Doncaster Royal Infirmary

Lord Kamall Excerpts

Monday 12th May 2025 Lords Chamber

[Baroness Merron (Lab)]

My noble friend is right about the effects of a poor estate. In addition to productivity, it very much affects safety, staff working conditions and capacity. The benefits are considerable, as she identifies—and indeed as the noble Lord, Lord Darzi, identified. I assure my noble friend that we are working across government—including with the Treasury and, to the right reverend Prelate’s point, with the local ICB and trust—to tackle this. My noble friend is aware that this Government committed nearly £20 million from the critical infrastructure risk fund to the hospital’s NHS foundation to move a section to the ground floor—not the part to which my noble friend referred, but it shows the seriousness with which we are taking this.

[Lord Kamall (Con)]

My Lords, the injection of capital to Doncaster Royal Infirmary is welcome. When the CQC inspected DRI in 2024, it found that the hospital

“did not have enough maternity staff with the right qualifications, skills, training, and experience to keep women safe from avoidable harm”.

While the Government develop their 10-year and workforce plans, what action are they taking in the meantime to address safety concerns from a lack of adequate staffing in maternity services? While we are on the subject, given the recently announced crackdowns on immigration and that many people who work in our health and care system are immigrants, how do the Government intend to encourage more British workers to fill vacancies in health and social care?

[Baroness Merron (Lab)]

On that point, I feel that the Government taking the backlog very seriously, against the background of what we have inherited, will make conditions far better for staff, which will make it a far more attractive place to work. That will be reflected when we report on the workforce plan. To the point about maternity, we are recruiting extra midwives and we are looking extremely closely at how we can better support best practice—as I saw just last week—how we can extend that and how we can bring better patient safety measures into the system. I am afraid that it is another area that we inherited in a difficult position, but noble Lords can be assured that we are working on it. I look forward to updating your Lordships’ House.

Care Quality Commission: Mental Health Care Waiting Times

Lord Kamall Excerpts

Thursday 8th May 2025 Lords Chamber

[Baroness Merron (Lab)]

As the noble Baroness says, it is very important that people use the right support. Otherwise, there is immense danger in going for what is perhaps less suitable. To my knowledge, we have not made a particular assessment, but I will pick up the noble Baroness’s point, because it is very right. On a more positive note, we are—and I am particularly—looking at what support we can develop in a digital and online sense to support people, not just on waiting lists but to prevent ill health and assist in their recovery.

[Lord Kamall (Con)]

My Lords, given that there is a waiting list for mental health care, including community-based services, and given the many competing demands on public finances, what can the Minister tell the House about conversations that her department and local ICBs may well be having with local community non-state civil society organisations, including those that offer music, art, talking drama, dance and other therapies, to help those on the waiting list?

[Baroness Merron (Lab)]

As the noble Lord is aware, I regard the contribution of the community sector—the third sector—as absolutely crucial here. I personally work very closely, like the department more generally, both to improve our practice and to recognise the difference that the creative arts, for example, can add to people’s mental well-being, as the noble Lord says.

Medical Devices (Amendment) (Great Britain) Regulations 2025

Lord Kamall Excerpts

Tuesday 6th May 2025 Grand Committee

Finally, I think that the Minister said that existing EU regulations will remain in force in Northern Ireland, but will that not potentially create trade barriers across the Irish Sea, although—I accept—it will prevent them occurring between Northern Ireland and the EU? Therefore, would not a UK-EU-wide regulation make much more sense in future?

[Lord Kamall (Con)]

My Lords, I thank the Minister for introducing this statutory instrument. I want to be clear that we on these Benches recognise the need for this measure, since, without it, key regulatory provisions would expire at the end of this month, as the Minister explained. That would create uncertainty and risk disruption to the oversight of medical devices in Great Britain.

We understand that this instrument is, in essence, a stopgap, as the Minister said, and that the MHRA’s consultation, particularly with small and medium-sized enterprises and clinicians, demonstrated strong support for continuity. But while the measure preserves the status quo for now, it has provoked some questions about the Government’s long-term strategy. I am grateful to the Minister for reassuring us that this is definitely a temporary stopgap and that they are looking for a longer-term and more pro-innovation solution than when we were in the EU.

As the Minister said, this revokes the sunset clauses in four areas in particular: performance standards for diagnostic devices, electronic instructions for use, the regulation of devices containing animal tissue and the designation and oversight of approved bodies. These are not mere technical footnotes; they are essential to ensuring safety, clarity and public confidence in the medical device sector, so we understand that revoking their expiry is necessary to avoid disruption.

Can the Minister add any more detail at this stage to what she has already said? This first phase, focusing on pre-market regulation, is expected in 2026. What further reforms are expected to follow? I know that she explained some of that in brief—I suspect that she did not elaborate as much as she could have for reasons of time—but can she say a bit more about the future plans for this regulation? If she cannot now, perhaps she will write to me, because that was a very welcome move. I was going to ask lots of questions about whether the short-term fix will remain in place for the long term, but the Minister has reassured us. Nevertheless, perhaps she could set out some more details either today or in writing.

