Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024

Lord Evans of Rainow Excerpts

Tuesday 22nd October 2024 Grand Committee

[Lord Scriven (LD)]

I thank the Minister for setting out the rationale for this draft statutory instrument so well. I agree that this is a step forward in the ongoing battle against the devastating impacts of opioid overdoses. As she said, opioid overdoses have reached alarming levels, claiming thousands of lives every year. According to the latest statistics, opioid-related deaths have surged alarmingly in most regions. This is not merely a statistic. This is about the loss of lives, families shattered and far too many left to grieve, so it is important to take further action that is effective and wrapped in compassion. The temporary measures taken in Scotland show that the changes outlined in these regulations work and will save lives.

Naloxone, when used in the right place at the right time, is a life-saving medication. This draft statutory instrument will facilitate local supply networks, ensuring a broader distribution system and therefore more effective use of naloxone, empowering, among others, healthcare professionals, the police, prison and probation staff, and people in the youth justice system to facilitate the supply of this life-saving drug.

In response to one of the issues that the noble Baroness raised, a question occurred to me. As this will not be a mandatory provision across the country, how will the Government monitor lives that could be saved but that may not be saved because of a lack of take-up of this in certain towns, cities or regions? It could end up that a life will be saved if one body decides to do this, while a life could be lost in a neighbouring county, city or town if that does not take place.

One of the key provisions in this draft statutory instrument is the move to enable the friends and family of those at risk to administer this drug. Allowing those closest to individuals at risk to carry and administer naloxone creates a lifeline that will, literally, make the difference between life and death.

I listened to what the Minister said about setting up local naloxone providers and supply co-ordinators, and I have read the draft statutory instrument and the explanation—but I am still not clear about what regulatory oversight of these bodies will be in place. Who will be the regulator and what powers will they have to deal with the improvement or, indeed, withdrawal of such a service if it is deemed that the local provider is not carrying out the rules laid down in the draft statutory instrument?

Clearly, the broader implications of these amendments are not merely about the use naloxone but about standing with those who struggle with addiction, and their families. These amendments are an essential evidence-based response to the dramatic increase in opioid use and overdoses. By enabling greater access to naloxone, they will help to save lives.

[Lord Evans of Rainow (Con)]

My Lords, I thank the Minister for setting out the provisions in the regulations before us so well. This debate touches on a vital aspect of this country’s public health. Opioids are a pernicious threat to our society, a destroyer of lives and a menace to our streets. The ONS reported that 2022 was the deadliest year since records began for drug-related deaths in England and Wales. Of those, opioids accounted for the largest number of mortalities, at 46%. That is 2,261 people dying every year from opioid toxicity. In Scotland, the statistics make for even starker reading. According to the National Records of Scotland, in 2023, opioids were implicated in 80% of all drug deaths.

So we have a problem, but we also have a solution. As noble Lords will be aware, naloxone is a highly effective treatment for opioid intoxication and has been successfully deployed to prevent death from opioid overdose. I am immensely proud that it was a Conservative Government who launched the consultation on proposals to expand access to this life-saving medication, which concluded in March. The regulations laid before your Lordships are the outcome of that process, and I welcome their positive measures.

I will take this opportunity to ensure that the Government have taken all the necessary considerations. As the second report of the Secondary Legislation Scrutiny Committee pointed out, there is no indication of the costs associated with the instrument. The Department of Health and Social Care told the scrutiny committee that services that wish to widen the availability of naloxone would have to do so out of their own pocket, which, given the financial pressures already faced by such providers, may limit the efficacy of the provisions laid before us.

For these regulations to have the desired effect—that is, of course, to reduce opioid-related deaths—access to naloxone products must also be expanded. What is the point of increasing the number of people who can administer the drug if they are unable to procure enough of the medication? Furthermore, will service providers be able to afford the necessary training for the administration and storage of the drug? Would this not somewhat undermine the efforts of the regulations? In the light of these concerns, can the Minister confirm that funding will not impact the rollout of these provisions?

