Puberty Suppressants Trial

Lord Kamall Excerpts

Thursday 18th December 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I begin by thanking the Government for their sensitive language in handling this delicate issue. I recall the noble Baroness, Lady Cass, telling the House that puberty blockers are currently licensed only for much younger children with precocious puberty or older adults with certain cancers. Trials are therefore needed to determine whether they are safe for adolescents with gender incongruence and to understand the interaction with the different processes of puberty. I understand that children taking part in the trials must have their parents’ consent, but can the Minister clarify two points that are clearly raising concern? First, what is the maximum and minimum age of children taking part in these trials? Secondly, what assurances can the Government definitively give that children taking part in these trials will not experience fertility issues or loss of sexual function or any conditions that are irreversible later in life? I also wish all noble Lords, staff and officials a merry Christmas, happy Hanukkah, happy new year and, as our American cousins say, happy holidays.

[The Parliamentary Under-secretary of State, Department of Health (Baroness Merron) (Lab)]

My Lords, I am grateful to the noble Lord for acknowledging the sensitive language. This is indeed a sensitive issue. For all the division and divided opinion that I know there is, there is also a determination—including across the House, I am sure—that we get this right. The clinical trial is just part of the PATHWAYS study. With regard to the clinical trial, it is extremely unlikely that anyone under the age of 11 will qualify as a potential participant and it runs up to the 16th birthday, so I hope that that is helpful. Can the noble Lord remind me of his second question?

[Lord Kamall (Con)]

What assurance can be given so that any health developments under these trials are not irreversible?

[Baroness Merron (Lab)]

I thank the noble Lord. Before participants enter the trial—and it is an extremely high bar, as it should be; there will be at least 226 participants required, but that is not a target and there will be no drive to get up to that number—certainly any possible impacts such as those the noble Lord describes will be fully discussed and mitigations will be explained and made available, particularly in terms of fertility. I absolutely take the point that the noble Lord raises.

NHS: Winter Preparedness

Lord Kamall Excerpts

Tuesday 16th December 2025 Lords Chamber

I am proud of the way that the NHS team has pulled together through strike action in the past, and I know they will move heaven and earth to keep patients as safe as they can this winter. I am just appalled that they are having to do so without the support of their colleagues in the BMA”.

[Lord Kamall (Con)]

My Lords, I want to ask the Minister about two cohorts in respect of which there are concerns about vaccination levels. The first is front-line health workers. Is the Minister aware of what percentage have been vaccinated and what action is being taken to improve the uptake of vaccinations, particularly among those front-line health workers? I know that there are stories and concerns expressed in the press about the rate of vaccination. On the second cohort, will the Minister tell the House which socio-economic or ethnic groups have the lowest update? What targeted plans does the department and NHS England have to increase uptake rates in these groups?

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

First, we have started earlier and done more than ever before to prepare for the winter pressures. The good news is that the flu vaccines are working well to protect people against severe disease, and they are certainly working well in comparison to how they used to. In fact, we are the first country in the world to show vaccines working this well. On the uptake of vaccinations, 60,000 more NHS staff have been vaccinated this year than last year, which is extremely welcome. We have delivered over 17 million flu vaccines, which is tens of thousands more than we had delivered this time last year. We have a particular programme of communication and support and availability to those groups which are less likely to take up vaccinations. Vaccinations are our best line of defence against RSV and flu. I will be pleased to provide more detailed information to the noble Lord.

Women’s Health Strategy

Lord Kamall Excerpts

Tuesday 16th December 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness is absolutely right, and we are taking every opportunity to find the right ways to communicate with women about their healthcare. If I had to give a big message, it would be, “Don’t not put up with it”. That is a basic challenge to get across, because so many women do put up with health challenges when they should not. Many women’s health challenges have become normalised—“It’s just part of life, it’s your age” and so on—and I am very keen that, in the renewed women’s health strategy, we will take on that myth and also take on the services to match that.

[Lord Kamall (Con)]

My Lords, I thank my noble friend for this Question and pay tribute to her consistent championing of women’s health issues. I also thank her for discussing the particular concerns behind this Question with me. I am sorry to return to gynaecology, but the Royal College of Obstetricians and Gynaecologists has raised concerns that cervical screening coverage remains well below NHS targets. Cancer Research says that low attendance is particularly evident in particular groups: the youngest as well as the oldest age group, and women from poor socioeconomic and ethnic minority backgrounds. Can the Minister update the House on how we can reach those women and encourage them to come forward for screening, particularly by working with local charities and community organisations that understand their communities far better?

[Baroness Merron (Lab)]

This is a very important point. The 10-year health plan restated the aim of eliminating cervical cancer by 2040 through the improved uptake of cervical screening and HPV vaccination. To the specific point, which is such an important one, in June—not many months ago—we announced that screening providers can offer home testing kits to underscreened individuals in the exact groups that the noble Lord refers to. I believe this will help tackle deeply entrenched barriers that keep some people away from life-saving screening. I am sure the whole House will reflect on the wise words and advice of His Majesty the King in imploring us all to take up the screening opportunities that there are. I certainly agree with that.

Resident Doctors: Industrial Action

Lord Kamall Excerpts

Monday 15th December 2025 Lords Chamber

The power to end these strikes now lies in the hands of doctors. Resident doctors face a choice: to continue the damaging industrial action in which everyone loses, or to choose more jobs, better career progression, more money in their pockets and an end to strikes. The deal that is on offer would mean emergency legislation to put our own homegrown talent first; to increase the number of extra specialty training places from 1,000 to 4,000, with a quarter of those places delivered now; to reduce the competition for training places from around four to one to less than two to one; to put more money in doctors’ pockets by funding royal college exam fees, portfolio fees and membership fees, with exam fees backdated to April; and to increase the less-than-full-time allowance by 50% to £1,500. It is a chance for a fresh start, to end this dispute and look ahead to the future with hope and optimism—a chance to rebuild resident doctors’ working conditions and rebuild our NHS. I urge every resident doctor to vote for this deal, and I commend this Statement to the House”.

[Lord Kamall (Con)]

My Lords, the announcement of further industrial action by resident doctors is obviously deeply concerning. These strikes, which we now know will go ahead after all, will have a serious impact on the capacity of our health service to function at precisely the time of year when demand is at its highest. Resident doctors make up almost half the medical workforce, and NHS leaders have already warned that action will cause significant disruption.