I do not believe in regulatory divergence for divergence’s sake, but let us be clear that neither should we agree with regulatory alignment for the sake of regulatory alignment. I understand the concerns of the noble Lord, Lord Rennard, but I recall that, when I was a Health Minister, many a supplier—regardless of whether they supported the UK leaving or remaining in the EU —asked me, “Now that we’ve left, can we take advantage of our independence and develop a more pro-innovation approach than the EU?” In technology—I spent 14 years in the European Parliament—the EU was known as an area for regulation; if you wanted innovation, that was in the US. We have to get a better balance between the two. Whereas the EU focuses more on the precautionary principle and less on innovation, perhaps we can get a better balance in this country, so that we do not align for alignment’s sake.

The Minister also mentioned Northern Ireland. As we know, as a result of what noble Lords, said there are some concerns in Northern Ireland but, given that the EU is seen as an area generating regulation, should the EU impose additional regulatory burdens on businesses in Northern Ireland? What steps will the Government take to support them to protect their competitiveness? That is one of the concerns I know from the most pro-innovation businesses in Northern Ireland.

Finally, on international trade, not strictly within the remit of these regulations, so I hope the Minister and her officials will forgive me—this does not have to be answered straight away—has the Minister or the department assessed the impact of recent US tariffs on medical device imports? Does the UK import a substantial number of medical devices from the US? I know that we talked about the importance of the US as an export market. Will these tariffs have an impact on medical devices from the US, particularly those that have been made with components imported from outside the US into the US before being re-exported? Does that have a price implication? Have the Government made any assessment of the implications for availability, cost and affordability, particularly for NHS procurement? Clearly, as the noble Lord, Lord Rennard, and others said, there is the impact on medical device suppliers exporting to the USA. Has any assessment been made of that market? Across the House, we all want a thriving life sciences sector in this country, but we should be assessing the impact of the proposed tariffs. I know some of them have been in abeyance.

I recognise that I have asked many questions, and I do not expect the Minister to have all the answers straight away, despite the advances of iPad technology and wireless communication. Maybe one day that will extend to telepathy. Perhaps the Minister can write to me on the questions that she is unable to answer today. In drawing my remarks to a close, I will be clear that noble Lords on these Benches support this measure as a necessary step to prevent regulatory disruption, but the real test follows. I hope the Minister, in answering the questions, is able to share a clear timeline for the programme for reform as we hopefully move towards a more pro-innovation approach.

[Baroness Merron (Lab)]

I am grateful to noble Lords for their valuable contributions and the way in which they have raised issues relating not just to the statutory instrument before us but this whole area of important work. I am also grateful for the support more broadly on the need to get the legislation right in order to protect patients, get the best medical technology within our grasp and support innovation. I am sure we will return to this subject. I will respond to a number of the points, and I will come back to noble Lords on anything significant that I have not responded to.

I reiterate that this SI is essential if we are going to prevent what I would call significant disruption. The words used were “a stopgap”. I think that is a fair legal term in this setting. It will preserve the status quo as we progress to more comprehensive regulation, which I know is what noble Lords are interested in.

The noble Baroness, Lady Finlay, asked for an assurance that we would not jeopardise not just the European market but other markets because we need to export technology. That is a fair point. I can say in response that over recent years we have learned important lessons from the implementation of new medical devices regulations in the EU as well as the global approach to regulation. How has this informed our approach to regulatory reform? It is why the Government are taking a phased approach to the delivery of these regulations to support the sector and adapt to the changes. It is also the reason why we are in continued discussion and are working closely with the sector.

We recognise the benefit of international harmonisation of medical device regulations in order to reduce, as we would all like, unnecessary regulatory burden or duplication of assessment for manufacturers, which is something that has been raised many times with me and I am sympathetic to. This means that, where sensible, we will align with the regulations of other jurisdictions, including those in the EU. Any reform to assimilated law will be to support domestic priorities and the Government’s national health and economic growth missions.

The noble Lord, Lord Rennard, raised a number of points. He raised the issue of products being subject to EU and UK regulations and whether this would make tech companies less likely to innovate. I believe the noble Lord also argued that we should be in line with the EU, and he raised the important issue of Northern Ireland. On these points, we will seek to align with international best practice and EU regulations where they are sensible, support manufacturers and support where we want to get to on patient safety and the contribution of medical technology.

On Northern Ireland, the MHRA is the competent authority for devices placed on the Northern Ireland market. It continues to have oversight of medical devices across the whole of the UK. We will continue to monitor any risks to the supply of devices to the whole of the UK market. I can give the assurance that, at present, the supply is stable and processes are in place to identify alternatives if needed. My final reassurance is that the SI before us today will not have any impact on the supply of devices to Great Britain or Northern Ireland.

The noble Lord, Lord Kamall, also raised a number of key points and requested more detail on what further reforms are expected to follow. He also raised regulatory alignment, making the point that, in his opinion, the EU can be more cautious and asking how we as a country can be more innovative. The noble Lord also asked about Northern Ireland and about the impacts that US tariffs have in respect of medical devices.

