NHS: Patients with Allergies

Lord Scriven Excerpts

Thursday 12th December 2024 Grand Committee

[Lord Scriven (LD)]

My Lords, I thank the noble Baroness, Lady Ramsey of Wall Heath, for introducing this debate. I also thank the noble Lord, Lord Mendelsohn, and the noble Baroness, Lady Keeley, whom it is a pleasure to follow, for bringing this issue to life with personal stories that go beyond the statistics and bring home exactly what we are talking about today.

Allergy services in the UK are at a critical juncture. As my noble friend Lady Burt said, with more than 21 million people affected, allergies are no longer a niche issue. They represent a public health issue, from life-threatening anaphylaxis to chronic conditions such as allergic eczema. These conditions profoundly impact individuals, families and the NHS yet, despite this growing prevalence, the UK’s allergy care system remains inadequate. The Government must act to bridge these gaps and create a robust, equitable allergy care framework, with the Government and the NHS at the helm of these reforms.

Let us acknowledge the scale of the problem. Hospital admissions for allergic reactions have increased by 615% in the past 20 years. As other noble Lords have said, shockingly, there are only 40 specialist allergists; that is one for every 525,000 patients. For patients, this translates into a postcode lottery of care, with many waiting more than 18 months for appointments. Primary care also faces significant challenges, with most GPs lacking adequate allergy training. This leads to unnecessary referrals, misdiagnosis and poorly managed conditions. The strain is particularly acute for children and young adults. Food allergies, which can be fatal, are rising sharply in children, yet there is a severe lack of specialist support during the critical transition from paediatric to adult services, as other noble Lords have said. What priority will the Government put on these transition services?

The gaps in care are not just a human tragedy; they are an economic burden as well. Allergy care costs the NHS more than £1 billion annually in emergency admissions, prescription costs and referrals. Addressing this crisis requires systematic change, not piecemeal change, with the Government and NHS having to play pivotal roles. I ask the Minister: what will the NHS do urgently to expand the workforce? This includes increasing the number of specialist allergists and immunologists, as well as training GPs and nurses in allergy management.

A promising model was demonstrated in a pilot project by Allergy UK, where nurse-led clinics reduced waiting times from 18 months to just four to eight weeks. Some 95% of cases were managed successfully in primary care, saving not just lives but costs. What is the Government’s view on this pilot being rolled out nationally? Additionally, the Government should allocate targeted funding to recruit and train more allergy specialists.

Investing in allergen immunotherapy services is also critical. Although they are costly up front, these treatments prevent severe reactions and reduce long-term healthcare expenses. As many other noble Lords have said, we need to appoint a national allergies tsar or clinical director to lead a co-ordinated strategy. This role would oversee data collection, resource allocation and policy implementation—and, to put it bluntly, it would knock heads together to make sure that action happens. What is the Government’s view on appointing such a clinical director, and is there a timeframe for doing that?

Empowering primary care is vital to reduce pressure on specialist services. This can be achieved by embedding allergy-trained nurses and dieticians in every integrated care system, as other noble Lords have said. These professionals would manage routine cases, leaving specialists to handle the more complex ones. Where will the move from hospital care to community care fit in within the 10-year plan?

The absence of robust reporting systems for allergic reactions is another glaring gap. A mandatory near-miss reporting system for anaphylaxis, akin to the system in place in Australia, would allow us to identify emerging risks and act upstream. Will the Government look at such a mandatory near-miss reporting system?

Lastly, we must focus on prevention. Early allergen introduction and proactive eczema management in children have been proven to reduce lifelong allergy risks, yet these strategies remain underutilised. Will the Government prioritise funding for education campaigns and preventive measures? Improving allergy services is not just about saving lives; it is about improving the quality of life for millions of people. By investing in specialist care, empowering primary care and adopting preventive strategies, we can take important steps to transform allergy care.

