Fracture Liaison Services

Lord Kamall Excerpts

Monday 6th July 2026 Lords Chamber

[Baroness Merron (Lab)]

I understand that point well and I am grateful to the noble Baroness for raising it with me separately. Similar to my response to my noble friend, I will gladly follow that up.

[Lord Kamall (Con)]

My noble friend Lord Black specifically asked about fracture liaison services implementation plans, timelines and milestones on progress towards universal coverage in 2030, to which the Government have committed. To double-check, does the Minister agree with the principle that there should be a published implementation plan, and that timelines should be published and annual milestones set?

[Baroness Merron (Lab)]

I am sure noble Lords would welcome that, and I have heard that call in here, but the noble Lord will know that that is not something we do with every single policy; rather, we take the steps to actually make them happen. The commitment and progress are there, and that will continue.

Children’s and Young People’s Mental Health Services

Lord Kamall Excerpts

Thursday 2nd July 2026 Lords Chamber

[Baroness Merron (Lab)]

The point about age is important and one that we will be considering as we go forward with the mental health strategy. Waiting times are way too long, but there is a particular challenge that we have to meet, which is that some 10% of young people are waiting for an inordinate amount of time, as the noble Baroness said. I was very glad that the report does recognise that increased prevalence is a driver. One in 10 17 to 19 year-olds was in need in 2017 and now it is 1.4. I think that gives some idea of the scale and of why we have to make such a systematic change.

[Lord Kamall (Con)]

My Lords, the report contains a wealth of information and new data on referral patterns, waiting times and outcomes. I welcome the Minister’s response that it will feed into the forthcoming mental health strategy. How is the Minister’s department using this information to target resources and to identify where children’s mental health services are under the greatest pressure, so that, at least in the shorter term, support can be directed to where it is most needed?

[Baroness Merron (Lab)]

What the noble Lord says is absolutely right. That is why the Young Futures hubs, the early support hubs, focus on particular communities. We have taken a view that it is important to go to where need is greatest rather than to where it is easiest to deal with. I should add that we have expanded mental health services in terms of the workforce by delivering 8,500 additional mental health staff three years ahead of schedule. Around 18% of them are directly on children’s and young people’s services.

Pharmacy Closures

Lord Kamall Excerpts

Wednesday 1st July 2026 Lords Chamber

[Baroness Merron (Lab)]

We are constantly in discussion with Community Pharmacy England and its organisations about how we develop their role. I am very enthusiastic, as many noble Lords are, about the role that they can play. I was looking at statistics between April 2025 and February 2026 about the millions of clinical services, not just vaccinations, that have been delivered. For example, there have been over 4.7 million flu vaccinations. There is scope for discussion on how we can expand the vaccination programme, but the service provided by community pharmacies is to be credited.

[Lord Kamall (Con)]

My Lords, has the department undertaken any analysis of the characteristics of pharmacies that are most of risk of closure to understand whether geography, deprivation, the ownership model or dispensing volume are the principal drivers? Does she agree that having this data might help the department to target some of the uplift more effectively and prevent closures? Can she update the House on whether the department carries out that analysis?

IVF Treatment

Lord Kamall Excerpts

Wednesday 1st July 2026 Lords Chamber

[Baroness Merron (Lab)]

I do find it unacceptable that people have different access to treatments in the way that noble Lords have described. I would expect that the move through the Health Bill will enable us to have a far more effective means, in all sorts of areas, to ensure that local populations are properly served. That is why we will be bringing the functions of the NHSE into the department. As my noble friend will know, that will ensure that we no longer have duplication and that we have the right resources. I very much expect and want to see adequacy of access and fairness, which is the basic thing in all NHS treatment, to be established in fertility treatment.

[Lord Kamall (Con)]

My Lords, I begin by thanking and paying tribute to the noble Baroness, Lady Nargund, and to her co-authors of this fascinating paper. Clearly, it shows that IVF is an area in which innovation is important but so too is the need for evidence. At a time when add-ons have sometimes quite fancy scientific names such as platelet-rich plasma, embryo imaging or intralipid infusion, it is understandable why patients may feel confused and think that this is a much-needed medical intervention. Are the Government aware of high-quality research into IVF add-ons that would give patients, clinicians and regulators greater confidence about which treatments generally improve outcomes for patients?