On plans for regulatory reform, the MHRA has published plans to introduce several SIs to amend the framework for medical devices. The post-market surveillance SI, which will come into force in June as noble Lords may recall, represented the first significant step in this reform. That legislation will put in place strengthened legal requirements for how manufacturers monitor and report on their devices once they are being used.

In November last year, the MHRA launched a consultation on further aspects of regulatory reform which will inform a subsequent pre-market SI that introduces, among other things, a new international reliance scheme, measures to improve traceability of implantable medical devices, more risk-proportionate changes to the classification of certain devices and the prohibition of misleading claims. We expect that legislation to come into force in 2026. I think that all those will put us in a much better place than we are currently, because they will allow us to keep pace with changes in the market.

The MHRA also continually monitors the UK’s medtech landscape for developments that could affect patient safety and the implementation of regulations. Details of further regulatory proposals will be communicated when available, and I look forward to bringing those before your Lordships’ House.

On US tariffs, there are ongoing discussions, and I will not seek to pre-empt them. The MHRA will monitor any impacts once they become clearer. That is very much under a watching brief.

I hope I have demonstrated the need for these regulations, not just for the public currently but as being key to the forthcoming 10-year plan. I hope that the Committee will agree that we are continuing with this assimilated law to prevent significant disruption to the current framework and to ensure that patients, device users and the economy are all protected.

Dementia and Alzheimer’s Treatments

Lord Kamall Excerpts

Thursday 1st May 2025 Lords Chamber

[Baroness Merron (Lab)]

We are abolishing NHSE. It is the biggest quango, and we are finding immense duplication. At this stage, I cannot comment on the exact matter to do with the team, but I can say that dementia work continues to be a very high priority, as I hope the noble Lord heard from my commitment to the noble Lord, Lord Evans. Indeed, we are keen to support not just those at risk of dementia but those who care for them. This is an expanding area of work. We have much good practice to draw on and we are extremely active, as the noble Lord has heard, in developing research to move further forwards more quickly.

[Lord Kamall (Con)]

My Lords, I thank my noble friend Lord Evans for raising this issue. We know that, often when a new drug is developed, even though some patients may benefit, it may initially be too expensive for NICE to recommend, based partly on a cost-benefit analysis. We know that eventually the price falls to a level which the NHS can afford and which can then be seen as good value for taxpayers. Given that this happens with many new drugs, have the Government considered convening a group of philanthropists, foundations, charities and other civil society organisations that might be willing to fund treatment for some, if not all, patients when new but expensive breakthrough drugs such as those my noble friend Lord Evans referred to are available but are considered too expensive initially?

[Baroness Merron (Lab)]

We are very open to all sorts of creative ways of dealing with the matter, but it is important to say on the drugs that we are discussing that lecanemab and donanemab can only slow the progression of the disease by between four and six months. The challenge is not just whether it is available on the NHS but how helpful it is. We have a lot of progress to make, and that is why we are committed to ensuring that new treatments can quickly become available and that prevention is key.

Prosthetics for Amputees

Lord Kamall Excerpts

Thursday 1st May 2025 Grand Committee

[Lord Kamall (Con)]

My Lords, I congratulate my noble friend Lord Mackinlay of Richborough for securing this debate. I also pay tribute to him for his courage in the various battles he has faced in recent years, and for his determination to come back and return to public life. I have to say that I am simply in awe of him, but I hope that does not come across as patronising or putting him on a pedestal either. Based on his own experience, he is fighting for the causes dear to him, and he can talk about it in a meaningful way based on his own experience.

I also thank my noble friend Lord Shinkwin for warning us about placing disabled people on a pedestal, something that I think we ought to be aware of, and for adding the issue of orthotics to this debate, which is very important. I thank my noble friend Lord McColl for explaining his experience. I think in those days the official term was artificial limbs, when he worked on that group, when asked by the Prime Minister at the time, Margaret Thatcher. I thank the noble Baroness, Lady Ludford, for sharing her experience based on diabetes and living with someone with diabetes.

I have two early experiences of prosthetics or artificial limbs—whatever language it was, given that I was born in the late 1960s—and one is storybooks and Long John Silver. In some ways, from what my noble friend Lord Mackinlay said, the service has not really moved on from that. We talk about Captain Hook and people are still being asked to have hooks. The second experience was a friend of my brother who was deaf and had type 1 diabetes. During the time we knew her she went blind, lost limbs and sadly died far too early. I really relate to the point the noble Baroness made. One of the issues for all type 1 diabetics—I say that, having a type 1 diabetic in my family—is to look after your limbs and the extremities of your body and get regular check-ups, as well as controlling and monitoring sugar.

Having heard the speakers, I think this is a matter of both policy and principle. Ensuring that amputees receive timely and appropriate prosthetics is more than simply a healthcare issue; it is a matter of dignity, independence and fairness. Those who require access to these services are those who have faced illness, trauma and those who may have suffered injuries while serving their country in many ways. My noble friend rightly raised the issues with current NHS provision of prosthetics. In this speech, I will look at two main challenges.

