Human Medicines (Authorisation by Pharmacists and Supervision by Pharmacy Technicians) Order 2025

Lord Kamall Excerpts

Tuesday 21st October 2025 Grand Committee

[Lord Scriven (LD)]

My Lords, as the noble Baroness said, the changes are enabling and not mandatory, yet the risk of financial exploitation of the regulations is real. Pharmacies are already funded below cost for dispensing, and my concern, mirrored by many in the sector, is that the department or NHS England may interpret this regulatory freedom as an automatic justification to reduce dispensing fees based on the assumption of a cheaper skill mix that may be automatically adopted. Any such reduction would threaten further the financial viability of community pharmacies, particularly small independent ones, risking closures and access issues.

The third issue is the ambiguity of supply “at or from” a pharmacy. Some in the sector feel that the proposed change to allow the supply of medicines at or from a pharmacy, while intended to cover home deliveries, introduces ambiguity. This phrase is viewed by some as a potential gateway to unsupervised remote supply models, such as unstaffed collection lockers in remote locations. The Government must emphatically stamp out any interpretation that undermines the fundamental principle that a pharmacist’s professional clinical input or availability is the bedrock of safe supply.

To ensure that we implement this modernisation safely and successfully, I ask the Minister for clear answers on these three points. On professional assurance, what guarantee can the Minister give to individual pharmacies that the new GPhC standards will explicitly address the concern over minimum competency and mandatory continual professional development, and that the accountability split is clear before the main authorisation provisions come into force?

On financial stability, can the Minister offer an unequivocal commitment that NHS England and the department will not use the new skill mix freedoms as a mechanism to unilaterally reduce the dispensing fees paid within the community pharmacy contractual framework?

On the safety of supply, given the sector-wide apprehension, will the Minister commit to publishing restrictive statutory guidance that clearly defines “supply at or from” a pharmacy to rule out any future implementation of unsupervised off-site collection points for pharmacy and prescription-only medicines?

This is a reform that will have good outcomes if implemented correctly. The move forward for progress must address the potential risks, ensuring support for the entire pharmacy team and financial stability for dispensing as well as, crucially, protecting patient safety and access to local dispensing community pharmacy.

[Lord Kamall (Con)]

My Lords, I also thank the Minister for the way she introduced this SI. I begin by also thanking the thousands of pharmacists and pharmacy technicians who deliver vital services to patients every day in both the community and hospital settings— I can see that your Lordships all agree with that.

From these Benches we support the principle behind this statutory instrument. As the Minister said, in many ways it is common sense. It reflects the evolution of community pharmacy practice, which has changed significantly since the original 1933 Act was introduced—a time when pharmacists still routinely compounded medicines by hand. Over the years, that role has evolved and medicines are now largely pre-packaged and supplied via global supply chains. Pharmacists increasingly play a critical role in delivering NHS services, from vaccinations to blood pressure checks, emergency medications and, of course, Pharmacy First consultations—which many noble Lords agree with. Given the Government’s priorities on moving from hospital to the community, they also play a vital role here.

This legislation rightly seeks to release capacity, allowing pharmacists to spend more time with patients, and it allows pharmacist technicians to take on more responsibility in line with training and regulation. As the noble Baronesses, Lady Hollins and Lady Bennett, said, there were concerns about the technicians and the differential in training level, and taking that on. In some ways, that takes us back to the physician and anaesthetist associates debate. Although the noble Baroness, Lady Bennett, and I were on different sides in that debate, I think that we would all agree that it was not right that those who were not qualified were taking on the role of those who were more qualified and taking on roles above their qualifications. What can the Minister say about that, given the experience of anaesthetist and physician associates? We welcomed that. Some of them were being asked to do roles for which they were not qualified. How do we make sure that pharmacist technicians are not repeating that?

Healthcare Provision: Inequalities

Lord Kamall Excerpts

Monday 20th October 2025 Lords Chamber

[Baroness Merron (Lab)]

We have discussed national insurance contributions a number of times in your Lordships’ House, and I can only repeat the previous assurance, given not just by me but by other Ministers: that in making the decision, the Chancellor took into account not just the funding available—for example, in the Department of Health and Social Care, which was notable and welcome—but the impact.