Although Regulation 8 does make provision for training, clarification is required. Naloxone can be administered by three different routes: intravenously, intramuscularly and by intranasal spray. Obviously, the first two require injection, which is a medical procedure for which specific training is required. The NHS, rightly, sets stringent guidelines on who is permitted to provide such services, so I think noble Lords could benefit from assurances that the IV and IM methods of administration are permitted only by medical professionals with full phlebotomy training.

Further to this point, I highlight that intranasal spray administration is, of course, the most effective method of widening access to the drug. Intranasal applicators can be used by the full range of providers specified in these regulations and can be easily distributed into the community. They therefore allow for a rapid response to an individual experiencing an opioid overdose and, I hope, should have a greater impact in reducing mortality rates. Can the Minister confirm that the Government will pursue greater distribution of the intranasal spray to complement this regulation?

I conclude by saying that we are pleased that His Majesty’s Government have continued the policy initiated by the previous Conservative Government by laying these regulations before us. I look forward to the Minister’s response to the questions I have laid out.

--- Later in debate ---

[Baroness Merron (Lab)]

That is understood. I am sure that the noble Lord will be delighted to know that this is to be established, but he is certainly quite right to raise that point. I will ensure that, once that detail is established, it is made known.

On the point about a potential additional burden on services, which the noble Lord, Lord Evans, raised, we certainly recognise the fact that there are challenges in the scope of these regulations. Our intention—I stress intention—is not to create any additional burden. I think I was quite clear in mentioning that these are enabling, not compulsory, requirements. That is important, because it means that no service or individual professional will actually be required to give out take-home naloxone as a result of these regulations. That potentially allows a more gradual introduction of this.

For example, I know that the noble Lord, Lord Scriven, mentioned that there may be differences in the level of take-up across the country. I suspect that may well be the case. It will be our job not just to encourage it to be taken up but to work out why it is not being taken up. We will not just bring in this instrument; we will seek to actively promote it. As I said, we are confident that there is a high level of support for these changes and we will continue to work closely with services and professionals to support them with provision.

The noble Lord, Lord Evans, rightly said that the previous Government undertook the consultation. I am most grateful for that because it has informed where we are today. That consultation under the previous Government received significant positive support from the sector, with the overwhelming majority of respondents agreeing with the set-up of the changes.

The noble Lord, Lord Evans, raised a question about costs. There is no direct cost to the Government associated with these changes since, as the noble Lord will understand, this is only an enabling provision. It will be for services to determine whether they use this power and give out take-home naloxone. At the moment, local authorities provide funding for naloxone, which is supplied through drug treatment services based on their assessment of local need. Although local authority public health services will want to support the wider provision of naloxone, I recognise that their resources are limited; I am sure that many of them will tell me that. This will potentially mean that there is an additional call on their resources and they may need to pay for it through their own funding streams. However, we will monitor demand and engage with services and local areas to understand where any pressures may be.

Another point here is that this is not a neutral act. There will be benefits, in relation not just to personal health and saving lives but to costs associated with dealing with overdoses. I hope that will be seen.

The noble Lord, Lord Evans, also asked whether the methods of administration are permitted only by medical professionals. It is already the case under current regulations that naloxone can be administered by anyone. I emphasise the point about high levels of safety and that it can be administered by a lay person.

I think I have picked up most of the points raised, but as I said, if I have not I shall be very pleased to look further into any other points and to write.

To summarise, the changes we are proposing will allow more services and more professionals to give out take-home supplies of naloxone without a prescription. As I said, it can already be administered by anyone but having more services with the ability to supply it will mean easier access for the people who are at risk of overdose. It will support them and those around them, as has been generously welcomed and acknowledged by the noble Lords, Lord Scriven and Lord Evans.

In short, these changes will widen access to a life-saving medicine. I am sure we can all agree that any death from an illicit drug is tragic and preventable, and we should take every step we can to reduce drug-related deaths; that is what we are doing today. On this basis, I hope that noble Lords will join me in supporting these important regulatory changes. I commend these draft regulations to the Committee.

[Lord Evans of Rainow (Con)]

I thank the Minister for her responses. In Australia, Canada and some states in the United States the nasal spray is available over the counter. Does the Minister have any knowledge of any plans to administer it via our pharmacies?

