Unpaid Carers: Patient Hospital Discharge

Lord Kamall Excerpts

Thursday 19th March 2026 Lords Chamber

[Baroness Merron (Lab)]

My noble friend makes exactly the right points. We certainly recognise the vital role that unpaid carers play in supporting those who are to be discharged. Decisions about staffing and the approach—I emphasise that a multidisciplinary approach is clearly needed here—are a matter for local areas, but I can say in addition that there is a regular cross-government meeting, which is really important when it comes to joining up the approach, that looks at providing unpaid carers with the recognition and support that they need, as my noble friend said. We are also working towards publishing a cross-government action plan later this year. So in this area, including the LGA work, the kind of approach that my noble friend talks about will certainly be considered.

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Pitkeathley, for being a tireless champion of unpaid carers over many years and successive Governments. She quite rightly pointed out that Carers UK found that only 14% of unpaid carers were asked about their ability and willingness to provide care before hospital discharge. I want to follow up on the previous question from the noble Baroness, Lady Andrews. One of the problems faced by successive Governments is that trusts and what were previously CCGs and are now ICBs are very bad at learning from other parts of the system that do things well. For example, Northumbria has been known to have a really good discharge system: it embeds co-ordinators and works out how to get that discharge going. How can the Minister’s department improve learning across the system where there is good practice, take that best practice and appropriately transplant it into other areas so that we can really tackle this problem once and for all?

[Baroness Merron (Lab)]

The whole system needs to do better, as the noble Lord outlines. It will be helpful that we are also looking at commissioning research in this area to look at best practice, as well as barriers and solutions, regarding the involvement of unpaid carers—I think that has been somewhat overlooked, if I am to be honest with your Lordships’ House. We have regional teams that have issued very practical toolkits to help hospitals implement their legal duties; we should remember that there are legal duties in this response. In addition, that is why we are involving the LGA’s better care fund support programme, as I said, as well as seeking to publish a cross-government action plan. These will be steps in the right direction, but I very much acknowledge that we do not start in a good place.

GP Contract

Lord Kamall Excerpts

Tuesday 17th March 2026 Lords Chamber

These ideas were not cooked up by someone sat behind a desk in Whitehall. What is happening is that we are taking the best of the NHS to the rest of the NHS, working with pioneering practices that have been doing these things for a long time. Today we can see that our policies are working, and after years of decline in general practice, we are getting the front door back on its hinges. Patient satisfaction with general practice is finally moving in the right direction. According to the Office for National Statistics, almost 77% of people described contacting their GP as easy in January this year, up from just 60%, where it was languishing in July 2024. I know that when he gets up, the honourable Member for Hinckley and Bosworth, Dr Evans, will hugely welcome, as will his honourable friends, the progress that we are making”.

[Lord Kamall (Con)]

My Lords, I am grateful to the Government for this repeat. The Minister in the other place pointed to 1.3 million referrals being diverted through something called “advice and guidance”. This means that GPs must seek input from a specialist before making a referral, but some professional bodies have warned that this mandatory approach will risk creating barriers to patients accessing specialist care and may compromise patients’ safety if they are not referred in a timely manner. To address these concerns, can the Minister set out what clinical safeguards are in place where a GP believes a patient needs to be referred directly to a specialist but is instead referred to go through this advice and guidance process? If a patient comes to harm as a result of any delay due to not being referred directly to a specialist, who will bear responsibility for that decision and how will accountability be determined?

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

As the noble Lord said, we have seen 1.3 million people diverted since April 2025. Otherwise, they would have been added to the electives waiting list, in clinical terms, unnecessarily. The main thing I can say to the noble Lord on advice and guidance is that I think the figures speak for themselves. That is why we are embedding it into the core contract. We are recognising it as routine practice. It provides more predictable funding and removes annual sign-ups. More generally, I must emphasise to the noble Lord that it does not take away a GP’s right to refer. That remains a matter of clinical judgment and, as in all things, clinical judgment will rule the day.