Health: Quad-demic

Lord Scriven Excerpts

Tuesday 10th December 2024 Lords Chamber

[Baroness Merron (Lab)]

We are aiming communications —I know the noble Lord will be familiar with this from his previous role—particularly at groups that are less represented in terms of vaccinations. From my discussions with the national medical director, I do not recognise the reference that the noble Lord made to hospitalisations; they are as I set out in the Answer to my noble friend. However, we are far from complacent and continue to push vaccination. We will get vaccination rates up because they are the best line of defence against infectious diseases.

[Lord Scriven (LD)]

My Lords, the chief medical officer at the UK Health Security Agency stated last week that NHS staff should get the flu vaccination. The Government’s own statistics show that last week, in the largest trust in the country, only 7.9% of those eligible had had flu jabs, and on average the number is in the lower 20%. Why has this happened? What are the Government doing urgently to improve the take-up of the flu vaccine by NHS staff?

[Baroness Merron (Lab)]

I must be honest: I cannot explain here the exact reasons why NHS staff are not taking it up, but I assure the noble Lord, as I have assured other noble Lords, that our focus is on getting vaccination rates up. That is why the national medical director made the comments that he did, as well as assuring me that we are not nearing a pandemic.

Physician and Anaesthetist Associate Roles: Review

Lord Scriven Excerpts

Thursday 5th December 2024 Lords Chamber

[Lord Scriven (LD)]

My Lords, this has been a short but useful debate introduced by the noble Baroness, Lady Bennett. The Question that she laid before the House underlines the lack of balance that she opened with. She asked

“what the review, announced by the Secretary of State for Health and Social Care on 20 November, of the physician associate and anaesthetist associate roles will cover, and what actions they plan to take in advance of the outcome”.

I would hope that if a review of this controversial issue was taking place, it would be considered wise to wait for the evidence and recommendations, not just do something on instinct or limited evidence. Therefore, it is welcome that the Government have opened the Leng review into how physician associates and anaesthetic associates are deployed as part of a team to improve patient outcomes working under the supervision of doctors to support the delivery of medical care.

I thank the approximately 5,000 physician associates and 300 anaesthetist associates who are registered or practising for the professional and dedicated work they do, and the thousands of doctors, nurses and other allied medical professionals of all levels who quietly but professionally and supportively work alongside PAs and AAs as part of the medical team to improve the health of patients.

If I were to think back to when other health professional roles were introduced into healthcare settings when I was managing in the NHS, the issues raised about the work that these healthcare professionals do, and the potential issues that arise, are no different. This is not anything new. What is new is the level of unprofessionalism and hostility that has been shown to these roles.

The lack of respect and the bullying behaviour that some medical leaders within the BMA have decided to adopt when dealing with the issues around the use and deployment of these professionals are not only unacceptable but go against the very GMC regulations that govern you as a doctor. On collaborative working, the regulations say:

“Work effectively … with colleagues in the multidisciplinary team”


and

“respect the skills and contributions”

of all healthcare professionals. Some of the examples of ostracisation, making false claims and bullying at work fall far below what doctors are expected to do and the standards that they are expected to uphold. To that small minority of doctors, I say, “Stop”.

It is clear that PAs and AAs have not had the introduction or supervision that has led to some care being optimal. However, to quote individual cases and then equate the lack of patient safety with all PAs or AAs is neither useful nor correct. The very nature of healthcare is that risk is there and can and does lead to problems. This happens across all professional groups involved in healthcare provision. The issue at hand is whether PAs and AAs have more never events or near misses than other medical and healthcare professionals. Surely, that should be a key line of inquiry to work out the safety of these professions.

Physician associates are mid-level healthcare professionals trained under a medical model to support doctors in diagnosis, treatment planning and patient care. They have a science degree, predominantly, and two years of postgraduate training. PAs can enter the workforce sooner than fully qualified doctors, and, as some evidence suggests, they can make a real difference in relieving pressure on overstretched health services.