We on these Benches agree with the Secretary of State for Health and Social Care when he says that the BMA has clearly chosen to strike when it will cause maximum disruption, causing untold anxiety at the busiest point of the year. We agree with Rory Deighton, the acute and community care director of the NHS Confederation, who warned that, with the winter now upon us and rising levels of flu and staff sickness, pressure on services will be intense, with the likely consequence of

“thousands of cancelled appointments and operations”.

The impact of these strikes is compounded by the fact that NHS England has warned that it is bracing for an unprecedented flu wave this winter. In London alone, there are three times as many people hospitalised with flu compared to last year, with an average 259 hospital beds occupied each day, compared to just 89 a year ago. It is in this context that the CEO of the NHS described the BMA’s decision to strike in the run-up to Christmas as

“cruel and calculated to cause mayhem”.

There is a wider concern, shared by patients and families across the country. When the Government caved in to the BMA last year with an unconditional 29% pay settlement, noble Lords on all Benches warned that this would only incentivise the BMA to come back year after year with more demands. At the time, the Secretary of State brushed off these concerns and criticised those who raised this obvious observation, claiming that there would be no further strikes, no more cancellations and no more disruption. While we agree with the Health Secretary that this action by the BMA is cynical, strong words alone will not keep operating theatres open or ensure that patients receive their care in a timely manner. Appointments will still be postponed or cancelled, operations will be postponed and patients will suffer.

Now that the BMA membership has rejected the latest offer and is pressing ahead with further strikes, will the Minister lay out the Government’s plan? What additional resources have been made available to mitigate the serious disruption that these strikes will inflict? Given the combined pressures of flu and RSV, what steps are being taken to ensure that those who are eligible for vaccination actually receive it?

It appears that we are stuck in a downward spiral. Strikes are threatened, offers are rejected, strikes happen, misery is inflicted and then it is threatened all over again. If the Government do find a way of ending the threatened action, will they please do a couple of things? Will they make sure that it is conditional on updating work practices, to ensure that we have a more efficient health system? Many people who work in the health system know that some practices are out of date and have not moved on since the 1940s. Will they make sure that it does not incentivise the BMA to pocket any settlement and return next year threatening more strike action? The very uncertainty surrounding future militancy by the BMA is deeply damaging. It should be a matter of grave concern to the Government that the public seem not to have any confidence in the Government’s ability to keep doctors at work and keep the health service functioning.

As part of this, does the Minister recognise that the Government’s Employment Rights Bill risks making matters significantly worse next year? Will they think again about their rejection of minimum service levels to protect patients in the future? Finally, we know that the OBR has said that the cost of industrial action is a major risk to health spending. What estimate have the Government made of the cost of strike action in December, and will costs be paid using existing NHS budgets? As we know, the Chancellor often says there is no more money.

We are clear that these strikes must end and that the behaviour of the BMA is indefensible, but we must remember that it is not Ministers, unions or negotiators who will bear the cost of this action; it is patients and their families and loved ones. They deserve better. I am sorry to say that we are not yet convinced that the Government are on top of this and working to end the threat of these damaging strikes now and avoid incentivising future strikes in future years. I really hope that the Minister can reassure noble Lords that the Government have a plan.

[Lord Scriven (LD)]

My Lords, I thank the Minister for putting the Statement before us, but do so with a measure of frustration—a feeling shared by countless citizens. This frustration with the ongoing and deeply damaging resident doctors dispute is directed at both parties, the Government and the British Medical Association leadership. We are witnessing a breakdown in negotiation, a failure of common sense and, critically, a failure of duty towards the patients who rely on the National Health Service.

First, let me address the actions of the Government. The manner in which this dispute has been handled is, frankly, not best practice. We have seen periods of silence followed by 11th-hour media interventions by the Secretary of State. This pattern suggests not a serious negotiation but a high-stakes, last-minute political gamble, PR approach. The way the reported details of the last-minute offer were put before the public and resident doctors serves only to deepen this suspicion. This approach disrespects the process and the professionals involved. Given that the issues addressed in the Government’s 11th-hour offer have been known since the general election, why did the Government choose a high-stakes, last-minute intervention, rather than presenting the offer within a calm, realistic timeframe that could have facilitated constructive consideration by resident doctors?

Further, I must express my dismay at the tone sometimes employed by the Secretary of State. Using rhetoric that seeks to divide resident doctors from the public is counterproductive. This dispute will not be solved through grandstanding but through respect and meaningful compromise. The Government must reflect on their tone and timing.

However, the frustration I feel over the Government’s handling is matched in equal measure by my frustration over some of the tactics and demands employed by the BMA leadership. The pursuit of this round of strike action, especially scheduled at the most challenging time of the year, is, in my view, deeply irresponsible. The BMA has a singular responsibility that transcends typical union negotiations. Their members are the direct custodians of people’s health. We are currently grappling with two severe pressures on the NHS: the rising tide of flu and the deliberate scheduling of this strike to coincide with the Christmas period. To choose this time, when hospital rotas are already thin and the NHS is under maximum strain, is totally unacceptable. It shows a disregard for the welfare of the most vulnerable patients. We on these Benches wish to thank the consultants, those resident doctors who decide to go into work, and the other dedicated staff who will keep our NHS safe during this unnecessary strike, for doing the right and decent thing.

The core demand pushed by the BMA leadership is full pay restoration. While I acknowledge the significant financial pressures facing resident doctors, a demand for full restoration to a prior decade’s real-terms value is neither achievable nor reasonable in the present economic climate. By focusing the entire dispute on this single maximum pay demand, the BMA leadership is allowing the Government to ignore the far more crucial systematic issues that genuinely plague resident doctors and threaten the future of the NHS workforce.

This failure is a stain on both parties. The Government must return to the table with a genuine commitment to a multi-year funded plan that addresses the systematic non-pay issues, and the BMA leadership must immediately reassess the morality of its current strike schedule and shift its focus from an unrealistic pay demand to achievable reforms in training and conditions.

I have two further questions for the Minister. The recent offer included a promise to create up to 4,000 extra speciality training posts. However, the BMA leadership has claimed that these posts are simply being cannibalised or repurposed from existing locally employed roles. Will the Minister confirm categorically that these 4,000 places represent genuinely new, funded training opportunities that increase the total number of doctors retained in the NHS career structure and are not merely a reclassification of existing roles?

Given that the pay restoration demand is deemed unachievable, how will the Government—outside of pay—guarantee fundamental reforms to the working time directive enforcement, the quality of training rotations and the rota planning to ensure that resident doctors are used efficiently for patient care and for the development of their skills, thereby making a medical career in the NHS sustainable and attractive?

