Tobacco and Vapes Bill

Lord Sentamu Excerpts

Report stage
Tuesday 24th February 2026 Lords Chamber

[Lord Blencathra (Con)]

My Lords, unlike the noble Lord, Lord Rennard, I rise to support my noble friends’ amendments in group 1, not to defend tobacco, but to defend common sense, public safety and the livelihoods of tens of thousands of small shopkeepers who would be most harmed by a policy that looks simple on paper but is deeply dangerous in practice.

First, the burden on retailers and communities is real. Small shopkeepers already face unprecedented levels of crime and intimidation. The Bill would force them to enforce a moving legal threshold every year, placing the full weight of policing on their shoulders.

We heard an awful lot from the noble Baroness, Lady Northover, on guidance. I am listening to my noble friend Lord Sharpe of Epsom describing what the shopkeeper would have to do, and I would love to see what the Government guidance will be for that shopkeeper. When they ask, “What is your age? When were you born? Prove it.”, how on earth will the shopkeeper be able to deal with people in their 20s, 30s and 40s when trying to stay on the right side of an ever- changing law?

The implementation of a generational ban on tobacco sales will have profound, unintended consequences for shopkeepers, law enforcement and retailers—to the benefit of organised criminals—across the UK for years to come. That is not hyperbole; it is a sober description of the risks we are being asked to accept with this.

Secondly, the policy will drastically expand the illicit cigarette market and hand control to organised criminals. Everybody knows the stark evidence—even though HMRC will never admit it—that illicit tobacco loses the Treasury £3.5 billion per annum. Some 25% of all cigarettes sold are illicit and cheap, and the price differential drives consumers to illegal sources in pubs, clubs and under-the-counter sales.

This ill-conceived generational ban—admittedly, a stupid idea from the last Government—will create a permanent cohort of consumers who cannot legally buy tobacco, and where demand exists, supply will follow. That supply will be by criminal networks. Let us look briefly at Australia as a sign of what will unfold in the UK. Organised crime gangs dominate the illicit tobacco market in Australia, which has led to arson, violence and the takeover of local markets by criminal gangs.

Thirdly, enforcement capacity is already stretched to breaking point. Trading Standards and other front-line agencies have lost staff and lack the resources to police a complex, ever-changing age rule. Enforcement bodies are underfunded and under-resourced; adding a perpetual generational rule will only widen the enforcement gap and shift the burden to retailers and local communities, who will be unable to cope. When enforcement fails, the law becomes a paper shield for criminals and a real threat to honest businesses.

What is the sensible alternative? It must be setting the age at 21, as set out in my noble friend’s amendment. This is not a retreat from public health; it is a pragmatic, enforceable measure that achieves the same long-term outcome for young people while avoiding the catastrophic side-effects of a generational ban. My noble friend set out in detail from the Government’s own impact assessment how raising the age to 21 would achieve the same long-term aim.

A minimum age of 21 is clear, static and much more easily enforceable. It allows retailers to train staff once and apply a consistent rule, and it reduces the incentive for criminal markets to exploit a permanently excluded generation. It also aligns with international practice and with the Republic of Ireland’s own policy direction, reducing cross-border legal friction.

Finally, we must pair any age change with stronger enforcement and support. If we raise the age to 21, we should simultaneously strengthen fixed-penalty regimes, resource trading standards and Border Force properly and invest in targeted education and cessation services. Enforcement must be credible—it is not at the moment. Everybody knows that you can get illegal cigarettes in any pub or club in the country. We need stepped penalties for repeat offenders, licensing powers that bite and better funding for the agencies that will be asked to do the work.

All of us in this House and Parliament share the aim of reducing smoking, but good ends do not justify bad, unworkable means. A generational ban risks destroying small businesses, empowering organised crime, overwhelming enforcement and creating legal chaos. A minimum legal purchasing age of 21 is a proportionate, enforceable and effective alternative that would protect public health without the catastrophic unintended consequences. If we come to a vote, I urge the House to reject the generational ban and support a measured, evidence-based approach that combines an age limit of 21 with robust enforcement and support for cessation. I support my noble friend’s amendments.

[Lord Sentamu (CB)]

My Lords, I listened to the noble Lord, Lord Pannick, and he persuaded me that, at the end of the day, we are dealing with a question of health, not choice. I will give an example. Colin Bennetts, Bishop of Coventry from 1998 to 2008, died in July 2013 after a period of illness due to cancer. His lungs were filled with deposits of smoke. He said to everybody, “I have never smoked in my life”, but as a youngster he had worked in an office where cigarettes were lit at every moment. Colin, who had not smoked, died of lung cancer. You do not have to smoke to die from it —others sitting near may get it.

I respect the noble Lord, Lord Clarke, but you cannot compare gambling on horses with smoking. Gambling on horses affects only those gambling, but secondary smoking is detrimental to anybody in a place where people are smoking. I do not think these amendments would be helpful. We should stick with the Bill as drafted, because we are trying to protect people’s lives and make them healthier.

I suffered what is called in medical terms a lung infarction, where bits of your lungs do not quite operate. I still have that illness, so every time I go into a place where there is a lot of smoking, I can barely breathe—I have to get out into the fresh air and get it in my lungs. Friends, this is about health. If we do not do this now, then when?

[Lord Stevens of Birmingham (CB)]

My Lords, I declare my interest as chair of Cancer Research UK. Given that smoking continues to be the single biggest cause of cancer, it will not be a surprise that I oppose the amendments in this group, which would substantially weaken this landmark legislation. In explaining why, I will respond to each of the six points made by the noble Lord, Lord Murray of Blidworth.

