Tobacco and Vapes Bill
Lord Patel Excerpts(1 day, 8 hours ago)
Grand CommitteeRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Patel (CB)
My Lords, I support this amendment. We know that nicotine is highly addictive. In fact, it is one of the most addictive substances there is, even in small quantities. The noble Lord, Lord Kamall, made the point that people use it for cessation of tobacco or cigarette smoking. That is true, but the dosage, even of 20 milligrams, is too high. High doses of nicotine cause serious diseases, as mentioned by the noble Baroness, Lady Grey-Thompson. But apart from that, in older people it causes higher risk of cardiovascular disease, not just by increasing heart rate and blood pressure but by making platelets stickier and leading to higher levels of fibrinogen, which increases the risk of forming a clot. This is a good amendment and there is no reason, to my mind, why the Minister should resist it.
Baroness Fox of Buckley (Non-Afl)
My Lords, the noble Lord, Lord Kamall, and the noble Baroness, Lady Grey-Thompson, have made some interesting cases probing the issue of the high nicotine content of pouches. However, it is worth noting that Cancer Research does not support these amendments. It says that there may well be a need for a deeper dive into the evidence, but it stresses something that has been missed in some of the debates we have had so far, certainly at Second Reading: it is tobacco that is the cancer-causing ingredient in cigarettes.
Nicotine patches do not contain tobacco. Nicotine is addictive, but the overall evidence does not support a direct causal link between nicotine and cancer: it is not carcinogenic. That is what the scientific evidence seems to show, and it comes from anti-tobacco lobbying groups and people whom I would not necessarily usually cite. It is noted that nicotine products and pouches are being used as recreational products, but they are also helpful for smoking cessation.
We have to consider what we are doing with the Bill. The NHS itself calls nicotine “relatively harmless”, and, in his 2022 review, Dr Javed Khan said that
“the government must facilitate access to the various already available safer alternative nicotine products such as nicotine pouches”.
We therefore have to be careful about demonising these things, because it is not straightforward.
There is a danger throughout the Bill—it will come up in other groups—of a constant slippage between tobacco and nicotine. Sometimes that occurs through a discussion around addiction. I would be interested to know what the Minister thinks about this—she talked about the problems of addiction on our first day in Committee—because the Bill is not necessarily tackling addiction; it is tackling harms. There is a danger that we get confused between that addiction, which, as I say, many people in the health professions do not see as a problem per se, and what we are targeting. I am worried that that slippage between nicotine and tobacco, between vapes and smoking cigarettes, leads to an unscientific mishmash of misinformation that, ironically, can damage public health.
In relation to young people using pouches until they vomit, young people use lots of things until they vomit. They can overuse a range of things, not helpfully, but it does not necessarily mean that the product itself is always the problem: sometimes, it can be youthful lack of restraint, which one might want to intervene in but not necessarily through the law.
Earl Howe (Con)
If it is a tobacco product, I take the point, but I thought that the noble Baroness was also arguing about handing out free vapes. Making it illegal for a shopkeeper to supply an adult with a regulated vaping product as a free sample feels very much like an unreasonable restraint of trade. If someone enters a shop to buy cigarettes—let us say he is a smoker—and the shopkeeper offers him a free vape, what exactly is wrong with that, as long as the regulations are adhered to? Do we really want to criminalise that kind of free supply? I am afraid that I am not convinced.
The Bill already imposes a series of significant new obligations and compliance costs on legitimate businesses. The restrictions contained in Clauses 13 to 15 alone are substantial and will likely require many retailers to make complex and costly adjustments. To introduce further constraints and prohibitions, as well as a substantial potential liability, however well-intentioned, has to be thought about very carefully before we go down that path.
Lord Patel (CB)
My Lords, if the nicotine contained in the vapes is not extracted from tobacco, where is it coming from?
Earl Howe (Con)
Perhaps the noble Lord, with his compendious knowledge, can enlighten us on that.