[Baroness Merron (Lab)]

I am waiting for inspiration, as the noble Lord will realise. In fact, I would rather write to him, as he has made an important point and I want to be quite clear on it. I thank him for reiterating the point.

Human Fertilisation and Embryology (Amendment) Regulations 2024

Lord Evans of Rainow Excerpts

Tuesday 22nd October 2024 Grand Committee

[Lord Evans of Rainow (Con)]

My Lords, when I came here today, I did not think I would be hearing about Enoch Powell. I think that, if he were here today, he would be very interested in what we have been debating. Enoch Powell’s consistency was Wolverhampton South West. In the 2010 election, a colleague of mine of Asian background, a Sikh, won by the same majority as Enoch won it by in 1950. I am glad to say that Mrs Enoch said that Enoch would have been delighted by my Conservative colleague Paul Uppal winning that seat. It shows that people change over time. I wish he were here to hear what I am about to say.

I welcome these regulations laid before us by His Majesty’s Government. They bring forward the plans from May this year that were established by the Conservative Government. Now, as then, we believe that equality under the law is a long-established principle in this country and any improvement towards this end is to be lauded. I am sure that can receive support from all noble Lords.

These regulations mark a further step towards ensuring equal access to IVF services for people living with HIV and for female same-sex couples. It is another stage in the process of ensuring that as many people as possible can fulfil their dreams of parenthood, and it builds on the incredible work done to reduce the stigma associated with HIV, which has for so long prevented people getting tested and seeking treatment. With these changes, we will make it clear that people with HIV can live happy and fruitful lives.

The conditions in these regulations limit donation to those with an HIV viral load of no more than 200 copies per millilitre, meaning that the infection is undetectable and therefore non-transmittable. This requires the donor and recipient to have a personal relationship with one another and ensuring that safeguards are in place to minimise any risks associated with partner donation from people diagnosed with HIV. This will benefit hundreds of couples who have been trying in vain to become parents, and it will also reduce costs relating to IVF.

I hope that His Majesty’s Government will continue in the steps of the previous Conservative Government with efforts to help those living with HIV to have equal access to healthcare services.

[Baroness Merron (Lab)]

My Lords, I am glad to sense not just support for this draft statutory instrument but recognition in this debate. Following the comments of the noble Lord, Lord Evans, I acknowledge the contribution of my predecessor as Minister responsible for this area, who pressed on with the SI and ensured that it was laid. I am glad to be speaking to it today, as I know he is. I am also pleased to note that Adam Freedman from the National AIDS Trust is with us today. He is most welcome to the Committee. He has come to see the statutory instrument debated. He and his colleagues have patiently encouraged the previous Government and this Government in the right direction, and I thank him for that.

On the points raised by noble Lords, the noble Lord, Lord Wigley, asked whether the devolved Governments were content. I delighted to tell him that they are. He also asked about additional costs. A de minimis assessment was carried out, and it estimates £46,000 to £92,000 for the impact on the fertility sector. Obviously, as has been evidenced and described in this debate, there is a hugely positive impact from the measures within this draft statutory instrument.

I note what the noble Lord, Lord Wigley, said. I put down that he, along with the noble Lord, Lord Winston, and other parliamentary colleagues past and present, are veterans of change and of the Acts we are talking about. As the noble Lord, Lord Scriven, said, this is a journey—one that I suspect is not at its end, although I am pleased to take us further on that journey today. I also pay tribute to the contribution in this area of the noble Lord, Lord Winston, over many years, and to the contributions of other colleagues, who have given it their support and professionalism.

The noble Lord, Lord Winston, asked what the case would be if a recipient were HIV positive. The answer is that they will be able to get IVF. They are not actually affected by these regulations, which impact donors, not recipients. I assure the noble Lord that he was far from wasting the Committee’s time with his comments. I heard clearly his comments about counselling and the need for support. I will look closely at that with officials, following his remarks. I clarify that the £1,000 I referred to was not for IVF. It was an estimated cost for the additional screening required for female same-sex couples, which we are now seeking to correct.