First, there is the issue of the workforce, which seems ironic; I see a smile from the Minister. As my noble friend said, skilled prosthetists are not being replaced quickly enough. The provision of high-quality prosthetic care is heavily reliant on a skilled workforce. I thank my noble friend for going into the details and making us all understand the importance of that. My noble friend highlighted training deficits in the field of prosthetics and orthotics. Noble Lords will know that Health Education England has acknowledged these challenges and is working to improve the education and training of prosthetists and orthotists.

I remember, when I was a Minister, the noble Baroness who is now the Minister and others rightly raised issues about the workforce and workforce planning. After pressure from noble Lords at the time, including from the noble Baroness who is now the Minister, the previous Government eventually published the NHS Long Term Plan to address some of these workforce challenges. But in this area, if we look at the numbers, the baseline training intake for 2022 was 57. The workforce plan looked to increase that to 89 per intake. It identified that between 25% and 50% of prosthetists could be trained via the apprenticeship route as part of an expansion of apprenticeships for allied health professionals. This is, as anyone can see, only part of the solution, and there is always more that needs to be done.

Can I ask the Minister to inform noble Lords how the Government will build on some of that work? Going from 57 to 89 clearly, for many, is not enough. What work is being done and what thought is being given to increasing that capacity and to making it an attractive career? One hears about the latest technology being used, such as computer aided design, so maybe there is a way of attracting the best engineering students who may never have thought about going into that career. They may have thought about designing cars or aeroplanes, but they might realise that they could put their skills to good use in improving the health, well-being and mobility of many of our citizens.

I know that the 10-year plan is going to be published at some stage. I am not necessarily asking the Minister to tell us what is in the plan, but does she know what consideration is being given to this specific area in the plan? If so, can she share that with the Committee at the moment?

The second issue to highlight, clearly, is inequality of care. Concerns have been raised. Some noble Lords have raised their concerns around a postcode lottery of care for amputees; others have raised other issues. As noble Lords have said, there have been innovations in the technology and expansions in access. Other noble Lords have referred to the NHS providing multi-grip bionic arms since 2022, using electrical impulses from the brain to control movement and representing what is considered the cutting edge of that technology.

However, we have to confront a painful irony: we can have the best technology out there but it is not much good if people cannot get it in the first place or have to jump through a number of hoops to do so. My noble friend Lord Mackinlay spoke about the stages that one has to go through before qualifying for the very latest technology; I wonder whether we can look at those. Is there a cost involved in patients going through all those stages? Could getting them to that final stage be more cost effective? Hopefully, the technology is always evolving anyway, but could we get them to the last stage quicker, rather than them having to jump through all those stages? Is there a way of making it more efficient?

As my noble friend Lord McColl said, it is about looking at the best technology in the world. Rather oddly, I remember a very interesting man I met. He used to be the rabbi of Richmond Synagogue, and he and I got on very well. As a sideline, he started a business based on the latest Israeli technology on prosthetics. In the end, the rabbi gave up, and he and his company developed to sell prosthetics based on Israeli technology to countries in central Asia. I noticed that he is still doing that; it just shows that there is really good technology around the world. It is great that Britain could be at the leading edge, I hope, but it is important that, when you need these devices—limbs or prosthetics—you get the latest ones. It is all very well us being proud of them being built in Britain or whatever, but surely it is better to get the latest technology.

We also understand—this is one of the challenges that we faced in government—the issues of funding for a trained workforce and the extra, increasing demands on health and social care. How do we challenge those? We know that, for example, veterans have in many cases been able to receive care due to dedicated funding streams—we pay tribute to those programmes and support both their continuation and their strengthening—but we have to ask: what can be done for civilians? What can be done for children and the elderly, who face longer-term waits or limited options? In one region, an amputee may receive a personalised limb with integrated sensors; in another, in certain circumstances, they might wait months for a basic replacement. Do the Government know about or understand the reasons for some of these disparities? Have they looked into disparities and understood them, or is it simply about having the workforce in the right area? Is it about the way in which resources are allocated? What steps are the Government taking to reduce some of this unequal geographic access to prosthetics? One of the challenges when I was a Health Minister was that there were always health variances. In some cases, they were the same for all types of health, but, in other cases, it was specific to a particular health or care issue.

This is not just about prosthetics and orthotics; it is also about opportunity. It is about having the ability to walk your child to school or to return to work. It is about having the ability not just to live but to survive—indeed, to thrive—having gone through a very traumatic experience. It is important, whatever our politics, that we think about how we can empower individuals to live their fullest lives. For amputees, that power begins with access to the right limb or limbs at the right time and with the right support. Our amputees deserve no less.

I look forward to the response from the Minister.

Self-harm: Young People

Lord Kamall Excerpts

Monday 28th April 2025 Lords Chamber

[Baroness Merron (Lab)]

The right reverend Prelate makes some key points. I can certainly assure her that I am working with the MoJ on the area she describes, where risk is indeed high, despite the numbers. We must be very alert to that.

[Lord Kamall (Con)]

My Lords, we all know the importance of evidence in driving and developing better policy. Regarding the data, what do we know, what gaps in knowledge are the Government aware of and what are they doing to fill those gaps to drive better policy?

