Terminally Ill Adults (End of Life) Bill

Lord Scriven Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Baroness Smith of Newnham (LD)]

I thank the noble Baroness. I note that my former tutorial partner from Oxford was intervened on, or interrupted, for speaking for too long beyond 10 minutes. I shall endeavour still to be within 10 minutes despite having been doubly intervened on.

The report noted that the committee had not taken evidence from terminally ill people. I will leave it at that in terms of responding to the noble Baroness, Lady Thornton. However, we took evidence, as we were requested to do, on safeguarding and procedures, and, within the confines of a very brief committee, we took a wide range of evidence. Should we and could we have taken more? Absolutely, but within the confines of what we were able to do I think we did a job. I certainly did not at any point speak or vote against, or indeed take any view on, the idea that we should not take evidence from terminally ill people, so it is unfortunate that that has become a topic of debate.

The reason I rose to speak is that the question of capacity versus ability is hugely important. There are references throughout the Bill to the Mental Capacity Act, but to suggest that this one amendment is not appropriate is an unfortunate legal point. The amendment says that people should have the ability to make the decision, but “ability” reaches far beyond the narrow confines of the Mental Capacity Act. At various points in Committee, we will talk about capacity. The committee took evidence on capacity, and a key thing to bear in mind about the Mental Capacity Act is that it was never designed for a life or death decision. We need to be very clear as a Committee of the whole House and as parliamentarians—

[Lord Scriven (LD)]

The Mental Capacity Act is used in life and death issues in healthcare. If someone decides not to have care, the doctor has to ensure that that person has capacity to make that decision, so it is already used in that way.

[Baroness Smith of Newnham (LD)]

My Lords, I am grateful to my noble friend for pointing out that the Mental Capacity Act is used for life and death issues, but it certainly was not designed for assisted dying and I suggest that it is not a robust test for these particular purposes. If we are going to pass this legislation, we need to be sure that we have tests that are as robust as possible.

A particular point that we need to bear in mind is that the legislation was not drafted in the way that it is normally drafted; it was done in a way that was described as “on a shoestring”. It is surely up to your Lordships’ House and the other place to ensure that the provisions we have in place do not look as though they have been made on a shoestring. They need to be robust. Decisions about capacity can be taken at a moment in time. We need to ensure that the decision where someone says, “Yes, I think I want an assisted death”, is when they are at a later stage in their illness.

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[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, earlier on in the debate, there was a discussion concerning members of the committee, on who was or was not called, or who was denied the right to be called to it. I suggest that the straitjacket of the time this House allocated probably did not allow the relevant committee the appropriate time to call everyone that it thought was appropriate. It ought to have been given more time, but it seems that it had to be rushed.

Concerning the Mental Capacity Act, Margaret Flynn, chair of the National Mental Capacity Forum, said it was designed to protect us

“when others start to make decisions about our lives … Assisted dying was not on the table during the Law Commission’s consultation which resulted in the MCA”.

Therefore, the suitability of the Mental Capacity Act 2005 as a test for a decision to end one’s life is a major source of debate. I believe the many experts and professionals arguing that it is insufficient for this specific irreversible decision.

The MCA was not designed for assisted dying. It was created to safeguard people who lack capacity in decisions about their care, treatment or finances. Assisted dying was not on the table during the Law Commission’s consultation. The Royal College of Physicians, as the noble Lord said a moment ago, said that applying the MCA to the decision to end one’s life is an entirely novel test in uncharted territory with no experience or precedent. It is a very low threshold. The Royal College of Physicians argues that assessing a person’s mental capacity to decide to end their life is an entirely different and more complex determination, requiring a higher level of understanding than assessing capacity for treatment decisions.

[Lord Scriven (LD)]

I have listened very carefully to the noble Lord and a number of others. I am still struggling to understand what the higher test of ability would be, over and above the Mental Capacity Act. Will the noble Lord let the House know what that higher test is that people would have to go through on ability rather than capacity?

[Lord McCrea of Magherafelt and Cookstown (DUP)]

The noble Lord knows that I am not a proposer of the change of words. I am dealing with capacity. Therefore, I am also dealing with the fact that professionals within the field have stated that to use the Mental Capacity Act for a decision to end one’s life is an entirely novel test and uncharted territory for which there is no experience or precedent. That is not my statement; that is the statement of professionals within the field. They say also that to decide to use it for the decision to end one’s life is an entirely different and more complex determination requiring a higher level of understanding than assessing capacity for treating decisions.

Capacity can fluctuate in terminally ill patients due to physical fatigue, illness, medication or delirium, making the irreversibility of the decision risky under this framework. Therefore, I ask this Committee to think carefully in trying to base its whole argument on this being good legislation because mental capacity is the deciding factor.

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[Baroness Murphy (CB)]

There is never enough training—let us assess that.

[Lord Scriven (LD)]

If I may help the noble Baroness, the answer is that the Oliver McGowan training—which is a statutory requirement for all doctors—is now in place. It is high-level training on both capacity and of dealing with people who are vulnerable.

[Baroness Scotland of Asthal (Lab)]

My Lords, I have hesitated to intervene at this point because we are going to come later to talk about capacity and why the Mental Capacity Act and its definition does not fit well with this Bill. I am disappointed in the way in which the last few comments have turned this debate, not least because all of us belong to professional bodies which express collective views on our behalf and have to be respected. It is disappointing that we should have in this House an attack on a view which is expressed by a professional body in this way.

However, there are real reason as to why the Mental Capacity Act is seen as having deficiency in this context, which it normally does not have. It is a fine piece of legislation that we were very proud to introduce, and it has given liberty, capacity and the opportunity to be heard to many people who had limited capacity in the past. I give quarter to no one about the power of that Act.