Baroness Merron (Lab)
My Lords, I thank all noble Lords for their contributions on this group of amendments exploring the part of the Bill that relates to the sale of vaping products. I will make a general point to start with, which may be helpful as it has come up a number of times in the debate. It is true to say that vapes are less harmful than smoking because they do not contain tobacco and have fewer harmful chemicals. However, because there is a nicotine content and there are unknown long-term harms, there is a risk of harm and addiction that comes with vaping. That is particularly acute for adolescents whose brains are still developing.
There is a careful balance to be struck in taking action against youth vaping, by which I mean children and young people, while ensuring that vapes absolutely remain accessible to adults who are seeking to quit. Noble Lords will have heard me refer before to the Chief Medical Officer, who is clear that if you smoke, vaping will be a better option; but if you do not smoke, do not vape. It could not be clearer.
Baroness Northover (LD)
I disagree that we can necessarily distinguish between nicotine and a tobacco product, given that most nicotine products are derived from tobacco and are, therefore, tobacco products. However, the key thing here is that nicotine is being targeted at children, who often then graduate to smoking cigarettes. So you have not only an addiction but a potential route into the problem that we have worked on together for many years: reducing smoking, especially among the young, for all the reasons we know about.
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.
MBRRACE-UK Report 2025
Lord Patel Excerpts(1 week, 1 day ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Patel (CB)
My Lords, we have another MBRRACE report and the same message. Black women are at twice the risk of dying and Asian women have a higher incidence than white women, and we are not addressing the issues that lead up to these deaths in these minority groups. Can the Minister tell us what measures the Government are likely to take in the maternity review to address this?
Baroness Merron (Lab)
This Government are committed to closing the black and Asian maternal mortality gap. It is unacceptable that, in 2025, black women are twice as likely to die in childbirth. I was speaking yesterday with a clinician who said that for every woman who dies, 100 women experience a severe maternal morbidity event, such as stroke, kidney failure or acute psychosis, which can lead to lifelong health implications, as the noble Lord has referred to. The maternal care bundle, which we have developed in partnership with MBRRACE, proposes intervention on the issue of blood clots, which are three times as likely to occur in black women and can have tragic consequences.
HIV: Testing and Medical Care
Lord Patel Excerpts(1 week, 4 days ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Merron (Lab)
As I have mentioned, the plan—which is due to be published by the end of this year—will include a focus on HIV testing and will take account of the groups that are less likely to be tested, because that will be key to our success in eradicating new HIV transmissions by 2030.
Lord Patel (CB)
My Lords, every time we have debated this subject, we have acknowledged the difficulty in identifying at-risk people who do not come forward to be tested for HIV. One such group of people are those who go to pharmacies or GPs to get a prescription for PrEP medication. What information do we give them about the need for getting themselves tested for HIV when they approach pharmacies and other sources for PrEP medication?
Baroness Merron (Lab)
Although I cannot answer specifically, I would be very happy to write to the noble Lord about what information is in pharmacies. I know the noble Lord will appreciate, as your Lordships’ House has welcomed, the greater use of pharmacies, not least because they are more accessible for those who otherwise would be disadvantaged.
Prostate Cancer
Lord Patel Excerpts(1 month, 4 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Patel (CB)
My Lords, I thank the noble Lord, Lord Mott, for initiating this debate. Some of my comments are shared by the noble Lord, Lord Winston, on whose behalf I also make them, as he is in hospital with a broken leg—but he is doing okay.
I agree with the comments that the noble Lord, Lord Mott, made about identifying and offering the PSA test for higher-risk patients. My comments are therefore not about GPs’ role in offering the test to men at higher risk of prostate cancer. My comment is mostly based on the use of PSA as a test for screening purposes. It is a test which has a fairly high degree of sensitivity but a very low degree of specificity, which means that the rate of false positives and false negatives is very high for a screening test.
I agree that some of the trials being carried out—the noble Lord, Lord Mott, mentioned one in Royal Surrey hospital, and there are others in Europe and the United Kingdom—may help us modify the guidance that could be given based on the results of the study and therefore could be targeted at a wider group of people. But we need a test that is much more reliable, easily carried out and much more accurate. Such a test as a preliminary study was developed by the Institute of Cancer Research and the Royal Marsden Hospital. It uses a spit test, which recognises 130 different modifications or mutations of DNA with a high degree of specificity, much higher than the PSA, and a high degree of sensitivity. In a model trial, it would have identified nearly 13,000 patients, the same number of deaths that occur per year, with low-grade prostate cancer. It is a test that requires further trials, because it is easily administered and may become part of a wider screening programme. So we need to be much more aware of innovations that may occur.