NHS: In-house Software Capabilities

Lord Kamall Excerpts

Monday 16th March 2026 Lords Chamber

[Baroness Merron (Lab)]

Cyber attacks across our whole government are extremely concerning, and that is why we have built resilience. On health and social care specifically, I can assure the noble Lord that, in 2025-26, we invested £75 million across health and social care; that built on the £375 million invested since 2017. When I had responsibility for the blood transfusion service, my own experience was that, where there was a cyber attack, we had the systems in place.

[Lord Kamall (Con)]

My Lords, there is always a very difficult balance between keeping something in-house or outsourcing it, and we should not forget the national programme for IT in the NHS in the early 2000s, which ended up costing between £10 billion and £20 billion. My question is on the company Palantir. The Minister will be aware that there are a range of views on Palantir. Some say that it is the best software available and that no one can match it; others say that they are worried that it will lock the NHS in long-term and scrape data for other uses. What specific measures have NHS England and the department put in place so that, in the event that the Palantir contract is not renewed, the healthcare system will be able to move seamlessly to another supplier?

[Baroness Merron (Lab)]

That seamless movement is an important point generally, but the federated data platform does not centralise or sell patient data. Data remains firmly under NHS control, and access is strictly governed. It is fully auditable and used only for approved patient benefit and NHS benefit. Palantir operates strictly under the instruction of NHS England and it does not, as I said, own or control NHS data. That access is tightly governed. In response to the earlier question, I note that the federated data platform to which the noble Lord refers is cyber resilient and subject to rigorous contractual, legal and information governance controls.

NHS: Heart Valve Disease

Lord Kamall Excerpts

Thursday 12th March 2026 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord is right to make the point that innovation research is one part of it, but it is actually its implementation that matters. However, the faster and more frequent detection of cardiovascular conditions is the key thing and training is certainly a part of that.

[Lord Kamall (Con)]

My Lords, I am grateful to the Minister for giving me time for this question. She will be aware that studies analysed in around 155,000 diagnoses of aortic stenosis in England have found that women were significantly less likely to be referred to specialists and far less likely to receive valve replacement. This also applies to patients from deprived areas and in some ethnic minority groups. What assessment have the Government made of these disparities and what action are the noble Baroness’s department and NHS England taking to ensure that patients have access to heart valve treatment regardless of their gender, ethnicity or where they live?

[Baroness Merron (Lab)]

The noble Lord is quite right: women are underdiagnosed, they are undertreated and some ethnic minority groups face poorer access. That is why I very much welcome the fact that, in the framework to which I referred, dealing with inequalities will be absolutely key. Research, in which we are partnering with the British Heart Foundation, will focus on tackling inequalities in higher-risk groups as well as unequal cardiovascular disease outcomes. Inequalities and tackling them will be at the heart of all our acceleration of progress as well as our research.

Tobacco and Vapes Bill

Lord Kamall Excerpts

3rd reading
Monday 9th March 2026 Lords Chamber

[Baroness Merron (Lab)]

My Lords, it has been a privilege to take this landmark Bill through your Lordships’ House. Smoking is the number one preventable cause of death, disability and ill health and tobacco claims around 80,000 lives every year. While tobacco remains the greatest threat, this legislation is about protecting future generations from the harms of not only tobacco but nicotine addiction.

I extend my thanks to noble Lords who have contributed from right across the House: in particular, on the Front Benches, the noble Lord, Lord Kamall, the noble Earls, Lord Howe and Lord Russell, and the noble Baroness, Lady Walmsley. My thanks go also to the Secretary of State for his leadership and support and to former Minister Ashley Dalton MP, who advanced this Bill to your Lordships’ House.

I also want to pay tribute, as many of us do, to former Prime Minister the right honourable Rishi Sunak for his ambition for a smoke-free generation. I also thank the Chief Medical Officer, Sir Chris Whitty, for his expertise and unwavering focus, and all the officials who have played a crucial role, including the Bill team, policy teams, analysts, the Bill’s senior responsible owners, my private office and the Government Legal Department and the Office of the Parliamentary Counsel for their invaluable contributions.

Finally, I pay tribute to Ministers and officials from the devolved Governments for their collaborative approach. This is genuinely a four-nations Bill which will ensure that we create a smoke-free generation and tackle youth vaping in every corner of our country. I beg to move.