Our healthcare system cannot afford this deadlock. I urge both sides to put down their political weapons, swallow their pride and focus on the real-world issues before the consequences become truly tragic.

Terminally Ill Adults (End of Life) Bill

Lord Kamall Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord Kamall (Con)]

As I set out last week and will repeat if noble Lords will forgive me, I completely agree with what the Government Chief Whip said about noble Lords ensuring that they speak to the amendments and do not give Second Reading speeches, but, at the same time, I think it is important that all noble Lords who want to speak to an amendment are given the opportunity to do so.

I thank the noble Baroness, Lady Finlay of Llandaff, for her amendment in this group. It seeks to ensure that someone who currently is or has recently been deprived of their liberty will not be eligible under the Act. This amendment refers to the Mental Capacity Act 2005, which is also the Act underpinning capacity for the purposes of this Bill. I appreciate the underlying logic behind the amendment, which has opened up a valuable discussion of who exactly should have access to assisted dying services. I am sure that all noble Lords would agree, whatever their position, that there should be robust provisions and safeguards in the Bill and that it should be available only to those who are suffering from terminal illnesses who are of sound mind, so that we do not inadvertently open it up to those with issues related to their capacity.

I am also grateful to the noble Baroness, Lady Berger, for her contribution in place of the noble Baroness, Lady Keeley. It is very important that, given the backlog in the system, not just those who have DoLS but those who have made an application for DoLS are deemed not to have capacity when seeking to end their lives. It would be very interesting to hear the Government’s perspective on this and that of the noble and learned Lord.

These questions all fundamentally ask whether the Bill is right to use the Mental Capacity Act 2005 as the basis for defining capacity. I am very grateful to the noble and learned Lord, Lord Falconer of Thoroton, for offering to meet those who have tabled these amendments. That is very constructive and helpful and should be acknowledged. I also look forward to hearing the noble and learned Lord’s responses to some of the issues that have been raised.

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

My Lords, I am grateful to noble Lords for their contributions on this group. To echo the comments of my noble friend the Chief Whip, the Government remain neutral on the principle of assisted dying and on the passage of this Bill. Whether the law in this area should change is a matter for Parliament. As before, any comments that I make will focus on amendments where the Government have major legal, technical or operational workability concerns.

This group relates to deprivation of liberty and eligibility for seeking an assisted death. I thank the noble Baroness, Lady Finlay, and my noble friend Baroness Keeley for tabling the amendments in this group. Amendments 16 and 114, tabled by the noble Baroness, Lady Finlay, seek to prevent individuals who have been deprived of their liberty within the last 12 months under the Mental Capacity Act being eligible for an assisted death. In the case of Amendments 16A and 114A, tabled by my noble friend Lady Keeley, someone would be ineligible as a result of an application for deprivation of liberty having been made, irrespective of the outcome of that application.

Noble Lords may wish to consider that the amendments would introduce a departure from the Mental Capacity Act framework by linking a lack of capacity in one area—capacity to consent to care and treatment arrangements that amount to confinement—to lack of capacity in another area, that being capacity to make the decision to end one’s life. Amendments 16A and 114A go further and would make a person ineligible on the basis that only an application for deprivation of liberty had been made. This may result in a situation where the application was unwarranted, but that person would still be ineligible for assisted death.

Regarding the European Convention on Human Rights—

--- Later in debate ---

[Lord Kamall (Con)]

The question that a number of noble Lords are concerned about, when discussing this amendment, is that the Mental Capacity Act was passed in 2005. Of course, the guidance has been updated, but it might be helpful to those in the Committee who are concerned that this Act is 20 years out of date to talk about any guidance that has been updated, so that it is not seen as out of date—if that makes sense. This is just to clarify that we are not dealing with an Act that was set in stone in 2005, as things have changed since then.

[Baroness Merron (Lab)]

I am grateful to the noble Lord and feel that this would probably be a very appropriate point to move on to my noble and learned friend.

--- Later in debate ---

[Noble Lords]

Front Bench!

[Lord Kamall (Con)]

I have never been so popular; it will not last, I know.

I thank the noble Baroness, Lady Grey-Thompson, for her amendments. I pay tribute to her for her sincere and long-standing commitment to protecting the most vulnerable in society. If we cast our minds back to Second Reading, many of the contributions made and concerns raised were regarding those who are the most vulnerable in our society. I remember at Second Reading being particularly touched by the words of the noble Lord, Lord Rees—he is not in his place now—who raised concerns about the vulnerability of some ethnic-minority communities, particularly those from disadvantaged communities as well.

Let us quickly rush through some of the points. On Amendment 22, which would make prisoners ineligible for end-of-life services as envisaged by the Bill, I completely understand the underlying principle. Many have spoken, rightly, about the vulnerability of prisoners. While for some it might seem wrong, as the noble Lord, Lord Farmer, has suggested, that a prisoner who has a terminal illness may have a way of cutting short their sentence by means of this Bill, as my noble friend Lady Coffey alluded to, others may say “Good riddance”. I also recognise the argument that prisoners with a terminal illness should be treated with the same compassion and care at the end of their lives as other terminally ill people subject to the Bill, as my noble friend Lord Markham recognised.

We also have to recognise some of the concerns over moral hazard. I do not know how large the incidence of this would be. Would it really encourage those who are terminally ill to commit crime? No studies have been done, but I am open to that concern. There is also the idea about higher levels of suicidal ideation, as raised by the noble Baroness, Lady Fox. These are really important points that we have to take account of.

The right reverend Prelate and my noble friend Lord Deben spoke about the pressure of reducing the prison population, while the noble Lord, Lord Carter, spoke about the higher rate of suicide among male prisoners. These are all reflections that should give us cause for concern, and things we should take account of as we consider what we will do between Committee and Report.

I thank the noble Baroness, Lady Grey-Thompson, for raising the issue of those who are pregnant. As the noble Baroness said, this was not debated in the other place, so I am grateful that the noble Baroness was able to give us the opportunity to debate it. I am also grateful to the noble Baroness, Lady Berger, for sharing statistics about expectant mothers. It was important that we heard those stats. I cannot begin to imagine the difficulty an individual in those circumstances may face. I understand the concern that it does not seem right that the safety of an unborn child may be endangered under the provisions in the Bill. I also understand that there might be precedence in other legislation. I wonder what the noble and learned Lord’s reflections on that are, given his expertise.