But is the Mental Capacity Act perfect when we come to consider this particular issue? It is not. Why is it not? Because you can have and suffer from a mental illness and still have capacity. Yet we know that, when individuals are faced with the terrible diagnosis that they are to die, and their families are distraught, and they themselves have to face that reality, depression is not abnormal; it is normal. The fact is that some of those people, many of whom we know, some of whom are within our families, some of whom have suffered deeply, contemplate whether it would not be simpler, easier, less painful for everyone if they simply ended their lives. But what else do we know? We know that, when that depression bites, there is means of alleviation. We know that, with good palliative care, they can be enabled to make an informed decision. That informed decision may be that they still want to take a step, but the opportunity to get that support is essential.

Yet when we look at the capacity Act, the fact that someone is deeply depressed does not mean that they lack capacity within the meaning of the Act—

Learning Disabilities Mortality Review Reports

Lord Scriven Excerpts

Thursday 13th November 2025 Lords Chamber

Asked by

[Lord Scriven]

To ask His Majesty’s Government what assessment they have made of the effectiveness of learning disabilities mortality review (LeDeR) reports in improving life outcomes for people with learning disabilities.

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

My Lords, we are committed to reducing the health inequalities faced by people with a learning disability and autistic people. Through our 10-year health plan, we are working to improve access to, and quality of, care, delivering holistic, place-based support. LeDeR annual reports support this aim by compiling insights from local reviews into the deaths of people with a learning disability and autistic people. These insights help ICBs and providers to make improvements to care.

[Lord Scriven (LD)]

As the Minister will know, the learning disabilities mortality review was commissioned a decade ago, yet people with learning disabilities still die more than 20 years younger than the general population, and 42% of those deaths are avoidable—twice the rate of the general population—so it is evident that the LeDeR process is not creating the systematic changes required. With that in mind, will the Minister commit to meeting me and a small group of people to explore what new enforceable systems are required to end these tragic and unacceptable early deaths?

[Baroness Merron (Lab)]

These are indeed tragic deaths, and avoidable in a number of cases, as the noble Lord rightly says. I can do better than agree to meet him and his colleagues—I have already got agreement from Minister Zubir Ahmed, who is responsible for this area and will be very pleased to meet them.

Goodmayes Hospital Mental Health Facility

Lord Scriven Excerpts

Thursday 13th November 2025 Lords Chamber

[Baroness Merron (Lab)]

As the noble Baroness will be aware, I take a broader approach. The current in-patient model is totally outdated and cannot address adequately the inherent risks in the mental health in-patient system, so we have to move to new models of care which are integrated in the community. Those changes will be made as part of the 10-year plan. Importantly for me, that will mean a new era of transparency as well as that rigorous focus on patient safety and care and also hearing and acting on patient and staff voices.

[Lord Scriven (LD)]

My Lords, from these Benches we also send our condolences to Alice’s family and loved ones. Considering that the judge noted that North East London NHS Foundation Trust’s finances were in an “absolutely parlous state”, what assessment have the Government made of the direct link between severe financial distress in NHS mental health trusts and the ability to maintain fundamental patient safety standards, such as ensuring rapid environmental de-escalation and adequate staffing levels?

[Baroness Merron (Lab)]

Of course, these matters are extremely important. On the specific trust, I am sure the noble Lord will be aware that there are particularly unacceptable issues that have been happening there. I gave the Answer straight off to my noble friend that it is in fact totally unacceptable. Looking to the future, following this terrible tragedy, the trust has replaced its leadership and is making improvements to services. The most recent CQC inspection found that services were well led and that they have improved. However, acute adult wards remain in the category of requiring improvement, as does its overall rating. I assure the noble Lord that we are continuing to work with the trust to raise its game.

Artificial Intelligence: Safeguarding

Lord Scriven Excerpts

Tuesday 4th November 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness makes a helpful challenge about how to regard AI services. Generative AI can indeed offer opportunities to enhance mental health support, and the National Health Service is looking at how we can, particularly through the NHS app, assist and support people. But such technologies must not replace trained professionals, including in crisis situations. It is about getting the right support, at the right place, at the right time—that is a delicate balance, but we should use AI for its great benefits.

[Lord Scriven (LD)]

My Lords, following on from the previous question and drawing on international best practice, will the Government look at what they can do to mandate that all general-purpose AI providers implement a prominent, context-sensitive hard stop and clear immediate signposting to UK mental health services when a user’s input suggests a high-risk mental health keyword or suicidal intent?

[Baroness Merron (Lab)]

The noble Lord makes a very useful suggestion, and I will certainly raise that with my ministerial colleague at DSIT. I note that companies—admittedly, they are doing this when under pressure—are looking at introducing, for example, age assurance functionalities to ensure that users get the right experience for their age. But we should not be leaving that to chance, and we should not be leaving that to the fact that this is arising following legal challenge. I certainly look forward to looking into the point the noble Lord makes.

Tobacco and Vapes Bill

Lord Scriven Excerpts

Committee stage
Thursday 30th October 2025 Grand Committee

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I stand with some trepidation on this one, but I will give it a go. I have some reservations about this series of amendments. On Amendment 12, I have a lot of sympathy with having more transparency as a general principle, but I ask the noble Baronesses, Lady Northover and Lady Walmsley, how we would deal with having a dangerous precedent on the commercial confidentiality and sensitivities, for any company, and what can and cannot be revealed. Asking for information is one thing; mandating it is a whole different ball game. Many companies hold data close to themselves, as they are allowed to, because they are private entities. It is a legal thing to do and there are reasons, beyond malevolent ones, why that might occur.