The NHS has been using a model of PAs since 2003, and their role has expanded over the years. Yet, despite 20 years of valuable contributions, their integration remains controversial. Some doctors have rightly voiced concerns about their short training period, lack of regulatory authority and potential competition for roles. These concerns deserve thoughtful consideration, which is why the investigation will take place, but they should not overshadow the evidence demonstrating the benefits that PAs and AAs can bring to our healthcare system.

Research led by Professor Vari Drennan and colleagues has provided compelling insights into the effectiveness of PAs across various settings. For instance, an observational study comparing PAs and GPs in primary care found that consultations with PAs resulted in no significant differences in re-consultation rates, diagnostic testing, referrals or patient satisfaction, while maintaining comparable patient outcomes. In secondary care, a BMJ Open study evaluated PAs working in emergency departments alongside doctors in training. It concluded that PAs were equally effective and safe, with no significant differences in clinical adequacy or unplanned re-attendances. What is more, PAs were praised for improving team continuity and efficiency, allowing doctors to focus on more complex cases. These findings demonstrate that PAs can provide high-quality care while addressing staffing mix issues in primary and secondary care settings.

To address the concerns, the new GMC regulation regime will help to deal with some of the genuine issues raised around the scope of practice. I need to be clear, as people keep talking about a national scope of practice. The scope of practice—that people are working within their competence—is down to the individual. That is exactly what the GMC does now with individual doctors. Individuals have to work within their scope of practice, and standards will be laid down by the GMC, which then allows the scope of practice and revalidation to take place. We need to be clear what we are talking about. Along with this new regulatory scheme, there will be professional accountability for education, training and conduct, and it will ensure that individuals undertaking these roles are safe to practise.

Secondly, it would be useful for the NHS to undertake a refreshed national public campaign to raise awareness of PAs and what they do. Some patients still mistake PAs for doctors or nurses, which can lead to confusion and undermine trust and satisfaction. Research conducted in 2021 revealed that a simple information leaflet, co-designed with patients, significantly improved patient understanding of and confidence in PAs. Expanding such initiatives across the NHS would enhance public confidence and empower patients to make informed decisions about their care.

As we move forward, and when the Leng review reports, we must ensure that PAs and AAs are regulated to the highest standards and adequately equipped to perform their roles. Furthermore, improving public understanding of PAs will help their role to be understood more widely by the public.

With these measures in place and other recommendations that will emanate from the review, PAs and AAs will not only help, as part of a modern medical team, to address the future demands of patients but, if the review identifies the key changes required and the Government act on them, become a vital part of a resilient NHS. I hope we can all embrace the opportunity to support our health service and improve patient care.

NHS Plan: Consultation

Lord Scriven Excerpts

Monday 2nd December 2024 Lords Chamber

[Baroness Merron (Lab)]

I agree with my noble friend: we have to hear from unpaid carers, because that will strengthen the exercise. We are constantly monitoring which groups are responding and which are not, and that allows us to tailor our approach to the underrepresented groups who are not coming forward. If that includes unpaid carers, the consultation absolutely will make special, tailored efforts to reach them.

[Lord Scriven (LD)]

My Lords, the life expectancy of people with learning disabilities is, on average, 20 years less than the general population’s. Research has shown that a major contributor to this is a lack of access to appropriate healthcare. What will the Minister do to ensure that this group of people will be not only consulted but listened to, and that the 10-year plan will provide appropriate services tailored to them?

[Baroness Merron (Lab)]

This is indeed one of the groups for whom we need to ensure absolute inclusion. As I mentioned, the work with integrated care systems will be particularly helpful in running the workshop. We train organisations to work with it, and it is designed so that it is easy to use. It can be used in events to reach the seldom-heard voices in communities, including those with learning disabilities. It is vital that we hear from them as we design an NHS fit for everybody for the future.