[Baroness Merron (Lab)]

All of this is important, not least because noble Lords will have seen in the women’s health strategy that we want to ensure that every woman can access effective fertility services easily and safely. I would certainly agree that there are areas where the fertility evidence base could be strengthened, and we are looking at how we can best support research and data collection, which was another point raised by noble Lords. We are currently working with NHS England, which will become part of the department, because we want to support equitable commissioning but also the right evidence base so that information is properly available. At present, there is scant evidence that many of these add-ons are anything other than optional and not recommended.

Extreme Heat: Resilience of NHS Infrastructure

Lord Kamall Excerpts

Tuesday 30th June 2026 Lords Chamber

[Baroness Merron (Lab)]

My noble friend raises an important point. It is important to note that extreme heat particularly affects buildings with poor insulation and limited natural ventilation, which, by their very nature—I am describing many health settings—heavily rely on such measures if there is heat-generating equipment like imaging suites and IT systems. Also, 11% of buildings in the NHS estate are older than the NHS itself, which gives some sense of the scale. We have committed £10.5 million in research funding to develop effective cooling solutions that can be used across the whole system. It may well be that the organisation to which my noble friend refers is part of that, but I will take his suggestion back to the department.

[Lord Kamall (Con)]

My Lords, I am grateful to the Minister for answering the Question of the noble Earl, Lord Russell, on new-build hospitals, but there is clearly a question about existing hospitals and facilities. I wonder what plan or strategy there is, and whether it is written down, to identify hospitals that do critical and time-sensitive procedures, to make sure that they are prioritised when there are extreme heat conditions, and to commission independent hospitals with the appropriate cooling and ventilation systems to allow those critical operations to go ahead.

[Baroness Merron (Lab)]

We are already investing some £30 billion of capital across the NHS estate. I have mentioned the most serious infrastructure risks, which the noble Lord rightly refers to. While we accept the age of the estate and its size—I noted in preparing for this Question that we are talking about the equivalent of 4,000 football pitches—we also have a backlog of maintenance issues, which have grown and grown. We estimate that some £15.9 billion is needed. While there are no easy solutions, we do have a resilience plan not just for overheating but for all threats to resilience arising from temperature. We are also providing the funding—although, to the point the noble Lord makes, it is down to local decision-making—and ensuring that we are assisting the estate across the country to meet the challenges, the priority being those areas that need it most.

Nottingham Maternity and Neonatal Services

Lord Kamall Excerpts

Monday 29th June 2026 Lords Chamber

I close where I began: with the families. Nothing can make up for what they have gone through, but this report is a tribute to their resilience and tenacity. I say to them directly: you had to drive this for so long, but you are no longer driving this alone. We are with you and we will not stop until you have the accountability and the justice you deserve. I commend this Statement to the House”.

[Lord Kamall (Con)]

My Lords, I thank the Minister for the opportunity to ask questions on this Statement on the report, which raises many troubling issues. I add my thanks to Donna Ockenden and her team for their extraordinary work in conducting what has been the largest review of maternity services in the history of our NHS. Our thoughts are with the thousands of mothers, babies, fathers, partners and families whose experience lies behind this report. It is only because of their courage and determination that these failures have finally been brought to light.

When, in the past, I have spoken to families who feel that they have lost a relative or friend due to medical negligence, they often say to me that they are reluctant to pursue justice, since it adds to their grief. They also point out that they often face hostility for raising concerns, as they are seen to be criticising the NHS. This is a terrible indictment. No organisation, including the NHS—perhaps especially the NHS—should be above criticism. The findings expose years of failures in leadership, governance and culture, not just a few isolated cases of clinical failure. Women were not listened to, families were dismissed, and staff were unable to raise concerns in an environment where bullying and intimidation were embedded. Most disturbing of all, the report noted that evidence of these failings already existed, yet action was repeatedly delayed or avoided.