I am particularly concerned about Amendments 192 and 194. As the noble Earl, Lord Russell, noted, tobacco companies already pay, or are responsible for, substantial duties that are collected. I am not sure that I entirely agree with the “polluter pays” principle—or, at least, it is quite complicated. It sounds virtuous, and in some instances I might well support it, but when I was reading these amendments I kept thinking, perhaps because of my left-wing, Marxist background, “Oh my God, this is a new form of legal wealth distribution by force”. It felt to me as though we were saying: “Forget economic growth. We’re just going take more from legal companies, but it’s all right because they are evil companies”.

In the words that the noble Earl, Lord Russell, used about his more specific amendments on what the money should be used for, if I may put it that way, I recognised an argument that I came across from Cancer Research. It has been very helpful in its briefings on the Bill and, in many instances, I agree with what it is putting forward. But in this instance, it said:

“At a time when funding for public health initiatives is limited, this proposal raises money without directly costing the taxpayer. Given the current economic challenges, this presents an opportunity for the Government to act decisively, should it choose to seize it”.


I kept thinking of this as a way of avoiding crises in public health, or in the NHS, by simply not resolving what should be an adequate health service for everyone while turning to private companies instead and trying to compensate for that. That is a dangerous precedent. Private companies should not let the state off the hook for what it should be doing, because those public health services should be provided by the state, regardless.

The fact that there is an economic crisis at the moment cannot just be meted out to companies that we do not like. I realise that tobacco companies have for some time been treated as especially evil, malevolent and harmful, but if you enter other debates and read the briefings of lobbying groups on other issues, you will hear similar moralistic arguments used about sugary foods, junk food, alcohol, gambling and even fossil fuels. I read a fascinating paper the other day which basically said that fossil fuels were killing us all and should be closed down, and so on. That is the kind of language being used.

I therefore worry about setting a precedent for a moralised hierarchy of legislators deciding which are the evil companies, and who gets to decide that, with a punishment then meted out. I say this because, briefly, I was a bit disturbed the other day at some mention of a report by KPMG. The data in it was dismissed as being from a report produced for Philip Morris, the tobacco company, as if that somehow closed down any possibility of a discussion—that having said that, the report could be laughed off. The idea that all you have to do is say the name of a tobacco company, and then close down valuable information, is quite dangerous.

It thought that was particularly unfair on KPMG. I am not necessarily a great fan of the big four accountancy firms, but they certainly have reputations. To write them off as being in bed with the evil Philip Morris, so that we take no notice of what they do, seemed a little unfair. If that were the case, have the Government let KPMG know that this is their view of it—especially since KPMG is a supplier to the Government, as I understand it, focusing on Civil Service training and economic matters? KPMG might have a case to answer on those things, but it should not be written off as a company because it has done some work for Philip Morris.

Neither is it appropriate for our discussions to always assume that everything a tobacco company says or does is evil because of the nature of the product. The product is harmful and contributes to cancer in many people—I know that—but if this Government believe that the tobacco companies are so uniquely evil that they are killing the population, they should have the courage of their conviction, make them illegal and ban them, not take their taxes and have it all ways.

[Lord Scriven (LD)]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Fox. Normal service is probably about to be resumed. I am on a different page from her on this issue.

These amendments give me the opportunity to clarify my position on the Bill. I fear that my previous opposition to the age-escalator provision in the Bill, meaning that some adults will never be able to purchase tobacco legally, has been misrepresented by some as a general objection to any form of regulation or restriction on tobacco. I state clearly that that is not the case. That is why I support all amendments in this group—Amendments 12 and 148, tabled by my noble friend Lady Northover, Amendment 192, tabled by the noble Lord, Lord Young, and Amendment 194 in the name of my noble friend Lord Russell.

I come back to something the noble Baroness, Lady Fox, said regarding the point made by my noble friend Lady Northover about data. If this was unique, some of those issues would need to be explored further, but this is not a first. For example, the water and energy companies have to give to the regulator investment details, asset details, investment plans and details of their costs and profits. This happens without commercial sensitivities going by the way. The amendments, particularly Amendments 192 and 194, generally represent a necessary and proportionate intervention to correct a profound fiscal and health imbalance, which is weighted too heavily in favour of the tobacco industry. The tobacco industry in the UK operates with a near monopoly, as many noble Lords have said, on selling an addictive product. The market structure allows them to generate excessive profits. They extract nearly £900 million per year in profit, while contributing little in terms of corporate tax to the Exchequer.

Simultaneously, the societal costs of smoking are vast, as the noble Lord, Lord Young, and my noble friend Lord Russell identified, with the NHS bearing the immediate cost of approximately £1.8 billion per year. The current system places the entire tax burden on the consumer and the taxpayer, while the manufacturer enjoys excessive returns. That is not only a moral wrong but an economic failure that government has a duty to correct.

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I assure noble Lords that we will consult on these requirements as we develop the necessary regulations. The noble Earl, Lord Howe, and other noble Lords may be aware that, as I referred to on our first day in Committee, the Government launched a technical call for evidence on 8 October; that included questions on registration and what information businesses may need to provide. I emphasise that it is the first stage in the process. I encourage the noble Baroness and other noble Lords to engage in that process in order to ensure that their views are considered. We think that it is best to wait until after the consultation has concluded to decide what information will be required to be provided by relevant producers and importers.

[Lord Scriven (LD)]

That is an important point. When will the consultation end? Will we have its results before we are asked to give this Bill its Third Reading?