First, the noble Lord argued that we do not need more tobacco control legislation anyway because smoking rates are already coming down. That is not correct; Javed Khan has pointed out that, among the most deprived parts of the country, on current trends we will not be smoke-free until 2044. In any event, some in the tobacco industry have come to the same conclusion. I quote from an advert that Philip Morris took out in the New Statesman, no doubt designed to influence people such as us: “Here in the UK, smoking rates are not declining fast enough. None of the home nations are on course to hit their smoke-free dates, and the most deprived communities are lagging significantly behind”. The suggestion that we can just assume that the status quo will produce a benign outcome is incorrect.

The noble Lord’s second argument was that, rather than having a generational tobacco sales restriction, we should instead just move towards delaying the age at which smoking can be initiated to 21. The tobacco industry would doubtless switch its efforts to targeting twenty-somethings instead of teenagers. On the surprising claims we have heard in respect of the behaviour down the decades of Gallaher or British American Tobacco, I simply say to noble Lords: google their internal documents. They have all been disclosed as a result of international treaties and court cases, and noble Lords will see the systematic duplicity, bribery and corruption that has continued across the world in advancing big tobacco’s agenda. Those documents, the internal files, are there: noble Lords can check them out for themselves.

The noble Lord, Lord Murray of Blidworth, referred to the Republic of Ireland as an example we should perhaps be following, when it proposed to adopt the age of 21. However, the director of the tobacco industry-funded front organisation FOREST said of the effect of adopting the age of 21 as a tobacco sales restriction:

“If you’re not careful, you’re actually going to make smoking … fashionable again. You’re going to actually encourage young people to smoke”,


on the back of this proposed sales restriction to over 21 year-olds.

The third argument we heard was about the black market. For reasons that are a non sequitur, we have several times heard cited the example of Australia. The amendments in this group relate to changes to the age of sale. There has been no change in the age of sale in Australia. As far as I am aware, it is still 18 and has been for 30 years. So, whatever else is going on in Australia, it has got nothing to do with the amendments in this group in respect of age of sale. In fact, the Australian example tells us that you need rigorous enforcement. Until very recently, there was no retail licensing available for New South Wales, Victoria or Queensland, covering about 70% of the Australian population, and it has only been patchily introduced subsequently.

There is agreement that we need strong enforcement to deal with the illicit trade, but the argument that we should essentially do whatever it takes to maximise revenue for the Exchequer is a flawed one. If that were the case, as we have heard from other noble Lords, we would be legalising and licensing handguns, assault weapons, fentanyl or crack cocaine. The fact is that, when it comes to tobacco control policy, it is not the Laffer curve that we should focus on, it is the life expectancy curve.

The fourth argument has been around the impact on retailers. I accept that there are legitimate concerns, and the noble Lord, Lord Sharpe of Epsom, has rightly drawn attention to the epidemic of violence and also noted the provisions that will be in the Crime and Policing Bill as one step to attempt to tackle this. But the fact is that the progressive age of sale restrictions in the Bill are an evolutionary measure that will be phased over many years, giving retailers much opportunity to adjust. There are substitutes that they can sell, including vapes, as alternatives to smoked tobacco. Surely, nobody is suggesting that the trump argument should be that we need to sustain the margins of retailers at the expense of 80,000 people who die prematurely from smoking every year.

The fifth argument we heard was around the Windsor Framework. It is fair to say that alternative legal opinions are available. Member states are free to determine the age limit that they see as appropriate on their territory. This does not constitute a trade restriction within the meaning of the EU treaties. In any event, even if a court found that it did, it could be justified on public health grounds. Perhaps the Minister can confirm that the Bill has the support of Northern Irish Health Ministers and that legislative consent has been received from the Northern Ireland Assembly.

Lastly, we come back to the liberty argument: the freedom of unborn smokers to become addicted in decades to come. Well, those of us who take the opposite view judge that this is a proportionate response to a great harm. It is a novel piece of legislation; we will need to see how it plays out in practice. One of the government amendments that will be before us on Report will be precisely a report on its real-world effects in the coming years. In the meantime, to weaken what has the potential to be one of the most fundamental health-improving pieces of legislation this Parliament has ever enacted would in my judgment be a grave error.

Resident Doctors: Industrial Action

Lord Sentamu Excerpts

Monday 15th December 2025 Lords Chamber

[Lord Sentamu (CB)]

My Lords, one of the four priorities named in the Budget delivered by the Chancellor of the Exchequer was reducing waiting lists. If this strike goes ahead, what increase would there be in the waiting lists? Secondly, the Secretary of State in his Statement said that he is putting

“money back in … doctors’ pockets by”

funding

“royal college portfolio, membership and exam fees … backdated to April”,—[Official Report, Commons, 10/12/25; col. 430.]

and increasing the allowance for less-than-full-time doctors to £1,500. Where is the money coming from? Is this funded, or will this money be borrowed?

Finally, taxpayers spend £4 billion training medics every year. Are the Government persuading resident doctors to keep their social contract with taxpayers? It seems to me that calling this strike at this point in time is a bargain betrayed.

