access to modern techniques?

LED Lighting: Health Effects

Lord Evans of Rainow Excerpts

Wednesday 28th October 2026 Lords Chamber

[Baroness Merron (Lab)]

My noble friend is absolutely right to highlight the fantastic King’s critical care roof garden. I was very pleased to see the media coverage of it earlier this year. Not only are the team providing full life support to the patients, staff and families, allowing them to feel the therapeutic effects of being outside and in nature, but they are using the spaces they have developed for research on whether it gives the right support and enhances people’s health. I am very much looking forward to what they come up with. It is very impressive on top of their medical excellence.

[Lord Evans of Rainow (Con)]

My Lords, given the growing evidence that exposure to artificial light at night can disrupt sleep and the circadian rhythms, does the Minister agree that the Government should do more to ensure that the public are aware of these potential health risks? Will the Minister commit to updating existing public health guidance to reflect the latest scientific evidence?

[Baroness Merron (Lab)]

If there are particular things the noble Lord thinks the Government are not doing, I would be very pleased to receive details. I am glad that he did not refer specifically to LED lighting. As I have said, there is no evidence that it is directly harmful in normal use in the general population. However, through the Committee on Medical Aspects of Radiation in the Environment, we are developing an evidence-based review programme on artificial light and health, just as he asks, and gathering evidence and identifying gaps. We are also supporting research and working internationally. I would be very pleased to give further details if the noble Lord would like.

Neighbourhood Health and Social Care

Lord Evans of Rainow Excerpts

Tuesday 15th September 2026 Lords Chamber

[Baroness Merron (Lab)]

I certainly agree with my noble friend on that point. That is why achieving neighbourhood health will rely critically on that strong partnership, which will include civil society, as she says.

[Lord Evans of Rainow (Con)]

My Lords, the noble Baroness did not answer the question from my noble friend the Front Bench spokesman on who will be accountable if this does not work out properly.

[Baroness Merron (Lab)]

All the local systems have their line of accountability, with which I know noble Lords are familiar. Currently, for example, ICBs report to NHS England. Subject to the passing of the Health Bill, that will now come within the department and there will be an accountability mechanism. Transparency will be a key part of that. If noble Lords have any particular concerns, I am always happy to hear them.

Foetal Alcohol Spectrum Disorder

Lord Evans of Rainow Excerpts

Thursday 25th June 2026 Lords Chamber

[Baroness Merron (Lab)]

My noble friend is quite right about the potentially lasting effects of foetal alcohol spectrum disorder on children, which is why the main priority is preventing it. There are three approaches. First, the clear advice—the safest approach, if you are pregnant or could become pregnant—is not to drink alcohol, and that will remain consistent. I have just referred to the legal requirement for alcohol labels. We will of course continue to look at how prevention messaging can best reach people pre conception. The obvious point here is that so many pregnancies are not planned, so there is no neat solution to getting to the right people. We have to get our messaging right, which is why we are taking the approach we are.

[Lord Evans of Rainow (Con)]

My Lords, the Department of Health and Social Care’s own health needs assessment noted that there are still no reliable prevalence studies for foetal alcohol spectrum disorder in England, despite estimates suggesting that the UK may have one of the highest rates in Europe. How can the Government effectively reduce the prevalence of foetal alcohol spectrum disorder when they still do not know with confidence how many children and adults are living with the condition? What steps have the Government taken to improve diagnosis and data collection?

[Baroness Merron (Lab)]

The noble Lord is quite right that we are working on estimates, and there are a number of practical reasons for that. To come to the noble Lord’s real point, the first National Institute for Health and Care Research challenge funding call was launched in 2024, backed by £50 million. That tasked researchers and policymakers with finding new ways to tackle maternity disparities and poor pregnancy outcomes, and clearly that will support further research and policy. So we are looking to the future and I take on that challenge; it is one that we are meeting.

Healthcare Services: Acute, Primary and Community

Lord Evans of Rainow Excerpts

Thursday 25th June 2026 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, I thank the noble Baroness, Lady Janke, for securing this important debate. There is broad agreement across the House on one central point: if we are to build an NHS that is sustainable for the future, we cannot rely solely on treating people once they arrive at hospital. We need strong primary care and early intervention that prevents illness escalating in the first instance.

