Tobacco and Vapes Bill

Lord Kamall Excerpts

Committee stage
Thursday 30th October 2025 Grand Committee

Moved by

[Lord Kamall]

13: After Clause 9, insert the following new Clause—
“Ban on manufacture of high-strength oral nicotine products (1) It is an offence to manufacture a high-strength oral nicotine product. (2) In this section “high-strength oral nicotine product” means a nicotine product that—(a) is intended for oral use,(b) is not intended to be inhaled or chewed, and(c) contains more than 20 milligrams of nicotine per portion.(3) A person who commits an offence under this section is liable—(a) on summary conviction, to imprisonment for a term not exceeding the general limit in a magistrates’ court, or a fine, or both;(b) on conviction on indictment, to imprisonment for a term not exceeding 2 years, or a fine, or both.”Member's explanatory statement
This amendment bans the manufacture of nicotine pouches containing more than 20mg of nicotine.

[Lord Kamall (Con)]

My Lords, I speak to the group of amendments in my name and that of my noble friend Lord Howe, supported by the noble Baroness, Lady Grey-Thompson, to whom I am grateful. Together, these amendments seek to prohibit the manufacture, sale and supply of high-strength oral nicotine products—those containing more than 20 milligrams of nicotine per portion—and empower HMRC officers to seize and detain such products before they reach consumers.

The reason for these probing amendments can be summarised by a BBC article in July which told the story of Finn, a 17 year-old who started using nicotine pouches after getting bored of vaping. What began as curiosity quickly became addiction. He described how he and his friends would use pouches so strong—some claiming to contain 150 milligrams of nicotine each—that they would vomit or become physically immobilised. At school, he hid them under his lip, until one day he turned “bright green” in class and had to run out of the room. His mouth, he said, was “shredded to bits”.

This is not an isolated case. Recent data suggests that use among 16 to 24 year-olds has risen sharply in recent years, a deeply worrying trend. These pouches come in bright tins, flavoured with mango ice or bubble gum, and are marketed as clean, safe, and discreet. In reality, some of these products are many times stronger than a cigarette and far more addictive. This is a form of nicotine ingestion which is socially acceptable and often unnoticeable. Children can and do consume these products, sometimes even in class.

The point is not that nicotine pouches have no legitimate role at all. For adult smokers trying to quit, properly regulated products can have a place as part of the harm reduction strategy and a pathway off smoking. Although the Minister knows that my classical, liberal views mean that I am generally against banning things I do not like, what we have at present is the sale of nicotine products that are so strong that dentists have reported that they can burn gums, cause lesions and even expose the roots of teeth.

For these reasons, more reputable manufacturers already limit their products to under 20 milligrams per pouch. They also want a market that encourages and rewards responsible production, and which acts against rogue operators flooding the market with dangerously high-strength pouches. These probing amendments suggest a possible, sensible and enforceable ceiling that would align with good industry practice and give clarity to both regulators and retailers.

However, prohibiting the manufacture and sale of these products is only part of the solution. Unless enforcement agencies have the statutory power to act, those prohibitions risk becoming little more than words on a page. That is why our amendment to Clause 88 proposes that HMRC officers should be explicitly empowered to seize and detain high-strength nicotine pouches, preventing them entering the market in the first place. I know that the Government have indicated that they recognise the need for action in this area; this amendment probes the Government on how they intend to address concerns over these high-nicotine products.

Do the Government think that we should rely on downstream enforcement after these products have already reached young people? That is my first question for the Minister. My second question is: do the Government agree with the sentiment of the amendment on the need to address this issue at the border, where these goods are entering the country in large quantities, especially by giving HMRC the clear legal authority to do so? Thirdly, do the Government see the need for immediate action, or will they require a series of future consultations? Finally—I know that I am asking a lot of questions—do the Government believe that it is more effective to have a firm and immediate statutory assurance in this Bill, in order both to allow these products to be controlled and to give enforcement agencies the clarity that they need to act?