I note the amendment tabled by the noble Lord, Lord Farmer, on access to this for those who are awaiting trial. Once again, I would be very interested in the noble and learned Lord’s legal experience on whether that seems relevant and should be within this Bill. During the debates on the Mental Health Bill, my noble friend Lady Berridge was assiduous in spotting gaps in legislation or inconsistencies between different Acts. My noble friend has done the same thing here by raising concerns over the vulnerability of those with education, health and care plans. I think this needs further consideration.

I also thank the noble Baroness, Lady Grey-Thompson, for her amendments relating to those who are homeless or who live in insecure and temporary accommodation. I welcome the experience of the noble Baroness, Lady Gray. I still remember a conversation I had with one homeless charity that we are all one or two unlucky events or bad decisions away from homelessness. I heard from homeless people who told me that they had a great job and a great family life and that everything was going their way. They lost their job, which then led to them losing their marriage. After incidents of sofa surfing and testing the patience of their friends, they ended up homeless. It could happen to anyone. It is important that we do not dismiss the homeless as people who cannot be bothered or are idle. It could happen to anyone. Any noble Lords who have met those in homeless communities will know that some people had been incredibly successful but, after two or three bad decisions or unlucky things that happened in their life, they suddenly found themselves homeless. They are also judged by the way they look when they are homeless.

I remind all noble Lords that the Bill relates only to those who are suffering from a terminal illness and those who have been given an expectation that they will not live for longer than six months. We have to be very careful that, although we have sympathy for the homeless and prisoners, the Bill relates only to those who have a terminal illness. I know there are concerns that the Bill may be widened beyond that, but that is the debate at this stage. We should be quite clear that we are focusing on those with a terminal illness. So, much like on the question of prisoners and others, I recognise the arguments on all sides, but this is an opportune moment, not only because of time but because of the noble and learned Lord’s legal experience, to hear his reflections—after the Minister, obviously.

[Baroness Merron (Lab)]

I am most grateful.

My Lords, I thank all noble Lords for their contributions to the debate on this group. As is my consistent introduction, my remarks will focus only on issues where the Government have major legal, technical or operational workability concerns. Many of the points that follow relate to the European Convention on Human Rights. These are risks that I am raising to inform noble Lords’ decision-making, as I said on the first group. I wish to be clear that the underlying policies are a matter for Parliament. I say to noble Lords who referred to my ministerial colleagues in the other place that it is the role of Ministers, whether in your Lordships’ House or in the other place, to flag the risks to the Bill, including potential legal challenges. As I said, policy decisions remain a matter for the sponsors. Decisions in this regard rest with Parliament.

I begin with Amendment 22, tabled by the noble Baroness, Lady Grey-Thompson, and Amendment 30C, tabled by the noble Lord, Lord Farmer. These amendments would make prisoners, a defendant on remand, a defendant on bail or those detained by a hospital order ineligible for assisted dying services, even if they have a terminal illness and meet all other criteria. Aside from the right to liberty—Article 5—the ECHR requires that prisoners, a defendant on remand or a defendant on bail should have the same rights as those who are not. The rights engaged by this amendment are Article 8 on the right to respect for private and family life and Article 14 on prohibition of discrimination. Noble Lords may wish to note the risk that making these groups ineligible for assisted dying would, on the face of it, lead to a difference in treatment, which would need to be objectively and reasonably justified in order to comply with ECHR obligations.

Likewise, making ineligible hospital in-patients who are under a hospital order would lead to a difference in treatment. Without sufficient justification for the discriminatory treatment, this may be a breach of the ECHR, which could lead the courts to issue a declaration of incompatibility.

The noble Baroness, Lady Grey-Thompson, has also tabled Amendments 24, 458, 308 and 347. The purpose of Amendments 24 and 458 is to exclude those who are pregnant from accessing assisted dying, while that of Amendments 308 and 347 is to make persons who are homeless, or living in supported or temporary accommodation, ineligible for assisted dying services. As I have previously noted, the reasons for this difference in treatment would need to be adequately justified to avoid the risk of a successful challenge under the ECHR.

Wheelchair and Community Equipment Strategy

Lord Kamall Excerpts

Thursday 11th December 2025 Lords Chamber

[Lord Kamall (Con)]

My Lords, I thank the noble Lord, Lord Hunt of Kings Heath, for securing this valuable debate. I also thank all noble Lords who have shared their own valuable experiences. I also welcome the noble Baroness, Lady Gerada—I hope I have pronounced that correctly—who, in her maiden speech, shared her valuable background, which we know will contribute hugely to this House.

At its heart, this is a discussion about people’s freedom, dignity and independence. Wheelchairs are, for many, the difference between participating in daily life or being excluded, by enabling people to leave their homes, to see loved ones and to access work and education. However, the reason for today’s debate is that the current system faces serious problems. NHS England’s 2025 wheelchair quality framework recognises this, while the APG for Access to Disability Equipment describes the system as being “in crisis”.

We welcome and acknowledge NHS England’s initial steps to improve wheelchair services, such as a national wheelchair dataset and personal wheelchair budgets. These steps are welcome and should be acknowledged, but data from the British Healthcare Trades Association shows that only around 80% of users received a wheelchair, or a much-needed modification, within 18 weeks, which is below the 92% national target, while people with complex needs can wait significantly longer. A delay in receiving a wheelchair is not simply an inconvenience or a statistic; it is a barrier to living a fuller life.

Also, we find that where a person lives determines how their wheelchair services are assessed, whether they qualify, their level of support, how clearly the process is explained, and what kind of equipment they ultimately receive. NHS England’s own national dataset shows significant regional variation between integrated care boards in meeting the 18-week standard. There is also a wide variation in eligibility criteria. In north Bristol, the threshold for regular use is at least 4 times weekly, on a regular basis. In Oxford, regular use is defined as at least three days per week. In Wirral and west Cheshire, regular use is worded as “more often than not”. For powered wheelchair assessment, we find that in west Suffolk a person must demonstrate indoor need and appropriate home accessibility, get GP clearance and pass a driving assessment, while north-west London uses a tiered categorisation system of need, with detailed thresholds and criteria for the effects that denying access to certain items could foreseeably have.

When noble Lords discussed this topic last month, the Minister said that

“integrated care boards are responsible for the commissioning of local wheelchair services based on the needs of the local population”.—[Official Report, 24/11/25; col. 1089.]

I appreciate the need for such flexibility, reflecting local populations, but could the Minister tell the House whether the Government believe there should be better co-ordination on eligibility and communicating the criteria, and what plans they have for achieving this?