[Baroness Merron (Lab)]

I certainly understand the noble and right reverend Lord’s point. The offer we made—which covered a number of the areas that the noble and right reverend Lord referred to, plus more—is not applicable because it was not accepted. We put it forward, developed it further and did all we could that was realistic. The noble and right reverend Lord asked whether it is funded, but I will change the tense of his question: it would have been funded, but the offer was rejected and therefore is no longer on the table. That is why it is not going ahead.

On waiting lists, as I mentioned to the noble Baroness, Lady Browning, we have proved that we can maintain a near full programme of elective work, with 95% of planned care being maintained—and, again, let us pay tribute to the NHS staff who have done that. But let us not suggest that there are no effects. It affects the staff who step in to cover for their colleagues. We have an NHS in desperate need of reform. We are turning it around, but these strikes get in our way. As I mentioned, we cannot underestimate the amount of effort, finance, direction and morale—the list could go on—that these strikes take up. I am grateful to the noble and right reverend Lord for raising those points.

Terminally Ill Adults (End of Life) Bill

Lord Sentamu Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, like many noble Lords, I grew up at a time when the family doctor was looked upon as a family friend who could always be depended on whenever you were ill or in a time of crisis. Unfortunately, that is not the situation today. There is a major problem across the United Kingdom: patients desiring to see a GP find themselves sitting on the telephone and ringing the surgery 120 times, perhaps, but still not getting through to someone and giving up at the end of it. That is the reality of the situation in many places.

I am sorry that the noble Lord, Lord Pannick, is not here. He posed a question to the noble Baroness, Lady Lawlor, concerning what happens if your GP retires. Let me give my small experience. My GP was in his late 50s. He was an excellent GP. During Covid, unlike many other practices, he still allowed patients to come to his surgery. Whenever elderly patients could not come, he went out to their houses and visited them in their own homes—unlike many other practices and GPs. Unfortunately, he got cancer and, in his late 50s, just recently, he passed away.

We were left with a practice in our town with several thousands of patients but nobody to take it over. So what happened to us? Our GP died, and so, without any consultation whatever, we were all farmed out to seven or eight practices around the countryside, some of them not even close—just to whoever would take us. It is unrealistic to imagine that somehow a new doctor would have any knowledge of the pressures, the problems or the complex challenges that his new patient was facing; he would not have any continuity of care whatever.

It was even worse than that, because it was several months before the notes went to the next practice that you were farmed out to. You were allotted a practice but the notes concerning any illnesses of the patients did not immediately follow; it was several months before they arrived. What has been suggested in these amendments today strengthens safeguards. Therefore, they are worthy of the support of noble Lords in this House.

[Lord Sentamu (CB)]

My Lords, I agree with the noble and learned Lord about why we are focused on GP practices, because they are the hub of information. Since I arrived in this country, I have had a lot of treatment for all kinds of conditions—I am one of those people—and all the national insurance I have been paying has being paid back to me about a hundred times, so I am a walking miracle.

An amazing thing happened to me recently. When my anaemia was so high—I did not think I would survive it—I went to see a consultant in Newcastle hospital and he called up my records from 1975. It was amazing that, apart from one GP who did not keep the record properly, he had it all; therefore, I was able to get proper treatment. Friends, the record keeping on health in this country—even if some do not do it well —really is amazing. The records are very clear. The GPs who are good will always keep up their information, which is digitalised so that they can send it quickly.

Therefore, for me, the whole picture is not just the GP doing it but GP practices, which are the hub from which a lot of information about anybody can be gathered. You sever that and put it somewhere else, and you may not actually get it. I have every confidence that in my GP practice at the moment, which has nine doctors, they will have access to that information.

I therefore think that noble Lords should stick with what is in the Bill about the GP, because it is the information that you want to get, and you get it now and I am amazed. I am therefore very thankful for the care that I have received and the records that speak about my journey, and I want to thank all those who have been involved in my health.

Terminally Ill Adults (End of Life) Bill

Lord Sentamu Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Baroness Scotland of Asthal (Lab)]

I never suggested that they should be alternatives. The truth is that palliative care is not available in all parts of our country, so this has to be a real choice. That is the only element I made.

Also, I hope that all of us would look at the evidence, from wherever it came. We know that we have to make evidence-based decisions, and the best evidence will help us to make the best decisions.

[Lord Sentamu (CB)]

My Lords, I want us to return to the amendment and my contribution will be very brief.

The wonderful joy of the English language is that it is always evolving to meet circumstances that were never perceived before. That is why it will continue to be the language of the world. The word “capacity” is no longer just a psychiatric term to assess people’s mental ability; it now applies to whether a council has the capacity to do one thing or another. The word now is no longer a very narrow word. I am quite surprised when I hear people say that the word has been used for a very long time in the medical circle. But the word “capacity” is not in the rules of the Persians and Medes that can never be changed—words grow.

When we are dealing with a new situation of assisted dying, we need to look at whether the word “capacity” is adequate to deal with the new circumstances we are discussing in our Parliament. Is it adequate for a person who is facing the question of death and saying “I want to end my life now”? What does the word “capacity” mean to them?

The word “ability” would probably come much nearer to the understanding of an ordinary person wanting to make a decision about ending their life medically. Let us not treat the word “capacity” as such a holy word which cannot be changed. Let us not be lazy but work hard and consult a lot of other people in the field who know the most adequate word to describe this. I thank the mover of the amendment. Perhaps it could be put into a melting pot with some other words and out will pop a word that makes sense, and the whole House can rally around it.