NHS: Dentistry Provision

Lord Scriven Excerpts

Monday 25th November 2024 Lords Chamber

[Baroness Merron (Lab)]

I commend the noble Lord for raising his long experience of facing and dealing with these problems locally in Norfolk. I note the report in September that the Norfolk and Waveney area has the worst ratio of NHS dentists to patients in England, with 1,000-plus people having to attend Norfolk’s casualty department last year due to serious dental issues, so this is a serious point. We are aware of the University of East Anglia’s interest in this area, and my colleague Stephen Kinnock, the Minister responsible for this area, recently met with east of England MPs to discuss this matter. However, as I have said, it is not the Government who make these decisions, although we encourage those new dental schools to be in areas of particular need. I encourage the University of East Anglia to take its proposals to the General Dental Council.

[Lord Scriven (LD)]

My Lords, has any extra allocation been made in-year—this year—from the Budget’s NHS allocation for the extra appointments the Government wish to see in dentistry, or is this expected to be bought from existing ring-fenced dentistry budgets?

[Baroness Merron (Lab)]

My Lords, the Government are investing around £3 billion in dentistry each year. As the noble Lord will be aware, I cannot yet confirm 2025-26 dentistry budgets, but they will be confirmed in planning guidance published by NHS England in due course. I know that the noble Lord will be aware that, despite the tough fiscal circumstances the Government have inherited, the Budget set out a big increase in day-to-day spending for health and social care. Regarding the process, and our planning, it is entirely normal that we set out matters in planning guidance. We are, of course, keen to reform the dental contract with a shift to focusing on prevention and the retention of NHS dentists. That work is immediately under way.

Mental Health Bill [HL]

Lord Scriven Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

[Lord Scriven (LD)]

My Lords, it is a pleasure to follow the noble Lord, Lord Bradley, who was the MP for the constituency I lived in when I was a student. In those days, I campaigned against him, but, from listening to his speech today, I am sure that we will campaign together in Committee on some of the reforms that may be required in the Bill.

This Bill is a welcome direction of travel for mental health legislation in the United Kingdom, but it is only an extra stop. As other noble Lords have said, sometimes we have to look at the bus we are on—the underlying legislation. That bus was built when I was 17 years old, if we go back to the 1983 legislation, and it had its last MOT 17 years ago, in terms of its amendments. I believe that, although these measures are welcome, there is still a fundamental issue in terms of the basis of what we are traveling on. I understand the problems with that.

The questions we are really asking in this Bill are quite limited in the sense of the balance between individual freedoms and public protection when it comes to the detention of individuals. Because we look at such legislation infrequently, we must do our best in Committee to ensure that the balance is at its best and that, wherever we can, we take a person-centred, rights-based approach to this legislation. Having said that, there are some pleasing points in the Bill, including the tightening of the criteria for the detention and compulsory treatment of individuals. It is welcome that the four key principles are mentioned but it is a shame that they are not on the face of the Bill and are down as guidance only. It is important that those of us who really support the principles fight for them to be on the face of the Bill in Committee.

The advance choice documents are a welcome provision but, as many noble Lords have said, they need to be fully accessible 24 hours a day, 365 days a year to those who care for people who have given an advance choice document. I question why they are only for people aged 18 and over. If we are looking at Gillick competence, there are issues around those who are younger, who should be able to provide an advance choice document. I worry that they are not a right or a duty but are only to be given as a consideration.

I welcome the right to a nominated trusted individual but many people who have been involved in healthcare will know that it is not just about having that person as a right; it is about the way in which professionals listen to them and carry out the advocacy that they provide. I am not sure, as we start with this Bill, that the balance is correct; I believe that certain issues will have to be addressed in Committee.

I have also looked at the potential implementation of the Bill. It is always good to start with the impact assessment. It has in it some quite startling issues that I think we will want to look at in Committee. For example, community treatment orders are not meant to change for at least another seven years, but the implementation start is in seven years. The existing CTO regime will last for another seven years and, from the Government’s impact assessment, it looks as though the new regime will start in seven years at the earliest.