As an aside, how is the department working with, say, local community civil society projects, which may well be working in local communities with people who have self-harmed and survived or who are in danger of self-harming?

[Baroness Merron (Lab)]

The role of civil society is crucial. I have had a number of very helpful meetings and visits, including most recently with the Samaritans. We very much believe that that sector supports the delivery of not just the national suicide prevention strategy, of which tackling self-harm is part, but tackling self-harm where it is not linked directly with suicide.

I refer the noble Lord to the work being undertaken by the multi-centre study of self-harm, which I know will be of interest. It has a long-standing research programme to keep an eye on—more than keep an eye on—and examine self-harm trends, and the findings also inform NICE clinical guidance. Recent research has looked at different ethnic minority groups, the characteristics and outcomes for children under 13 who self-harm, and patterns and risk factors for self-harm among university students—and that is just a snapshot.

Tobacco and Vapes Bill

Lord Kamall Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I begin by declaring my interests as set out in the register. I am an unpaid member of the Academic Advisory Council of the Institute of Economic Affairs and have written for the Politeia think tank, both of which have published on health issues. The former has also examined some of the evidence published by the Government and others on the Bill. As a professor of politics and international relations at St Mary’s University, Twickenham, I am helping it set up its new medical school and am giving it advice on that. I am a visiting scholar at the Vinson Centre at the University of Buckingham, which also has a medical school. I am also an unpaid member of the advisory council of the Startup Coalition, some members of which are health-related start-ups, and some are perhaps even related to smoking cessation. I just wanted to be clear and get all that out.

This has been a long but excellent debate with many speakers—so long, in fact, that I suspect that noble Lords who are members of the informal Terrace smoking club will be longing to reach for their cigarettes or vapes. In detaining them a little longer, I thank all noble Lords who took part in today’s Second Reading. I am also grateful to the Minister for introducing the Bill in her usual clear way, and to her officials for meeting us earlier.

We have heard a range of views. At one end of the spectrum, there are those who believe that smoking should be banned as soon as possible and in as many places as possible. At the other end, there are those who see the debate in terms of freedom of choice and the right to smoke despite knowing the harm that it causes. Earlier today, when I was discussing this with another noble Lord, he quoted Kingsley Amis to me:

“No pleasure is worth giving up for the sake of two more years in a geriatric home”.


I respect the range of views, but in doing so, I think there are probably a few truths on which I hope we can agree. First, smoking is not good for you. That might sound like British understatement; maybe I should go stronger and say that smoking kills and nicotine is addictive. Secondly, the current evidence suggests that vaping is safer than smoking. The current evidence also suggests that not vaping is healthier than vaping. In recognising these three truths, I appreciate that the Government are trying to achieve a difficult balance—or, as the Minister said earlier, a “nuance”—between these two positions. The first is that vaping is a useful pathway away from smoking. The second is: how do we stop young people from taking up vaping and encourage current vapers to quit? The noble Lord, Lord Rook, very eloquently put the case of how we need to tackle youth vaping.

To achieve this difficult balance, we on these Benches want to see the Government making laws based on evidence, but also in a way that is effective, accountable and pragmatic. My noble friend Lord Howe raised the Government’s additions to the previous version of the Bill, especially the huge number of delegated powers. I thank my noble friend Lord Blencathra, a former chair of the Delegated Powers and Regulatory Reform Committee, for highlighting his concerns over criminal offences being made by secondary legislation or even just by delegated powers. That is something that we will probe from this side.

Among these delegated powers are the new powers in Part 7 to expand smoke-free places and impose further restrictions on where people can vape. We will want to probe whether it would be more appropriate to put it on the face of the Bill to make healthcare settings, children’s playgrounds and educational establishments smoke-free, rather than relying on the intention of some future Government. We should also consider the evidence for expanding vape-free areas, given the current lack of evidence about the harms of second-hand vape inhalation, and as that evidence evolves, we should find ways of reacting. I can understand that as an argument for delegated powers, but we have to get that balance right and not use it as an excuse.

We will also want to probe the possible unintended consequences of being seen to treat vaping and nicotine products in the same way that we treat tobacco products. As the noble Baroness, Lady Fox, mentioned, research has shown that approximately 50% of all UK adults believe that vaping is as harmful as, or even more harmful than, smoking. We know that current evidence does not suggest that. This is despite the fact that the NHS website says:

“In 2022, UK experts reviewed the international evidence and found that ‘in the short and medium-term, vaping poses a small fraction of the risks of smoking’”.


It also says:

“Vaping has not been around for long enough to know the risks of long-term use. While vaping is less harmful than smoking, it is unlikely to be totally harmless”.


We will probe whether placing similar restrictions to those on cigarettes on vaping and nicotine products will unintentionally deter current smokers from switching to less harmful vaping products.

A number of noble Lords, including the noble Lord, Lord Dodds, raised the impact of the Bill on small businesses, as did many of my noble friends, including my noble friend Lord Sharpe. Small independent retailers and convenience store owners have faced increased costs, such as the increase in national insurance contributions and the national minimum wage. Whatever their merits, the cost of those increases has clearly been passed on to small businesses.