Diabetes: 10-Year Health Plan
Lord Patel Excerpts(4 months ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Merron (Lab)
The matter of health inequalities is, obviously, one we are very concerned about. A national review is currently under way to update on monitoring, including of various groups. NHS England supports ICBs in improving diabetes care, including through the use of the medical technologies that the noble Baroness referred to, and, importantly, in reducing the variation in care that we still see across the country. It does that by using national data and insights, funding local clinical needs and addressing health inequalities through the national diabetes prevention programme. I certainly agree with the noble Baroness about the importance of raising awareness and the incredible contribution that new technology is playing. It has to be available for all and I hope we will establish that in the way I have mentioned.
Lord Patel (CB)
My Lords, I declare an interest as a patron of the South Asian Health Foundation. The south Asian population has a very high incidence of diabetes, particularly type 1, which is probably related to a strong gene marker. Some 50% of people with type 1 diabetes have some kind of gene marker. Those who have a strong gene marker in a particular region, the HLA region of chromosome 6, have a very high incidence. My point is that, if we screen people, particularly those with a family history of diabetes, for genetic markers, we will identify them much earlier, even in childhood. The prevention that is therefore required—changing their environment and diet—becomes more effective. This ought to be one of the preventive strategies for diabetes in high-risk populations.
Baroness Merron (Lab)
The noble Lord is quite right in his observations, which play to the point of the NHS that we want to see not just now but in the future. Noble Lords may have heard the announcement earlier this week that the Government are committing the necessary funding to screen babies early in their lives through the use of genomics, in order to, as the noble Lord said, identify underlying conditions that can be dealt with early on. There are some that cannot be prevented, but if they are diagnosed and anticipated, their management will be much better.
NHS: Private Equity
Lord Patel Excerpts(4 months ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Merron (Lab)
Again, if there is particular information I should have, I would be delighted to receive that. I can only wholeheartedly agree with my right honourable friend the Secretary of State about the need to use capacity in the private sector. It is one of the ways we are driving down waiting lists and offering more appointments. As I am sure the noble Lord knows, we committed to 2 million extra appointments in our first year of government; we have far exceeded that already with 3.6 million.
Lord Patel (CB)
My Lords, I accept what the Minister said about how the leasing arrangements will remain the same. But can we be assured that both KKR and PHP—whichever wins the bidding war—will follow the same procedures; that is, they will be responsible for providing the equipment and the rents will not increase based on what equipment they provide, and that, therefore, patient care will remain of the highest quality?
Baroness Merron (Lab)
I thank the noble Lord for seeking that reassurance, which I can indeed give.
Perinatal Mental Health
Lord Patel Excerpts(4 months ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Merron (Lab)
I do not share the view that it is discretionary funding, not least because what matters are the outputs, which are, as I described, that a record nearly 65,000 women accessed a specialist community perinatal mental health service or maternal mental health service in the 12 months to April 2025. That gives some idea of the scale—that is a 95% increase compared with four years earlier. So the output is absolutely there. Was it ever the case that all needs were met? No, it was not, even before the change to the planning guidance and the ring-fencing. I emphasise again that this Government’s whole approach is to ensure that local communities are properly served. That is why ICBs can make decisions about how they provide what I regard as first-rate services.
Lord Patel (CB)
My Lords, I support much of what the noble Baroness, Lady Berger, said, particularly about the leading cause of maternal deaths—39% of them—being suicide. Not only that: 37% of those mothers who took their own lives had a known history of mental health issues, yet they were not properly looked after. That is the main problem. Although guidelines exist for screening mothers during pregnancy and after the birth of a baby, they are not universally followed. There is a great variation in the adoption of these guidelines and using the screening tools that are available to identify mothers at risk during pregnancy. We need to put much more effort into that. On the cost, there is only one small model that describes the benefits of identifying mothers at risk during pregnancy and after delivery. We need a detailed study to show the cost-benefit analysis of doing that.