[Lord Kamall (Con)]

My Lords, we have now reached the conclusion of what many will see as a landmark Bill. I thank all noble Lords who have contributed throughout the various stages of its journey through your Lordships’ House, which began with its introduction as long ago as March last year. From these and other Benches, we heard a range of views on its various proposals and on the Bill itself. For some, it goes too far. For others, it does not go far enough. However, among all the disagreements, there were three points that I think noble Lords can agree on. First, smoking is bad for your health. Secondly, current evidence shows that vaping is less harmful than smoking tobacco. Thirdly, not vaping is healthier than vaping.

Beyond that, our debates covered a number of issues, from the evidence base to how to make vapes an attractive alternative to adults who wish to quit smoking while not appealing to children, as well as matters of individual liberty. We also debated the illicit sale of tobacco, the treatment of specialist retailers, cigarette filters, the compatibility of the Bill with the Windsor Framework and the enforcement of a regulatory regime of considerable complexity. We also probed the Government on the evidence behind some of the proposals, for example on the relative harm of heated tobacco compared with combustible tobacco for smokers who have tried vapes but did not like them, so reverted to cigarettes.

While we did not always agree, I thank the Minister and her officials for meeting my noble friend Lord Howe and me throughout the passage of the Bill. I particularly thank her for the concessions made: we particularly welcome the amendment permitting vape vending machines in secure mental health settings. These are vulnerable people in restricted environments for whom access to cessation aids is not a luxury but a genuine health need and it was right that the Bill was amended accordingly.

Independent Commission on Adult Social Care

Lord Kamall Excerpts

Monday 9th March 2026 Lords Chamber

[Baroness Merron (Lab)]

Yes, indeed. We have three core foundations in place in our government objectives for adult social care, one of which is—to the point made by the noble Lord—strengthening the join-up between health services and social care services, because people need to experience more integrated, person-centred care. I am glad that the noble Lord welcomes the immediate actions, set out by the noble Baroness, Lady Casey, that the Government must take on adult safeguarding, dementia and motor neurone disease. We are not wasting any time in taking those recommendations forward.

[Lord Kamall (Con)]

My Lords, picking up on the points made by the noble Baroness, Lady Pitkeathley, and the noble Lords, Lord Young and Lord Laming, when we were in government, we published a White Paper on an integrated national health and care service, to be available for patients from birth to their later years. When the new Government were elected, as was their prerogative, the Secretary of State talked about creating a separate national care service, but we have heard little since. Can the Minister tell your Lordships’ House whether we will have to wait until the next stage of the Casey commission, in 2028, to get any further details at all, especially on how it will work in tandem with our healthcare system, or can we expect any clues or hints before then?

[Baroness Merron (Lab)]

The noble Lord does not have to wait because, in addition to the work by the noble Baroness, Lady Casey, which, as I have said, is independent, she has set out immediate recommendations, which we are working on. We have already made commitments on the disabled facilities grant for housing, so that people can stay in their own homes. We have announced a £500 million investment in the first ever fair pay agreement, and we are uplifting social care allowances to support disabled people more than they ever have been. Those are just some examples, and I would be very happy to direct the noble Lord to other ways in which we are already taking action.

Tobacco and Vapes Bill

Lord Kamall Excerpts

Report stage
Tuesday 3rd March 2026 Lords Chamber

[Lord Lansley (Con)]

I say a big thank you to the Minister for listening; as she rightly said, she has listened and taken on board the comments made in Committee. Amendment 78, which I tabled in Committee, is in fact in the same terms as the Minister’s Amendment 64, which she introduced earlier this afternoon. My purpose was to ensure that local authorities would be able to enforce, more effectively and more substantially, the provisions of the Bill and their trading standards responsibilities generally. I am very glad that the Minister listened so positively to our Committee debate.

[Lord Kamall (Con)]

My Lords, I was very happy to give way to my noble friend to allow him to heap more praise on to the Minister. Sometimes Government Ministers cannot always be assured of receiving praise from other Benches.

My noble friend Lord Howe and I welcome these government amendments and are grateful to the Minister and Department of Health and Social Care officials for reflecting constructively on our debate in Committee on fixed penalties.