These amendments can be seen an opportunity to protect people, in particular young people, before they become addicted instead of punishing them afterwards. It is about ensuring that, if these products are so dangerous, they should not be able simply to be bought over the counter or ordered online. I recognise that all tobacco products may to some extent be classified as dangerous—or, at the very least, as not good for you— but the products at which these probing amendments are aimed are particularly dangerous. I am, therefore, interested in the Minister’s answers; in the Government’s position on high-nicotine pouches; and in how the Government intend to address the concerns here, as exemplified by Finn’s story. I beg to move.

[Baroness Grey-Thompson (CB)]

My Lords, I shall speak on Amendments 13 to 15. I apologise for not adding my name to Amendments 139 and 140, but I strongly support them.

I added my name to this group of amendments because I did not know an awful lot about oral nicotine. I was talking to a group of university students about my strong dislike of vaping. They introduced me to the subject and told me—they were at several different universities—that many university students use vapes almost continuously for lots of different reasons.

A lot of my concerns are around the impact on young people. Growing up, I remember the TV adverts that showed all the damage that smoking would do to your lungs, with images such as the pouring out of a glass of tar, but I am not sure that young people necessarily understand the impact that vaping will have on them. I am concerned about the high levels of nicotine in these products, but I am also concerned about the potential for vaping to lead to addiction and cardiovascular issues such as increased blood pressure.

I have read the same report as the noble Lord, Lord Kamall. It mentions young people talking about using vapes until they vomit. The report talks about a young man, Finn, using vapes and says that they immobilise the individual—especially when they use two or three in one go—which is not at all the intended consequence of them. Finn goes on to say:

“You feel this burning sensation against your gums, and then you get the hit”.


As the noble Lord, Lord Kamall, said, these products have impacts on oral health, including gum disease and gum recession. Vaping is also linked to an increased risk of certain cancers, such as oral, pancreatic and oesophageal cancers. It can also have, potentially, a negative effect on adolescent brain development.

My problem with these products is that they are so easy to hide. The fact that children in school are able to use these products should be cause for concern, because young people are talking about sweating, salivating and struggling to concentrate. These products that should not be anywhere around young people. There is also a lot of discussion about how they can be used as a gateway to vaping or smoking. There is a lot of debate around how vaping and smoking are meant to be helping each other, but I have concerns about that as well.

--- Later in debate ---

Returning to the issue of protecting young people, our commitment is to act swiftly and responsibly, which is why we have already launched the comprehensive call for evidence to better understand the available evidence. It would be extremely problematic if we were categoric at this stage and then found, in a very changing landscape, new potential harms that we would not be able to deal with in the appropriate way. For the reasons I have outlined, I hope that I have reassured noble Lords that we are taking this exceptionally seriously and that the noble Lord will feel able to withdraw his amendment.

[Lord Kamall (Con)]

My Lords, I am grateful to all noble Lords who have spoken in this debate; I welcome their thoughtful discussion and the important points that a number of them made. As I said earlier, this was a difficult group for me to put into words, in moving this amendment, because, as many noble Lords will know, I tend to take a classical, liberal perspective on many things and I do not like banning things.

The intention of the amendments in this group was to probe the Government on whether they believe that action to address these products, which have such high levels of nicotine that they lead to consumers vomiting, is required sooner rather than later; dentists also warn that these products physically burn gums, cause lesions and expose the roots of teeth. In probing the Government, the intention was to set clear, enforceable limits rather than pursuing an outright ban.

These probing amendments were aimed at achieving a balance between taking dangerous products off the market when they are easily obtained by young people and allowing properly regulated, lower-strength products to continue to help people come off smoking. However, one of the advantages of probing amendments is that you are able to test your argument and to hear other arguments—either those in favour, which reinforce your view, or those that challenge your view.

I am grateful to the noble Lord, Lord Patel, and the noble Baronesses, Lady Watkins and Lady Finlay, for raising their concerns about pouches. That is an important point. We should understand whether the Government believe that nicotine pouches can play a role and that they are an effective pathway off smoking. Given that vaping is probably seen as the thing that the Government would promote most as a pathway off tobacco, that would be a very interesting conversation to have.