However, we on these Benches wish to be constructive in our response, since maternity safety has challenged Governments of all political persuasions. Will the Government and the healthcare system introduce measures that genuinely improve safety and strengthen accountability, and will they listen to women and families? If so, they will have our support. But the real test will be whether the report leads to meaningful and lasting change across every maternity service in England, because, regrettably, many of the report’s conclusions are not new. Previous inquiries in Morecambe Bay, Shrewsbury, Telford and East Kent identified many of the same underlying themes: women not being listened to, poor communication, inadequate staffing and weak governance. This report must become the point at which recommendations are accepted and demonstrably delivered.

I have four questions for the Minister. First, can she outline whether the national implementation plan will include clear milestones and regular public reporting, so that Parliament, families and clinicians can judge whether progress is being made? Secondly, how will boards be held accountable for creating an environment and a culture in which openness and patient safety genuinely come first? Thirdly, what steps are the Government taking to ensure that maternity services have the workforce training and leadership they need to provide safe care? I understand that the former Secretary of State felt that there should be more of a focus on technology than recruitment. That is not necessarily a bad thing, but can the Minister explain how this would work in maternity care?

I also welcome the Government’s recognition of the distressing findings on mortuary services. The treatment described in the report represents a lack of dignity and compassion towards bereaved families. The actions announced are important and I look forward to the Minister reassuring the House that the lessons from these failings will be embedded across the NHS and not just confined to Nottingham.

Fourthly, the Minister will be aware that Henrietta Hughes, the Patient Safety Commissioner, is increasingly frustrated that, having proposed a system for redress and compensation for those poor victims of valproate and pelvic mesh, there has still been no movement from the Government. Can the Minister update us on that?

No woman’s experience of pregnancy or childbirth should be determined by their ethnicity, background, language or confidence in navigating the healthcare system. This report highlights clear disparities. The evidence of racism and discrimination identified in the review is deeply concerning and underlines the importance of ensuring that every woman receives safe, personalised and compassionate care. This is not asking for special treatment for anyone; it is about making sure that patients of all backgrounds are treated equally.

Trust in our maternity services will not be rebuilt through apologies alone. It will be rebuilt when women know that they will be listened to, when families see concerns acted upon rather than dismissed, when staff are empowered to speak up without fear, when boards are judged by the safety they deliver and when Parliament sees clear evidence that today’s commitments have become tomorrow’s reality.

The families of Nottingham and other maternity scandals have carried this burden for far too long. They should never have had to fight so hard simply to be heard over many years. They now deserve our determination that this report marks a genuine turning point, and, if the Government achieve that, they will have the support of all Benches. I look forward to the Minister’s response.

[Baroness Pidgeon (LD)]

My Lords, the Statement before us today from the Secretary of State in the other place is distressing reading, as is the report by Donna Ockenden. This review shocks us all to the core and must shake the Government into real action at every level of our health service and its regulation. Staff concerns were dismissed, a board did nothing and regulators failed in their duties. There was a simple refusal to listen to women and their families, causing such loss, trauma, negligence and damage, alongside bullying, organisational failures and the horrendous misplacing of bodies. Words just cannot express this horror. What brave and resilient families to keep fighting for justice; I thank them all.

I heard the deeply moving testimony at the press conference last week about the mental health legacy for bereaved parents. One explained how she had lost all trust in the NHS and had the constant, triggering experience of having to engage in her daily life with the organisation she holds responsible for the loss of her baby. It is hard to imagine.

This review, and the upcoming wider review from the noble Baroness, Lady Amos, must draw the line. This has to stop. Mothers, babies, children and families must have confidence that they will be provided with first-class maternity services, wherever they live in our country. There must be quality services that meet their needs whatever their age or background, with respect and dignity at the heart.

I welcome the taskforce, chaired by the Secretary of State. It will be crucial to ensuring the implementation of recommendations at every trust and to ensure that whistleblowing throughout the NHS works. An independent patient voice must remain part of our health service to help hold NHS trusts to account. We will revisit this point with the NHS Bill later this year.