Some worry about the cost of the Employment Rights Bill and now there is the additional licence fee for implementing the generational sales ban and the advertising ban on nicotine products. There will also probably be further regulations and restrictions under the number of secondary powers in this Bill.

I will quote Gurpal Jhutty, who runs a Nisa local in Leamington Spa. In a submission to the Public Bill Committee in the other place, he said:

“Look, I’m not a lobbyist. I’m not a politician. I’m just a shopkeeper trying to make a living, and I’m writing to you today because the proposed Tobacco and Vapes Bill has me seriously worried about the future of my business. You can consider this a retailer’s plea for common sense … I’m tired of being ignored. Retailers are on the front lines of this issue, and we have valuable insights to offer. Let’s ditch the bureaucratic nonsense and work together to create a policy that actually makes sense”.


Let me be clear: we are not asking to ditch this Bill, but we will probe it to create a Bill that is workable and makes sense.

The noble Lord, Lord Scriven, and the noble Baroness, Lady Fox, have rightly raised concerns about personal liberty, problems with prohibition and the practicality of the measures, especially age differentiation. We have heard both sides of that debate.

Noble Lords, including my noble friend Lord Brady and the noble Lord, Lord Teverson, have pointed out that smoking cannabis is illegal but is pervasive in many parts of London. The point is that this is not a Bill against smoking; it is a Bill against the sale of tobacco and vape products. We have to be clear about that.

Having said that, Inga Becker-Hansen of the British Retail Consortium told the Public Bill Committee on 7 January:

“in 30 years’ time if you have someone who is 45 versus 44 from the date of January 2009, it may lead to ID for each sale of a given product … Points of sale can be a flashpoint for violence and abuse against retail and shop workers, so it is a real concern for retailers”.—[Official Report, Commons, Tobacco and Vapes Bill Committee, 7/1/25; col. 58.]

We will also probe the impact of this Bill on the illicit trade in tobacco and vaping products. HMRC has estimated that in 2022-23 illicit tobacco accounted for 14.5% of the total UK market. Current estimates show that illicit vapes account for about 30% of the total vaping market. A 2024 report by the Home Office’s National Business Crime Centre found that the provisions in this Bill mean that

“the demand for illegal tobacco products is set to grow dramatically”.

We have to be careful about these unintended consequences.

Like my noble friends Lord Naseby and Lord Leicester and the noble Baroness, Lady Hoey, we will want to probe whether restrictions on vaping products could lead to an increase in the illegal trade, leading to a risk of more dangerous and unregulated products being used and finding their way into circulation. We are all united in wanting to tackle illicit and illegal products.

Noble Lords, including my noble friend Lord Murray, have expressed concern that the Government appear complacent about the illicit tobacco trade. While they rely on figures that show a drop in illicit tobacco sales, a Europe-wide report from KPMG—based on looking at discarded tobacco packages, rather than on assumptions and mathematical formulae—reported an increase in illicit consumption in the UK in 2023. I understand why these figures have been dismissed, because the report was funded by a tobacco company; I completely understand that reasoning.

However, I would be interested in understanding whether the Government will commission similar research looking at discarded tobacco packets as a method of understanding the illicit tobacco trade. If they will not, can they explain why—not immediately, but in writing? Could they explain why they have doubts about this methodology and prefer the formula used by HMRC, which has been criticised by many people for the assumptions it makes around smoking? We will be probing the Government on this and on what action they will take to tackle this rise in illicit sales. We know that all noble Lords will agree on tackling illicit sales of illegal products.

Finally, I am a huge believer in the role of local community non-state initiatives that improve people’s health. I have worked with organisations that help to tackle obesity and local financial and other problems. We will probe the Government on what they have learned and can learn from local community initiatives that have reduced smoking. We have not heard enough today about local community initiatives, the people who understand their local communities and the projects in those communities that could reduce smoking. Most of it has been about top-down measures to try and reduce smoking.

Whether noble Lords smoke or not, I hope we are united in our desire to reduce the incidence of smoking-related deaths and share concerns over the rise in youth vaping. I am also sure many of us will want to help the Government achieve an appropriate balance based on evidence, pragmatism and proportionality. I thank all noble Lords who spoke and look forward to the many days of debate ahead.

Mental Health Bill [HL]

Lord Kamall Excerpts

3rd reading
Wednesday 23rd April 2025 Lords Chamber

[Baroness Merron (Lab)]

My Lords, it has been an extraordinary honour and pleasure to take this Bill through the House with my noble friend Lord Timpson. As we are all aware, numerous aspects of the Mental Health Act 1983 are not serving us today. Over the decades, we have seen racial inequalities, inadequate care for individuals with learning disabilities and autism, and insufficient empowerment of patients who have not had an adequate voice.