The noble Lord, Lord Hunt, shared an article from Paul Sagar about his home experience. While he was on his hospital bed, distressed and worried about his future, he was phoned by the wheelchair service when he was obviously unable to speak. He assumed that he would be called back. Instead, a letter was sent to his home address: an upstairs flat which he would never access again. I thought that showed just how Kafkaesque a situation some users find themselves in. What is the recourse for patients where local ICBs offer such poor and unempathetic services? What is the accountability mechanism for that and, while respecting local differences, what is the department’s thinking on making them accountable for allowing such poor services? Do the Government have any plans for regular reviews of wheelchair service providers to make sure that they are all meeting standards?

I appreciate that noble Lords have asked a lot of questions, but I hope the Minister, who we know cares deeply about patients, will appreciate that we see this not as a party-political issue but as one which all Benches can agree touches directly on people’s independence, dignity and everyday lives.

Terminally Ill Adults (End of Life) Bill

Lord Kamall Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Noble Lords]

Front Bench!

[Lord Kamall (Con)]

My Lords, I hesitate to rise as I want to ensure that everyone feels that their voice has been heard in this debate. We do not want to make law on a basis on which people look back and say that we did not properly debate a particular issue. If all noble Lords who wish to speak in this debate have spoken, I am very happy to make my contribution, but if there are any other noble Lords who wish to make their point, I should give way.

Well, that answers that question; I tried my best. I want to make that point clear. It is really important that everyone who feels they want to speak can do so, but I also say to noble Lords, including my noble friends, that it is also important to respect the rules and conventions, to speak to the amendments and not to repeat Second Reading speeches or make wider debates. I hope we can get that appropriate balance. I have taken time making those points, so I will try to be brief.

I pay tribute to the noble Baroness, Lady Berger, especially for the way in which she delivered the Select Committee process that preceded our deliberations in Committee. The evidence submitted to that committee will be invaluable to noble Lords as we continue our work to scrutinise the Bill.

Without making a long speech, I will reflect on the specific amendments on changing the minimum age. I was talking to a noble and learned friend about this, and he said that, frankly, the law around age is a mess—and that has come out in some discussions. Sometimes we are speaking from our own experience. My two children are in their 20s, and I wonder whether they would really have the capacity to make this decision. But at other times, I sit in awe of them and the decisions they make. They express maturity way beyond 20 years, and, in fact, more maturity than much older people.

It very much depends on the individual in these cases. We have to look at whether there is a way to achieve that right balance; otherwise, we will just be making another age limit. You can join the Army at 16 but you cannot serve in combat until you are 18. The Government are talking about reducing the voting age to 16, but then we are hearing debates on neurological competence and capacity. It is important that we understand and express these points.

The point that came out for me in this whole debate about neurological development is that there is no such thing as “the science”. Science is contestable. We heard this from noble Lords who are experts in their field. We must be very careful about saying that “the science says this”. It also has implications for other decisions.

I turn to a couple of points which may already be treated in the Bill. I want to check the understanding of the noble and learned Lord, Lord Falconer of Thoroton, on what is in the Bill. The noble Baroness, Lady Hollins, asked: what happens if a new treatment is available? Clause 2 says

“which cannot be reversed by treatment”,

which probably takes care of that point, but I would like the noble and learned Lord, Lord Falconer, to share his interpretation and say whether it addresses her concerns. The noble Baroness, Lady Hayter, said that we should think about these young people who will be suffering and in pain, yet nowhere in Clause 2 are the words “pain” or “suffering”. We must be very careful to read what is in the Bill when we are making these points.

I welcome the intervention by the noble and learned Lord, Lord Falconer, that while he is quite clear about 18, he is sympathetic to the idea of cognitive development and maturity between 18 and 25, and there might be some discussion. Who knows—I cannot speak for the noble and learned Lord, who has looked into this issue very deeply—but perhaps in those discussions he may be persuaded. He is saying 18 at the moment, but clearly he is open to enhanced measures for those aged between 18 and 25. That is something that I hope the whole Committee will welcome.

There are many other points that I could make, but it is important to hear from the Government and what the noble and learned Lord believes in response to the points that have been raised.

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

My Lords, I am grateful to noble Lords for their contributions to this debate on the age of eligibility for those who are provided with assistance under the Bill. I have made it clear previously, and reiterate, that I will keep my comments limited to the issues on which the Government have major legal, technical or operational workability concerns.

The amendments tabled by the noble Baronesses, Lady Berger, Lady Lawlor and Lady Hollins, seek to raise the age at which an individual would be eligible for the provision of assistance under the Bill. The points that I wish to raise here relate to the European Convention on Human Rights. There are potential risks that I am raising to inform the decision-making of noble Lords, but the underlying policies are rightly a matter for Parliament. Under the convention, the amendments in this group could give rise to legal challenge; for example, that excluding people who are under 21 or 25 from accessing assisting dying may not be justified under Articles 2 or 8 of the EHCR, or that this amounts to unjustified discrimination under Article 14.

Noble Lords will be aware that differential treatments, such as raising the age of eligibility, may be lawful if it is possible to persuade the courts to agree that the age limit is justified, necessary and proportionate. There would need to be a reasonable justification for restricting access to assisted dying to people aged either 21 and over or 25 and over. Noble Lords will want to consider this in relation to these amendments.

Supply of Blood and Blood Products

Lord Kamall Excerpts

Wednesday 3rd December 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness is quite right. We have to go to where people are and not just expect them to come to us, and using a whole range of venues is important, as are mobile donation facilities. This is constantly kept under review: the service is constantly reviewing where the most successful places are and looking at new venues and new opportunities to take up.

[Lord Kamall (Con)]

My Lords, to continue on the line of the noble Baroness, Lady Watkins, I remember that when we were looking at vaccine hesitancy, we looked at how we could reach certain communities—they do not like being called hard to reach because they feel they are being patronised. Quite often, it was through faith organisations; sometimes, it was through community leaders. What work has been done on the lessons learned from the vaccine hesitancy campaigns to encourage more people to give blood? I want also to ask about guidelines. I was speaking to a noble friend who said she had volunteered to give blood but was told that because she had passed the age of 66 and had never given blood in the UK before, she was not allowed to donate. Can we have some clear guidelines for those who are willing to give blood, especially Members of this House?

[Baroness Merron (Lab)]

Of course, is the answer to the noble Lord. On his point about reaching certain groups, we have invested across 51 organisations this year that are very much rooted in the community, and 31 of the projects across those organisations have worked nationally to boost awareness, understanding and behaviour change in black, Asian, mixed-heritage and minority-ethnic communities, where we need more people to come forward to donate blood in order that we have the blood we need for the conditions that they are there to meet.