I am also grateful to the noble Baroness, Lady Fox, because she made some interesting points in sharing the evidence from, I believe, Cancer UK. She also posed some questions. What are we trying to achieve here? Are we trying to address the harms of tobacco or are we trying to tackle addiction? Should we be tackling addiction or harm? These are important points. What is more harmful? That seems to be the debate in this Room: we agree that tobacco is harmful, but how harmful is nicotine? That needs to come out a bit more, perhaps, as we debate the Bill more.

I am grateful to the Minister for answering directly some of the questions that I put to the Government. That was really important. Having listened to the Minister, and to the many noble Lords who challenged the intentions behind these probing amendments, I beg leave to withdraw my amendment.

Amendment 13 withdrawn.

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[Lord Patel (CB)]

May I join the argument? The noble Earl is quite right: there is a synthetic nicotine product, which is manufactured chemically. So you can have nicotine that is not a tobacco product. However, as far as we know, most of the nicotine used in vapes is derived from tobacco.

By the way, I want to come back, slightly tongue-in-cheek, on the noble Earl’s question about where it comes from. Of course, I was hoping that he would say, “From tomatoes, potatoes, nightshade and some other plants”, from which you can also get small amounts of nicotine.

[Lord Kamall (Con)]

My Lords, if we take the logic of the noble Baroness’s argument about nicotine being derived from tobacco, does that drive a coach and horses through the distinction between tobacco products and vaping products? Wherever you stand on this argument, are we now arguing that vaping products are, in fact, tobacco products because the nicotine in them is derived from tobacco? We all have to clarify this, whichever side of the argument we are on.

[Baroness Merron (Lab)]

I fear to tread here—I will be brief. The Bill distinguishes between tobacco products, nicotine products and vaping products. They are separate products. I emphasise the point that I made earlier: vapes are not risk-free, although they are less harmful than smoking. They do not involve burning tobacco, which releases tar and carbon monoxide. However, I must say, having heard the range of debate, I feel that it would be very helpful for me to write to noble Lords with further clarity on these points.

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Moved by

[Lord Kamall]

26: Clause 13, page 7, line 12, leave out from first “consult” to end and insert “and take into consideration the view of—
(a) retailers of relevant products or their representatives, and(b) any other person the Secretary of State considers it appropriate to consult.”

[Lord Kamall (Con)]

My Lords, this group of amendments in my name and that of my noble friend Lord Howe are probing the Government, in one way or another, on the question of consultation. What we seek to do is quite simple in many ways: to recognise that the impact of the Bill is not just on big tobacco, as many noble Lords have said; it will impact some vaping companies, not all of which are big tobacco. It is really important that we make that distinction. Some tobacco companies have vaping divisions. In fact, I have asked tobacco companies: when these Bills go through, what will you do and where will you diversify? It is very interesting to hear some of their answers, which I would be happy to share at some other stage.

The other thing we need to understand is that this will impact retailers, some of which are specialists and some of which sell other products but this is part of their income stream. We want to make sure that we get the balance right.



What we really want is to understand the nature of the consultation. Which voices with experience are being listened to? Which retailers are being listened to? On manufacturers, I want to be slightly careful, because I have had some conversations since these amendments were laid. In fact, I have been told by some people that we should not ask the manufacturers, particularly big tobacco, for their views. I have also been told that some companies do not want to be consulted, because that would be seen to be diluting the result of that consultation. Given that these are probing amendments, I will be a little careful about which manufacturers should be consulted and which should not.

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I confirm that we have already started this engagement. On licensing and some of the Part 5 powers, such as registration and product requirements, we have launched a call for evidence. Those with evidence to share can contribute now and we will consider their feedback prior to consulting on specific proposals. We will publish a consultation on our proposals for display regulations shortly. With those comments, I hope that I have given the reassurance sought and that the noble Lord therefore feels able to withdraw his amendment.

[Lord Kamall (Con)]

I thank noble Lords who have contributed to this debate, and the Minister for her response. With these probing amendments, we were trying to make sure that the consultation was as wide as possible. We completely understand the WHO requirements, but we sometimes worry about some of the more specialist cigar manufacturers, which are not big tobacco but much smaller specialist organisations.