[Lord Goodman of Wycombe (Con)]

My Lords, in debating ability and capacity, I will speak briefly as a member not only of the Delegated Powers Committee that considered the Bill but of the Select Committee that also did so. Noble Lords have heard differing views from members of the Select Committee about the various goings on that took place there, but I am sure we can all agree that we heard some very fine evidence.

All I wish to do in intervening here is to quote what Professor Alex Ruck Keene, whom my noble friend Lady Berridge referred to earlier, said about capacity and the role of psychiatrists, as it is extremely relevant to the debate on this clause. He said:

“The point I am trying to make is that, if you simply say, ‘Apply the MCA. Apply the principle of the presumption of capacity. Support the person to have capacity to decide their own life’, I anticipate, if you asked very many psychiatrists, they would go, ‘How am I supposed to think about that?’ That is for a very specific reason. For psychiatrists, most of the time, their job is to secure life. Their job is suicide prevention”.


He concluded:

“We need to know—and one of my real concerns is—how this Bill sits in the wider landscape of the law. I need to be able to tell, because I am going to be one of the people writing the books here and giving the training. I need to be able to say, with absolute crystal clarity, to a psychiatrist, ‘This is the point where you are not in the suicide prevention zone, and if you do not do all steps necessary to try to secure this person’s life, you could be prosecuted or you could be charged in various different ways or be civilly liable’. I need to be able to say, with crystal clarity, ‘You’re no longer in that zone; you’re now in the zone of the Terminally Ill Adults (End of Life) Bill’”.


I quote the professor simply to draw to the Committee’s attention once again the complexity of the issues before us. Although “ability” may be flawed and legally powerless, as the noble Lord, Lord Pannick, suggested, “capacity” is deeply problematic in the context of the Bill.

Prostate Cancer: National Screening Programme

Lord Sentamu Excerpts

Thursday 27th February 2025 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Lord for sharing his personal experience. I am not suggesting that the PSA test should not be used, but we are talking about extending it and using it in a screening program. I thank him for giving me the opportunity to reassure your Lordships’ House that that is why we have the trial, which will report later this year, to find a better answer; the answer we have currently is not where we need it to be. Yes, there is a role for it, but we must strive for better than we have got currently.

[Lord Sentamu (CB)]

My Lords, 13 years ago, a PSA test saved my life. I had an operation in Leeds hospital and I now have no sign of that, and every year they test me by the same method. I encourage the Minister not to give mixed messages. We need a very clear message that, at the moment, the PSA test saves a lot of lives.

[Baroness Merron (Lab)]

I agree about the need for clear messages, and I hope the noble and right reverend Lord will agree on the need for striving to do rather better.

Hospices: Funding

Lord Sentamu Excerpts

Thursday 24th October 2024 Lords Chamber

[Lord Sentamu (CB)]

My Lords, I too am grateful to the noble Lord, Lord Farmer, for securing this debate. I have experienced the amazing work and care offered to many people at the end of their lives. I have been patron of and fundraiser for St Leonard’s Hospice in York, and as Archbishop of York I supported in numerous ways Martin House Children’s Hospice, founded by the Archdeacon of York, the Venerable Richard Seed, supported by the generosity of thousands of people who raised the money.

Aisha, the mother of our two foster children, George and Davina, died of breast cancer and was superbly cared for by St Christopher’s Hospice. My mother, Ruth, spent three weeks in Royal Trinity Hospice, where she lost her battle against throat cancer. Her peaceful death inspired our little children.

Hospices are homes providing the best end-of-life care. As charities, they depend on constant fundraising and people’s generosity. The question of the noble Lord, Lord Farmer, invites His Majesty’s Government to put hospices on a sure income footing and foundation. I invite His Majesty’s Government to apply to the funding of hospices the lesson of the RA Butler 1944 Education Act, which was replicated in Scotland in 1945 and in Northern Ireland in 1947. It repealed all previous education legislation, belatedly raised the school leaving age to 15 and made secondary education free and universal. The terms “voluntary aided” and “voluntary controlled” appeared in the Butler Act. Before this was enacted, the voluntary schools provided by churches were largely funded from the income of historic trusts or from the giving of the parishioners. In voluntary-aided schools, the church is responsible for only 10% of the cost of the upkeep of the building; the rest is provided for by the state.

Could His Majesty Government reimagine the funding of hospices in a similar way to the funding of voluntary-aided schools, not the voluntary-controlled schools, which are entirely funded by the state? Hospices need not be funded entirely by the state. A mixed funding model could work well, provided that government remains the last person standing in terms of funding. Hospices could become voluntary-aided hospices.

St George’s Hospital: Patient Deaths

Lord Sentamu Excerpts

Wednesday 18th May 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord raises a very important point about the complexity of having a number of investigating bodies. When I was being briefed yesterday, I was surprised by the number of ongoing investigations. We acknowledge that there needs to be a consistent approach to establishing and running investigations and inquiries. We are currently looking to develop an effective and user-friendly guide to handling inquiries and involving DHSC policy procurement IT colleagues in the development of a framework. We are working also with the Cabinet Office to ensure consistency across government, so that whatever we do in health is consistent with other investigations.

[Lord Sentamu (CB)]

My Lords, the murder of Stephen Lawrence really caused a lot of trouble. The Met had a review and another review—and another review. The last person to do an apparently thorough review, Sir William Macpherson, turned up at the inquiry and said, “Your evidence is so awful we cannot listen to it any more.” Kent Constabulary carried out a review, but it did not uncover all the stuff that the Stephen Lawrence inquiry found. It was therefore suggested that there must be an independent police inquiry body so that the police are not marking their own homework. I wonder whether the same thing is happening here and whether this new independent review will uncover all that is required.