On Amendments 66 and 68 in the name of the noble Baroness, Lady Walmsley, while I do not disagree with the sentiment, which is admirable—since in theory hypothecation of taxes, public fines and penalties would lead to more transparency on how taxpayers’ money is spent—there is also a strong argument in favour of more fiscal devolution to local authorities, and whether we should use legislation to tell local authorities what they should be doing with the funds they are responsible for. Nevertheless, I would be interested to hear the Minister’s reaction to those amendments, and I thank her and the Government once again for their amendments.

[Baroness Merron (Lab)]

My Lords, I am most grateful for the contributions to this debate. I can assure the noble Lord, Lord Kamall, that there are no limits to the amount of praise that can be received by Ministers on this Front Bench, and noble Lords should feel free, at any time, to heap praise. We will always be grateful.

I am grateful for the welcome from the noble Lord, Lord Lansley, the noble Baroness, Lady Walmsley—we are very pleased to see her back in her place in good health—and the noble Lord, Lord Kamall. On the noble Baroness’s Amendments 66 and 68, I have heard the call for, as she described, a broad approach. We recognise the importance of local smoking cessation services, which is the very reason we are investing an additional £260 million pounds over the next three years within the public health grant. This will mean that at least £150 million is ring-fenced for stop smoking services every year. The funding is protected, as the noble Baroness seeks, and cannot be used for other public health initiatives. It provides assurance and stability for these essential services.

In addition, we have extended the national smoke-free pregnancy incentive scheme for a further three years from 2026-27 to 2028-29, with funding worth up to £15 million—£5 million per annum. We are also committed to integrating opt-out smoking cessation services into routine care within all hospitals, as set out in the 10-year health plan.

I hope that this reassures the noble Baroness, Lady Walmsley, about how committed we are to providing support for smokers to quit without the need to fund services using proceeds from fixed penalty notices. Instead, as your Lordships’ House has heard, we believe that proceeds can be better used by local authorities on the enforcement of the Bill and other tobacco and vape legislation. It is important that local authorities are able to retain the proceeds to cover their costs in issuing fixed penalty notices and reinvest any remaining funds in enforcement. Strong enforcement of the measures in the Bill and other tobacco and vape legislation will help ensure that we deliver our ambition to achieve a smoke-free UK and to protect future generations from the risk of nicotine addiction. In other words, on the very important points that the noble Baroness is pursuing through her amendments, that ultimately is the best way of reducing smoking.

Government amendments 64, 65, 67, 69 and 74 will support this by allowing local authorities to retain all the proceeds from the £2,500 licensing offence fixed penalty notices as well as the £200 fixed penalty notices in the Bill, which goes further than noble Lords were originally requesting. With that, I hope that noble Lords will support these important amendments.

--- Later in debate ---

[Lord Kamall (Con)]

My Lords, before I respond to the specific amendments, I will touch on two things that the noble Earl, Lord Russell, said. First, I was previously in the European Parliament and worked on a number of technology regulations, and we can never be absolutely certain that we have legislated for the future or completely future-proofed anything. The only way to do that is to ban everything, frankly. We therefore often find regulation having to keep up with technology when it is far behind it, but we can put certain provisions in place. We can predict certain things but we cannot predict all innovation completely. Secondly, I hope the noble Earl will not mind me gently reminding him that not all vape companies are connected to big tobacco. A number of vape companies have nothing to do with big tobacco, and it is important that we understand that distinction.

My noble friend Lord Howe and I welcome the amendments from my noble friend Lord Lansley. Before the Minister speaks to them, we also very much welcome the two government amendments in this group, which we think respond very helpfully to the issues raised in Committee by my noble friend Lord Lansley. We believe that adding these provisions is a good way of future-proofing the Bill, as much as any Bill can be future-proofed, without necessarily compromising any decisions that Ministers may wish to make in the short term—but also without committing the Government or a future Government to any specific technology solution or to one company’s specific solution. With that in mind, I look forward to what the Minister has to say.