Baroness Merron (Lab)
The noble Lord, building on my noble friend’s point, makes a very important point. I will add to what he said. The impact on affected families is absolutely devastating and has very long-lasting effects, particularly on children. As the noble Lord said, the suicide prevention strategy outlines what clinicians should do, which is complete screening of women’s mental health during pregnancy and the first year after pregnancy. I hear the points that the noble Lord made and will put them into my discussions about suicide prevention, because I am also concerned about the number of people who take their own lives who are in no contact with the health services; we have to find a way of making contact with them. This is less the case in this circumstance, but that theme is still there. I thank the noble Lord for that contribution.
Learning Disabilities Nursing
Lord Patel Excerpts(4 months, 2 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Merron (Lab)
This is indeed a vulnerable group, as the noble Lord says, and it is probably best that I refer to the upcoming 10-year plan, which will deal with inequalities throughout a number of sectors, including the most vulnerable and including this group.
Lord Patel (CB)
My Lords, coming back to original Question, in which the noble Baroness, Lady Monckton, alluded to a drop in recruitment of 42% and only one place where such learning disability nurses are trained, is there not a need to expand ways of getting more people to train for learning disabilities without the penalty of fees for three years and for them instead to train as apprentices, where they do not have to incur such fees? Is that not an impediment to the recruitment of more nurses?
Baroness Merron (Lab)
Certainly, apprenticeships are important, and that is one of the ways we have expanded the routes into the nursing profession, including learning disability nursing. That means that the apprenticeships we are applying allow opportunities for people from all backgrounds and in underserved areas, which is another important area of ensuring that we remove the barriers to training in clinical roles.
Preterm Birth Committee Report
Lord Patel Excerpts(4 months, 3 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Lord Patel
That this House takes note of the Report from the Preterm Birth Committee Preterm birth: reducing risks and improving lives (HL Paper 30).
Lord Patel (CB)
My Lords, I am pleased and honoured to lead the debate today on the Preterm Birth Committee report. Before I do so, I thank most sincerely all those who gave evidence to the committee and, in particular, the mothers and parents of children born pre term who told us of their experiences, as well as the perspective of adults who were born premature. It is their powerful evidence that forms the backbone of our report and its recommendations, and I will come back to that. My sincere thanks go too to the specialist advisers, including Eleri Adams, consultant neonatologist and president of the British Association of Perinatal Medicine.
I give my and the committee’s thanks to the dedicated committee staff who supported us and did so brilliantly—Eleanor Clements, committee clerk; Babak Winstanley-Sharples, policy analyst; Mark Gladwell, committee operations manager; and Alec Brand, media and communications officer—a huge thank you to them all for their hard work and support.
I give my personal thanks to all the committee members. It was a privilege and fun to be their chair because of their dedication and help in making sure that we delivered an evidence-based report that helps improve the lives of mothers, parents and the families of children born pre term.
Thanks go also to the noble Baroness, Lady Bertin—I am pleased that she will speak today, and I look forward to her speech—who could not join us as a member of the committee but was instrumental in persuading the Liaison Committee to set up the inquiry. I enthusiastically look forward to the speeches of all noble Lords taking part today, including the Minister.
A committee was set up in 2024 to consider the prevention and consequences of preterm birth. The title of the report, Preterm Birth: Reducing Risks and Improving Lives, summarises it all. I declare my interest, which is probably no longer relevant, of 39 years’ experience of being an obstetrician who delivered a lot of preterm babies.
By definition, preterm births are babies born before 37 weeks, and the current incidence is 7.9% of all births. It is the main cause of neonatal deaths in the UK. Around 75% of neonatal deaths are in babies born pre term, mostly the very pre term. For most babies born pre term, the outcome is good. For many, it is not. Some 4.2% of those born preterm end up having a severe disability at age 18 and 18.5% have a mild to moderate disability. Children born pre term have a higher prevalence of need for special education: the lower the gestation at birth, the higher the incidence. Some 82.6% of those born at or near 24 weeks have a need for special education. Children born pre term also have lower educational attainment.