[Lord Kamall (Con)]

The noble and right reverend Lord raises a number of important points about consistency and the number of investigations. Their remits are often different, which can confuse the picture, and sometimes some of the investigating bodies are seen to extend beyond their remit, causing further confusion. In this case it is important to recognise the difference between the coroner’s inquest and the work of the independent mortality review. Coroners’ inquests are different, and an independent mortality review was not undertaken to determine the cause of death in individual cases or to attribute blame. It was all about processes, procedures and culture.

Health Protection (Coronavirus, Restrictions) (Self-Isolation etc.) (Revocation) (England) Regulations 2022

Lord Sentamu Excerpts

Thursday 17th March 2022 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I would like to ask some questions about data. We are told that the Government’s policy has been data driven. As my noble friend just pointed out, the Prime Minister suggested that the case figures and hospitalisations are going down, when in the last seven days cases have gone up by 52% and hospitalisations by 18.4%. This is a trend: the Prime Minister constantly fiddles the figures. First, we had him misleading Parliament on unemployment figures, then on crime figures, and now on Covid figures. This is very important.

I would like to know why the Government are withdrawing funding from some of the studies that enable us to know what the data is, such as the ZOE study. Without the data, the experts cannot properly advise the Prime Minister and the Prime Minister then cannot, if he chooses to, take the right decisions. Why are we withdrawing funding from these studies? As my noble friend says, if the virus is endemic, we still need to control it and we need the figures to do so.

Lateral flow tests that people can take at home are particularly important, especially in the light of the symptoms of this new subvariant—B2, I think—of omicron because the symptoms start as a bit of a runny nose. If somebody has a runny nose, yes, it could be a cold, but it could be Covid. If we are being asked to be sensible and to protect other people, if it is a Covid runny nose one should stay at home, and if it is a cold one should take precautions, but without the test—and poor people cannot afford £20 a box—people will not know which kind of runny nose it is. Can the Minister say how people on benefits or low incomes, who cannot pay the price that some companies are charging for these lateral flow tests, can afford to have them standing by at home so that when they get symptoms they can check the cause of those symptoms and protect everybody around them?

[Lord Sentamu (CB)]

My Lords, as I said in this House on Monday, I had to stay at home for seven days because I had a very bad chest cough, a bad cold and a lot of catarrh. I tested myself and the test was negative. Those bad symptoms continued for nearly six days and I tested myself every other day. It was very clear that I had a sudden form of flu, but its effects on me were quite strong. I was encouraged because I was able to test myself and the lateral flow tests revealed that I did not have Covid but had an awful cold and flu.

The programme that the Government embarked on in testing and tracking was world class. When we are still in the middle of this very cold weather, why withdraw free testing in April? It is the only assurance we have. I hope the Government will think again about that possibility, although the regulations have gone. To take responsibility for yourself, you need to know whether you have Covid, otherwise you will go out and infect other people, which you should not do.

The messaging still needs to go out. I was quite shocked when “Look North” said that people in our area who are testing positive and sometimes ending up in hospital had stopped washing their hands. That is a shock. It may be said that we have all grown up and know how to wash our hands regularly, but I am afraid that in some places that has gone, so the messaging should still be going out that for the protection of other people we must take responsibility and wear a face covering, not because it is regulated but to be considerate towards others. Sometimes you should keep your distance when you hear people coughing. You are keeping your distance to try to protect people.

When these regulations have all gone and such things are no longer mandatory, will the Government please continue to inform people that there are some places where you still need to keep your distance, some places where you must continue to wash your hands and some places where wearing a face covering is the responsible thing to do? Although it is not going to be policed, we need to create that culture. It happened during lockdown. I used to be shocked when I went to a toilet and people who had not washed their hands came out. We are now going back to our bad habits. Although the regulations have gone, could the messaging still go out to persuade people that the steps we took during lockdown and before these regulations are still worth doing?

[Baroness Merron (Lab)]

My Lords, we, too, do not want to see restrictions in place for a day longer than necessary but, as noble Lords have said, lifting the legal requirement to self-isolate needs to be backed up with a plan and an understanding. While it is one thing to acknowledge that free tests cannot go on for ever, while the number of infections remains so high, it is surely sensible to monitor the situation and guard against any new and potentially more severe variants. Not to do that risks being somewhat blindsided by future mutations of the virus. We know that testing is one of the key ways that the return of the restrictions can be avoided. It makes long-term sense to make tests widely available while the threat of a new wave remains.

Questions remain about the implications of the revocation for people’s lives. For example, if you need to care for a clinically vulnerable relative, will you be left out of pocket for that test? After all, should we not be encouraging people to make sensible decisions rather than making it harder for them to do so? I remain unclear about whether unpaid family carers, in particular, will retain access to free testing to allow them to look after their loved ones safely. Perhaps the Minister will comment on this point in addition to confirming that free tests will remain for NHS staff. We cannot have vulnerable patients going into hospital and being treated by NHS staff who have been unable to get tests.

I agree with my noble friend Lord Hutton that this does not feel like the right time to be having this debate, but we are in the situation we are in. In acknowledging that, I echo the points made by the noble Baroness, Lady Brinton, about those who are clinically extremely vulnerable and immunosuppressed. We should have regard to how they are feeling as well as giving them continued practical support. I am sure the Minister will respond to the questions asked by the noble Baroness, Lady Brinton.