[Baroness Merron (Lab)]

I will gladly come back to the points that the noble Lord has just made, if he will allow me. In the meantime, there is no doubt as to the intention and ambition of each of the amendments before us, but it is the Government’s view that they either are unnecessary, due to existing powers, or would risk introducing complexity and unintended consequences; they would not do the job that I know we all want them to do. Once again, I assure noble Lords that we remain committed to reducing smoking, to improving public health and to ensuring transparency around the tobacco industry’s activities.

In so doing—this is perhaps the overall point of this group—I can say that the answer to the question from the noble Lord, Lord Scriven, it is 3 December 2025 on which we can set that date for the call for evidence to close. What I am trying to say to noble Lords is that that is very soon. In answer to the noble Lord’s concerns about how long these things might take—

[Lord Scriven (LD)]

My question to the Minister was slightly different. It was not about when the consultation will close. It was about whether we would have the results and the Government’s view before Third Reading. That is the critical question—not, “When will the consultation close?”

[Baroness Merron (Lab)]

The noble Lord will be glad to know that I am reminded of what I should know already: matters in relation to the dates for Third Reading are matters for business managers. It will also depend on how much progress we make.

Tobacco and Vapes Bill

Lord Scriven Excerpts

Committee stage
Monday 27th October 2025 Grand Committee

[Lord Bourne of Aberystwyth (Con)]

My Lords, I will speak briefly on this group of amendments, which are regrettable, in my view. The previous Prime Minister, Rishi Sunak, is to be applauded for what he did, as are the previous Government and this Government. This measure should be nothing to do with party politics.

Interestingly, this is a measure on health, but the proponents of the amendments have not so far mentioned the word “health”. We have heard many arguments, some of which I understand—I will address them briefly in a minute—but, in essence, this is a health measure and we have our own Health Minister, quite rightly, responding to this set of amendments. It is her measure and the Government’s measure. This is a health measure and we should not shy away from the fact that it will save lives.

Those proposing the amendments said they were in favour of bringing in restrictions—there is an age limit now—but they did not say that to me when they were proposing this. It did not sound like that. When I was preparing for this debate, I looked at this set of amendments and, at the back of my mind, I was vaguely reminded of something. I remembered what it was—and they will not like this comparison, so forgive me. It was when Jeremy Corbyn was supposedly in favour of Remain and went around giving speeches on it. Similarly, this proposal seems very half-hearted.

At the core of the current legislation is an age limit. This alters only the way that the age limit applies. The suggestion, in its hyperbole, is that we are going to face a Wild West of people opposing this and so on. Perhaps we need more resources on enforcement, and we certainly need to put in resources to anticipate what small businesses will be doing, but do not forget that this will be a gradual ban; it will not happen overnight. We also need to spend money on cessation services. All of that comes up in a later group of amendments.

These amendments address something outstanding that the Government are doing, which the previous Government were committed to. We should not shy away from it. We can improve this legislation, but this set of amendments would drive a coach and horses through what is necessary.

[Lord Scriven (LD)]

My Lords, I find myself in difficulty in this debate. As many noble Lords will know, my party will have a free vote on the generational ban if any amendments are pushed on it. At Second Reading, I made my view about it very clear. I reaffirm my commitment to the aim of the Bill to reduce smoking and have a healthier nation, which is a crucial public health objective, and I support greater regulation that helps people quit and prevents addiction. I say that as somebody who saw both parents die of smoking-related illness, so I understand the effect that it has.

My worry about the Bill, and the reason I support the amendment in the name of the noble Lord, Lord Murray, is the assumption that by banning something, demand will automatically go. It will not go; it will just be shifted to a different market: the black market. That is what will happen; evidence throughout history always shows that. The question is: will the Bill therefore be enforceable to the shift in demand to different markets?

At Second Reading, I raised the issue of proxy demand. Where people are legally able to buy, how on earth will trading standards and the police be able to police every single household in this country, where adults will share tobacco and cigarettes? That is what will happen. I ask the Minister directly whether it will be legal if someone in England who is not able to buy tobacco because they are deemed below the age threshold goes to Jersey, buys tobacco, brings it back and smokes it. Will they be deemed to be carrying out an illegal activity in the UK? Where we had booze runs in previous generations, will we have ciggie runs for this generation? It is a real question.

If somebody goes to France, buys cigarettes and then gives them to somebody back in the UK who is not deemed able to buy them in the UK, will the fact that they have bought them in France but given them to somebody in the UK be an illegal act? Smoking will not be illegal; it is the buying, so if somebody buys in a foreign country, will that be deemed illegal? These are really important questions. The whole enforcement of this relies on those kinds of questions being asked. I do not know the answers, so I ask these genuine questions.

I also worry about trading standards. I heard what the noble Lord said about trading standards, but I declare an interest as vice-president of the Local Government Association. Trading standards officers and organisations I speak to are very happy with what is being proposed but raise great questions about how enforcement will be carried out. They welcome the extra £30 million over the next five years but make it very clear that, in their view, three times that amount will be required to effectively enforce this. They also worry about rolling age verification, particularly as this goes into the future—distinguishing between a 30 year-old and a 31 year-old, as the noble Lord, Lord Murray, said. There will be a rolling issue of enforcement.

Finally, I made clear my fundamental philosophical issue at Second Reading and I shall not dwell on it today. The illicit trade already accounts for one in four cigarette sales. That is according to figures in Civil Service World. They are not HMRC figures. The Civil Service World article stated that, historically and to date, HMRC still underestimates the illegal trade and suggested that it is more like one in four sales. My view is that, by moving demand, we will move more of this into the illicit trade and therefore the enforcement will be even more.