On funding and the issue of availability on the National Health Service, as noble Lords will know, funding for IVF is devolved to ICBs. I am very well aware of the differential provision to different groups and individuals. I will consider future policy options, having picked up this part of the brief and spoken to a number of people about their concerns.

The noble Lord, Lord Scriven, also asked about access to IVF on the NHS. In addition to the point about consideration of advice that I will be getting about improving the service, I want to share his comment about this being just one more step in a positive direction. It is about supporting the fact that families come in all shapes and sizes. A family or a household is a family or a household, and parents are parents. They are there to support and bring up their child in a positive way, and we want to support that too.

I finish by thanking the noble Lord, Lord Evans, for reminding us that one thing that these regulations will do is take us a step on another journey—that of reducing the stigma for those who live with HIV. There have been so many medical advances, which is why we are able to bring this instrument forward today. But attitudes continue to be something to be challenged at times, and I am glad that noble Lords recognise the contribution of the legislative change we seek to make.

We want to ensure that those who want to start a family do not face barriers where there is no reason for those barriers. I place on record my thanks to the organisations who have pushed for and supported these reforms, particularly the National AIDS Trust, Stonewall, the Elton John AIDS Foundation and the Human Fertilisation and Embryology Authority. As I said earlier to the noble Lord, Lord Wigley, I thank all those parliamentarians and others along the way who have got us to this place today.

NHS Hospitals: Apheresis

Lord Evans of Rainow Excerpts

Wednesday 9th October 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank my noble friend for raising that important point. I will be very pleased to look into this further, so I can answer him in full.

[Lord Evans of Rainow (Con)]

My Lords, I pay tribute to the noble Baroness, Lady Ritchie, for her work in this area. In England, leukapheresis can be performed only by the NHS Manchester apheresis unit, and the Birmingham unit can carry out only three of the apheresis services. Are His Majesty’s Government committed to expanding the range of apheresis services available at each unit?

[Baroness Merron (Lab)]

Further to my answer to the noble Baroness, NHS Blood and Transplant is seeking to expand capacity in the way I outlined. It is probably worth going back to the point about the apheresis working group. It met for the first time last month to determine the extent of the capacity issues which we know exist. It will also be looking at who delivers what, how and for what uses. It will identify the issues in respect of workforce, machinery, finance and efficiency, and seek to come up with a recommendation. It will report in spring of next year, so we have a route forward.

Support for Infants and Parents etc (Information) Bill [HL]

Lord Evans of Rainow Excerpts

2nd reading
Friday 6th September 2024 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, I begin by congratulating my noble friend Lord Farmer on securing time for his Private Member’s Bill. I also pay tribute to his work over many years on family policy, preventing family breakdown, and on the welfare of children, and especially to his work on creating and growing the family hubs network, supported by Dr Samantha Callan. I also pay tribute to my right honourable friend Dame Andrea Leadsom, who has worked tirelessly on this subject. There is no doubt that my noble friend’s passion and commitment are behind the Bill today, and his belief, shared by many noble Lords, that we need to give all newborn babies the best possible start in life, no matter what their background.

The importance of the Start for Life approach cannot be underestimated. It ensures that there are welcoming family hubs, usually run by local authorities, through which new parents of newborns can access a wide range of family support services such as parenting support, help for relationships between new parents and between parents and new babies, health visitors, breastfeeding and other infant feeding services and mental health services. These services are provided by local authorities, the voluntary sector and private sector partners.

My noble friend Lord Farmer has highlighted how local authorities that receive Start for Life funding are required to publish their offer. Indeed, it is one of the conditions for local authorities receiving transformation fund money. The Bill is in some ways simple in its aim, which is to ensure that they contribute to offer Start for Life beyond the end of that fund. Of course, this will require additional funding, but in the context of some of the larger sums of billions that we debate in this Chamber, we are speaking about only £500,000 per annum across England. As with any taxpayer spending, my noble friend Lord Farmer proposes that there should be a proper procedure in the Commons to make this relatively small sum available.