In respect of rural areas, the national approach to inform action to improve equality in healthcare does define groups, including those in rural and coastal communities, so I can assure the noble Baroness that this issue does get the attention she seeks.

[Lord Kamall (Con)]

My Lords, to address inequalities we need better data. We have heard from noble Lords about granular data in some areas, but in many areas we still need to collect data and publish it in a much more granular manner, based on region, ethnicity and income, but also other measures. What are the Government doing to improve the collection of data, and particularly its granularity, so that we can address these inequalities?

[Baroness Merron (Lab)]

I agree with the noble Lord about the importance of data. We have discussed this a number of times in respect of racial inequalities. But it is not just about data; it is also about the use of digital services. We must ensure that those in the most deprived areas are not excluded because of their inability to deal with digital aspects. As the noble Lord knows, moving from analogue to digital is another core part of what we are doing. I assure him that we are improving data collection and its availability and use.

HIV: Testing and Medical Care

Lord Kamall Excerpts

Monday 20th October 2025 Lords Chamber

[Baroness Merron (Lab)]

We are currently in the process of reviewing existing mechanisms as well as options for improving retention and re-engagement in care for people who live with HIV. This is a crucial part of the new HIV action plan, for which we will not be waiting very long. The noble Baroness makes an important point: there are all sorts of reasons for disengagement from care. It can be due to complex mental and physical needs but also the fear of stigma, as she referred to, particularly in the most vulnerable population groups, which means that they are disproportionately challenged. However, I assure her and your Lordships’ House that the plan will take account of that. Indeed, the 10-year health plan already makes that commitment.

[Lord Kamall (Con)]

My Lords, does the Minister agree that routine opt-out HIV testing—offering HIV tests to all patients in healthcare settings, such as emergency departments, unless they specifically decline—has proved highly effective, having identified over 1,000 cases of HIV that may well have gone undetected otherwise? Do the Government have any plans to extend this approach beyond the current pilot projects?

[Baroness Merron (Lab)]

I certainly agree that giving people who are attending an emergency department a blood test as part of a routine examination—unless they opt out—has assisted very much in engaging people in care and in identification. We have 79 emergency departments in the programme and they are making a substantial contribution. We will continue to assess where it is successful and how we can extend the success into areas that are not currently benefiting.

Terminally Ill Adults (End of Life) Bill

Lord Kamall Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness Berger (Lab)]

My Lords, I have spoken already about how my experience as a Member in the other place has made me very concerned about this Bill, and more determined that it must not be a cause of further harm to vulnerable people. Many unanswered questions about the Bill before us have been raised during the course of this important debate. This is why I have tabled the amendment and the following Motion to hold a Select Committee before Committee of the whole House begins.

This is a significant and complex piece of legislation by any definition. It demands a process that can withstand the weight, but it is clear that there are serious shortcomings, as both the Constitution Committee and the Delegated Powers and Regulatory Reform Committee noted in their reports last week. Indeed, I am concerned that the legislative process is being asked to compensate for the absence of robust policy-making before the Bill was published: no comprehensive review; no public consultation or prior engagement with professionals and other stakeholders; no Green Paper or White Paper, which we would have seen had it been a government Bill—I understand the case made for why it is not a government Bill, but that has diminished what is before us today; and no published analysis of international experiences. Instead, Parliament has been asked to grapple with questions about implementation, safeguards and NHS implications without this groundwork, which we would usually turn to for a law change of this magnitude.

Back in March, Jill Rutter of the Institute for Government—which is neutral on the principle of assisted dying—said:

“We’re expecting Commons scrutiny to do far too much—things it simply can’t do … Commons scrutiny is being left to solve a whole range of problems it isn’t equipped to deal with”.


We have seen the dropping of key but expensive safeguards, such as the review by a High Court judge, and whole new clauses and schedules introduced to replace them with very little opportunity for thorough scrutiny.

It was a clear pattern in the other place that when significant concerns were raised that had not been anticipated, the response was often to add another delegated power. There are now, as we know, 42 delegated powers contained within the Bill: 42 areas where government will work out the detail later, with Parliament largely excluded from the conversation. The result is a Bill that is today substantially different from when the Bill Committee in the other place took evidence in January this year, but now with less clarity.