I will come back to people with learning difficulties and autism in a second, but the implementation of the measures for them not to be held for more than 28 days and for other provision in the community to have to be available will be in three years’ time, according to the impact assessment. However, there is no money in the next two years to start to provide for those community facilities. It is as though they will come on stream the second the implementation date is reached; I question the Government’s planning on that and whether it is a realistic adaptation for people with learning difficulties and autism.

My passion and focus in Committee will probably be learning disabilities and autism, because they are personal to me. I have close family members who are loving and warm but very misunderstood by those who do not have a close relationship with them. It is scandalous that, in 2024, having those labels attached to you means that you could be detained under the Mental Health Act for more than 28 days. I welcome the fact that the Bill’s provisions will move away from Section 3 and towards Section 2 detention, but I worry that it will not stop detention of people with learning disabilities or autism. For example, DoLS will be used, because these people are misunderstood. The legislation in itself will not change what happens to them. Individuals who are seen not as a threat but as difficult will be detained. As other noble Lords have said, fused legislation needs to be used to ensure that those individuals are not detained using different pieces of legislation.

As other noble Lords have said, it is also worrying that people with learning disabilities or autism who are under a Section 2 detention or detained under the Mental Capacity Act will not have access to Section 117 community facilities. It is quite fascinating that the very things under Section 117 that need to be in place to ensure that these people are not detained are the very facilities that they do not have a statutory right to. That needs to be looked at in this legislation.

There are many things to welcome, but many further questions need to be asked and drawn out, particularly regarding some of the contradictions in different parts of the legislative process on mental health provision within the UK and around the rights-based approach, which the Government seem not to have in place. We will want to explore that as we go forward.

NHS: Treatment of Children from Other Countries

Lord Scriven Excerpts

Thursday 21st November 2024 Lords Chamber

[Baroness Merron (Lab)]

I will be glad to take back to the department the comments of the noble Baroness and the noble Lord, but I reiterate that it is individual expert centres that are responsible for liaising with referring clinicians. By definition this has to be done on a case-by-case basis because we are talking about highly specialised treatments for rare diseases. Again, there is no set nationwide policy for local implementation because of the very nature of the challenge and the specialism to which the noble Baroness refers.

[Lord Scriven (LD)]

My Lords, maybe a good place to start would be to be bolder and more ambitious with the rare diseases framework that already supports international collaboration as part of the Government’s policy. As part of this framework, will the Minister investigate setting up an international centre of excellence in the UK that could be funded by both the UK and international partners for procedures and R&D to be carried out here, which would deal with some of the problems that both noble Lords have mentioned?

[Baroness Merron (Lab)]

The noble Lord is right to make reference to the UK rare diseases framework. The intention of that is to improve the lives of those with rare diseases—for example, by helping to get a faster diagnosis, increasing awareness of rare diseases, better co-ordination and care, and improving access to care, treatment and drugs for those in this country. I will add his suggestion to the list of matters to raise with the department.

National Insurance Contributions: Healthcare

Lord Scriven Excerpts

Tuesday 19th November 2024 Lords Chamber

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

I assure the noble Lord that there is no intent to squeeze out any providers, which are much valued and appreciated. We will continue to listen to their concerns and consult them as we make allocations, which is, as he knows, the usual practice for every Government. On the Budget settlement for the Department for Health and Social Care for 2025-26, I assure him that the Chancellor considered the impact of all the changes in the Budget.

[Lord Scriven (LD)]

My Lords, the net cost to the already struggling community pharmacy sector from the national insurance changes is roughly £50 million. One community pharmacist told me last week that this means that they either reduce services to patients by closing for the equivalent of one day a week or make one and a half members of staff redundant. What advice would the Minister give to that community pharmacist and many others in her situation?

[Baroness Merron (Lab)]

What I would say to each sector, including pharmacists, about the services they provide and what is expected in return from any contract is that, as in previous years—I emphasise that it is business as usual in this respect—employer national insurance contributions are dealt with as part of the process. We are very appreciative of the pharmacy sector’s contribution, not least because it will assist with one of the three pillars in moving from hospital to community services. I encourage all pharmacists to work with us to achieve what I believe they and we in government want: a service that is fit for the future.