It may be argued by some noble Lords that, with £500,000 here and another £500,000 there, pretty soon we are talking serious money. However, against this we need to consider the cost of family breakdown in the UK. Aside from the emotional, social, mental health and societal costs of family breakdown, the Centre for Social Justice think tank estimates that the cost to the Government and ultimately the UK taxpayer is at least £51 billion a year.

In terms of societal costs, the Centre for Social Justice also found that those who experience family breakdown when aged 18 or younger are more than twice as likely to experience homelessness, twice as likely to be in trouble with the police or spend time in prison, almost twice as likely to experience educational underachievement, and almost twice as likely when they themselves become parents to break up with the other parent of their children. They are also more likely to experience alcoholism or teenage pregnancy, suffer from mental health issues, fall into debt or experience being on benefits.

Much has been said by my noble friend Lord Farmer and noble Lords on all Benches about the importance of support for newborns and their families to give our nation’s children the very best start in life. My noble friend has committed his political life to founding and growing the network of family hubs to help parents and children of all backgrounds, and for this reason, I commend him for his equally noble work in this area.

Some noble Lords may say that we should leave this to the decisions of integrated care boards and partnerships or health and well-being boards. However, giving the best start in life to children involves far more than just being health focused. From speaking to my noble friend Lord Farmer, I understand that he believes that it is important to keep Start for Life as integrated as it currently is, with a wider remit than just health.

In preparing for this debate, my noble friend Lord Kamall contacted the office of the Minister, asking for an indication of whether the Government are inclined to support the Bill. The Government were not able to tell him whether they will do so. However, that fateful—but we hope not fatal—day for my noble friend Lord Farmer’s Bill has now arrived.

I have a few questions for the Minister. Do the Government intend to support or reject my noble friend Lord Farmer’s Bill? If the Government are not minded to support it, where do they disagree with it? If the Government are not supportive, are they considering introducing their own Bill for Start for Life? If so, what timeframe can we expect for such a government Bill, and in the meantime what will happen to the funding for the Start for Life programme?

My noble friend Lord Farmer has devoted his life to family hubs. He has made a compelling case for the Start for Life programme. I am sure that he and other noble Lords, including the Opposition Front Bench, are looking forward to the Minister’s answers to these questions.

Vaginal Mesh Implants: Compensation

Lord Evans of Rainow Excerpts

Thursday 5th September 2024 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, this has been an excellent debate. I thank my noble friends Lady Sugg, Lady Berridge and Lady Wyld, the noble Baronesses, Lady Bennett and Lady Brinton, and my noble friend Lord Mancroft, who all made very powerful points in their speeches. I congratulate my noble friend Lady Cumberlege on securing this important debate. I pay tribute to her work on this issue over many years and her leadership on the First Do No Harm report of the Independent Medicines and Medical Devices Safety Review, as well as to her team of Sir Cyril Chantler, Simon Whale and Dr Valerie Brasse, and the patient groups.

Simply put, victims have suffered as a result of two medications and one medical device. The medications are: hormone pregnancy tests such as Primodos, which were later withdrawn due to concerns over birth defects and miscarriages; and sodium valproate, the anti-epileptic drug which was later found to cause physical malformations, autism and developmental delay in children after being taken by pregnant mothers. The medical device is the pelvic mesh implants which were used to repair pelvic organ prolapse and address urinary incontinence. Their use has been linked to crippling, life-changing complications.

My noble friend Lord Kamall tells me that when he was a Minister in the department he was horrified that progress for helping the poor women who had suffered from these two medications and one medical device was far too slow. Fortunately, the then Minister, Maria Caulfield, asked the Patient Safety Commissioner to explain what the Government should do to meet the needs of individual patients who had suffered these avoidable harms.

In government, we completed four of the initial recommendations in the report of my noble friend Lady Cumberlege, and another three were in progress in March 2024. The most important of these is the setting up of nine specialist centres which can provide the support needed in terms not just of redress surgically or treatment-wise but of the support that people need to help them cope with the issues. We expect the Government to deliver financial compensation for those affected by these treatments as soon as possible.

My noble friend Lady Cumberlege has said that after “first do no harm” should come

“and now do some good”.