While advances in obstetrics and neonatal care have led to improved survival, there has not been a corresponding improvement in neurodevelopmental outcomes. Incidence of brain injury, for example, is 26 per 1,000 births in those born pre term compared with 3.5 per 1,000 births in those born to term. It results in disability, cognitive impairment, memory loss and other functions. Adults born pre term told us that issues they experience could be subtle but multiple. Added to this, a lack of awareness within the healthcare system of the long-term effects of prematurity means that informed or specialist support is difficult to access.
It is not only the children born pre term for whom we can do better but the parents who are to care for these children. A survey showed that 24% of parents showed signs of post-traumatic shock. As one mother said:
“Life before the neonatal unit is mostly irrelevant when you find yourself stood, post-partum, next to your baby in an incubator, hoping and wishing that you make it out safely … The vulnerability is beyond crippling”.
The impact of prematurity does not end upon discharge from the neonatal unit. The experience stays with you for life. As this quote demonstrates, preterm birth can be sudden, unexpected and have significant—sometimes lifelong—impact on those born pre term and on their families.
Many parents will spend weeks and months in hospital caring for their babies, often in hospitals that are a long way from home, incurring practical and financial difficulties. A mother of twins, who were born very pre term and cared for in two different hospitals because of lack of capacity of neonatal beds, described vividly to us her daily difficulties and the stress it caused her to travel between two hospitals as she visited and cared for her two tiny babies.
Some 75% of intensive neonatal care units do not have accommodation for parents. Most have poor facilities, even for mothers to express breast milk or rest. Evidence we received clearly showed the benefits of involving parents in the care of their preterm babies—so-called integrated care, where parents and all health professionals are involved in the care of the baby. The involvement of parents in the care of their babies not only improves outcomes but, importantly, gives parents the confidence they need when the time comes to take their baby home. There is a need to make integrated care more widespread.
Although we will not completely prevent preterm birth, our inquiry clearly showed that we can reduce its impact with better policies for the care of babies and support for parents. For example, the Saving Babies’ Lives Care Bundle, developed by NICE and NHS England, has guidelines that would improve outcomes if implemented in full. The evidence we got showed wide variation in the use of these guidelines in important areas such as the timing of the clamping of the umbilical cord—noble Lords might be surprised by the effect that has on the outcome for both preterm and term babies—the timing of the administration of steroids to mothers prior to birth, the use of non-invasive ventilation, and several other areas. The result is poor outcomes for babies. There is an urgent need to implement the guidelines more widely and eliminate the variation in care. What role does the Minister think the Department of Health and Social Care can play to bring about this change?
We also heard of the challenges parents face after discharge from hospital. Community services not only lack capacity but often do not have the training required to be of any help to parents. In his report, the noble Lord, Lord Darzi, highlighted the important role of health visitors in the early years development of children. Shortages of not only health visitors but midwives, specialist neonatal nurses, neonatologists, physiotherapists and clinical psychologists all impact on outcomes for babies born pre term. A recent report from the Royal College of Midwives says that newly qualified midwives are worried about not getting a job; that cannot be right when we want to expand the midwifery workforce. Can the Minister give an assurance that the workforce issue will be addressed in the NHS 10-year plan?
National guidelines stipulate the need for a series of assessments of children born preterm prior to starting school, particularly at ages two and four. Delivery of this is, at best, inconsistent; in the majority of cases, it does not happen at all. Figures show that at age two, 85% of babies born pre term are followed up, but this drops to 6.7 % at the crucial preschool age of four. There is a need to urgently address this issue; I hope the Government will take urgent action to do so.
I come now to the important issue of prevention and reducing the incidence of preterm births. The prediction and prevention of preterm births are challenging because of the wide range of factors that contribute to a woman’s individual risk, with many having no risk. Studies reported to us showed a strong association of preterm birth linked to smoking, the socioeconomic status of parents, and ethnicity. These need urgent attention if we are to reduce the incidence of preterm birth. I hope the Minister will comment on how the Government intend to address each of these issues. We explored the role of screening methods to identify women at risk of preterm birth. We came to the conclusion that better-designed, more focused studies to find the right screening methods are needed, if that can be done.