That principle is not new. Successive Governments, including the Conservatives, have spoken about shifting care closer to home. The current Government have made it one of the central pillars of their health strategy through the proposed neighbourhood health service and the commitment to move from hospital- to community-based care. The question, however, is not whether we support that ambition, but whether the Government are delivering it.

The figures set out in the House of Commons Library briefing are striking. Between 2015-16 and 2023-24, spending on acute services increased by £14.3 billion, while primary medical care increased by only £1.7 billion and community services by £3.1 billion. Those figures illustrate the scale of the challenge in rebalancing the system; they also demonstrate why simply announcing a shift is not enough. Resources must genuinely follow patients into community settings if the policy is to succeed.

These Benches welcome the Government’s stated commitment to shift care out of hospitals into communities. We also recognise the potential benefits of neighbourhood health centres in bringing diagnostics, rehabilitation, mental health services and primary care together and closer to where people live.

However, there are legitimate questions to be asked about pace and delivery. Before the election, Ministers spoke about increasing the proportion of NHS funding allocated to primary and community care by 2029. That objective has now been pushed further back to 2035. For many patients and practitioners, that will feel like a significant delay.

These Benches also have concerns about whether primary care is being given the tools it needs to succeed. The Opposition have consistently raised concerns regarding changes to the GP funding formula and the expectations placed on GPs through the advice and guidance system. Community care cannot become simply a mechanism for managing demand that would previously have gone elsewhere in the system. If primary care is expected to do more, it must be properly resourced to do so.

I turn briefly to mental health, where the relationship between acute and community services is particularly important. Community support and accessible treatment can prevent deterioration early and reduce hospital admissions. It is therefore concerning that the share of NHS spending devoted to mental health has fallen in each of the last three years—from 9% in 2023-24 to a projected 8.4% in 2026-27. At the same time, local systems are no longer required to increase mental health spending in line with overall NHS spending. These developments appear difficult to reconcile with the principle of parity between mental and physical health.

In closing, I therefore have four questions for the Minister. What specific milestones will the Government use to demonstrate that the promised shift from hospital to community care is taking place? What assessment has been made of the impact that recent GP contract changes will have on primary care capacity? How do the Government intend to ensure that mental health services do not lose out as NHS resources are distributed across the system? In the case of eye care, there is already a workforce and infrastructure in the community to treat patients effectively, yet access depends on where you live, which pushes avoidable demand into hospitals. What steps are the Government taking to ensure equitable access across England?

Strong hospitals will always be essential, but an NHS fit for the future also requires strong community services and effective early intervention. The challenge for the Government is not setting out that vision but delivering on it. I look forward to the Minister’s response.

Resistant Hypertension

Lord Evans of Rainow Excerpts

Wednesday 24th June 2026 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord makes a helpful point. Indeed, the modern service framework will soon be published. Of course, as blood pressure is one of the seven risk factors for cardiovascular disease, as the noble Lord referred to, we have to improve detection and management. That is what the modern service framework will drive forward, particularly in local areas. Yes, it will make reference not just to hypertension, which is more widely applicable, but to resistant hypertension, as he suggested.

[Lord Evans of Rainow (Con)]

My Lords, NICE has recognised renal denervation as a potential treatment option for resistant hypertension, yet its use remains limited and subject to special arrangements for governance and research. What assessment have the Government made of the extent to which eligible patients are able to access renal denervation across England? Are Ministers concerned about the emergence of a postcode lottery in access to the treatment?

[Baroness Merron (Lab)]

Looking to the future, obviously, one can only act on clinical guidance. Renal denervation, as I mentioned to my noble friend, is an emerging option for carefully selected patients at the moment, as the noble Lord said. What matters now is that evidence is emerging, and that is why it is being reassessed. We will not have to wait too long to see what the future will bring in this regard, but it certainly has a role to play.

Severe Myalgic Encephalomyelitis

Lord Evans of Rainow Excerpts

Thursday 18th June 2026 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, I thank the noble Baroness, Lady Scott, for securing this important debate. I join others in paying tribute to the patients, families, clinicians, researchers and charities who have worked tirelessly to improve understanding of myalgic encephalomyelitis. For too long, people living with this condition have faced scepticism and inadequate support.