I do not wish to detain the House any longer than is necessary, but I have been asked many questions on the process about what is before us, which I will seek to address. My amendment ensures that we can have some evidence, expertise and insight on the Bill before us today. We need this information before we commence line-by-line scrutiny.

Noble Lords will have received a letter setting out a condensed list of witnesses that I and other supporters believe this House must hear from, including my noble and learned friend Lord Falconer of Thoroton and those who will bear the responsibility for delivering the Bill, should it pass, and setting out how they would use their delegated powers. These witnesses are to include the Secretary of State for Health and Social Care, the chief executive of NHS England, the Secretary of State for Justice and the Chief Secretary to the Treasury.

We must also take evidence from the professional bodies whose members will be asked to carry out the functions that the Bill sets out: the Royal College of Psychiatrists, the Royal College of Physicians, the Royal College of General Practitioners, the British Association of Social Workers and the Law Society.

We are, of course, not able to hear from serving members of the judiciary, but may hear from the former Chief Coroner of England, Thomas Teague KC, and Sir James Munby, President of the Family Division of the High Court. We must also ensure that we understand the impact of the Bill on our hospices and care homes, through Hospice UK, the Association for Palliative Medicine and Care England.

A previous suggestion of a Select Committee in parallel, alongside a Committee of the whole House, would not achieve—

[Lord Kamall (Con)]

I apologise, I do not want to detain the House any longer than is necessary. Just to clarify, will all the evidence before the Select Committee be published?

[Baroness Berger (Lab)]

I am very grateful for the intervention, and I was just about to come on to that, but I will answer that now. The answer is yes, absolutely. The intention is that all the evidence accumulated and amassed during that time will be published for everyone in the House to interrogate and consider in advance of us going into Committee of the whole House. To confirm, this Select Committee cannot take place in parallel in order that we can receive evidence on vital parts of the Bill before we go into debate, so that we are not in the unenviable position of knowing what is wrong with the Bill but being unable to amend it.

My Motion provides that a Select Committee would be intended as a focused piece of work, hearing vital expert oral evidence, as I have just set out, rather than it being a more time-intensive open exercise. It may report by simply publishing that evidence before we go into Committee of the whole House, in order to inform our detailed consideration of the Bill. As I understand it from the clerks, the revised timetable allows the committee to hold six meetings over three weeks, with two panels of witnesses on each of the days, to begin the week commencing 20 October and allowing it to conclude by 7 November. The revised timetable ensures that the Bill can progress to its next stage and maintain the opportunity for four sitting Fridays before Christmas.

We have, over the past two Fridays, shown the determination of your Lordships’ House to discuss the Bill in a considered and constructive way, and it is my strongest hope that we can continue to do that. If my amendment is accepted, I do not intend to speak on the Motion that will follow, which contains the detail that I have just set out. I am grateful to my noble and learned friend Lord Falconer of Thoroton—

Genome Screening: Newborn Infants

Lord Kamall Excerpts

Thursday 18th September 2025 Lords Chamber

[Baroness Merron (Lab)]

I am grateful to the noble Lord and will be very pleased to write to him on that specific. Part of this work in the programme we are referring to is on treatable diseases. For example, the Generation Study covers hereditary fructose intolerance, which means that babies would not be able to ingest fructose normally. By identifying it, we can then recommend removing fructose from their daily diet, which is a way of overcoming that condition. So, by spotting the condition early, we can take action. As the noble Lord says, there are indeed a number of areas in which further work needs to be done, but I would be very glad to write to him on the detail.

[Lord Kamall (Con)]

My Lords, while genome screening of newborns is welcome and could be an important part of the prevention agenda, it raises a number of ethical issues. I will focus on just one: at what stage do you tell someone who has a high probability of getting a medical condition, say in their 40s or 50s, about the probability or even certainty of developing that condition, without causing undue distress or even premature treatment? Can the Minister briefly tell noble Lords about the conversations that are going on in the department about these ethical issues, perhaps with the medical profession, and perhaps write in more detail later?