I come back to my central point. Legislation in itself is useless if it cannot be enforced and I have no idea how proxy buying will be enforced in individual homes. People may say that they are not buying for somebody but then pass it on. I therefore believe that the Bill will not create the smoke-free generation that some want by having a generational ban. A cut-off point of an age, followed through with better regulation and better smoking cessation policy, with money paid by the tobacco industry for those things—there are amendments further down that we will come to on that—will be more effective than this view that a generational ban will magically stop the demand and stop younger people smoking throughout their lives.

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

My Lords, I am most grateful for the amendments and also the contributions today. As we know, this group of amendments seeks to change or to place conditions on our smoke-free generation policy. As the noble Lord, Lord Young, and the noble Earl, Lord Howe, both observed, this group is very much at the core of the Bill and I understand the amount of interest that we have had today.

Let me say at the outset that there are a number of areas raised by noble Lords that I will return to in much greater detail, including, as the noble Baroness, Lady Walmsley, to: verification and retailers in group two; illicit sales and licensing in group 13; tobacco products that are in scope in group 16; and vaping, which is in groups five and six. I look forward to the detail of those debates when we get to them.

Perhaps I could say that I am grateful for the supportive comments on this Bill, which, as we have been reminded throughout, was introduced under the previous Government. Credit goes to them for doing so, in particular for the commitment that was shown by the former Prime Minister, the right honourable Rishi Sunak. I am therefore grateful to my noble friend Lady Carberry, the noble Baroness, Lady Northover, and the noble Lord, Lord Bourne, who helpfully reminded us all that this is a health Bill, and that is what we are here to consider. I also thank the noble Lords, Lord Bethell and Lord Young, and the noble Baroness, Lady Walmsley, all of whom have been supportive of the smoke-free generation principle and have emphasised to the Committee today the amount of public support for that and its role in stopping the cycle of addiction.

I will start with the amendments tabled by the noble Lord, Lord Murray of Blidworth, which propose changing the age of sale and proxy purchasing offences. These amendments would make it an offence to sell tobacco products, herbal smoking products or cigarette papers to a person under the age of 21. They would also make it an offence to buy or attempt to buy these products on behalf of anyone under the age of 21.

I am also grateful for the points that were just made by the noble Earl, Lord Howe, on this group of amendments. I cannot fail to emphasise that smoking is indeed the number one preventable cause of death, disability and ill health. It is unique in its harm, because it claims the lives of around 80,000 people a year in the UK, it causes one in four of all cancer deaths in England and up to two-thirds of deaths in current smokers can be attributed to smoking. I am sure that, over the years, noble Lords have heard the Chief Medical Officer’s opinion of the contribution that smoking makes, and that there is no safe level of smoking.

To the point raised by the noble Baroness, Lady Fox, who spoke about restrictions on adults’ individual autonomy, three-quarters of people who smoke wish that they had never started smoking. The majority want to quit and we want to help them. In my view, smoking is not about freedom of choice; I believe that the tobacco industry takes that choice away through addiction, particularly at a young age. In my view and that of a number of noble Lords whom I have heard speak, there is no liberty if we are speaking of addiction.

Almost every minute, someone is admitted to hospital because of smoking and up to 75,000 GP appointments can be attributed to smoking every single month. There is, as has been referred to, an economic cost. It is estimated to cost our society more than £21 billion a year in England alone, including £3 billion a year in costs to our health and care service. This is far from insignificant.

That is why this Government has made a commitment to create a smoke-free generation, so that anyone born on or after 1 January 2009 will never be legally sold tobacco products. I recall the noble Lords, Lord Scriven and Lord Mackinlay, making a particular reference to the potential contribution of people bringing tobacco back from abroad, but the noble Baroness, Lady Fox, and the noble Lords, Lord Murray and Lord Strathcarron, talked about the Bill prohibiting smoking. Let me make it clear: the smoke-free generation policy is not about criminalising people who smoke. It will not be an offence to possess or consume tobacco, regardless of your age. I can tell the noble Lords, Lord Scriven and Lord Mackinlay, that we are not imposing new restrictions on bringing tobacco back into this country.

I agree with my noble friend Lady Carberry. It is my belief—it is not just a belief, in fact; it is based on experience—that, if we raise the age of sale to 21, to which this group of amendments refers, the tobacco industry will simply change its business model and target older adults; a number of noble Lords referred to this. It will not meet our ambition of a smoke-free UK.

Similarly, the Bill makes proxy purchasing an offence such that anyone over the age of 18 cannot legally purchase tobacco products on behalf of someone born on or after 1 January 2009. The noble Lord, Lord Scriven, and the noble Earl, Lord Howe, asked important questions about the handling of proxy purchasing. I have explained clearly what the offence is and who would be responsible for it. This is about protecting children from the harms of smoking. I reiterate that tobacco is uniquely harmful. As I have said, there is no safe level of smoking; I emphasise that, to my knowledge, no other consumer product is killing two-thirds of its users.

[Lord Scriven (LD)]

I just want to pursue the issue of proxy purchasing abroad. My question was not about whether people will be able to buy tobacco abroad or whether duty-free limits will cease. My question was: if somebody buys cigarettes in a jurisdiction outside the UK and, when they come back, gives one of them to someone who is not legally entitled to buy them here, will that be an illegal act for the UK citizen who has bought that product abroad?

[Baroness Merron (Lab)]

The purchasing referred to is within our jurisdiction.

That gives me an opportunity to make a general but important point. This is about changing culture and practice. It is not about everything staying the same. This is not just a message but a practice in terms of what is acceptable and what is not. All noble Lords have seen changes over the years, as I did when I was the Public Health Minister in the previous Labour Government, which have meant that we can speak about this Bill, as we are doing today, in a way that I do not think would have been possible just a few years ago. Tobacco is a deadly addiction, and preventing children starting to smoke is undoubtedly the easiest way to reduce smoking rates. We have to be bold and brave on this, which is why we are committed to creating a smoke-free generation.