Reform to the Mental Health Act is therefore long overdue. Many of the processes in the Act are out of step with a modern mental health system and with society at large. It has been a privilege to advance these reforms to deliver the Government’s manifesto commitment to modernise the Act to give patients greater choice, autonomy, enhanced rights and support, and to ensure that everyone is treated with dignity and respect throughout treatment, while ensuring that patient and public safety is paramount.

As noble Lords will be aware, this Bill is the product of the combined effort, over many years, by Members of both Houses and many outside Parliament who have worked for change and to whom thanks are due. I express my sincere gratitude to members of the former Joint Committee on the Draft Mental Health Bill: the noble Baroness, Lady Buscombe, as chair, as well as my noble friends Lord Bradley and Lady McIntosh of Hudnall, and the noble Baronesses, Lady Barker, Lady Berridge and Lady Hollins. The work and careful consideration that went into their rigorous scrutiny of the draft Bill, along with the constructive recommendations made, have undoubtedly strengthened it.

I pay tribute to the former Prime Minister, the noble Baroness, Lady May, who identified the need for modernisation and set up the independent review of the Act in 2017, chaired by Sir Simon Wessely and supported by the noble Baroness, Lady Neuberger, as one of the vice-chairs. Without this, we would not be here today.

I extend my heartfelt thanks to all Peers who have engaged with the Bill’s reforms. In addition to those previously mentioned, gratitude is due to both Front Benches—to the noble Lord, Lord Kamall, the noble Earl, Lord Howe, the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler. I am grateful to all noble Lords from across the House who have spoken during the various stages of the Bill and engaged with me and my officials over the past few months.

Because I would like to think that I am wise, I also thank my Whip, my noble friend Lady Blake, and my previous Whip, my noble friend Lord Cryer. I thank the Chief Whip and the whole of the Whips’ team and the team in the Leader’s office, including Ayeesha Bhutta and Michael Bleakley. My appreciation, as ever, goes to the clerks, doorkeepers and staff of the House.

I extend my heartfelt gratitude to all the officials who have played a crucial role in the progression of this Bill, and hope your Lordships’ House will indulge me while I give them the honour of mentioning them by name, because I believe they deserve it. Special thanks go to Phillip Dunkley, our Bill manager, and his dedicated team, Callie Mulligan, Sam Monday, Emily Bouldero and Rhys Jose. I am deeply appreciative of the Bill’s senior responsible owners, Kathy Smethurst and Caroline Allnutt, as well as the DHSC officials, including Esther Horner, Hannah Coaker, Alice Devlin, Matt Siddons, Tabitha Mufti, David Nuttall, Jennifer Rhodes, Megan McIvor and Mihiri Seneviratne, and their teams.

Additionally, I want to acknowledge the invaluable contributions of the Government Legal Department officials, Matt Smith, Lizzie Rattee, Nicky Richardson and Tim Spencer Lane, and their wider team, along with my private office staff, including Carl Plane and Yetunde Agaga, as well as Diggory Bailey and Victoria Griggs from the Office of the Parliamentary Counsel.

While I cannot list every individual, I express my appreciation to all officials who have played a part, including officials from the Ministry of Justice. Their unwavering support and dedication have been instrumental in the successful advancement of the Bill, and their work with Peers—as noble Lords across the House will testify—has been exemplary. I am confident that this legislation will make the Mental Health Act fit for the 21st century and give greater and better support to people when they need it. I look forward to it receiving support in the other place. I beg to move.

[Lord Kamall (Con)]

My Lords, as the Minister has said, debating the passage of the Bill through your Lordships’ House has been a pleasure. We have seen a genuine spirit of constructive engagement with a Bill that we all acknowledge will help patients who encounter mental health services, as well as a cross-party desire to improve the Bill. This was not a particularly political Bill; we found alliances across political lines and did not play political games. We wanted to improve the Bill and make sure that patients receive the best possible care. That is a wonderful demonstration of the value of this House.

I extend my thanks to all Peers who took part. I also thank the members of the pre-legislative committee whom the Minister acknowledged. Like the Minister, I acknowledge my noble friend Lady May of Maidenhead, the former Prime Minister, who we have to thank for beginning the process that led to this Bill. My noble friend identified the issue of racial disparities in the use of community treatment orders and wanted to reduce the involvement of police where they are not needed. Even though my noble friend was unable to be in her place to speak to her amendments on Report, I am grateful to all noble Lords who supported them, and I am delighted that the House has decided that they should be inserted into the Bill. We look forward to how that will be debated in the other place.

It was also welcome to see the House rally behind my noble friend Lady Berridge’s amendment to ensure that the process for appointing nominated persons for patients under 16 aligns with the Children Act 1989. My noble friend was crystal clear that there has to be consistency between different Bills, and that we do not want people falling between Bills and into harm’s way. She highlighted this and gave some harrowing examples of what could happen if we do not align these Bills. We have to make sure that we align them as much as possible.

I also thank the noble Lord, Lord Scriven, and the noble Baroness, Lady Tyler, for their dedication to improving community treatment orders and addressing racial disparities. Noble Lords will remember that this is probably the issue that was closest to my heart, and we probed the Government heavily on it. There are still too many racial disparities. We understand that it is a complicated issue, but the Government assured the House that they are looking into the data around this. What do they know? What do they not know? How will they fill that gap and what will they do to address racial disparities? I hope that is something that all noble Lords can agree on.

