Learning Disabilities Nursing

Lord Patel Excerpts

Tuesday 17th June 2025 Lords Chamber

[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

Friday 6th June 2025 Lords Chamber

Moved by

[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.

--- Later in debate ---

[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.

Motion agreed.

Primary and Community Care

Lord Patel Excerpts

Thursday 5th June 2025 Lords Chamber

[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.

Health: Ultra-processed Food

Lord Patel Excerpts

Tuesday 3rd June 2025 Lords Chamber

[Baroness Merron (Lab)]

The important point that the noble Lord raises is that our role is to encourage people to ensure that they are choosing a healthy diet and can achieve a healthy diet. As the noble Lord said, the word “could” is a bit of a problem. That is why we continue to invest in research and, as I say, work closely with the Scientific Advisory Committee on Nutrition.

[Lord Patel (CB)]

My Lords, several speakers have alluded to the evidence available that associates ultra-processed and processed food with disease or health conditions. Would the Minister agree that all the evidence cited is from observational studies? No studies report as a causative factor a direct link between processed and ultra-processed food and any disease—including the British Heart Foundation, the BMJ and the one that the noble Lord, Lord Sikka, mentioned. It is right that we should fund research that associates the causation of these food processes to disease.

[Baroness Merron (Lab)]

The noble Lord is absolutely right. There is concern, and I am very aware of it, about the effect of ultra-processed foods, but nobody knows whether it is the processing or the content. What we do know is that it is definitely the content. We also know that high-fat, high-sugar and high-salt foods damage people’s health. Our focus is on what we know, and it is important that we continue to do that while researching what other links there may be.

Healthy Life Expectancy

Lord Patel Excerpts

Tuesday 20th May 2025 Lords Chamber

[Baroness Merron (Lab)]

Prevention is certainly the best approach. As noble Lords will be aware, one of the three pillars of the published 10-year plan is moving from sickness to prevention, so that will feature very much in the plan. We work closely with industry to ensure that government can benefit from its information and its approach, and that we can bring industry along with us to ensure that, collectively, we are taking the best approach to making healthier foods available. We also have to make sure that people have the resource to have healthier foods, as well as information. It is, again, a many-pronged approach, but that is why it has to be a joined-up approach.

[Lord Patel (CB)]

My Lords, while accepting what the noble Baroness, Lady Alexander, and the Minister have said about social inequalities in health outcomes, there are other issues. For instance, period mortality affects life expectancy, so a male aged 65 will expect to live another 18.5 years and a female another 21 years. In turn, period life expectancy is affected by mortality rates so if you improve mortality rates, particularly for diseases where the rates are highest, you will improve life expectancy irrespective of social inequalities. That means that we need the health service to deliver high-quality care for those conditions which result in high mortality rates. Any forward plan or 10-year plan should address that issue. Does the Minister think that might be wise?

[Baroness Merron (Lab)]

I do feel that that would be wise, and we as a Government have already shown that trajectory. To give just one example, smoking remains the preventable killer in our country, and the landmark Tobacco and Vapes Bill will deliver the ambition of a smoke-free UK. We will have a smoke-free generation and will gradually end the sale of tobacco products across the country. We have to break that cycle of addiction and disadvantage which is particularly focused on areas of greater disadvantage. As ever, the noble Lord speaks wise words.

Health Research

Lord Patel Excerpts

Wednesday 12th February 2025 Lords Chamber

[Baroness Merron (Lab)]

I note my noble friend’s observation. I certainly can give the assurance that the United Kingdom will continue to support and promote its research capability at home and, where we can, internationally. It might be helpful if I tell your Lordships’ House that, on 10 February, a United States district judge temporarily blocked the Administration’s cuts following a lawsuit which was led by attorneys from 22 US states. There is a further hearing scheduled for 21 February, so it is wait and see, and we continue to keep a close eye.

[Lord Patel (CB)]

My Lords, NIH is the world’s largest supporter of biomedical research. A long time ago, I was a part beneficiary of its funding. It is renowned for developing many technologies for medical care, the two latest being CRISPR technology for treating disease and messenger RNA for developing vaccines. The UK is the first country in the world to license using CRISPR technology to treat sickle cell anaemia and thalassemia. In view of the cuts in NIH funding, we have an opportunity to increase our recruitment process for talented scientists who will be now be looking for a new home. As the country with the second-largest research profile in biomedical research, we may be able to benefit from it, so I hope the Government will refocus their efforts in the life science strategy and remove the impediments to the recruitment of talented scientists.