Despite this, there are opportunities to reduce the incidence of preterm birth. When will the Government revise the maternity safety targets and focus efforts to reduce the rate of preterm births across all groups of women? Do the Government have a target reduction for the preterm birth rate? Providing women with information prior to pregnancy about their general health and lifestyle should be an important part of reducing the incidence of preterm birth. Does the Minister agree that this should be part of the Government’s women’s health strategy? There is currently underinvestment in pre-pregnancy advice. The Government’s 2024 manifesto said:
“Labour will prioritise women’s health as we reform the NHS”,
and in her evidence to the committee, the Minister said that the Government intend
“that the health of women is optimised before we get to pregnancy”.
There is an opportunity today for the Minister to say how this will be done.
The consequence of being born pre term, particularly very pre term, weighing as little as 600 grams, with the body organs that sustain healthy life not fully developed, would be death or lifelong disability for many. With the provision of good care, the outcome for not just a few, but many, will be better, so why would we not put policies in place to do so? I beg to move.
Lord Patel (CB)
My Lords, I thank the Minister for her response. We often say, “This has been a good debate”. This has not been a good debate—it has been a brilliant debate. All the speakers showed a passion for making the service for mothers and babies better. I heard no political issues in any of the speeches. I heard one thing only, and that was to support future mothers and future preterm babies so that that their lives are made better. We heard the same passion from the noble Baroness, Lady Brinton—I thank her for her courage—that we heard from many, many witnesses.
I said at the beginning that the report was underpinned by the evidence we heard from mothers and the lived experience of adults who themselves were born pre term about how services were failing them—services failing them when not much in the way of resources are required. What is required is the dedication that is shown by the professional, but the professional is not supported, and I hope that we will do so.
I have to say that I think the Minister had a difficult task in answering all the questions that were raised, but they were all good questions. It will require careful reading of her response to know how far she showed the same compassion, or the Government show the same compassion—I do not mean her personally, as I know she is compassionate about it—that will deliver for future mothers and babies born pre term, because babies will be born pre term. I sadly have to say that I delivered my godson at 26 weeks; he is 54 years old and severely handicapped. I also delivered, 10 years later, a young preterm baby who weighed exactly 600 grammes, who I later, as a Chancellor, twice graduated in law. So there are people, as the noble Baronesses, Lady Blackstone and Lady Brinton, said about twins, who are born premature and survive.
I hope we will not forget this debate, because there are mothers and babies out there who need our support. I agree with the noble Baroness, Lady Wyld, that we must not let this be the only occasion on which we discuss this: having the same debate every year might help.
Primary and Community Care
Lord Patel Excerpts(4 months, 3 weeks ago)
Lords ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Baroness Merron (Lab)
Our commitment to moving towards a neighbourhood health service obviously allows for attention to be given to different circumstances, including in rural areas. It will mean that more care can be delivered locally and that problems can be spotted earlier, including any problems with rollout. We will shortly provide details of a national neighbourhood health implementation programme. We liaise with various groups, including the Patients Association, and I am grateful for their input and for flagging up any difficulties, which we absolutely seek to resolve.
Lord Patel (CB)
My Lords, while I accept that in vitro diagnosis at the point of care has great benefits, it is important to address the challenges that we will need to face. They include quality control and the standardisation of equipment used, as well as making sure that the appropriate people are trained, that assessments are made of the results obtained and that proper, good outcomes are delivered. Who will be in charge of delivering this, at the integrated care board level and the national level, to make sure that it is effective?
Baroness Merron (Lab)
The noble Lord is right that it is one thing to provide a service; it is another—and so important—to make sure that it is provided appropriately and accurately. ICBs will have their own arrangements. Within that, NHS England is currently responsible for ensuring that this takes place. We will ensure that there are regular updates. If any noble Lord is aware of particular difficulties, I would be very pleased to hear about them; for example, if there is a problem with quality control.