Tobacco and Vapes Bill

Lord Kamall Excerpts

Committee stage
Wednesday 26th November 2025 Grand Committee

Moved by

[Lord Kamall]

181: Clause 138, page 79, line 2, leave out from “designating” to end of line 3 and insert “as vape-free any place in England that is a—
(a) public playground,(b) provider of early years education, or(c) school.”Member’s explanatory statement
This amendment restricts the Secretary of State’s power to designate vape-free places to only playgrounds, providers of early years education and schools in England.

[Lord Kamall (Con)]

My Lords, this group of amendments deals with the designation of vape-free places. As with the earlier debate on smoke-free places, they probe—I stress, probe—the Government on the powers they seek to extend the restriction of the use of vaping products, and whether those powers will be exercised proportionately and responsibly.

There is a careful balance to be struck here, just as with other issues. We all agree on the importance of protecting children and preventing the normalisation of vaping among young people, but at the same time we must recognise that for many adults vaping represents a less harmful alternative to smoking—a point that the Minister has repeatedly made—which can be an essential part of a person’s journey towards quitting altogether.

It is with this balance in mind that we have tabled what I stress are probing amendments—Amendments 181, 183 and 184. Amendment 181 would restrict the Secretary of State’s power to designate vape-free spaces to three categories of child-centred environments where there is arguably a rationale for such prohibition. But beyond the specific context, the case for ministerial intervention may become weaker. As with the earlier group of amendments, we are probing the Government on the level of discussion and accountability in granting Ministers this very wide discretion to designate almost any public or quasi-public space vape-free, provided that it is also designated smoke-free.

This gives rise to two questions. First, if the Government are not minded to accept this amendment, as with the question on tobacco-free spaces, can the Minister tell the Committee whether the designation of vape-free spaces would be by way of the negative procedure, the draft affirmative procedure or the “made affirmative” procedure?

My second question relates to the consideration the Government have given to the effects of passive vaping as opposed to passive smoking, particularly in outdoor environments. I tried to look for papers on the effects of passive vaping and my impression is that there is as yet no definitive conclusion on the harms from passive vaping in outdoor settings. One study concluded:

“Bystanders in both settings (a car and in a room) experienced some short-term irritation symptoms, expressed as dry throat, nose, eyes, and phlegm. In conclusion, short-term use of an e-cigarette in confined spaces increased harmful particulates of 2.5 micrometres or less and caused some irritation symptoms in bystanders.”


Another study looked at the effects of 76 subjects who were vaping next to 73 non-vaping subjects who had agreed to be exposed to the vapour. The conclusion was that non-vaping subjects exposed to vapour had significantly higher oral temperature after 20 minutes of exposure, but blood sugar and forced vital capacity—in simple terms, a measurement of lung function—were not significantly affected by vaping or exposure to vapour.

The point here is that the vapers were sitting next to the non-vapers or passive vapers, and I have been unable to find any studies on the harms of passive vaping in outdoor environments. So my second question is a simple one: what evidence do the Government have on any negative effects of passive vaping in outdoor spaces? Can the Minister write to noble Lords with links to and details of these studies, and the department’s own assessment of them? Can she give an assurance that, if the Government designate further outdoor spaces, this will be based on scientific evidence of harm?

I also have to admit a certain concern about messaging. We know that some people believe that vaping is as harmful as smoking, which is clearly a barrier to encouraging smokers to switch to vapes. If the Minister does not believe that the harm profile of passive vaping is the same as that of passive smoking, what is the rationale for linking smoke-free and vape-free places? If the Minister does indeed recognise that the harm profiles of these products are in fact different, does it not make sense that the places liable for designation under the Bill should in fact be different?

Amendment 183 is equally important and would prevent the Secretary of State from designating as vape-free any hospital or part of a hospital that provides mental health services. We have had the discussion before: in many mental health settings, many people have a higher risk of smoking than those in the general population. Vaping can be a vital tool in reducing harm, improving well-being and supporting gradual cessation. To impose a ban on such settings not only would be counterproductive but, in some cases, could be inhumane. It would risk forcing some of the vulnerable individuals in society back towards cigarettes and undermine the very public health objectives that this Bill seeks to promote.

I want to probe the Government on how the nuance will translate into practice. On an earlier set of amendments, the Minister said that

“vapes will still be able to be sold in healthcare settings via on-site shops. It is the sale through vending machines that we are seeking to prohibit in the Bill”.

When my noble friend Lord Moylan raised the issue of vapes for smoking cessation in hospitals, the Minister replied:

“We know that a number of mental health trusts, for example, are providing free vape starter kits as part of our national Swap to Stop campaign. The noble Lord’s point was well made, and we continue to work on that”.—[Official Report, 30/10/25; col. GC 232-33.]


Could the Minister clarify what was meant by “we continue to work” on that? Is she saying that all patients in mental health settings who want a cigarette or vape will be offered one of these free vape starter kits? If not, what is the solution that the Minister is working on to make sure that those who do want access to an e-cigarette or a vape can get one, as my noble friend Lord Moylan intended in his earlier set of amendments?

Amendment 184 in my name and that of my noble friend Lord Howe simply suggests clear definitions for “public playground”, “provider of early years education” and “school” to ensure that any designations made under these powers are precise, transparent and legally consistent.

I turn briefly to Amendments 182 and 187 from my noble friend Lord Udny-Lister. They offer an opportunity to probe the Government on whether they intend to prohibit only those under the age of 18 from vaping on school premises or whether they have had any discussions with teachers’ organisations or perhaps trade unions on banning teachers and adult visitors from vaping on premises of schools and colleges. I believe that most if not all noble Lords agree that vapes offer smokers a pathway to quit smoking. We understand the concerns about children taking up vaping, so how do we get that balance in settings where there are children but also adults—some of whom, maybe after a stressful class, will want to turn to a cigarette or a vape?

I quickly turn to Amendment 182A in the name of my noble friend Lord Howard of Rising, which raises the important issue of age and responsibility. In spaces where we know that most people will be over 18, it makes sense that vaping should be permitted. I understand that there may be certain settings where people under 18 manage to creep in. I am sure that in our youth we all did that, although I have no evidence of my own past misdemeanours in that sense. What consideration has the Minister given to the challenge that the noble Lord has raised and what is the Government’s view on the potential harms that vaping in such a space could have? In other words, why do they believe that the Bill as drafted, particularly with respect to these issues on vaping, is necessary? I look forward to the answers from the Minister and I beg to move.