[Baroness Merron (Lab)]

My Lords, government Amendments 130 and 132 provide a power that would allow the Government to regulate the technological features of vaping products and tobacco-related devices, and the software associated with those features, to address emerging risks and to protect children. While the Bill already provides powers to regulate various device features, such as colour, size and shape, I listened carefully to the points raised in Committee about vape technology and the need to future-proof the Bill in order to respond quickly to new risks. I appreciate the support of both Front Benches on this point, particularly the comments of the noble Lord, Lord Kamall, about how far one can ever go when future-proofing. I can assure him that we are not planning to ban everything, but I thank him for the interesting suggestion.

The noble Earl, Lord Russell, spoke to concerning examples of the emergence of technology being used to make vapes more enticing to young people. As he said, some can now come with gaming functionality and others can be linked to what are called puff leaderboards and reward systems, so the more you inhale, the more credits you build up. Emerging evidence suggests—and it is worrying—that these interactive and gamified vaping features may heighten their appeal to children. This raises serious public health concerns around their potential to escalate dependence on nicotine. Our amendments therefore ensure that such emergent technology features can be appropriately regulated to reduce the appeal to children.

I turn to Amendments 124 and 131 tabled by the noble Lord, Lord Lansley. Let me first reassure him, as well as the noble Earl, Lord Russell, with regard to Amendment 124, that the powers in the Bill already enable us to regulate markings, which could include digital markings such as QR codes, to be used as part of a system to authenticate products. On Amendment 131, with reference to the device itself, I am very grateful for the noble Lord’s suggestions and his contributions on how best to future-proof the Bill, including on age-verification technology.

While it is not the Government’s policy to verify age at the point of use, and we have no intention to do so at this time, we recognise that need, as I have said, to be able to regulate technology to protect public health and respond to evidence, as the noble Lord, Lord Lansley, acknowledged. It is for this reason that we are introducing the new regulation-making power on technology to which I have just spoken. I therefore ask the noble Lord to withdraw his amendment.

--- Later in debate ---

[Lord Kamall (Con)]

My Lords, I start by thanking my noble friends Lord Udny-Lister and Lord Sharpe for their amendments in this group. I begin with the amendments proposed by my noble friend Lord Udny-Lister. Many noble Lords have raised concerns about the unintended consequences of this Bill. Just yesterday, HMRC published data showing that legal tobacco sales in the United Kingdom fell by 52% between 2021 and 2025. That statistic will be welcomed by those who want to eradicate smoking, but there is still some way to go in encouraging smoking cessation. My noble friend’s amendments simply ask a question akin to that debated in group 5—namely, how far we should go with regulation of vaping and nicotine products, especially when we are trying to promote them as alternatives to smoking tobacco?

Of course, some regulation is certain to be necessary with products such as vapes, but we have to be careful that we confine them to responsible use. We should also be careful not to use a sledgehammer when a nuanced approach might be a more effective way forward in a particular circumstances and settings. If we overdo the restrictions, we risk driving smokers away from quit aids and alternatives such as vapes towards easily available alternatives—unfortunately, such as illicit tobacco, which we know is still too accessible to some smokers. Many noble Lords have spoken to their own experience in local authorities about trying to tackle illicit tobacco. In the right settings, advertising and displays of vaping products can play a role in encouraging adult smokers to switch from cigarettes to less harmful alternatives, and we know that many are already doing so. It is important for the Government to find the right balance.

I turn to the amendment from my noble friend Lord Sharpe of Epsom. There is really little that I can add to the case that he has made so persuasively. The hospitality sector has faced sustained pressure in recent years, including rising energy costs and an increase in the cost of taking on new employees, staff shortages in some areas and increasing regulatory burdens. It is therefore reasonable that when we introduce further restrictions, we carefully consider their cumulative impact on licensed venues.

My noble friend’s amendment is tightly drawn. It would apply only within the curtilage of premises licensed under the Licensing Act 2003; only where advertisements are not visible from outside; only in age-restricted venues with appropriate safeguards; and it explicitly excludes tobacco products. It also provides for regulations to be subject to the affirmative procedure, and requires consultation and a full impact assessment, something very much in line with better regulation, in which many noble Lords believe. That framework suggests a helpful attempt to strike a balance, maintaining strong protections for children and the wider public while recognising that adult-only controlled environments may justify a different approach. It seems reasonable to at least explore whether limited, carefully regulated flexibility of this kind could be accommodated without undermining public health objectives. I hope that the Minister will look favourably on such flexibility.