[Baroness Merron (Lab)]

As I mentioned to the noble Lord, Lord Kakkar, the matter of ethics is crucial in this development. It might help if I restated— I absolutely understand the noble Lord’s point—that that is why the Generation Study, which is directed at newborns, is for treatable conditions that may develop in the first five years of life, not later on. I understand why that would be of concern, and similarly of concern to my noble friend Lord Winston, so I hope that assurance will be helpful.

National Health Service Regulations

Lord Kamall Excerpts

Tuesday 16th September 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, as the Minister will know, the 2025 amendments to the regulations made several key changes, one of which was to keep online consultation talks open during surgery hours. While these Benches welcome the shift from analogue to digital, we understand that the National Pensioners Convention estimates that between 500,000 and 700,000 older people would not be able to access either the online consultation tool or patient records, either because they are not online or because they struggle to navigate apps and websites. Can the Minister update the House about what her department is doing to work with GPs and, in fact, the whole system of health and care, to make sure that that small minority of people who are not digitally literate, including older people, are not locked out of receiving health and social care?

[Baroness Merron (Lab)]

The noble Lord makes an important point. There is absolutely no intention that people will be disadvantaged in any way. This is about equalising access, which means keeping all forms of access open. That may be online, but it will also be possible to deal with things in person and on the phone. Obviously, if we can take pressure off phone access, or personal access, through the use of online, that will assist the group to which the noble Lord referred.

Respiratory Syncytial Virus: Vaccination Programme

Lord Kamall Excerpts

Tuesday 9th September 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Ritchie of Downpatrick, for securing this debate today on RSV, particularly on vaccines for children. I pay tribute to her for continuously raising awareness of RSV. As she reminded me, when I was a Minister she raised it a number of times and continues to raise it. That shows how important it is and the vital role she plays.

As we know, RSV, alongside flu and Covid, is a leading cause of serious respiratory illnesses. Before the rollout of the vaccination programme, it was responsible for more than 10,000 hospital admissions and 4,000 deaths each year among adults aged over 75. The noble Baroness reminded us that it poses a danger in early childhood, with, as other noble Lords have said, over 30,000 hospitalisations and up to 30 deaths each year among children under five. One of the reasons that children are especially at risk is due to their developing smaller airways, which makes them particularly susceptible to bronchiolitis, a condition in which the lungs become inflamed during the fight against infection. We also know that RSV is perhaps more widespread than is commonly known and can seriously affect the most vulnerable people in our society.

I welcome the opportunity that this debate allows us in taking the time to speak about RSV and to ask the Government about the steps they are taking to prevent it as much as possible and to treat it. The previous and current Governments and the many health professionals are to be congratulated on the fact that RSV vaccine coverage has been rising steadily. It is good news that, among eligible older adults in England, the vaccine uptake has risen from 23% in September 2024 to around 63% by the end of June 2025. Similarly, as others have said, maternal vaccination has followed a similar trajectory, so that among mothers who gave birth in March 2025, 55% have been vaccinated. I know noble Lords have given out various statistics today.

The challenge now, as the noble Baroness has identified, is how to increase this coverage further. We know that the vaccination works; a recent study, looking at data from 14 hospitals in England up to March 2025, found that vaccination reduced the chances of hospital admissions with RSV infection by 82%. It is important that we repeat some of these statistics so people recognise that vaccines work. More relevant to today’s debate is that the estimated reduction in RSV risk was 58% for infants whose mothers were vaccinated at any time before delivery. It is sometimes easy to quote statistics and figures and see who has the best or the more up-to-date statistics, but sometimes we forget the human element. It is clear that taking the RSV vaccine protects us, our friends and our loved ones from harm and hospitalisation, and we should not forget that.

Despite that good news, though, as with other conditions, there are substantial disparities in how effective these measures have been in the population data, as my noble friend Lord Mott, the noble Lord, Lord Rennard, and indeed the noble Baroness, Lady Ritchie, said. As we have seen, recent data from the UKHSA showed that the uptake of the RSV vaccine for pregnant women in London was about 44%, compared to a figure of 65% in the south-west. We have heard from other noble Lords that members of the “Black or Black British—Caribbean” ethnic community are substantially less likely to be vaccinated than the highest uptake. Interestingly, ethnically Chinese people are the most vaccinated group, but in the “Black or Black British—Caribbean” cohort the coverage reported by the UKHSA earlier this year was only 28%.