While significant challenges remain, it is right to acknowledge that progress has been made. There is now a much greater recognition that ME is a serious and often profoundly debilitating condition requiring appropriate clinical care and support. We on these Benches welcome the publication of the ME delivery plan in 2025. Many of the origins of that work lie in the commitments made by the previous Conservative Government in 2022 to develop a cross-government approach to ME. It is encouraging that the plan contains a broad range of actions across health services and educational research. We also welcome reports that a substantial number of those actions are complete or in progress.

However, publication of a plan is only the beginning. What matters to patients is whether they experience tangible improvements in their daily lives. The plan contains 44 actions, but patients and charities have raised understandable concerns about how delivery will be monitored in practice, who will ultimately be accountable for implementation, and how responsibilities will be managed as NHS England functions transfer into the Department of Health and Social Care. I therefore hope the Minister can tell the House today when the promised progress report will be published and who will be responsible for ensuring delivery across government and the NHS.

Nowhere are these questions more urgent than for those living with severe and very severe ME. These are often the patients with the greatest needs and the least ability to advocate for themselves. It is therefore concerning that the only delayed action within the delivery plan relates to consideration of specialised services for this group, with the decision now not expected until April 2027. The evidence presented by charities and campaigners illustrates why this matters. Preliminary findings from Action for ME’s recent survey suggest that many people with severe and very severe ME are unable to access existing specialist services because they are simply too unwell to attend them. Large numbers report receiving little or no ongoing support from either specialist services or primary care, while many face serious challenges in meeting basic needs, including nutrition. This matters not only because of the immediate impact on the patient’s quality of life but because early intervention and appropriate support can prevent longer-term deterioration.

If people have access to advice, treatment, system management and practical support at an earlier stage, there is a greater chance of helping them maintain their independence and remain connected to education or employment where appropriate. Delays in accessing support can leave people becoming progressively more unwell, making recovery and participation in everyday life considerably harder. That is why timely and effective services are so important, not only for those who are already severely affected but for those at risk of reaching that point.

It is also important to recognise that ME disproportionately affects women. Evidence consistently suggests that women are significantly more likely to be diagnosed with ME than men. Can the Minister therefore say what assessment the Government have made of the reasons behind this disparity and whether the needs of women living with ME are being specifically considered as the delivery plan is implemented?

Recent prevention of future deaths reports have also highlighted serious concerns regarding the care available to some of the most severely affected patients. The Government have stated that integrated care boards remain responsible for commissioning appropriate services in the meantime. Can the Minister therefore explain what assessment has been made of the current provision for severe and very severe ME, whether significant variation exists across the country, and what interim support will be available before any decision on a nationally commissioned service is reached in 2027?

We must also not lose sight of the critical importance of research. We welcome the support provided for the DecodeME survey. Its early findings identify potential genetic links involving the immune and nervous systems, representing an encouraging step forward in understanding the biological mechanisms underlying this condition. Yet ME remains significantly under-researched relative to its prevalence and impact. The Government have rightly spoken about the UK’s ambition to lead in life sciences and post-infectious disease research. There is a strong case for ensuring that ME forms part of that agenda, including through support for research into diagnostics, biomarkers, treatments and clinical trials.

In closing, I ask the Minister three questions. When will the Government publish their next formal update on the delivery of the ME plan? What interim support will be provided for people with severe and very severe ME before April 2027? Can she assure the House that the decision on specialised services will not be subject to further delay? Those living with ME have waited a long time to be heard. They deserve not only recognition and promises, but delivery.

Cancer Outcomes in the UK

Lord Evans of Rainow Excerpts

Tuesday 21st April 2026 Grand Committee

[Lord Evans of Rainow (Con)]

My Lords, I thank the noble Lord, Lord Patel, for securing this important debate. When I was a Minister, the noble Lord used to stand up and ask me extremely searching questions—well, they were searching questions to me—to which I did not always know the answer. Come to think of it, there are a couple of noble Lords in the House who used to do something similar: the noble Lord, Lord Sikka, and the noble Baroness, Lady Finlay. I used to go back to the department and ask for answers to these legitimate searching questions, but sometimes the answer was not forthcoming. So I used to press and stretch the civil servants to come back, because I had to come back and report to the noble Lord, Lord Patel.