I have a question about plans and support for those who live with long Covid. We should not forget that it continues to be a blight on the lives of a number of people. In this regard, it would be helpful if the Minister will tell us about any discussions that have been held with the Secretary of State for Work and Pensions about working with employers to protect clinically vulnerable employees and to assist, through support and guidance, employers of people still suffering from long Covid.

More than 1.3 million vulnerable people are eligible for Covid-19 treatments, such as antivirals. Can the Minister indicate whether they will be eligible for free tests? What about their families, friends and close contacts? Will there be a limit on how many tests eligible people can receive? It would be helpful to have clarification from the Minister to give people the reassurance they need.

The potential confusion in public health messaging has been referred to. On the one hand, there is guidance telling people to self-isolate if positive, yet on the other there are still pressures—financial from employers, or from elsewhere—that force people to go to work. This suggest that the message that people will take is that Covid-19 is no longer a threat, but we know that the pandemic is not yet over. The British Medical Association has argued that asking individuals to take greater responsibility for their actions while taking away free testing is likely to cause more uncertainty and anxiety.

Finally, I shall raise the matter of sick pay with the Minister. What is the reasoning behind the Government’s decision to scale it back? Those who are sick with coronavirus will now have to wait until the fourth day of their sickness before claiming statutory sick pay. We are highly concerned that when people cannot afford to stay at home they will be forced to bring their infection into work. To put this into some perspective, after April some 7 million workers will have to survive on just £38 per week if they find themselves suffering from Covid. Covid is not going anywhere, and it is right that we learn to live with it, but proper provision needs to be in place to help people make the right choices in what is, I hope, a late stage of this pandemic. I hope the Minister will be able to give assurances to your Lordships’ House today.

Health and Care Bill

Lord Sentamu Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Lord Alton of Liverpool (CB)]

My Lords, the House will want to move on quickly, so I will not make the speech that I intended to make on this issue, but I would very much like to endorse what the noble Baronesses, Lady Fraser and Lady Stowell, the noble Lord, Lord Balfe, and my noble friend said in their earlier speeches. I know Connie Yates and Chris Gard, who are the parents of Charlie Gard, who died in 2017 of mitochondrial DNA depletion syndrome. Indeed, I have entertained them here in the House, arranged meetings for them and travelled with them. I entirely agree with what my noble friend is trying to do. This will make mediation work; it will create a proper balance and equality of arms. No parents should have to face litigation in these often tragic and troubling circumstances, so this is a good amendment and I hope the Minister will feel he can accept it.

[Lord Sentamu (CB)]

My Lords, I was patron of Martin House in York, which is one of the amazing hospices that care for children and their parents. I was invited by the parents of a nine year-old, who was having a very difficult and trying time, to talk to clinicians, because they did not think that they were being heard. As we talked, it became clear that that was not true: the clinicians were on the side of the parents, but their language was not helpful. We had this amazing conversation, and as a result the needs of the child and the aspirations of both the parents and the clinicians matched, and we were able to get very careful care. What the noble Baroness, Lady Finlay, is trying to do is recognise that in most cases parents have good desires, and clinicians probably know more than they are willing to say but hold back because of the sheer pain and difficulty that they see on the faces of everybody, and another voice can help in these situations.

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Can the Minister tell the House of any contract that the Government have agreed that has had that result? Has this alternative, which the Government pray in aid, been deployed by them to such an effect that it has significantly bitten into the unbelievably unjustifiable inequity in the share of vaccines around the world?

[Lord Sentamu (CB)]

My Lords, I was not going to speak, but I am driven to respond to what I have just heard. I first declare an interest as chair of Christian Aid, which works in some 29 countries, most of which have experienced what I call vaccine inequality. We constantly get letters urging us to try to help.

As far as the British Government are concerned, in relation to some of those countries, the money and the way that they have tried to help—which must be acknowledged—certainly with AstraZeneca, there has been a far greater equity coming out. When we had the Kent variant, the Government were very quick to share that information with everybody else. What I think the amendment is asking is that, when the World Health Organization declares a health emergency, if we have information we should make it available immediately.

Secondly, on the question of equity, we have just had a big Commonwealth service in Westminster Abbey and there are particular people—noble Lords may not believe it—who come from those 54 countries of the Commonwealth who still look to the United Kingdom as giving them not only language but the ability to understand the sheer pressure of inequality. I would have thought that this particular amendment would help us to answer some of our supporters out there in the global south by saying that we are very serious, given some of the help that has been provided—though it has not gone far enough; the antivirals and all those drugs have not been given equitably. I therefore ask the Minister to realise that the issue is not whether we have or have not done enough; it is that, if there is a global health emergency—locally and internationally—the Secretary of State is in a better position sometimes to speak and to help those who are struggling and finding it difficult.

Nkrumah said that Ghana would not be free until the rest of Africa was independent, and I believe the same is true now. I have had my double vaccine and my booster, but I am not fully vaccinated until the rest of the world is vaccinated.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

I thank all noble Lords who have taken part in this debate for the passion they have shown. I think we are all concerned by vaccine inequity—as noble Lords have rightly said, we are getting our third or fourth vaccines while some people have not had their first yet—but we also have to be clear how we get to this stage. It is easy to say, “We spent this much money on public research and that led to the vaccines”, but it is not as simple as that. It may have led to the research but that does not lead to the production of millions of vaccines that can be distributed worldwide. There is a clear difference between pure research and turning that into actual vaccines and, once they are produced, getting them into people’s arms. You can certainly deliver them to countries but they do not always reach the arms. We have heard stories of vaccines being thrown away because of a lack of distribution in particular countries.