Hospices: Funding

Lord Scriven Excerpts

Thursday 24th October 2024 Lords Chamber

[Lord Scriven (LD)]

My Lords, I thank the noble Lord, Lord Farmer, for instigating a vital, enriching and at times personal debate about the outstanding work, compassion and care that the hospice movement provides and the perilous state of the funding platform that it sits on. Wonderful examples of hospice and palliative care within the sector have been given. I add my thanks to the staff and volunteers who provide the services, including those at the wonderful St Luke’s hospice in Sheffield, a place where warmth, compassion and outstanding care are given to those at the end of life and the loved ones around them. Indeed, it is a microcosm of the hospice sector. In the last few years, it has been

“‘routinely’ budgeting for annual deficits”,

to quote its chief executive. The ICB funding accounts for just 26% of its £12 million annual budget. The examples of St Luke’s and others outlined in this debate show that unless short and medium-term action is taken by government on funding for hospices, services in some areas will be in serious decline or could collapse.

I say to the Minister that two things could happen, possibly in the short term, regardless of the budget. The first is that when NHS pay increases are made, they should be automatically applied to the in-year contracting values that the hospices receive, so that those extra costs can be absorbed without having to cut services. The other issue is that there should be parity of funding per person who uses a hospice and palliative care, regardless of the setting. It should be an equal base, whether it is in the independent hospice sector or in an NHS setting.

In the medium term, we need to introduce a fair funding deal for hospices and to include palliative and end-of-life care services in the priorities and planning guidance for the NHS. Will the Minister look at that and ask NHS England to implement it?

Investing in hospice care not only enhances quality of life for people who are receiving the care but supports families during incredibly challenging times. To ensure equitable access to comprehensive palliative and hospice care, we must ensure that the Government adopt fair and equitable funding for all who provide services.

Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024

Lord Scriven Excerpts

Tuesday 22nd October 2024 Grand Committee

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

My Lords, this draft statutory instrument proposes amendments to the Human Medicines Regulations 2012, which will expand access to naloxone, a life-saving medication that prevents death from opioid overdose. In addition, this draft statutory instrument makes amendments to keep the regulations current by updating references to Public Health England and the Health and Social Care Board, following the dissolution of those bodies.

We know the devastating impact that illicit drugs cause. Drugs destroy lives, tear families apart and make our streets less safe. Drug misuse deaths have doubled in number over the past 10 years, and we know that people who die from drug misuse often do so at a tragically young age, often in their 40s. Almost half of drug misuse deaths in 2022 involved opiates such as heroin. These deaths are avoidable. Dedicated drug treatment services provide the path to recovery and this Government are continuing to ensure that treatment is available and of high quality.

However, we also know that over half of people struggling with opiate addiction are not engaged in treatment. These are incredibly vulnerable people who often have multiple and complex needs; they are at increased risk of accidentally overdosing and dying. Tackling this issue supports the Government’s health mission. It will ensure that people can live longer, happier and healthier lives, and it chimes in with our collective efforts to break down barriers to opportunity and create a fairer society.

Naloxone is a highly effective antidote to opiate overdose. It can already be administered quickly and safely by anyone in an emergency, but current regulations specifically enable only drug and alcohol treatment services to supply it for future use without a prescription. That limits the reach of this life-saving medicine.

The draft instrument that we are debating today proposes two key UK-wide changes to existing regulations: first, to expand the list of services and professionals named in the regulations who can give out naloxone without a prescription. That means that professionals such as registered nurses and probation officers will be able to provide take-home supplies of naloxone where appropriate, should they wish to do so.

Secondly, it proposes to establish national registration services across the whole UK. This will enable other services and professionals who are not able to be named in the legislation but who come into contact with people at risk of overdose, including housing and homelessness services, to register and procure naloxone.