We saw that the uptake of RSV vaccine for pregnant women in some of the UK’s largest ethnic groups is also quite low, with white British people at 62% and British Indian people at 56%. This data shows that, while many people have been vaccinated against RSV and the numbers have certainly increased, there are many communities where vaccination levels remain low. Clearly more needs to be done.

When I met the Caribbean and African Health Network last week, it explained some of the factors behind vaccine hesitancy within their communities. Sometimes it stems from a lack of trust of the organisations promoting vaccines, as well as a lack of culturally and linguistically appropriate information. We also know, as other noble Lords have said, about misinformation about the harms that could be caused by vaccines, spread via social media but also by politicians in some parts of the political spectrum.

Noble Lords will recall that we had to tackle vaccine hesitancy under the Covid programme. We found that asking local community organisations—people in the communities, especially faith communities, who knew the people we were trying to reach—to take the lead helped to build trust, but it did not always solve the problem. It is very easy to point to one success story. Indeed, in at least one case, there were certain churches that were actually discouraging their congregations from being vaccinated. That just shows how granular we have to be in reaching those communities and trying to understand some of those barriers.

So, while noble Lords may extol the benefits of vaccination programmes for RSV, Covid, HPV and MMR, there is clearly more work to be done in reaching out to individuals in the communities where uptake is low. We need to understand their concerns and the barriers that they feel they face, and we need to understand how we can tap into the power of trusted local community organisations to ensure that as many people as possible benefit from RSV and other vaccines.

The noble Baroness, Lady Ritchie of Downpatrick, stressed the importance of vaccinating infants, but we need to reach the children via their parents and the communities in which they live. I am sure that noble Lords across the House share the ambition to break down barriers of access and build trust in communities, and to make sure more people are protected against RSV.

When we returned after the short break, the Minister said she missed a number of questions from noble Lords across the House, so, as in any debate, I want to make sure that I help her in that respect. I have questions but, if the Minister cannot answer now, perhaps she will write to us. What specific steps are her department and organisations such as the Office for Health Improvement and Disparities and the UKHSA taking to address these disparities in RSV vaccine uptake, not only regionally but also ethnically? What initiatives are there to increase uptake in those ethnic communities where vaccination levels are particularly low? What has worked and what has not?

Is the Minister able to share some good stories where specific programmes to tackle vaccine hesitancy have actually showed some success? How can that best practice be rolled out to other communities in other parts of the country? I think the noble Baroness, Lady Ritchie of Downpatrick, asked about disaggregated data—what disaggregated data is available on RSV vaccine uptake? If it is not yet available, will the Minister look at or perhaps commit to publishing regular disaggregated data on RSV vaccine uptake by region, ethnicity and socioeconomic group so that Parliament and the public can track progress in ensuring equity of access? I am sure the noble Baroness, Lady Ritchie of Downpatrick, would appreciate such disaggregated data, as all noble Lords would.

I once again thank the noble Baroness, Lady Ritchie of Downpatrick, for securing this debate today and for the opportunity it has afforded the full Benches to discuss this important issue. Your Lordships recognise that the Minister takes this issue seriously, so we look forward to the responses.

Suicide Reduction

Lord Kamall Excerpts

Monday 8th September 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Ritchie, for raising this important issue today. The Minister will be aware that the data on suicides shows some disparities: for example, men make up three-quarters of reported suicides and the north-east of England has a suicide rate nearly twice as high as that of London. What research are the Government aware of that explains such disparities? What is being done in local communities, especially by civil society organisations, to try to reduce the rates of suicide in those communities?

[Baroness Merron (Lab)]

The noble Lord is right that there is disparity, which is often linked to priority risk factors, including, for example, financial difficulty, physical health, alcohol and drug abuse, harmful gambling, domestic abuse, social isolation and loneliness. Those priority risk factors are, sadly, more at play in the more disadvantaged areas to which the noble Lord referred. As we seek to develop further the effectiveness of the strategy—we have made great progress so far, but it is not enough—we need to ensure that the whole country is attended to and that we address the risk factors for suicide for everybody.