The sharing of knowledge has played and will continue to play an important role in the rapid scale-up of Covid vaccine production. The UK Government are very committed to addressing vaccine equity on every front. As the son of people who came from outside the EU—not white, privileged Europe—I believe very strongly in global Britain.

The experience of the pandemic has shown that it is voluntary collaboration that has made real, positive impacts on vaccine delivery. The scale-up of vaccine production at record pace has been driven by more than 300 voluntary partnerships. This unprecedented collaboration around the world has meant that global Covid vaccine production now stands at nearly 1.5 billion doses per month. Voluntary partnerships such as AstraZeneca and the Serum Institute of India, and Pfizer-BioNTech and Biovac in South Africa, show what is possible if you work together.

The intellectual property framework has been crucial in facilitating this knowledge sharing. Indeed, the legal certainty it produces cannot be overstated. It gives innovators the confidence to form partnerships and continue investing in the innovative health products and technologies that have contributed so positively to our global pandemic response. The intellectual property framework similarly supports the production and dissemination of vaccines and other products across the world.

Yes, 97% of the investment in research is public funding, but research is not vaccines. There needs to be a whole chain from that pure research to scaling up and distribution, and universities cannot do that. Waiving intellectual property rights would dismantle the very framework that has facilitated this collaboration. It would undermine not only the knowledge sharing that has helped to develop and produce Covid-19 vaccines at the pace and scale now seen but the framework needed to support the development of new vaccines and treatments, should these be needed in future.

It should also be noted that the least-developed countries are exempt from implementing the Trade-Related Aspects of Intellectual Property Rights—or TRIPS—Agreement, meaning that they already have a de facto TRIPS waiver. In addition, the TRIPS Agreement already provides flexibilities to enable countries to achieve their public health objectives, and we fully support the right of these countries to use these where needed—but you have to build the capacity. Low and middle-income countries can access medicines in times of emergency through flexibilities that allow them to manufacture or import without the consent of the patent holder.

For these reasons, the UK does not consider intellectual property rights a barrier to supplying and improving access to Covid-19 goods. The noble Lord, Lord Russell, can put another £10 in the Christmas bag. Instead, we shall continue to be a visible champion of those elements of the intellectual property framework that support effective knowledge sharing.

The noble Baroness will be aware that we have contributed vaccines through the COVAX scheme—a partnership of the Coalition for Epidemic Preparedness Innovations, Gavi, the Vaccine Alliance, UNICEF and the World Health Organization—but we know that is not enough. As noble Lords have rightly said, we have to learn from what we have done during this pandemic. One part of my ministerial portfolio that I am very proud of is international relations and health diplomacy. A constant theme in my G20 and G7 Health Ministers’ meetings is how we tackle these vaccine inequities and learn the lessons that many noble Lords have rightly raised.

Last week, the British Government hosted the Global Pandemic Preparedness Summit to learn those lessons: to make sure that we brought together all our experiences as countries, learned from those and asked what we could do next time. I was very privileged to host a working lunch with several overseas Health Ministers, as well as Dr Richard Hatchett, CEO of CEPI; Dr Seth Berkley, the Gavi CEO; and Dr Tedros, the director-general of the World Health Organization, sitting next to me. One of the issues that came up in our discussions was, rather than developing and less-developed countries relying on donations via COVAX, how we ensure that, first, there is more local and regional manufacturing of vaccines through public-private partnerships and, secondly, that vaccines get into people’s arms as quickly as possible once they are manufactured or are imported into a country. We need to avoid those situations where vaccines were wasted because they were not stored or transported properly, or where there was difficulty distributing them once inside a country.

With international partners, we are looking at a whole range of issues and new technologies, such as new distribution methods. Some noble Lords may well have read about drones being used to deliver vaccines to certain remote areas. Before using these drones, it is all very well having all these vaccines in the capital, but how do you get them into people’s arms? We have to look at that area. Intellectual property rights are irrelevant here. The fact is that the vaccines are there but you have to get them into people’s arms. We have to train more vaccinators and we need better transport.

We agree that the vaccine supply must be matched by the capacity of health systems to deliver them, and we have been working to strengthen health systems around the world. Our recently launched health systems strengthening position paper sets out this Government’s determination to do more to build overall capacity, from policy through to delivery.

But there are other issues. Just as there are the vaccine-hesitant in this country, there are many vaccine-hesitant people in other countries. Our African vaccine confidence campaign is working with experts in countries such as Botswana, Ghana and Uganda to reinforce communities’ trust and build demand from the ground up. Once again, you can get the vaccines there but you have to get them into people’s arms. We have also been working to minimise constraints on supply chains, such as tariffs. This has been demonstrated by our sponsorship and promotion of the trade and health initiative as well as the unilateral measures we have taken, including tariff suspensions.

We have also provided support for the development of regional manufacturing capabilities. This includes technical support to develop business cases for the manufacture of vaccines in South Africa, Senegal and Morocco. We are working with the COVAX supply chain and manufacturing task force to champion other practical efforts to scale up capacity. We believe that we are doing lots of things with our global partners—with Gavi, CEPI and the World Health Organization.