--- Later in debate ---

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

My Lords, I am most grateful to noble Lords for their contributions to this debate. Let me first turn to the opposition to Clause 138 standing part of the Bill, which has been proposed by the noble Lord, Lord Udny-Lister. Clause 138 amends the Health Act 2006 to insert new provisions relating to vape-free places in England. These provisions allow the Secretary of State to designate certain places and vehicles as vape-free, but only where they are also smoke-free.

The noble Lord, Lord Kamall, asked about evidence. The fact is that evidence is developing, as the noble Lord himself rightly acknowledged, but we do know that while vapes are less harmful than smoking, there is a reason why the Chief Medical Officer says:

“If you smoke, vaping is much safer; if you don’t smoke, don’t vape”.


Vapes are not harm-free; there are legitimate concerns regarding the unknown long-term health impacts of vaping. They produce aerosol that exposes people to nicotine and potential toxicants, which poses health risks to children and medically vulnerable people in particular; for example, they can trigger asthma attacks. It is therefore important and right—I say this to the noble Lord, Lord Robathan—that the Government act to protect more vulnerable groups from potential health harms. I should also say that evidence suggests that, in adolescence, the brain is more sensitive to the effects of nicotine, so there could be additional risks for young people compared to adults.

As the noble Baroness, Lady Walmsley, said, many businesses and enclosed public places already have in place, on a voluntary basis, schemes to prohibit vape usage on their premises. We want to introduce legislative requirements to make it clear to the public where it is illegal to use vapes and to enable enforcement agencies to enforce accordingly. I know that noble Lords understand the reasons for wanting to be clear about what is and is not legal, and this Bill and the provisions in it are very much part of that.

Again, as the noble Baroness, Lady Walmsley, welcomed, the main answer to all the questions today— I will continue to go through the various amendments—is that we will be consulting on making indoor settings that are subject to existing smoke-free legislation vape free. The consultation in this area and beyond is crucial, because we also plan to consult on making some outdoor places where children are present vape free—for example, children’s playgrounds, and the outdoor areas of schools and early years settings.

The noble Lord, Lord Kamall, asked about how we will recognise the difference between harms. I can assure him that this is an area we absolutely want to get right. We do want to ensure that adult smokers who are using vapes as quit aids are doing so in appropriate places, such that they do not return to smoking. That is exactly why we will consult before making regulations and carefully consider the responses to ensure the policy seeks the appropriate balance.

Amendment 182A tabled by the noble Lord, Lord Howard of Rising, would mean that some indoor areas, for example nightclubs, would not be able to be made vape free. I am grateful to the noble Baroness, Lady Walmsley, for her views on this. As I have already outlined, vapers pose potential risks to both users and non-users, especially indoors. We had a debate in an earlier group about the workability or otherwise of designating particular areas as able to police themselves. It is quite important to say to the Committee that the vast majority—around 90% of those over 16—do not currently vape. Just because someone is in an over-18 setting does not mean that they are content to be exposed to these second-hand harms.

As discussed, this is a particular concern for medically vulnerable people whose conditions may not be in the least visible to the vaper, who I am sure does not wish to cause harm—for example, those with asthma. Additionally, people who wish to vape will still be able to do so in outdoor hospitality settings—for example, in the outdoor smoking areas of an over-18 nightclub. We have been very clear that we will not be consulting on including those outdoor areas in the scope of vape- free places.

Ultimately, the Bill grants powers to make places vape free and does not itself make any place vape free. The consultation will ask questions relating to areas that should become vape free, any necessary exemptions and any additional evidence on the second-hand harms of these products. Therefore, in our view there is no change needed to the primary legislation.

It is appropriate now to turn to Amendments 181 and 184, tabled by the noble Lord, Lord Kamall, which would seek to limit the locations that can be designated as vape free. As I have already outlined, the current power allows us to respond to evolving evidence at a later time and ensures the Bill is future-proof. The noble Lord asked about the process. I can confirm as I have done previously that the power for vape-free places will be through an affirmative regulation. That will mean, as the noble Lord knows, a debate in both places. The noble Baroness, Lady Walmsley, talked about vape-free areas being specified in the Bill. I hope I have explained why that is not the case. It is particularly important as we talk about evolving evidence that we look to the future. That is why we will be consulting and why we will turn to regulations.

The noble Lord, Lord Kamall, mentioned vape-free schools and asked whether that measure applies to children or adults. I can confirm that it is about the area rather than the people in it. So there are no limitations on people of a certain age; it is the area that would be designated.

I turn to Amendments 182 and 187 in the name of the noble Lord, Lord Udny-Lister, which relate to vape-free policies in schools and colleges in England that are made vape-free places. It is my view that these amendments are not necessary. As I have said, we have already made it clear that we will consult on making schools, sixth-form colleges and early years settings vape-free places. Public consultation will allow us to gather views from a wide range of stakeholders, including those who run education settings. Enforcement officers will have the power to issue on-the-spot fines or pursue convictions where they deem it necessary for the offence of using a vape in a vape-free place. However, we anticipate—this may be helpful to noble Lords—that there will continue to be a role for internal sanctions for pupils found vaping on the premises. Schools are already required to publish a behavioural policy.

In relation to education provisions for pupils on vaping, we have worked closely with the Department for Education to incorporate education on the risks of vaping and nicotine use in the recently updated relationships, sex and health education statutory guidance for schools and teachers; I am sure that the person referred to by the noble Baroness, Lady Bennett, will benefit from that in future.

I appreciate the points made by the noble Lord, Lord Kamall, and his intention in Amendment 183, to which the noble Baroness, Lady Walmsley, also spoke. I agree that it is important that patients receiving care in a mental health setting have access to appropriate smoking cessation tools; that is particularly true given that smoking rates among those with a long-term mental health condition are far higher than in the general population. As I have mentioned previously, in England, we are considering making inside hospitals—but not outside them—smoke-free. I appreciate and am alive to the fact that there are particular considerations in the case of mental health facilities, but I assure noble Lords that we are keen to get things right in this area and are going to follow the evidence. We want to ensure that vapes can continue to be accessible as an effective quitting aid for adult smokers; noble Lords have made strong and important points about this. As outlined, we believe that the details of any exemptions are best explored through the consultation process, although we understand the intention behind the amendment.

I hope that this provides reassurance and understanding to noble Lords that the settings that will be in scope of the vape-free policy will be fully considered by consultation and then considered under the affirmative procedure. I hope that the noble Lord feels able to withdraw his amendment.