I understand that, in 2018, over 50 members of staff wrote to the chair of Nottingham’s board, stating plainly that there were significant safety concerns. The letter was not even discussed by the board—it went to a sub-committee and was buried. In 2023, the chief executive found that the trust had never formally investigated staff shortages. I cannot get my head around this, as someone who has sat on many different boards over the years. This is not good practice. I therefore ask the Minister what urgent work the Government are undertaking to assess the competence of NHS trust boards. What changes may take place to strengthen them and to ensure that they carry out their serious role and responsibilities thoroughly and robustly?

The Government must also take action to strengthen whistleblowing powers in the NHS. My Liberal Democrat colleagues in the other place have tabled amendments to the Health Bill which would provide new powers for coroners and medical examiners to report suspected health failings. Will the Government look to support those amendments to strengthen whistleblowing in the NHS?

Finally, families need to have confidence in their local maternity services, and those services need to all be at the highest standard. Will the Government commit to a maternity rescue package to deliver this, including one-to-one midwifery care for every woman in labour and consultant obstetricians present 24/7 on every labour ward?

A big step change is needed to transform maternity services across the country that every family and every individual can have confidence in. I look forward to the Minister's response.

Prostate Cancer Screening: AI

Lord Kamall Excerpts

Thursday 18th June 2026 Lords Chamber

[Baroness Merron (Lab)]

We always take into full account my noble friend’s very important point. She referred to the TRANSFORM trial, which will enable all eligible Black men to be invited to stage 2 of the trial. It is worth saying that Black men are historically underrepresented in clinical trials, and we are working closely with Prostate Cancer UK to work alongside and draw in communities from across the United Kingdom.

[Lord Kamall (Con)]

My Lords, I will follow up on that reference to the TRANSFORM trial. Black men are around twice as likely to develop prostate cancer and to die from it, yet historically they have been underrepresented in many screening and research programmes. The Minister mentioned the TRANSFORM trial, which hopefully will transform that inequality, but what assurance can she give that AI tools being developed for prostate cancer screening will reduce as much as possible any bias against higher-risk populations, such as Black men, and will not inadvertently widen health inequalities?

[Baroness Merron (Lab)]

Yes, I can give that commitment.

Integrated Care Boards: Budgets

Lord Kamall Excerpts

Wednesday 17th June 2026 Lords Chamber

[Baroness Merron (Lab)]

I understand why the noble Baroness is asking that question. I cannot confirm that that is the case, but I will gladly raise that point with my colleague the Minister for Care.

[Lord Kamall (Con)]

My Lords, I will follow up on the question asked by the noble Baroness, Lady Gerada, on the Health and Care Act 2022. I remember that during the debates on the Bill there were calls for many specialisms to be represented on integrated care boards. In order to avoid unwieldy boards, we compromised on the phrase, I think, “with regard to”. With hindsight, we see that that did not always happen. We also find that ICBs are often dominated by large trusts, something that might be made worse by the forthcoming NHSE abolition Bill. Given these two factors, what is the Minister’s department saying to ICBs to make sure that there is an emphasis on community-led provision of health and care services?

Compassionate Use Medicine Schemes: VAT

Lord Kamall Excerpts

Tuesday 16th June 2026 Lords Chamber

The tax system is, as Members know, a matter for the Chancellor, so I will not get into details about that at the Dispatch Box, but under long-standing VAT rules, supplies of goods free of charge can still be treated as taxable ‘deemed supplies’ where input tax has been recovered. That means that VAT can apply even where no payment is made, reflecting established principles of the tax system. We recognise the concerns raised by industry and others about the potential impact of this treatment on the provision of free-of-charge medicines. We are working closely with the Treasury and His Majesty’s Revenue & Customs to explore options to address these issues, as witnessed by my honourable friend the Exchequer Secretary to the Treasury, who is here with me on the Front Bench. We will carefully consider the legal, fiscal and operational implications of any potential changes. Until then, we will continue to engage constructively with industry, the NHS and all our partners to make sure that British patients, whom we have in our thoughts at all times, have access to innovative medicines”.