Prostate Cancer

Lord Kamall Excerpts

Wednesday 3rd September 2025 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend Lord Mott for securing this important debate and for sharing some of those startling statistics. I also thank other noble Lords who contributed today and shared their personal experience. Time constraints and a Paddington Bear stare from the noble Baroness, Lady Anderson, prevent me naming them all.

I hope noble Lords will forgive me if they have heard this before but, when I worked in Belgium, a urologist advised me that men over 45 should seek an annual prostate cancer test. So, when I came back to the UK, I asked my GP about this and he was dismissive, suggesting that I ask for a PSA test at my next blood test. When I did so, the nurse asked me if I was sure that I wanted one and said, “They’re not very reliable”. Given that attitude from some medical staff—not all, it has to be said—it is not surprising that the data I looked up today shows prostate cancer incidence in Belgium to be below the UK’s.

I understand concerns about overdiagnosis of what is termed slow-growing, localised, or benign prostate cancer, which, when unnecessarily treated, may lead to incontinence, erectile dysfunction or bowel issues. I also understand concerns about misinterpreting data from enlarged prostates. These are important points to bear in mind, but surely this should not be an excuse for reluctance or inaction by some clinicians, especially given the alarming racial disparities mentioned by a number of noble Lords.

I welcome the Minister back to her place after her recent absence. In doing so, I will ask her some questions. Given the emphasis on “from sickness to prevention”, how do the Government intend to raise awareness of checking for prostate cancer, particularly in those disproportionately affected communities?

Some noble Lords mentioned trials—some introduced under the last Government. There are also reports of tests. I know we have to be very careful about what we read in the media and some of the claims, but some suggest that these tests are up to 96% accurate in detecting prostate cancer. Can the Minister say any more at this stage about these trials, the ongoing evaluation, and whether there is a rough timescale for a definitive test we can all have confidence in?

Given the concerns that have been raised, what guidance is available now for medical practitioners on prostate cancer tests such as the PSA, then later the PCA and others? How do we ensure that patients can be encouraged to come forward? How can we be assured that prostate cancer is given the attention it deserves?

Care Workers: Foreign Worker Visas

Lord Kamall Excerpts

Wednesday 18th June 2025 Lords Chamber

[Baroness Merron (Lab)]

Perhaps I could assist by clarifying that the spending review, which allows for an increase of over £4 billion of funding available for social care, is by 2028-29; it is not a matter of waiting for that long. That is in comparison with 2025-26. I hope I was helpful to your Lordships’ House in identifying a number of actions we have already taken to professionalise, upskill and allow people to build careers in the social care workforce. That is absolutely crucial. That, aligned with stopping international recruitment in this area—with a period of time for transition of some years—will shift to improve and increase the adult social care workforce in this country.

[Lord Kamall (Con)]

My Lords, while there are legitimate concerns over the levels of immigration, it is important to recognise the contribution that immigrants have made to our great country, not least to recall that after the war, our public services were saved by immigrants, especially from Commonwealth countries. We should not forget that.

My question is about the NHS and Care Volunteer Responders programme, which was set up during the pandemic and extended to adult social care in 2023. Unfortunately, the Government recently closed the volunteering service without an obvious alternative. While I recognise that volunteering will not make up for workforce shortages, what action are the Government taking to ensure that those who wish to volunteer in the social care sector can make a worthwhile contribution?

[Baroness Merron (Lab)]

While I absolutely agree about the value of volunteering, as we have discussed before, I should make clear that volunteering is not a substitute for employment on the right pay, the right terms and conditions and with the right status. I also absolutely agree with the noble Lord about the contribution that has been made by those from overseas to supporting our care services, and indeed by all care workers.

As we have discussed in this Chamber, the scheme was not simply closed. It was something that was appropriate for when we were in a pandemic but not for now. In fact, we have introduced a whole range of measures which I will be very pleased to remind the noble Lord of, to ensure that we can have more volunteers who are better used and more highly regarded. They are a complement to our workforce, and very valuable they are too.