[Lord Kamall (Con)]

My Lords, I thank the Minister for her response; I also thank all noble Lords who spoke on this group. I am grateful to the Minister for confirming that any further extension of the designation of vape-free places will be done via the affirmative procedure, which is very welcome.

I have a couple of outstanding questions; I suspect that the Minister and her department were not able to get the answers quick enough, thanks to the power of the internet or whatever, so I wonder whether the Minister could write to noble Lords on these matters. First, is there any evidence yet from studies of passive smoking in outdoor settings? As I said, the studies I looked at were all on indoor settings; nothing has been done on outdoor settings. It would be good to know what evidence the department currently has. I also ask the Minister to share that evidence, with the appropriate links, so that we can all understand it. usbI understand that the consultation is all about seeking further evidence, but it would be interesting to know what evidence the department currently has—on the understanding that the evidence is evolving, as the Minister rightly said.

Mental Health Bill [HL]

Lord Kamall Excerpts

Consideration of Commons amendments and / or reasons
Monday 24th November 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I start by adding my thanks to the Minister for her extremely constructive engagement throughout the Bill and particularly in recent weeks, as we have discussed community treatment orders and strengthening measures to monitoring racial disparities. My noble friend Lord Scriven has already covered the former, and I simply want to say that I am very grateful for the steps that the noble Baroness has taken to strengthen those measures for monitoring. Looking at racial disparities was, after all, the underlying rationale for this piece of legislation, so I am very glad that we are now going to have monthly reporting that we can access through the database and the dashboard—that is very good news. We will most certainly be scrutinising that data very carefully on these Benches and drawing any areas of concern to the attention of the House.

Liberal Democrats welcome the Bill. It is long overdue as an important step in ensuring people’s dignity and human rights, but we also recognise that it comes amidst a very challenging landscape for mental health services more broadly. We all know the serious shortcomings in current mental health services. Throughout the process of scrutinising the Bill in both Houses, we have urged the Government to back calls to invest in community mental health services and to produce a clear, costed implementation plan with clear timescales. We consider that very important because our outstanding concern is that the Bill on its own does not include adequate measures to promote preventive and early intervention services to stop people reaching crisis point and all the issues that we have discussed during this passage of the Bill.

We have been very glad to contribute to the Bill. It constitutes the biggest piece of legislation on mental health in 40 years. In the same vein, it could be the case that we do not have another major piece of legislation for another 40 years. I hope that is not the case, but these Bills do not come along very often. That is why we are determined to push the Government to look beyond the relatively narrow scope that this Bill has offered, to include community-led preventive care rather than simply focusing on helping people as they reach crisis point.

It has been a very important piece of legislation. I would like to thank the Minister again for her extremely constructive engagement and the tone she has set throughout this Bill. I would like to thank all noble Lords, from these Benches and from all Benches, for their extremely well-considered and very expert and heartfelt contributions. Last of all, I would like to thank officials, the Bill team and Adam Bull in the Liberal Democrat Whips’ Office.

[Lord Kamall (Con)]

My Lords, I too start by thanking the Minister, her officials and her special adviser for their constructive engagement on the Bill. The Bill has been returned to us from the other place without the amendments made in this House. Obviously, I would have preferred it if those amendments had remained in the Bill, but I understand that the Government believe that they are not necessary.

Amendments 1 to 4, and 11, remove the amendment proposed by my noble friend Lady May of Maidenhead and tabled by me and my noble friend Lord Howe on Report, which would have allowed a wider range of people to undertake detention under Sections 2, 3 and 5 of the Mental Health Act. I thank my noble friend Lady May for giving specific examples of why that was called for.

I understand that there were two main concerns with those amendments. First, some were concerned about setting a precedent beyond the Bill for being detained by personnel who are not police officers. Secondly, some of the health professionals who would have been affected by this change felt that they had not been properly consulted. I am therefore grateful to the Minister and her officials for suggesting a consultation on whether these powers could be extended. It is good that we are going way beyond just this and having a wider consultation.

Amendment 6 removes Clause 35 from the Bill. It was inserted after a successful Division on Report and was moved by my noble friend Lord Howe. It was intended to ensure that those who are detained and given treatment for their mental health receive a proper debriefing after their discharge and that the system can learn and not repeat the same mistakes. My noble friend mentioned the experiences of young people who felt that they were not being listened to, but during our meeting with the Minister, she agreed to outline at the Dispatch Box how the Government would ensure that more is done to listen. We welcome the assurances she has given.

Another question we raised was on patients having a right to an advance choice document. We would of course have preferred that to be in the Bill, but we understand that Amendments 7 to 10 are a step in the right direction, and in fact the Government have said that there is not really much difference in practice between the wording in the Bill and the alternative wording that we suggested. Once again, I welcome the assurances, but we will pay close attention to make sure that ICBs and trusts are making people who should have the right to an ACD aware that they do have that right. I think that is something that many noble Lords agree on.

On Amendment 19D from my noble friend Lady Berridge, I understand that she had some concerns, which she was able to share with the Chamber, supported by other noble Lords. One was on the use of “or”, and there is some debate about whether we need “or” in the Bill to imply “or”. I am not a legal expert, but I hope that some assurance can be given there. I also hope that some of the other issues my noble friend mentioned can be resolved in further discussions between her and the department, and possibly either in the code of practice or in specific guidance—but also in discussions with the relevant health professionals who have raised the concerns with her.

One issue that I raised a number of times, and I thank noble Lords from the Lib Dem Benches also for raising it, is racial disparities. We have been speaking about racial disparities for far too long, and for far too long we have been given the answer, “It’s too complicated” or “The data is much more granular than you think”. I welcome the fact that the data will be published more frequently, but I hope that we take that data and make changes based on the evidence in it so that we are not looking at anecdotes or people’s prejudices but are tackling the real problem. For far too long, people of Afro-Caribbean descent have been detained, and no one has really got to the crux of the matter. I know that this is an issue which noble Lords from all Benches agree that we really need to hone in on and tackle.

Given all that, I again thank the Minister, her officials, her special adviser and others for their constructive approach. I also thank all noble Lords from all Benches. Many of us said that it was not a particularly political Bill, but it was an issue that we just wanted to get right. Given that, as the noble Baroness, Lady Tyler, said, this issue does not come up frequently enough and that it might be another 10 or 20 years before we discuss it again, and things move on and we are more aware of issues and understand some of these conditions in more detail, I thank all noble Lords and the Minister for the constructive way in which we have all worked together. Hopefully, we can now ensure that the Bill makes its way on to the statute book.