But I started thinking for myself and looking into some of this, and the answer came down to technology. The noble Lord, Lord Drayson, has really made my speech—one of the problems with speaking at the end is that everything has been said. He is right that, two or three years ago, artificial intelligence was just starting to make an impact in certain industries. He made a very powerful point.

Time is short and I have a few things to say. I am speaking as a former Minister who looked into this matter and as a Member of Parliament to whom constituents used to come, pleading for treatment or to get assessment and diagnosis. Not knowing is a problem if you have a lump but you do not know what it is. They used to come to MPs’ surgeries, not just mine, to see if they could cut through the red tape to try to get an answer from the local NHS trust. I used to do my best to help, but it happened frequently.

As I say, I am a family man and have had two experiences of cancer. The first was my late sister, who died of pancreatic cancer. I was listening attentively to the comments of the noble Baroness, Lady Warwick, who mentioned a spray that can detect pancreatic cancer. That was not available until relatively recently. Pancreatic cancer is a terrible disease.

The second was my late mother, who lived to quite a good age. Ovarian cancer is not always easy to detect. I was surprised as a carer that it took a while for the GP to make a referral and, once you got the referral, to secure a scan and get communication from the hospital to the patient—that is, my mother, who had dementia. In a way, she could not understand that; they should talk to the carer. I thought it was old-fashioned to write a letter to someone who could not read it rather than dealing with them directly, perhaps using artificial intelligence, via the NHS app to speed things along.

My contribution to this is that early and timely diagnosis is important to ensure that the right treatment can be given at the right time to get the best possible outcomes, especially for children and young people, whose cancers are often more aggressive and faster growing and require specialist treatment. Despite this, young cancer patients regularly report needing multiple visits to doctors before a cancer diagnosis is given. Data shows that the median time for under-18s to be diagnosed after first symptoms is 4.16 weeks; it takes longer than this for half of them. Teenagers from 15 to 18 years of age have the longest time to diagnosis—a median of 8.7 weeks. Some 60% are diagnosed as an emergency. On average, 14 different healthcare professionals are consulted.

This is further reflected in the NHS cancer patient experience surveys, which show that more than two in five children and young people, 42%, see their GPs three or four times after their cancer symptoms before being told to go to hospital. This compares to the majority of adults, 62%, seeing their GP just once. Not only does this prolong receiving a diagnosis but it can impact trust and relationships with healthcare professionals throughout treatment and after. This experience can be worse for minoritised groups. Data on time to diagnosis is not routinely monitored for children and young people nationally, despite those issues. It is crucial that a diagnostic interval measure is introduced for young cancer patients, as was committed to in the national care plan, to consistently track and improve time to diagnosis.

I have a question for another special person, the Minister, whom we are very lucky to have in your Lordships’ House—she does a fantastic job as Minister. The noble Lord, Lord Stevens, talked about sweating NHS assets, but I am not asking about that. The noble Lord, Lord Patel, and others referred to the Danish model. Denmark has a population of 6 million. In London the figure is 10 million, in Manchester it is 3 million and England as a whole it is 60 million. The noble Lord, Lord Drayson, made a point about artificial intelligence—he talked about economic growth, wealth creation, NHS trusts not talking to one another and scaling up our own domestic industry—and he is exactly right.

My question is not original but is about a pilot scheme to implement artificial intelligence, in order to establish best practice and set international standards of early diagnosis for all cancers but particularly those of low survivability. There are 36 integrated care boards—there were 42 in my day, but I understand that they have been condensed. Not all are the same: we have different populations, rural areas, seaside communities, post-industrial towns and metropolitan areas. We should appoint the best and the brightest from the NHS or industry to implement artificial intelligence throughout the NHS.

What does success look like and how do you measure it? I respectfully say that the best survival rates in the G7 would be a good starter, but artificial intelligence is an opportunity for the NHS to modernise its back-office administrative processes. As noble Lords have pointed out throughout this debate, there is so much good research out there that AI has to have an impact. That is not about sweating the assets but about improving the current workforce, certainly in the back office, so that they can at least communicate with those hard-to-reach populations and communities in the country.

That is my question to the Minister: can we have a pilot scheme of hand-picked individuals and integrated care boards in select areas of the country, to see whether we can introduce this to the NHS to make a difference and the world-beating healthcare system that we all want?