[Lord Kamall (Con)]

My Lords, I thank the Minister for accepting this Urgent Question repeat. Life science companies have warned that the decision to charge VAT on early access and the innovative medicines that they provide free of charge could lead to them ending providing these free treatments to patients before routine NHS funding is available. The second fact is that recently released government papers reveal that the Cabinet is being asked to look at who they can tax to pay more in benefits. I have three quick questions. First, can the Minister unequivocally state that these two issues are not linked? Secondly, what discussions have the Government had with life science companies, especially those that have raised concerns over charging VAT on free medicines? Thirdly, have the Government looked at whether they could spend that revenue from VAT on improving access to innovative medicines?

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

It is important to say, first, that this is not a new policy. There is recognition that while early access and compassionate use programmes are crucial, they are voluntary for pharma companies, which are aware, as I say, that VAT is applicable in these instances; it has been in place for decades. To be brief in answering the questions, first, I am not aware of the second issue that the noble Lord raised with regard to discussions—this is a totally different matter, in any case. Secondly, we are working closely with pharma companies, patients and anybody else who needs to be involved to find a sensible solution on this long-standing policy, which I understand was particularly discovered in 2023 by HMRC—so we are dealing with it from then. I have forgotten the third question, but I would be happy to write—oh, I know it. Yes, we always look at where revenue can be used, in a generic sense, but what matters here is that is not new. It was discovered in 2023, and it is entirely up to pharma companies—to which we are most grateful for the compassionate use of medicines, I should add—whether they wish to do it.

New Autism Strategy (Autism Act 2009 Committee Report)

Lord Kamall Excerpts

Wednesday 10th June 2026 Lords Chamber

[Lord Kamall (Con)]

My Lords, I begin by thanking my noble friend Lady Rock for opening this debate, for her work as chair of the Autism Act 2009 Committee, and for her wonderfully concise and coherent summary of the report’s findings. It comes as no surprise to me to hear about her chairing skills and the way she was able to convene people of vastly different views together—and to put noble Lords such as noble Lord, Lord Addington, in order, as it were.

I thank all noble Lords who served on the committee—including the noble Lord, Lord Wigley, who, despite his understandable frustration, managed to persist and contribute in a meaningful way—and the individuals and organisations who gave evidence to the committee. As the noble Baroness, Lady Goudie, said, without them there would be no report.

The Autism Act 2009 was a landmark piece of legislation introduced by the late Conservative MP, Dame Cheryl Gillan, and passed with cross-party support. I pay tribute, as other noble Lords have, to her friend, my noble friend Lady Browning, for championing this issue for so many years. I learned much from her contributions on the Mental Health Bill and from one-to-one conversations about autism.

The Act was the first disability-specific Act of its kind anywhere in the world and established the important principle that people with autism—or autistic people—should not be overlooked by government or public services and should receive the support they need to live independent and fulfilling lives. The committee’s report provides a stark assessment of what more must be done for that ambition to be realised. As others have said, why is it not being done?

Across healthcare, education, employment, housing, and the criminal justice system, autistic people continue to face barriers that limit their opportunity and diminish their quality of life. As your Lordships have heard, the committee’s central recommendations were straight- forward and unambiguous. It urged the Government to begin work immediately on a new cross-government autism strategy to come into effect when the current strategy expires in 2026.

However, the Government’s response has been commented on as notably cautious. The noble Baroness, Lady Ritchie of Downpatrick, said it could have been stronger. While Ministers agreed to consider the committee’s recommendations, they declined to commit to many of the report’s specific proposals. Since then, unfortunately, we have had little clarity about what will replace the current strategy or, indeed, whether there will be a new strategy and, if so, when it will be published. That uncertainty is clearly of concern to noble Lords on all Benches and those who work or live with autistic patients or family members.

I was grateful to the noble Baroness, Lady Dacres of Lewisham, for sharing her experience from local government. When we are talking about national strategies, we often ignore the local elements. The current national strategy, published by the last Conservative Government in 2021, established six priority areas: understanding, support, employment, health inequality, community support, and justice. While there has been some progress, as the noble Lord, Lord Touhig, said, progress has been insufficient under Governments of all colours. That means that those priorities remain highly relevant today. Regrettably, the evidence presented to the committee suggests that many of these challenges remain unresolved.