As other noble Lords have referenced, the Patient Safety Commissioner’s report, published earlier this year, states that

“there is a clear case for redress based on the systemic healthcare and regulatory failures”

for women and children affected by the issues in England.

There is agreement across this House that Governments of all political colours have been too slow in delivering justice and financial compensation to victims of scandals in the past. We need mention only the Post Office Horizon scandal to remind ourselves of the importance of delivering justice to those who have been wronged. When these problems come to light, it is essential that we help the victims of these scandals as quickly as possible. Too many people suffered over the Horizon scandal and too many people and families suffered due to delays in helping victims of the infected blood scandal. Likewise, too many women, children and families have suffered as a result of women being prescribed Primodos, sodium valproate and pelvic mesh implants. The Government must act urgently to help those women who have suffered, so will the Minister give an undertaking today to make this a priority?

On 23 July, my noble friend Lord Kamall submitted a Written Question to the Minister asking when the Government intend to respond to the Hughes report and when they anticipate making the first payments under the recommended redress scheme. I thank the Minister for replying within three days, saying:

“The Government is considering the recommendations of The Hughes Report, and to prevent future harm, the Medicines and Healthcare products Regulatory Agency, NHS England, and others have taken action to strengthen oversight of valproate prescribing and mesh procedures”.


My noble friend Lord Kamall followed up on 29 July to ask the Government

“by which date they expect to issue a response to the Hughes Report, and whether they plan to offer compensation as the report recommends”.

Again, the Minister responded promptly with the Answer:

“The government is carefully considering the valuable work done by the Hughes Report and will respond in due course”.


We recognise that the Government are relatively new and need time to get up to speed, but can the Minister be more specific at this stage in answering the timescale question?

My noble friend Lord Kamall tells me that when he was a Minister there were two phrases in briefings that he was not fond of. One was “at pace” and the other was “in due course”. Can the Minister give noble Lords an approximate timescale for a decision—for example, by the end of 2024, mid-2025 or indeed the end of 2025? If not, can she enlighten noble Lords on when she will be able to give an estimate of the date by which she will know the date of the Government’s response? It is vital that they give some certainty to noble Lords—and, more importantly, to the many women and children who have suffered for far too long physically, mentally and economically. I know that the noble Baroness is a formidable operator as a Minister and, to speak personally, she has our full support on this side of the House.

Palliative and End-of-life Care: Funding

Lord Evans of Rainow Excerpts

Wednesday 4th September 2024 Lords Chamber

[Baroness Merron (Lab)]

As the noble Baroness said, in 2024-25 the £25 million in funding from NHS England was distributed, for the first time, via integrated care boards. As I understand it from the previous Government, that was in line with NHS devolution. We will carefully consider the next steps on palliative and end-of-life care funding much more widely in the coming months and will take on board the comments of the noble Baroness and other noble Lords.

[Lord Evans of Rainow (Con)]

My Lords, everyone should be able to access quality palliative and end-of-life care and patient care in their local area. Under the Conservatives, we made integrated care boards legally responsible for commissioning palliative care services to meet the needs of the local population. What assessment has the Minister made of access to palliative and end-of-life care across the country? What steps will the Government take to ensure that everyone, especially those living in rural areas, can access quality end-of-life care?

[Baroness Merron (Lab)]

As the noble Lord will be aware, statutory guidance and service specifications are provided to support commissioners in ICBs to meet their duty. As I am sure the noble Lord is also aware, NHS England has developed a palliative and end-of-life care dashboard that brings all the relevant local data together and helps commissioners to understand the situation so that they can provide for their local populations. This is part of ongoing work for this new Government to see how we meet requirements to provide dignity, compassion and service at the end of life and just prior to the end of life.