[Baroness Merron (Lab)]

My Lords, I am most grateful for the contributions to this debate. I begin with the amendments in the name of the noble Lord, Lord Udny- Lister, Amendments 149, 151, 155, 157, 159, 161, 163 and 169.

Survey data shows that there has been a significant growth in awareness of vaping promotion among young people, with 55% of all children aged 11 to 17 aware of promotion in shops. This figure relates to 2025, and that is up from 37% in 2022. We are therefore delivering on our manifesto commitment to stop vapes from being advertised to children, while still enabling them to be promoted by public health authorities as a means for adult smokers to quit smoking, something that noble Lords have emphasised correctly, once again, in this group.

Tobacco advertising, including for heated tobacco products, is already prohibited under the Tobacco Advertising and Promotion Act 2002, and will remain so under the Bill. On Amendment 168 in the name of the noble Lord, Lord Sharpe, I can clarify that the advertising provisions do not restrict the use of, or sale of, products, and therefore should not overly impact on the hospitality sector. I will come back to reference to the hospitality sector, following the comments of the noble Baroness, Lady Fox, when we get to the final group, which is coming up next.

Evidence for tobacco has found that partial bans, as referred to in this amendment, are not as effective as comprehensive bans in reducing tobacco consumption. I therefore feel that it is extremely reasonable to draw similar conclusions for vape advertising. Under current legislation, there are already strict restrictions for vape advertising. We believe that the promotion of vaping to quit smoking is best led by the appropriate public health authorities, because they can provide tailored advice to the individual with the necessary behavioural support.

In response to the comments of the noble Baroness, Lady Fox, the Bill already includes defences for the limited circumstances in which advertising would be appropriate. As I outlined on the first day of Report, following my prior assurances on public health campaigns, we are introducing a specific defence which will strengthen this capability by allowing businesses, such as pharmacies and GPs—something that noble Lords rightly drew my attention to—to advertise non-branded vapes, if it is part of a campaign agreed with the public authority for public health purposes. We are not considering further exemptions due to the risk of loopholes, the potential for poorly enforced entry rules, and the fact that evidence has shown that comprehensive bans on tobacco advertising have reduced consumption, but partial bans, as I mentioned before, have had no significant effect.

On Amendment 152, in the name of the noble Lord, Lord Udny-Lister, the language of “has reason to suspect” is standard practice and already included in the existing Tobacco Advertising and Promotion Act 2002. This wording is specifically designed to avoid loopholes and to ensure that those involved in the design of advertisements cannot evade responsibility by claiming ignorance where there are clear grounds for suspicion. I say again, this is standard legal practice.

Finally, on Amendment 153, in the name of the noble Lord, Lord Udny-Lister, it is important that we recognise and respect the established criminal law system within each nation of the UK. As noble Lords will know, Scotland has a separate criminal justice system, and 12 months is the maximum penalty on summary conviction for this type of offence and is fixed in line with its criminal justice system. For the reasons that I have set out, I hope that the noble Lord, Lord Udny-Lister, will withdraw his amendment.

NHS: Violence Against NHS Staff

Lord Kamall Excerpts

Monday 2nd March 2026 Lords Chamber

[Baroness Merron (Lab)]

I think I understand my noble friend’s question; if I have misunderstood, I will gladly write to her. The point here, I think, is about not just practice but culture. We need to see good leadership. We need good organisational culture to improve staff engagement and staff responsibilities when faced with dealing with such incidents. Again, our NHS working cultures need to be more compassionate and more inclusive, and they need better support, including around occupational health and staff well-being. Practitioners are part of the solution, and of course we give them our full support.