There is a positive background to these changes. The Department of Health and Social Care consulted on them at the beginning of this year and received over 300 responses spanning a range of organisations and professionals from across all four nations of the UK. Of these responses, approximately 95% agreed with the proposals that are set out. This demonstrates the level of interest in this important issue and the breadth of support for the changes we are seeking to achieve.

These changes have also been called for by experts in the sector such as the Advisory Council on the Misuse of Drugs in its review of naloxone in the UK. In addition, Dame Carol Black recommended naloxone provision as an important harm reduction measure in her two-part independent review of drugs.

Allowing more services and professionals to supply naloxone will mean easier access to it for people at risk, which in turn will mean lives saved. With the growing threat posed by synthetic opioids, which are often more potent and more deadly, the importance of this work only continues to increase as time goes on.

I want to provide reassurance that, with these changes, there is no compromise on safety. Naloxone is very safe and effective, even when administered by a layperson with no prior experience. It has an effect only if the person has been taking opioids and it is already widely used across the UK and internationally.

We are taking steps to mitigate against any very limited risks associated with wider access. We will provide updated guidance for services in scope, and we will set out robust requirements for training and safeguarding. I reassure the Committee that the intention of these changes is not to create additional burdens for services, particularly as we are aware that many of those in scope will already be facing pressures. These new powers are enabling, not mandatory. They provide an opportunity for increased provision, based on local need, but they do not make any requirements.

Finally, addiction is not a choice. It is often fuelled by wider issues, such as trauma and housing instability. This is a complex public health issue and must be tackled as such. We must change the narrative on addiction to one that is about the prevention of drug use, the reduction of harm and enabling recovery. The changes we are discussing here will save lives. On this basis, I beg to move.

[Lord Scriven (LD)]

I thank the Minister for setting out the rationale for this draft statutory instrument so well. I agree that this is a step forward in the ongoing battle against the devastating impacts of opioid overdoses. As she said, opioid overdoses have reached alarming levels, claiming thousands of lives every year. According to the latest statistics, opioid-related deaths have surged alarmingly in most regions. This is not merely a statistic. This is about the loss of lives, families shattered and far too many left to grieve, so it is important to take further action that is effective and wrapped in compassion. The temporary measures taken in Scotland show that the changes outlined in these regulations work and will save lives.

Naloxone, when used in the right place at the right time, is a life-saving medication. This draft statutory instrument will facilitate local supply networks, ensuring a broader distribution system and therefore more effective use of naloxone, empowering, among others, healthcare professionals, the police, prison and probation staff, and people in the youth justice system to facilitate the supply of this life-saving drug.

In response to one of the issues that the noble Baroness raised, a question occurred to me. As this will not be a mandatory provision across the country, how will the Government monitor lives that could be saved but that may not be saved because of a lack of take-up of this in certain towns, cities or regions? It could end up that a life will be saved if one body decides to do this, while a life could be lost in a neighbouring county, city or town if that does not take place.

One of the key provisions in this draft statutory instrument is the move to enable the friends and family of those at risk to administer this drug. Allowing those closest to individuals at risk to carry and administer naloxone creates a lifeline that will, literally, make the difference between life and death.

I listened to what the Minister said about setting up local naloxone providers and supply co-ordinators, and I have read the draft statutory instrument and the explanation—but I am still not clear about what regulatory oversight of these bodies will be in place. Who will be the regulator and what powers will they have to deal with the improvement or, indeed, withdrawal of such a service if it is deemed that the local provider is not carrying out the rules laid down in the draft statutory instrument?

Clearly, the broader implications of these amendments are not merely about the use naloxone but about standing with those who struggle with addiction, and their families. These amendments are an essential evidence-based response to the dramatic increase in opioid use and overdoses. By enabling greater access to naloxone, they will help to save lives.