NHS: Breast Screening Programme

Lord Evans of Rainow Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Merron (Lab)]

I am sure that the noble Lord, Lord Darzi, is listening, but if he is not I will ensure that the noble Lord’s comments are drawn to his attention. I can say to your Lordships’ House that this Government intend to transform the NHS from a late-diagnosis, late-treatment health service to one that catches illness earlier and also prevents it in the first place. It is that shift that will make the greatest change. I have been interested to see that, across all the screening programmes, something like 15 million people are invited for screening and 10 million take it up. That still leaves us with 5 million people to work on. It is important to note that the 10 million take-up figure for screening saves a considerable number of lives. We need to continue to drive up the take-up on screening, across the various cancers and not just breast cancer. As noble Lords will know, there are programmes in respect of cervical and bowel cancer, and there will be a lung cancer screening programme as well.

[Lord Evans of Rainow (Con)]

My Lords, I begin by paying tribute to the noble Baroness, Lady Morgan, for her excellent work with Breakthrough Breast Cancer and more recently with Breast Cancer Now. We are very lucky to have her in your Lordships’ House. We know that the NHS wants to shift the emphasis from cure to prevention and screening, which, whether for breast cancer or other conditions, is a vital part of prevention. The previous Conservative Government took action to drive up breast cancer screening, with new breast cancer screening units and our community diagnostic centre programme. What steps will the Government take to further increase the uptake of breast cancer screening?

[Baroness Merron (Lab)]

The measures that the noble Lord refers to did indeed assist, but as I mentioned earlier we have a stubborn problem in returning to pre-Covid rates. The improvement plan that exists sets out the priorities and the interventions, but also the monitoring of what is working and what is not. The kinds of things that are being tested and introduced now include, for example, new IT systems to enable communication with women in 30 different languages, and new IT systems that mean people know when their appointment is and are reminded of it. All these things sound quite straightforward, but they have not been in place across the country and it is important that they are. I mentioned the importance of addressing fears and embarrassment, improving information and reassurance to women, as well as more convenient times and booking systems. It is very important that we make better use of mobile screening units, so that screening is near to where women are.

Covid-19 Inquiry

Lord Evans of Rainow Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, I reflect today on the first report from the Covid-19 Inquiry—a report that is not only sobering but necessary. It marks a vital step in understanding the full impact of the pandemic on the United Kingdom and learning the lessons necessary for future crises.

I begin by expressing my gratitude to the noble and learned Baroness, Lady Hallett, and her team for their diligent and comprehensive work. The evidence presented in this report, especially from those who have suffered loss and trauma, is invaluable. Their testimonies are vital in shaping our understanding of the pandemic’s impact and informing our future strategies. The report highlights the shortcomings in our pandemic preparedness and response. These failures transcended party lines; they are failures in planning, leadership, resourcing and the ability to adapt swiftly to an unprecedented situation. We must confront these failures openly and honestly, not to cast blame but to ensure that we are better equipped to protect our citizens in the future.

Preparedness is not the responsibility of any single Government or institution. It is a shared duty that extends beyond political lines and encompasses all levels of government, public institutions and international bodies. The role of the World Health Organization and Public Health England in this pandemic must be scrutinised. Were we adequately prepared to rely on their guidance? Were these organisations equipped to offer the necessary support and leadership? It is clear from the report that the advice and recommendations from these bodies was not always as robust or adaptable as the rapidly changing situation demanded. For example, Public Health England was equipped to manage only a limited number of cases, not the extensive testing and contact tracing needed for a pandemic the scale of Covid-19. Similarly, the report cites several instances where the World Health Organization’s advice either was delayed or failed to reflect the developing reality, such as its initial denial of human-to-human transmission, the delayed declaration of a global emergency and its resistance to implementing travel restrictions.

The report also highlights a critical flaw in our previous focus on pandemic preparedness, which was largely centred on influenza, as evidenced by the Exercise Cygnus framework. While this focus was, reasonably, based on the information available at the time, the Covid-19 pandemic has emphasised the need for a broader, all-hazard approach to pandemic planning that is flexible and can adapt swiftly to unforeseen challenges. We must avoid being unprepared in the future due to an overreliance on outdated models or narrow perspectives.

Given these findings, I propose several questions to the Government. What measures are being taken to ensure that our emergency planning structures are more cohesive and comprehensive, integrating the insights and needs of devolved Administrations and local government bodies? Our response must be unified, yet flexible enough to address regional and local circumstances.