[Lord Kamall (Con)]

My Lords, in advance of this Question, the Medical Defence Union wrote to a number of noble Lords, for which we are grateful. It outlined that if a healthcare professional is the subject of violence in the workplace, the police may be required to arrange for a forensic physician to examine the victim. This experience of course doubles the terrible experience that the individual has been through and is daunting for them. Can the Minister confirm what steps or guidance the department and NHS England, as long as it continues to exist, are putting in place to support medical staff in such instances?

[Baroness Merron (Lab)]

I understand the point. All NHS staff have access, for example, to a helpline for support and to Practitioner Health for when they need more complex mental health support. Of course, anyone who is experiencing violence or abuse should report it to their line manager so that it can be properly investigated, including reporting it to the police. These are very difficult situations for the person who has suffered abuse and for members of the team who have to support them. I take the point about forensics; forensic investigation can worsen it, but it is also necessary to secure conviction where necessary.

Medical Training (Prioritisation) Bill

Lord Kamall Excerpts

3rd reading
Wednesday 25th February 2026 Lords Chamber

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

My Lords, NHS staff told us through the 10-year health plan engagement that they were crying out for change. This Bill is but one step in delivering that change. It will ensure a more sustainable and resilient medical workforce. It will ensure that we make the best use of the substantial taxpayer investment in medical training, and it will give our homegrown talent a clear path to becoming the next generation of NHS doctors.

The issue of bottlenecks for postgraduate medical training has been growing since the removal of the resident labour market test in 2020. I am most grateful to Parliament for expediting the passage of the Bill to tackle this problem, while giving it the careful scrutiny it deserves. I express my gratitude to noble Lords across the House for their constructive engagement throughout its passage. I wish to thank and credit noble Lords for passing the Bill unamended. My thanks are also due to officials and leaders from the devolved Governments for their support and commitment to ensuring we have a process that works for all of the United Kingdom, and for their determination to ensure that all legislative requirements were met within what was, and is, a challenging timeframe. I thank my officials in the department, as well as our lawyers, for their tireless work over these past few months.

We are clear that this Bill does not and cannot resolve all the workforce issues within our National Health Service. It sits alongside a range of action that the Government are taking to ensure that the NHS has the right people in the right places, with the right skills to care for people when they need it. The changes that the Bill introduces for foundation specialty training are a crucial step forward and will lead to a more sustainable medical workforce that can meet the health needs of our population.

I again thank all noble Lords who contributed their knowledge and insight during the Bill’s consideration. I beg to move.

[Lord Kamall (Con)]

My Lords, although this was emergency legislation, we have had detailed and constructive debates on prioritisation. We have also had the opportunity to debate some of the deeper issues around the supply of medical specialty training places, and I am grateful to the Minister for her letter. We will continue to hold the Government to account on the delivery of these places over the coming years. As we have said previously, the Bill is not a complete solution to the problem, as the Minister graciously acknowledged. We accept that it is a step forward.

During our debates, we touched on a number of issues, including whether UK citizens who are graduates of UK medical schools should be given first priority. We discussed the issue of international medical graduates who chose to contribute to the UK system of healthcare rather than go to another country, but who may now find themselves at the back of the queue. We discussed graduates of overseas branches of UK medical schools, some of which follow the same curriculum as UK medical schools, and whether some could be granted so-called grandfather rights. We also pressed for secondary legislation to be subject to the affirmative procedure. We understand why the Government have come to their position and why Ministers have not been able to take action on these points in this emergency legislation. However, given more time, I hope Ministers will continue their work to resolve these concerns, which were eloquently set out by a number of noble Lords from all Benches.

There was some debate about whether this was really emergency legislation or whether, in reality, it was simply giving the Secretary of State a bargaining chip in negotiations with the BMA. That may be no bad thing in itself, but the question remains of whether emergency legislation should be used to give Ministers bargaining chips.

Before I sit down, I thank the Minister and her officials for all their engagement throughout the Bill. As His Majesty’s loyal Opposition, we look forward to working closely with the Minister as the Government press ahead with its implementation.

[Baroness Gerada (CB)]

My Lords, I know it is not normal to speak at this stage, so I will be brief. I thank the Minister and everyone who has worked on this Bill, but I want to raise one or two anxieties which have already been touched on.