Of course, I have to thank my noble friend Lord Howe for his stalwart support and advice on this Bill, and for his experience not only of parliamentary procedure but of previous iterations of this Bill. I appreciate his sagacity, and I am grateful whenever he agrees to work with me on Bills—sometimes to curb my schoolboy enthusiasm and keep me on the right path. I am grateful that he has agreed to work with me on the Tobacco and Vapes Bill, which your Lordships will debate later today.

I also thank the Minister—and of course her noble friend, the noble Lord, Lord Timpson—for taking time at the Dispatch Box, and for the fact that the Minister and her officials were always available to meet us to try to iron out some of the disagreements or find compromises. That is very much appreciated by all noble Lords in this House. I thank Ben, the special adviser in her office, for his input, and, in our office, our adviser Jamie Tucker, who was amazing in his understanding of the Bill.

I will end by mentioning a quote that was sent to me and my noble friend Lord Howe from the charity Blooming Change. On hearing that the House had voted in favour of my noble friend’s amendment on mandatory debriefing for mental health patients, a younger person told the charity:

“I genuinely for the longest time felt like I didn’t matter, to anyone or anything, that the universe didn’t need to hear my voice, that what I went through didn’t matter. It took so long to build my confidence and to find my voice … I’m glad I decided to use my experiences to fight for change and I’m so happy our words have made a difference. We will keep fighting for more changes, little by little”.


As the Bill now progresses to the other place, I hope all Members involved will heed those wise words.

[Baroness Tyler of Enfield (LD)]

My Lords, it has been a privilege to be involved in scrutinising and improving this vital Bill, for which we had waited so long. Our debates have been, rightly, exhaustive, and at times—again, quite rightly—passionate. I will make one general observation, which is a point that was made on a number of occasions throughout our deliberations. You get only one chance about every 15 years to reform and modernise mental health legislation, so it is really important to get it right and to include all the relevant issues before the ship sails. Some would like to have seen more fundamental fusion legislation between mental health and incapacity, but that was not on the table, so you work with what you have.

Funerals: Death Certificate Delays

Lord Kamall Excerpts

Thursday 3rd April 2025 Lords Chamber

[Baroness Merron (Lab)]

I do not have the figures to hand, but I would be very pleased to write to the noble Lord. As I said, this is a complex area. The reforms were introduced in September, and it is very difficult to make before and after comparisons. Since 2001, a long-term trend has shown an increase in the median time between death and registration, and that cannot be attributed to death certification reforms. In addition, the reforms are about the introduction of statutory medical examiners as opposed to the non-statutory arrangements that existed before—and there was even more regional variation before September than we are finding now. I assure your Lordships’ House that I am working very closely with officials to understand the reasons for this so that we can take more action.

[Lord Kamall (Con)]

My Lords, I thank the noble Viscount, Lord Stansgate, for the conversation we had about this Question. As we all know, when a loved one passes away, it is a distressing time, and surely delays can only add to that distress. I am sure that noble Lords understand why these reforms were brought about in the first place: they were introduced after a qualified doctor, Harold Shipman, murdered his patients and signed the death certificates himself. In a recent Written Answer on these delays, the Minister for Public Health in the other place said:

“The expectation on doctors and medical examiners is clear … they should complete certification as quickly and efficiently as possible, and the Government is working with all stakeholders to make sure this is the case”.


Can the Minister explain to your Lordships what that means? Is the department simply asking them to complete the certificates, or is it identifying blockages or misunderstandings in the system to help unblock them in order to speed up the process?

[Baroness Merron (Lab)]

The noble Lord’s observations are correct. As I said, it is so important to be timely and sensitive at a time of bereavement. Governments and Ministers have been working to bring in the system over the last 50 years—in fact, it has been overdue for reform for that long, so I am very glad to have taken this action. Introducing this robust system means working with medical examiners as well as the bereaved, so that we hear from them about what has happened. We also work very closely across government, including with the MoJ and the Home Office. As the noble Lord will know, the medical examiner system is led by NHS England through the office of the National Medical Examiner. I reiterate that delays are not due solely to this introduction; it is very important to unpick this issue. We now have better data and get weekly reports, which is helping greatly.

NHS Pensions

Lord Kamall Excerpts

Thursday 3rd April 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, in the other place, in response to a question from the honourable Member for North Shropshire, the Minister there said:

“HMRC has also confirmed that self-assessment late filing penalties will be waived on appeal in certain circumstances where a member receives a delayed pension savings statement as a consequence of the implementation of the McCloud remedy”.—[Official Report, Commons, 1/4/25; col. 166.]


One of the frustrations that people sometimes have when dealing with government or large organisations is that their advice is not always clear. I want to ask the Minister two questions. Can she explain to your Lordships the specific “certain circumstances” where the penalty will be waived, and can she explain the thinking behind the Government deciding not to waive the penalty for everyone affected, given that responsibility for delays is with the NHS and not with those affected?