I seek some clarity from the Government at this point. Are they saying that the WHO guidelines mean that they cannot speak to these small, specialist manufacturers? We understand not consulting the big Philip Morris Internationals of this world, and others, but is it the Government’s understanding that they cannot speak to the small specialist cigar manufacturers because WHO guidelines preclude them from doing so? Or are they saying that they can speak to those small manufacturers?

Clarification on that from the Minister would be welcome. Is she able to give an answer, or shall I witter on a bit and hope that the officials can give her an answer in that time? I will do that; I am trying to be helpful. That clarity is essential. I am not asking that they call in the likes of the big firms, such as BAT and Philip Morris, every time they want to do a consultation; we know what their business models are. This really is about the small specialist manufacturers who feel that they are excluded and lumped in with big tobacco all the time. Their demographic is very different. It is an ageing demographic; perhaps literally a dying demographic —who knows?

The newspaper that came to see me told me that its readership was not consulted even though their trade associations claimed that everything was fine. Therefore, we need to understand those nuances. In my experience, I have seen some trade associations claiming to represent a wider membership than they do. They are not the ones who are damaged.

I welcome the sentiment behind the noble Baroness’s response. I had a conversation with the Minister only yesterday about a particular organisation not feeling that it had been consulted. Immediately, she said, “Let’s meet with that organisation”, so I recognise the sentiment. However, I would like that clarification now if it is available.

[Baroness Blake of Leeds (Lab)]

We require all those with links, direct or otherwise, to the tobacco industry to disclose them when answering consultations. I hope that is the clarification that the noble Lord requires.

[Lord Kamall (Con)]

Just to understand, they can be consulted—that sounds reasonable; I do not think anyone would say otherwise. It is important that they do not hide where they are from.

If there are organisations that have written to me about this in the past and I have had conversations with them, I am sure that the Minister will be open to having conversations where appropriate. With those reassurances, I beg leave to withdraw the amendment.

Amendment 26 withdrawn.

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[Baroness Blake of Leeds (Lab)]

I am at the mercy of the Committee, but we have some more time and the ability to go on until 5.15 pm. If noble Lords agree, we have one more group to do to get to the target. Shall we continue?

[Lord Kamall (Con)]

My Lords, my noble friend Lord Mott is not here to move Amendment 29 and has obviously not sent a substitute to speak on his behalf. What is the procedure from here?

[The Deputy Chairman of Committees (Lord Haskel) (Lab)]

I suggest that the Committee adjourns.

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

Lord Kamall Excerpts

Tuesday 21st October 2025 Grand Committee

[Lord Scriven (LD)]

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

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

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

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

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

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

[Lord Kamall (Con)]

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

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

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

Healthcare Provision: Inequalities

Lord Kamall Excerpts

Monday 20th October 2025 Lords Chamber

[Baroness Merron (Lab)]

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

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

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

HIV: Testing and Medical Care

Lord Kamall Excerpts

Monday 20th October 2025 Lords Chamber

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

Terminally Ill Adults (End of Life) Bill

Lord Kamall Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness Berger (Lab)]

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

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

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

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


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

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

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

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

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

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

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

[Lord Kamall (Con)]

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

[Baroness Berger (Lab)]

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

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

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

Genome Screening: Newborn Infants

Lord Kamall Excerpts

Thursday 18th September 2025 Lords Chamber

[Baroness Merron (Lab)]

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

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

National Health Service Regulations

Lord Kamall Excerpts

Tuesday 16th September 2025 Lords Chamber

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

Respiratory Syncytial Virus: Vaccination Programme

Lord Kamall Excerpts

Tuesday 9th September 2025 Lords Chamber

[Lord Kamall (Con)]

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

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

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

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

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

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

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

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

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

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

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

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

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

Suicide Reduction

Lord Kamall Excerpts

Monday 8th September 2025 Lords Chamber

[Lord Kamall (Con)]

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

[Baroness Merron (Lab)]

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

Prostate Cancer

Lord Kamall Excerpts

Wednesday 3rd September 2025 Lords Chamber

[Lord Kamall (Con)]

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

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

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

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

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

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