I believe that the Bill fundamentally challenges one of the principles that I have always held dear, which is fairness. It is unfair to international medical graduates, who we have entreated to come to this country for the last two decades—we have even paid for them to come —to work in hard jobs, in places where UK graduates did not want to do them. Now that we have more people than places, we are basically pulling the rug from under them. We are jeopardising their careers, their futures, their families and their visas.

It is also unfair to those UK nationals who chose, again in good faith, to study overseas and now have been treated like international medical graduates, when they are not. Finally, it is unfair to the commitment that the Department for Education has made around transnational undergraduate and postgraduate education. This Bill, I am afraid, takes away that commitment and says that we do not really mean what we say.

However, I look forward to working with Ministers and officials to see whether we can address some of what I fear will be the unintended and, I suspect, intended consequences of this Bill.

Tobacco and Vapes Bill

Lord Kamall Excerpts

Report stage
Tuesday 24th February 2026 Lords Chamber

[Lord Young of Cookham (Con)]

My Lords, I have added my name to two amendments in this group. Before coming to those, I will say a word about Amendment 77 from the noble Baroness, Lady Bennett, which I was initially attracted to. Like many other noble Lords, I went to a presentation by ASH, where we listened to health experts explain that filters do not prevent anything noxious reaching the lungs. On the contrary, they have ingredients in them that might be damaging. Far worse, because of the filter, smokers inhale more than they would have done had there not been one, as they think it is safe. It may be that the 25 government amendments achieve in a rather roundabout way what the noble Baroness seeks to do in Amendment 77. We will listen with interest to the Minister when she speaks to her amendments.

Amendment 133 was ably spoken to by the noble Lord, Lord Rennard. As I have said before, when I was a Health Minister in 1979, I tried to get the tobacco industry to adopt putting a warning on cigarettes and it declined on the grounds that ink was carcinogenic. This was not an argument I found very persuasive. Here we are, nearly 50 years later, still discussing something that at the time was world-beating, although I understand that I have now been overtaken by Canada.

Amendment 204, spoken to by the noble Earl, Lord Russell, sits rather uneasily in this group, which is otherwise about filters, in that it is about the tobacco levy. I want to make a number of points. First, previously the Government ruled this out on the grounds that they consulted on a levy model in 2014. Indeed they did, but this is a very different model from that which they consulted on. Crucially, in the one they consulted on, the levy would have been passed on to the consumer, with all the impact on RPI or CPI. This model has been constructed to avoid that; it would control the price that tobacco can be sold for, leading to very different outcomes from the model consulted on by the Treasury, and would not allow tobacco companies to pass the costs on to consumers as they do at the moment. It would raise revenue. One estimate has been £5 billion. Even if it is a fraction of that, it is money well worth having.

The scheme would not be complex to administer. As the noble Earl said, there are only four manufacturers. The department already operates the PPRS, controlling medicine prices, with far more manufacturers than are involved in tobacco. Crucially, the Khan review, already referred to, which was initiated by Sajid Javid when he was Health Secretary, pointed out that the Government were not going to hit their then target of a smoke-free England by 2030. It recommended the levy—this was an independent review commissioned by the last Conservative Government—and reinvesting the money in media campaigns targeted at those elements of the population who were still smoking.

Finally, I know that the Minister will not mind me reminding her of what she said when a similar amendment was debated in 2022 and passed in your Lordships’ House by 213 to 154. She knows what I am going to say; she supported and voted for that amendment, saying that it would

“provide a well-funded and much-needed boost, and a consultation would allow this proposal to be tested, refined and shaped”.—[Official Report, 16/3/22; col. 297.]

Well, that is what we are asking for today. She did not persuade me in Committee when she gave the reasons why she had changed her mind. Perhaps she can have another go this evening and explain why she will now urge the House to reject what she thought was a good idea four years ago.

[Lord Kamall (Con)]

My Lords, since this is the first time I have spoken on Report, I declare my interest as a professor of politics and international relations at St Mary’s University, Twickenham, where I teach an MBA module on healthcare policy and strategy. I also work with the Vinson Centre for the Public Understanding of Economics and Entrepreneurship at the University of Buckingham, and we sometimes run seminars on evidence behind public health policy.