[Baroness Merron (Lab)]

The noble Lord makes an important point. Decisions made by other countries, including the United States, are a matter for them. As the noble Lord said, if this goes ahead—I have made comments on a lawsuit, so I am limited in what I can say—while the US is indeed one of the UK’s closest partners in this area, we will seek every opportunity internationally and continue our commitment to see research at the heart of our NHS into the future.

National Cancer Plan

Lord Patel Excerpts

Monday 10th February 2025 Lords Chamber

[Baroness Merron (Lab)]

This is an extremely important point which will very much feature in the cancer plan. I am sure all noble Lords will join me in being glad to see the right reverend Prelate in rude health. I share his comments about the quality of care that is offered. I was fortunate enough to visit the Royal Marsden NHS Foundation Trust and Institute of Cancer Research on the day of the launch of the national cancer plan and the AI-assisted trial for women to tackle breast cancer. I assure the right reverend Prelate that that is crucial. I say from the Dispatch Box that I would expect any plan and work to take account of inequalities. I mentioned earlier targeting lung cancer; that is exactly what it does, and we need to see more of that.

[Lord Patel (CB)]

My Lords, the fact is that our best cancer services deliver as good a result as any in the world; they are second to none. We do not need to focus on what might happen in the future, with the promise of AI, etcetera. It may promise utopia, but we need the same degree of care as our best delivery provided universally to every cancer patient in our health service. That is what I hope the cancer plan will focus on, and not get carried away by a future that may look promising and bright but which may not deliver. I am delighted that there will be a separate children’s cancer plan, because that is needed. I hope that, in the meantime, it will stop any discussion about shutting down about our best children’s cancer hospital, for whatever reasons—which I think might be political.

[Baroness Merron (Lab)]

I want to clarify that while the cancer plan is not specifically aimed at children and young people, such evidence will be welcomed. Also, the taskforce will be relaunched this year, alongside the national cancer plan. As we do with adults, equally, we want to identify ways to improve outcomes and patient experience.

I hear the noble Lord’s point about AI. It is not a utopia, but it is a tool in the box that we would absolutely be right to look at. I am also struck by how AI is not something separate from human beings; it is human beings who guide it, and it has great potential. On the noble Lord’s point about tackling inequalities in access, which was also made by the right reverend Prelate, he is absolutely right. It is not acceptable that some people, because of where they live or who they are, are not accessing care. This is a constant issue for us, and we continue to tackle it.

Care Homes: Safety Ratings

Lord Patel Excerpts

Wednesday 5th February 2025 Lords Chamber

[Lord Patel (CB)]

My Lords, whether or not the newspapers were correct in reporting what the CEO said, I am sure we would agree that the Care Quality Commission has been found deficient in its performance. With particular reference to the reports on maternity services, which are now in crisis, what are the Government going to do about properly evaluating maternity services?

[Baroness Merron (Lab)]

I absolutely agree that the CQC has been deficient in its performance. We can look back to 2023 for the roots of that, when a new single assessment framework for assessing providers, coupled with a new IT system and changes in the CQC’s staffing model, were all brought into play. That produced a stark reduction in its inspection activity, as well as causing huge problems in the time taken to carry out re-inspections. In all of the ways that I have already mentioned, in addition to discussions on reducing the backlog and looking at the technology, staffing structure and improving governance within the CQC, this will be a root-and-branch change and will greatly improve inspection for maternity units and others.

Mental Health Bill [HL]

Lord Patel Excerpts

Committee stage
Monday 20th January 2025 Lords Chamber

[Baroness Tyler of Enfield (LD)]

My Lords, I want briefly to make a couple of comments on this important group. As everyone has acknowledged, an absolutely vital change to the Bill is that, in the future, people with learning disabilities and autism will not be detained by the Bill and their needs are to be met in the community. I am sure we can all agree on and gather around that.