To be honest, I am incredibly inspired by some of the work that I see going on. This is about building real capacity. It is about transferring knowledge and technology and making sure that we have that capacity. It is about making sure that we live up to global Britain, in which I firmly believe given my own family history—not from white Europe, but from a global perspective. I believe very strongly in that. I believe that waiving intellectual property rights will not help overcome these challenges. I may be passionate about this but I feel very strongly about it. I feel strongly about global Britain. I feel very strongly about my distant relatives who come from developed countries and about my own history, my own heritage. I feel much more strongly about this than noble Lords may well feel.

This is the right approach. I am hugely encouraged by this international co-operation and the potential of new technologies to help. I would be very happy to continue to engage with the noble Baroness. I think we probably share the same passion for making sure that this happens. Given that, I hope she will consider withdrawing her amendment.

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[Baroness Bennett of Manor Castle (GP)]

My Lords, I rise briefly to support Amendment 183. My background in this goes back to March 2020, in those difficult, scary, early days of the pandemic, when your Lordships’ House was operating on a skeleton crew. That led to me, as very new Peer, moving the amendment to the coronavirus regulations that would have allowed for telemedicine. I thank the noble Baroness, Lady Barker, who I note has signed this amendment, for supporting me through that process, because I had little idea about what I was doing in terms of your Lordships’ House. It is worth noting that we were doing that in part in acknowledgement that women would not otherwise have access to the necessary medical service of an abortion, but also because we knew that NHS resources were going to be enormously stretched. We are still in a situation where NHS resources are enormously stretched. Earlier we were talking about the Ukrainian refugees whom we will be welcoming here and the medical services that they will need.

Of course, we want to say that, in this area of medicine, we should be putting resources into all the NHS services that women need, but the evidence is overwhelming that telemedicine abortion is giving women a better service. I pick up the point made by the right reverend Prelate that there may be safeguarding concerns. There is evidence, particularly from MSI Reproductive Choices, reporting a major uplift in safeguarding disclosures, including from survivors of domestic and sexual abuse, with telemedicine.

On the medical side of this is a simple clear fact: since telemedicine has been introduced, complication rates from abortion have fallen by 20%. You do not have to listen to just me on this; permanent provision of abortion telemedicine is supported by eight royal colleges and medical societies, including the Royal College of General Practitioners, the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the British Medical Association. I also point out that abortion telemedicine is going to continue in Wales and Scotland, based on the evidence. The arguments are simply overwhelming: this is the best option.

[Lord Sentamu (CB)]

My Lords, I was not going to speak on this, but I listened to the noble Baroness, Lady Finlay, and that encouraged me to stand up and speak, together with other noble Lords who are a bit cautious about all of this. I was a vicar of an inner-city parish in which there were a lot of teenage pregnancies, and those who made them pregnant tried to force them to have abortions. The only person they felt they could tell was the vicar, not their parents, because their parents would hit the roof. Some of them would get corporal punishment as a result. I found myself in difficult, tricky situations, but I was fortunate, because in the congregation we had midwives and doctors. I simply said, “I listened to what you are saying to me, but I am not medically qualified to give any advice. We have experienced people who can give you that advice.” I was grateful that those midwives and doctors were able to accompany these teenage girls and help them come to a more sensible position.

I speak as somebody who is not against abortion, because the welfare of the mother and her rights need to be protected, but I am concerned about a measure that was brought in because of extreme circumstances. The Government were right, during the pandemic, to allow the kind of arrangement that was set up. But I am with the noble Lord, Lord Bethell, that we should not change overnight a tradition and circumstances that were accepted by the majority who see the right of abortion. We should not say that we will now go down this almost administrative route as the norm. Most people would be very concerned if we were going down a particular route.

I strongly believe, because of my experience of those teenage pregnancies in Tulse Hill, that the role of doctors, specialists in counselling and others is absolutely vital. You cannot do away with that because it is easier at the end of a telephone. You may not believe it, but young boys who had made girls pregnant would put pressure on them to have these abortions, for no reason other than that they wanted to move on to the next young girl. I still find that unacceptable.

Hospitals: Patient Transport

Lord Sentamu Excerpts

Tuesday 4th April 2017 Lords Chamber

[Lord O’Shaughnessy]

The five-year forward view delivery plan is a publication by NHS England. We continue to back it to deliver its ambitious plans, which include further increases in diagnostic tests and making sure that even more people survive cancer. We are focused on ensuring that the system is as efficient as possible in order to do this.

[The Archbishop of York]

My Lords, the Minister speaks with such clear diction that we can hear every word he says. He is not producing a drama, but although I have been listening to him carefully, I do not think that he has answered the Question put to him by the noble and right reverend Lord, Lord Harries. He asked what steps were being taken,

“to reduce waiting times for patients using hospital patient transport”.

I did not hear the answer. All I heard was that the Minister was willing to have a word with him, but it is not just about the noble and right reverend Lord and his wife. A lot of other people are in the same predicament. We want to know what those steps are. That is the nature of the Question and, if I did not hear the response, I apologise.

[Lord O’Shaughnessy]

I thank the most reverend Primate for giving me the opportunity to come back on this. First, NHS England is working with clinical commissioning groups to make sure that the kind of delays outlined by the noble and right reverend Lord, Lord Harries, do not happen. Also, a series of 39 pilots are being conducted in rural areas which are particularly badly affected by patient transport delays to put in place the kind of transport necessary to make sure that people who cannot get to hospitals and may miss appointments are able to do so.