My noble friend Lady Carberry mentioned the impact assessment. Modelling shows that creating a smoke-free generation is expected to help reduce smoking rates among 14 to 30 year-olds to near zero by 2050. That is a prize worth having, in my view. Over the next 50 years, it will save tens of thousands of lives, as well as many years lived in ill health with misery, discomfort and pain; it will also avoid up to 130,000 cases of lung cancer, stroke and heart disease. As I say, all of these are, I believe, prizes worth having.

On the impact assessment, a number of noble Lords said that an “age 21” policy would have just the same impact as a smoke-free generation policy. That is not true. We are aware that the tobacco industry has been telling parliamentarians this. I must say, again, that it is incorrect. The published modelling considered different scenarios for the impact of the smoke-free generation policy; it did not model the impact of raising the age of sale to 21. I believe that we have a responsibility to protect future generations from becoming addicted to nicotine; to break the cycle of addiction and disadvantage; and to allow people the chance to live healthier lives.

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The noble Lord, Lord Scriven, mentioned an article in Civil Service World that referred to a particular percentage of cigarettes being illicit. I understand that that article was written by Philip Morris Ltd; I will, therefore, leave noble Lords to make their own decisions on it.

[Lord Scriven (LD)]

The Minister must be clear that the report was done by KPMG; it was commissioned by Philip Morris Ltd, but it was not written by that organisation.

[Baroness Merron (Lab)]

I am happy to accept that clarification, but the point that I am driving is still being driven.

I now move on to Amendments 5 and 205 in the name of the noble Lord, Lord Moylan, which seek to introduce an interim age of sale of 21 at Royal Assent, before the smoke-free generation provisions come into force. Although I appreciate the noble Lord’s ambition in seeking to raise the age of sale for relevant products, which we are discussing, it is my view that these amendments are not necessary; indeed, they would distract from our ambitions. Let me explain why.

Under this Bill, the smoke-free generation will come into force in 2027 when people born on or after 1 January 2009 turn 18. Subject to timetabling, these amendments would mean that any interim age of sale proposed by the noble Lord would be in place for only a year or less. Retailers and enforcement agencies—they are, as many noble Lords have acknowledged, absolutely key to the success of this measure—would not be provided with any time to prepare for the increase to 21. I do not feel, therefore, that a measure such as this one would be helpful; indeed, it would divert resources.

The important matter of communication to the public came up in the debate. The noble Lord’s amendments would confuse all such communications if a different regime were to apply for such a short time.

The noble Lords, Lord Strathcarron and Lord Mackinlay—as well as other noble Lords—referred to the situation in Australia. Let me say this in response: we are not aware of any evidence for the illicit market in Australia being the result of a change in the age of sale. In fact, I am advised that Australia has not changed its age of sale since 1998. I say this to noble Lords: the UK is highly regarded for its robust, comprehensive approach to tackling illicit tobacco. Despite what the tobacco industry may say, implementing tobacco controls does not lead to an increase in the illicit market.

MBRRACE-UK Report 2025

Lord Scriven Excerpts

Thursday 23rd October 2025 Lords Chamber

[Baroness Merron (Lab)]

I can give that assurance in respect of services across the country. The independent maternity and neonatal investigation will act at pace. It is an independent investigation and will be chaired by the noble Baroness, Lady Amos. In addition, the Secretary of State, Wes Streeting, is showing how high a priority it is for us to provide urgent action on this by chairing the maternity and neonatal task force himself. These projects will work at pace to bring about the change we need to see.

[Lord Scriven (LD)]

My Lords, I am pleased to hear the Minister say that this is urgent. While waiting for the review to take place, the report called for improved interagency working. While the Government are waiting for that review, are there any specific changes to information sharing and co-ordinated care pathways between maternity services, social services, specialist domestic abuse services and other statutory agencies that the Government will ask to be implemented on an interim basis, to ensure that as many women as possible live?

[Baroness Merron (Lab)]

It is important to say that we are not waiting for the results of investigations or task forces in order to take action. A number of projects are already in train and making a difference. For example, we are rolling out maternal mental health services and specialist perinatal mental health services in every area across the country. I will give one example to address the point that the noble Lord raised. A single patient record will ensure that maternity teams have all the information they need about previous consultations. That will be of great assistance in improving safety and efficiency.

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[Lord Scriven (LD)]

While we are talking about Leeds, can the Minister explain, following on from the previous question on leadership, how the former chief executive of the Leeds Teaching Hospitals, who was in post at the time that this was happening, can then go on to become the chief executive of the CQC? Do recruitment processes need to be looked at, particularly for chief execs who have been leading failing services such as the ones in Leeds?

[Baroness Merron (Lab)]

I note what the noble Lord says and will take his comments back to the Secretary of State.

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

Lord Scriven Excerpts

Tuesday 21st October 2025 Grand Committee

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank the Minister for her very clear introduction of this SI. It is a pleasure to follow the noble Baronesses, Lady Hollins and Lady Ritchie, and to say, perhaps counterintuitively, that I agree with both of them. It is very clear that there are arguments for steps forward because of the way in which circumstances and technology have changed: there is an argument for reform. But the questions put by the noble Baroness, Lady Hollins, are very important and we have to put those into context.

I note that a survey put out in August by the National Pharmacy Association and Community Pharmacy England said that 63% of pharmacies could close in the next year and only 6% of pharmacies were profitable. Only 25% of pharmacies are independent; the rest are either corporate or supermarket-owned pharmacies.