Furthermore, how do the Government intend to improve co-ordination across all levels of government and civil society? The pandemic illustrated the importance of a collaborative approach, where clear communication and co-operation are paramount. Without such co-ordination, efforts will remain fragmented and less effective.

Finally, I reiterate the importance of including a broader range of perspectives in our decision-making processes. How will the Government ensure that Ministers can access a broad spectrum of advice, including dissenting and minority viewpoints, to prevent groupthink and encourage more robust decision-making? It is crucial that we create an environment where critical thinking and diverse perspectives are not just welcome but actively encouraged.

I affirm our commitment to working with the Government and all Members of this House in the national interest. We must learn from the findings of this report and the forthcoming recommendations from the noble and learned Baroness, Lady Hallett, to strengthen our nation’s resilience and preparedness. Our collective responsibility is to ensure that we are better prepared for whatever challenges the future may hold. With this commitment, I hope that we can overcome the shortcomings highlighted in the report to emerge stronger and more prepared in the future.

With that in mind, I ask the Minister what measures are being taken to ensure that our emergency planning structures are more cohesive and comprehensive, integrating the insights and needs of devolved Administrations and local government bodies. How do the Government intend to improve co-ordination across all levels of Government and civil society? How will the Government ensure that Ministers can access a broad spectrum of advice, including dissenting and minority viewpoints, to prevent groupthink and encourage more robust decision-making?

NHS Continuing Healthcare

Lord Evans of Rainow Excerpts

Monday 2nd September 2024 Lords Chamber

[Baroness Merron (Lab)]

As the noble Baroness is aware, the responsibility for this lies with integrated care boards and a framework applies to both adults and children and to young people. It is for NHS England to ensure that the framework is properly applied. Certainly, the framework for children and young people has not been revisited since 2016 and we need to look at whether it is doing the job it is intended to do, because we want people to be getting the care they need. Each case is unique and complex and, as a person-centred service, that brings its own complexities. We should therefore ensure that the frameworks are applied correctly and get to the right people at the right time.

[Lord Evans of Rainow (Con)]

My Lords, I take this opportunity to warmly welcome the noble Baroness to her place; I look forward to working with her. During consideration of the Health and Care Act, the last Government committed to moving away from care homes. Are this Government also committed to allowing those needing care to be given support to live at home? What changes do they believe need to be made to the NHS continuing healthcare programme to allow them to stay at home, rather than be in care homes? The noble Baroness and I have exchanged comments about this in private, and I am very happy to discuss it again with her at a later date.

Social Care Reform

Lord Evans of Rainow Excerpts

Monday 2nd September 2024 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness raises an important point about actually making it work, but certainly the fair pay agreement is crucial to professionalising the care service and, indeed, raising the visibility of and regard for those who work in this sector, which is nearly 1.6 million people. We will be working closely, as I mentioned, with trade unions, local authorities, the sector and all those with an interest to make sure that the first ever fair pay agreement for care professionals can work and will deliver what we want, which is a stable, well-regarded and well-trained workforce.

[Lord Evans of Rainow (Con)]

My Lords, during the passage of the Health and Care Act, the previous Government came up with a compromise solution to fund healthcare for an ageing population. It was by no means perfect but it made a start, while addressing the concerns of the Treasury. The new Government have scrapped this scheme but have not yet proposed an alternative. A report from the Health Foundation claimed that Labour’s plans for social care are the most general, with a headline commitment to create a national care service but no detail about timescales or resources. Can the Minister give us any indications on the timeframe, such as “the end of 2024”—preferably a date, rather than “in due course” or “in the fullness of time”?

[Baroness Merron (Lab)]

I welcome the advice from the noble Lord and I will resist using those terms, which I am sure he will appreciate. However, as noble Lords have already understood, this is not going to be done overnight; we are talking about a 10-year vision but we will be talking about steps along the way. I think it is very important that we make progress on the national care service in the short term, because we have to build the foundations, by working with the sector and those with lived experience, to develop those new national standards. It will be work in progress and I hope that noble Lords will be patient but also press me about what progress we are making.