The noble Lord, Lord Beamish, made the point that, far too often in the past, people with learning disabilities and autism have been overlooked. I see the Bill as a real opportunity to do something substantive about that. That is why I note some of the amendments we have heard about in this group—certainly those in the names of my noble friends Lord Scriven and Lady Barker, and others—about the importance of having properly trained staff with up-to-date knowledge and expertise, as the noble Baroness, Lady Bennett, has just mentioned.

For any of this to happen, it is important that there is a proper plan, that is costed; the resources need to be available, and properly trained staff with up-to-date expertise need to be available in the community. To ensure that there is some sort of accountability around all this, I reiterate the question that my noble friend Lord Scriven asked the Minister: when will we see new targets—we have not got any at the moment—to reduce the number of detentions of people with learning disabilities and autism? It would be helpful to know that those targets will be put in place and that there is some way of monitoring the progress on all the important things we have been talking about in this group.

[Lord Patel (CB)]

I agree with what has been said: we need a definitive plan for how things will work out. We cannot rely on it being in five or 10 years because, as the noble Baroness, Lady Murphy, said, it then just becomes an ambition rather than a target to achieve.

I support the amendment of the noble Baroness, Lady Browning, which strongly asks that the people who look after children with autism and learning disabilities are properly assessed by properly trained and accredited people. We know that, currently, children are ending up in detention inappropriately because they are assessed to have a psychiatric condition such as schizophrenia—as the noble Baroness, Lady Browning, said—when, although they might have some psychiatric sub-condition, they fundamentally have autism or learning disability problems.

I am sorry that the noble Lord, Lord Adebowale, is not here to speak to his Amendment 150, which asks quite powerfully for a clear plan to be laid out, with resources tied to it, to achieve the ambitions there are in the Bill. I would have supported his amendment probing the Minister as to how resources will be allocated to achieve the ambitions for those targets to be met.

[Lord Kakkar (CB)]

My Lords, I support Amendment 42A in the name of the noble Baroness, Lady Browning, and I ask the Minister what justification there could be for refuting the amendment. It seems entirely appropriate, and indeed essential, that in taking such an important, far-reaching decision, one of the two registered medical practitioners who is responsible for that decision, taken at one point in the management of the natural history of disease in that individual, has the specialist skills and training to be able to make an appropriate assessment, one that will affect interventions on all future occasions for that individual.

I hope that, in addition to accepting this important principle, the noble Baroness might outline how His Majesty’s Government will go about ensuring that the development of such medical practitioners and their training is adequately resourced to ensure that, in future, as a result of the Bill being enacted, what we have seen in the past, regrettably on repeated occasions, does not remain the norm for managing patients with autism and learning disabilities.

First-cousin Marriage

Lord Patel Excerpts

Monday 20th January 2025 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Lord for his support in this area, which is indeed sensitive. The statistics he quotes are quite right. It is of course an interesting reflection that the risk of genetic abnormalities does not just double from 3% to 6% in those infants whose parents are first cousins, but also doubles in older white British mothers—I am a bit worried about saying “older” because it is actually over 34. However, the point is well made that it is not just this group. NHS England has recently published guidance to improve the recording of national data on closely related couples, so I hope that noble Lords will find this of interest as we go along. But of course, there has also been much investment in research as well as data development, and I absolutely agree that data is what has to drive us.

[Lord Patel (CB)]

My Lords, we know that there are over 6,000 genetically related rare diseases and that, apart from first-cousin marriages, there are other high-risk areas. One, which the Minister just mentioned, is the age of the mother, but this also applies to the age of the father, to people who undergo certain medical technology treatments for fertility reasons, and to mothers who smoke at a higher rate. So, there are lots of other influences that may give rise to genetic-related issues at birth. But the important question is: are there any areas where we can definitively say, “If you do X, Y and Z, or if you do not do X, Y and Z, the incidence of genetic diseases will be reduced”?

[Baroness Merron (Lab)]

The noble Lord is absolutely right that there is a whole range of factors in this area, and I am grateful to him for bringing that before your Lordships’ House. He will of course be aware of the main pillars in the 10-year plan: for example, moving from sickness to prevention, which is key. The noble Lord also mentioned tackling smoking, which we will continue to drive forward. But I wanted to use the Question to highlight that the NIHR is undertaking research projects into improving early recognition, diagnosis and treatment of specific genetic and congenital diseases, particularly in communities with high rates of marriage between close relations. So, to the specific point, I again hope that that will be helpful.