The concerns are obvious when we are talking about that last group. There is a risk of seeing one pharmacist having effective control and providing authorisation to a large number of pharmacy technicians where there might be corporate structures that put a large amount of pressure on financial returns rather than ensuring absolute safety and the controls that are needed. So we need to understand this SI in that context. Obviously, in some ways that is what is driving the SI, but we also need to think about the controls and where there is huge financial pressure on independence. A majority of prescriptions now come through giant corporate companies with very distant methods of control.

My second question is on timing. I note that on 1 October the General Pharmaceutical Council opened its consultation on overhauling the pharmacy technician training framework, including plans to move study from level 3 to level 4. It rather feels that we have just opened a consultation on changing the training, yet here we are bringing in regulations that almost seem to be assuming that that training has already been stepped up. Would it not be a better idea to step up and overhaul the training and then bring in the different regulations? The consultation suggests there is a very clear understanding that there is a need to improve the training of pharmacy technicians.

My final set of questions has to go back to physician and anaesthesia associates and the Leng review. I would like to understand how this SI fits within the broader framework of regulation of all the medical professions. I note, looking back over the history of this, that we go back to 2014 and the Law Commission recommendations about the regulation of a new single legal framework for health and care professionals. Under the previous Government we had consultations in 2017, 2019 and 2021, all of them in this space. So far as I have been able to discover, they did not seem to cover physician technicians: certainly not in much detail. This whole physician and anaesthesia associates débâcle, I have to say, was supposed to be part of a whole process of looking at all stages of medical regulation right across the board. How does this SI fit within that framework?

Finally, I have to note that, in the Chamber on 16 July, I was told that the Government would be delivering an implementation plan for the Leng review in the autumn. I have noticed that quite a lot of leaves seem to be changing their colour at the moment. I know that the government definition of “autumn” can be quite extended, but perhaps the noble Baroness could update us on when we can expect to see that implementation plan.

[Lord Scriven (LD)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Bennett. In fact, it is a pleasure to follow all noble Baronesses who have spoken and to be the first Baron to speak in this debate. A bit like the noble Baroness, Lady Bennett, I counterintuitively support quite a lot of what has been said, even though some of it is quite contradictory and does prompt questions, even though the generality is supported.

I also thank the Minister for outlining in a clear and understandable way the order before the Committee. In my role as vice-chair of the APPG on Pharmacy, I have been able to speak not only to a number of organisational groups but to individual pharmacists to understand some of the differences of opinion within the sector.

This is without doubt a pivotal moment, marking a significant shift in pharmacy regulation. I offer the Government our general support for the core principle of modernising an outdated legal framework to unlock clinical capacity. As the noble Baroness, Lady Ritchie, pointed out, for far too long—in fact, since 1933—regulations have been rigid, forcing highly qualified pharmacists to oversee tasks that can be safely and competently managed by other registered professionals.

This order, by introducing the concept of authorisation and delegation to pharmacy technicians, corrects this historical anomaly. The benefits are clear; it empowers pharmacists to fully embrace clinical roles: prescribing, consulting and administering services, probably as part of the new neighbourhood health services that the 10-year plan suggests. It validates the expertise of pharmacy technicians, providing them with greater autonomy, particularly in complex environments like hospital aseptic facilities. It introduces, to use the Minister’s phrase, common sense measures of allowing trained staff members to hand out pre-checked, bagged medicines in the pharmacist’s temporary absence, ending needless patient delays.

However, the consultation process responses, which saw over 5,000 replies, revealed a sector divided. Although professional bodies and pharmacy technicians largely welcomed the proposals, we must not ignore the fact that many individual pharmacists expressed profound concern, as quite rightly highlighted by the noble Baroness, Lady Hollins. It is here in the detail and the perceived risk that we must focus our scrutiny. Indeed, while welcoming the statutory instrument, there could be some unintended consequences. The issues raised are not frivolous; they are structural and require ministerial assurance.

I wish to highlight three major areas of risk. The first one is patient safety, training and accountability. The core objection from many pharmacists relates to the level of initial education and training required by pharmacy technicians to take on these new autonomous roles. As the noble Baroness, Lady Bennett, pointed out, the consultation has just started. It ends on 24 December. It will not pick up pace until at least early 2026, and then there will be the training, the qualifications for the training and the accountability for the training. Are the Minister and the Government convinced that there is enough time to roll out not just the training but to assure its quality before technicians are allowed to do this?

The noble Baroness, Lady Hollins, has really highlighted the problems that could come around with vague authorisation. If a pharmacist gives a general or oral authorisation without clearly defining the scope, conditions and limitations for the technician, it could lead to confusion and mistakes, particularly concerning high-risk medicines. I was going to ask similar questions to the noble Baroness, Lady Hollins, but I will leave those to one side.

There also is, potentially, an accountability gap. While the order notes that a pharmacist’s failure to have a

“due regard to patient safety”,

may lead to professional misconduct, establishing clear accountability when a technician makes an accuracy error under general supervision could be challenging for regulatory bodies. There is a contradiction there that needs to be understood.

Also, on dispensing queries, the new rule allowing a sale supply of ready dispensed products in the pharmacist’s absence creates a challenge. For example, will a shop assistant who has been there for one day and works in the pharmacy be allowed to do this? It does say “any member”, so I am pleased that the Minister is shaking her head. I seek reassurance on that particular point.