[Lord Evans of Rainow (Con)]

My Lords, I thank the Minister for setting out the provisions in the regulations before us so well. This debate touches on a vital aspect of this country’s public health. Opioids are a pernicious threat to our society, a destroyer of lives and a menace to our streets. The ONS reported that 2022 was the deadliest year since records began for drug-related deaths in England and Wales. Of those, opioids accounted for the largest number of mortalities, at 46%. That is 2,261 people dying every year from opioid toxicity. In Scotland, the statistics make for even starker reading. According to the National Records of Scotland, in 2023, opioids were implicated in 80% of all drug deaths.

So we have a problem, but we also have a solution. As noble Lords will be aware, naloxone is a highly effective treatment for opioid intoxication and has been successfully deployed to prevent death from opioid overdose. I am immensely proud that it was a Conservative Government who launched the consultation on proposals to expand access to this life-saving medication, which concluded in March. The regulations laid before your Lordships are the outcome of that process, and I welcome their positive measures.

I will take this opportunity to ensure that the Government have taken all the necessary considerations. As the second report of the Secondary Legislation Scrutiny Committee pointed out, there is no indication of the costs associated with the instrument. The Department of Health and Social Care told the scrutiny committee that services that wish to widen the availability of naloxone would have to do so out of their own pocket, which, given the financial pressures already faced by such providers, may limit the efficacy of the provisions laid before us.

For these regulations to have the desired effect—that is, of course, to reduce opioid-related deaths—access to naloxone products must also be expanded. What is the point of increasing the number of people who can administer the drug if they are unable to procure enough of the medication? Furthermore, will service providers be able to afford the necessary training for the administration and storage of the drug? Would this not somewhat undermine the efforts of the regulations? In the light of these concerns, can the Minister confirm that funding will not impact the rollout of these provisions?

Although Regulation 8 does make provision for training, clarification is required. Naloxone can be administered by three different routes: intravenously, intramuscularly and by intranasal spray. Obviously, the first two require injection, which is a medical procedure for which specific training is required. The NHS, rightly, sets stringent guidelines on who is permitted to provide such services, so I think noble Lords could benefit from assurances that the IV and IM methods of administration are permitted only by medical professionals with full phlebotomy training.

Further to this point, I highlight that intranasal spray administration is, of course, the most effective method of widening access to the drug. Intranasal applicators can be used by the full range of providers specified in these regulations and can be easily distributed into the community. They therefore allow for a rapid response to an individual experiencing an opioid overdose and, I hope, should have a greater impact in reducing mortality rates. Can the Minister confirm that the Government will pursue greater distribution of the intranasal spray to complement this regulation?

I conclude by saying that we are pleased that His Majesty’s Government have continued the policy initiated by the previous Conservative Government by laying these regulations before us. I look forward to the Minister’s response to the questions I have laid out.

[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Lord, Lord Scriven, who I do not believe I have had the opportunity of welcoming formally to his new Front-Bench role. I am delighted to do that today; he is most welcome. I very much look forward to working with him and hope that he enjoys his role. I am also grateful to the noble Lord, Lord Evans, as ever, for his contribution.

I am pleased that both noble Lords, on behalf of their Front Benches, have been so positive in welcoming these regulations. I certainly agree with the closing words of the noble Lord, Lord Scriven: in doing this today, we are standing with those who struggle with drug use and with those around them—the communities, their families and their friends. It is with that motivation in mind that we are doing this.

I will of course write to noble Lords if there are any points that I do not manage to cover adequately. To pick up some of the points, however, the noble Lord, Lord Scriven, asked who will regulate. As part of the legislation, as I said in my introduction, there will be training and data-reporting requirements attached to both routes for new providers. Those new providers could be the emergency services, for example, and they will have to report on levels of prescribing so that effectiveness and safety can be monitored. That will absolutely be required of them.

[Lord Scriven (LD)]

The Minister might not still welcome me to my place now but although I understand that, my point was: what powers do those whom they report to have in ensuring compliance? That is the bit I did not get from reading the regulations.