One area of particular concern is diagnosis and assessment, as the noble and learned Lord, Lord Hope of Craighead, pointed out. The number of people seeking autism and ADHD assessments has increased dramatically in recent years. The Government recognised the scale of this challenge by commissioning the independent review into autism and ADHD diagnosis. I saw that the interim report was updated today, in advance of the final report that is expected this summer. There are legitimate questions about how services should respond to the growing demand but, whatever conclusions the review reaches, one fact is beyond dispute: rising demand makes effective planning more important, not less.

The committee rightly emphasised that support should not be delayed any longer than necessary. It asked the Government to outline what steps they are taking to ensure that support is based on genuine need and is sustainable. So, in seeking answers from the Government, I repeat the questions asked by my noble friend Lady Rock. Do the Government expect to publish a new autism strategy before the current one expires? If not, when will they publish it? Will it be accompanied by updated statutory guidance under the Autism Act, as recommended by the committee? How will the findings of the independent review be incorporated into that work?

On employment, the previous Conservative Government took important steps to support disabled people into work, including through the national disability strategy and the local supported employment programme. Yet too many autistic people remain excluded from the labour market despite possessing valuable skills and talents, as my noble friend Lord Elliott pointed out when he very movingly shared his own experience. Indeed, I remember speaking to a Transport Minister, who shall remain nameless, who told me that when it comes to the timetabling for railway services, quite often the very best people in timetabling are those who are somewhere on the spectrum. That just shows that we are not taking advantage of those very specific skills that would contribute to the economy and the growth that this Government want to see.

The noble Baroness, Lady Antrobus, spoke about the importance of relationship and sex education. It is an important point, which she was right to emphasise, because it is one of the ways in which we can raise awareness and make people who are autistic—or autistic people—feel more included in our communities.

We welcome the Government’s stated ambition to reduce economic inactivity and narrow the disability employment gap, but ambitions alone are not enough—the detail and delivery matter. My noble friend Lord Sterling spoke very movingly about wanting a better future for his autistic grandchildren.

On healthcare and community support, the committee heard compelling evidence about health inequalities and the continuing challenges faced by autistic people in in-patient settings. During the passage of the Mental Health Bill, MPs and Peers on all Benches were repeatedly pressed for robust plans to ensure adequate community support. The lack of sufficient support has been made clear in the report. I thank and pay tribute to the autism charities and advocacy organisations that have continued to hold Governments of all political affiliations to account. Their message has been consistent: autistic people and their families must be at the heart of policy development.

The committee has provided the Government with a clear road map. The challenge now is not in identifying the problems but in delivering the solutions. Those of us, from all parties, who have been in government know that good intentions often come up against the Treasury’s financial discipline. That is no bad thing, since we expect the Treasury to ensure that taxpayers’ money is spent wisely. But this is where fine aspirations often meet financial prudence. So I ask the Minister: has there been any assessment of the cost of delivering the strategy? The noble Baroness, Lady Hollins, alluded to the cost. If there is an estimated cost, and if it has met resistance from competing priorities within the relevant government departments, or from other government departments, as the noble Lord, Lord Crisp, spoke about—the state fighting the state—or even from the Treasury, has the Minister’s department looked at which of the recommendations could be delivered by better deploying existing spending?

Which recommendations might actually save the Government money? As the noble Lord, Lord Addington, said, many of these people will become taxpayers, save the Government money and contribute more positively. Which of the recommendations may have to wait for future spending rounds? I hope the Minister will accept that I ask those questions in a spirit of pragmatism and trying to be constructive.

The Autism Act was a pioneering piece of legislation. Seventeen years later, the report from the committee chaired by my noble friend Lady Rock makes it clear that autistic people deserve clear leadership and a credible strategy for the future. I look forward to hearing from the Minister about the work that is under way and how, when and with whom it will be delivered. I hope she is able to provide reassurance to noble Lords across the House who have raised many concerns and want to work constructively with the Government to deliver for autistic people.