What if a patient has a question about the medicine? The person carrying out the transaction must know when they are qualified to answer and, crucially, when they must stop the transaction. How will this be addressed and understood by all concerned? The safety mitigation is reliant on the General Pharmaceutical Council-strengthened guidance and rules—work that is still pending, as we have heard. We must ensure that this guidance provides absolute clarity on the minimum competence standards required for authorisation and, crucially, that the professional indemnity cover for those roles is appropriate for the new scope of the responsibility.

Secondly, on the risk of undervaluing dispensing services, as the Minister said, the changes are enabling and not mandatory, yet the risk of financial exploitation is real. Pharmacies are already funded below cost for dispensing. My concern mirrored—

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[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?

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[Baroness Merron (Lab)]

It is important to keep all matters under review—and I would want more than that—because we need to see how things are going. Certainly, the monitoring will continue. However, I would counsel a bit of caution: increases may not be directly related. As the noble Baroness well knows, it is always a complex situation, but certainly monitoring will continue. We will want to see how these reforms are working.

On training, I say to the noble Lord, Lord Scriven, that initial education training is assured by the regulator. Post-qualification training is a responsibility of NHS England. No pharmacy technician should be acting outside of their competency, and pharmacists have the responsibility that I outlined of ensuring that they are delegating tasks appropriately.

On accuracy errors, which the noble Lord, Lord Scriven, raised, pharmacists and pharmacy technicians remain professionally accountable for their actions. There is no change to that. On the question from the noble Lord, Lord Scriven, about a patient having a question about their medication, the pharmacy technician, or the other professional handing out the medication, will be trained to refer this back to the pharmacist. So, again, that assurance can be given.

I make reference to pharmacy funding because the noble Lord, Lord Scriven, raised it. We have been quite clear that funding community pharmacy is a priority. The new community pharmacy contractual framework, which has been secured by this Government, is the first step in rebuilding community pharmacy as part of our plan for change. There is a £3.1 billion deal; it is the largest uplift in the funding of any part of the National Health Service, which shows, I believe, our commitment to supporting community pharmacy and building a service that is fit for the future.

[Lord Scriven (LD)]

I know that the sector welcomes the commitment from the Government to the uplift—that is not in doubt—but that fact is that, even with the uplift, dispensing fees are still below cost. The question was quite specific, because it is causing a bit of worry in the sector: can the Minister assure the sector that, because this measure is enabling and not mandatory, the Government will not use a skill-mix change as a way of trying to reduce dispensing costs?

[Baroness Merron (Lab)]

I will be pleased to write to the noble Lord in greater detail, if he will allow that, because his question raises a whole range of points, and I would like to be accurate in my response to him.

I move on to the points made by the noble Lord, Lord Kamall, about the transition period. I hope that it is helpful for me to say that, following the approval of the Privy Council and royal approval, provisions on handing out checked and bagged prescriptions in the absence of a pharmacist will apply, as I mentioned earlier, some 28 days later. The other measures will be brought into force after a one-year transition period, which will be enacted by an Order in Council to be agreed with the Privy Council. This will allow time for the professional regulations and guidance that are absolutely crucial to making this work to be updated; we cannot do this without that time.

Noble Lords have made extremely helpful and important points today. I know that there is more work to be done to ensure that the sector is fit for the future so that we can deliver the change described in the 10-year health plan. I am grateful for noble Lords’ support for innovating and modernising the regulatory framework, because pharmacy services must be sustainable, deliver quality services and deliver the outstanding patient care that we all deserve. I thank noble Lords for their contributions and questions.

HIV: Testing and Medical Care

Lord Scriven Excerpts

Monday 20th October 2025 Lords Chamber

[Baroness Merron (Lab)]

I certainly can assure my noble friend that, in our discussions with the devolved Governments, we highlight this area and will continue to do so.

[Lord Scriven (LD)]

My Lords, I have a question about regional variations. Some 37% of all community tests were carried out in London in 2023, but only 1.1% in the north-east. What action will the Government take to deal with this regional variation?

[Baroness Merron (Lab)]

The UKHSA supports local areas to improve delivery, not least through data monitoring and reporting, which is vital. Without commenting on specifics, I will say that there will be variation because of incidence and the needs of local populations. We account for this in our funding and direction. What really matters is equality of access and outcome, which will remain a real focus of the plan that I look forward to presenting to your Lordships’ House.

Healthcare Provision: Inequalities

Lord Scriven Excerpts

Monday 20th October 2025 Lords Chamber

[Baroness Merron (Lab)]

I can indeed give that assurance, and I am grateful to my noble friend Lady Brown for her voice on the matter of women’s poor hysteroscopy experiences. These are unacceptable and part of a wider issue of women’s pain being normalised. Women must be given the opportunity to discuss pain relief with a clinician before the procedure. While I am glad to say that updated guidelines from the Royal College of Obstetricians and Gynaecologists do emphasise minimising pain, it is clear that more action is needed. I assure my noble friend that we are updating the Women’s Health Strategy for England to address what I believe is a wider issue, and to improve the experiences of women across the country.

[Lord Scriven (LD)]

My Lords, clinical evidence has established that poor health care directly contributes to the current 22-year life expectancy gap between people with learning disabilities and the general population. Why is this unacceptable inequality simply becoming a grim statistic that the Government continue to pay millions of pounds to measure, but are reluctant to take statutory measures to end?

[Baroness Merron (Lab)]

It is an unacceptable situation, as the noble Lord says. However, I refer him to the national approach, which will inform action in communities, including for people with a learning disability and those who are autistic. The Core20PLUS5 informs the reduction of healthcare inequalities among a range of groups; and, extremely importantly, it supports NHS organisations in identifying who might be at risk of poorer experiences, and in addressing this. I agree with the noble Lord that this must include those with a learning disability and those who are autistic.