Preterm Birth Committee Report

Lord Weir of Ballyholme Excerpts

Friday 6th June 2025 Lords Chamber

[Lord Weir of Ballyholme (DUP)]

My Lords, I am only the third male Member of this House to speak in this debate, following on from the noble Lords, Lord Patel and Lord Winston, which, in addition to the other excellent contributions that have been made, gives me a slight feeling of being woefully inadequate to comment on this subject.

But I will start by commending what is an excellent report. While the scope of the report deals with England and Wales, the lessons that are drawn from it are applicable in all parts of the United Kingdom. It focuses on the two critical points, which are the incidence of preterm births and how we can optimise care for both the babies and their families in the days after birth.

It is critical because it goes to the heart of one of the two great nightmares that any parent can face. The second-worst situation for any parent is to be left in a situation in which your child is faced with a life-threatening condition, where you are left with weeks or months of trauma, not knowing whether your child will survive, not even being able to give that child comfort, and often then being faced with a situation in which that baby is faced with lifelong conditions. That is the second-worst situation for any parent. The worst situation, which sadly also pertains to a number of parents in preterm births, is the death of their child. There is no greater trauma that any parent can face, and that is why this this issue is so vital.

In the time available to me I want to look at three aspects of the report. The first is the incidence of preterm births. We are, thankfully, living in an era in which we have seen consistent improvement on a wide range of medical issues. No more so is that the case, over the decades and centuries, than for issues around birth and maternity. In human history, not that long ago, mortality rates for babies and mothers were extremely high. That applied not simply to those with socioeconomic problems but equally, quite often, to the most privileged and richest in the land. Thankfully, we have seen considerable improvements in that.

This is why the statistics produced in this report are quite worrying. As indicated earlier, a target was set 10 years ago to reduce the number of preterm births from around 8% to 6%, yet, in that 10-year period, figures have remained stubbornly high. Currently, the figure in England is 7.9%; in Wales, it is 8.1%. As indicated in the report, those figures mask further underlying problems, in the higher level of incidence for mothers from both lower socioeconomic backgrounds and ethnic minorities. The statistic is stark that a black mother is twice as likely as a white mother to have a very preterm birth. Similarly, the figures have not shifted for neurodevelopment issues.

As indicated, there is a multitude of reasons, of risk factors, for this. Mention has been made of smoking, drinking, mental health issues and diabetes. There is a wide range. One key aspect, on which I know the Government are focused, is the wider public health message, because a lot of these problems can be eased prior even to pregnancy taking place. We know the risk factors, but one of the areas highlighted in the report is the job of work still to be done, with greater levels of research, to work out the level of causality between risk factors and the end results.

Secondly, a wide range of screening, treatments and scanning takes place but, while new technologies can make improvements, we need to drill down in this area, with a much greater level of research, to try to make sure that what we provide prior to birth is the best possible situation to avoid preterm births.

A further area is the very welcome recognition that, while birth and the weeks after it are important, issues with preterm birth go well beyond that. It is important, particularly when we are looking at targets, that we acknowledge the number of cases where preterm births are medically induced, where it is both necessary and virtuous because it produces a better result for the mother and baby. However, we also know that around 75%—another statistic referred to in the report is 79%—of neonatal deaths are preterm babies. Beyond that, the figures also suggest that 46% of deaths of children under 10 were preterm babies. We know that, among preterm babies, there is a greater incidence of severe and milder disabilities, such as ADHD and cerebral palsy. The figures suggest that the incidence of children with severe brain injuries is around seven times higher than it is for babies who have gone full term. So there are important repercussions beyond the initial period in a neonatal unit.

The report is also very good at establishing some of the problems that are created not just for the babies themselves but for their families. We know that this can be a very traumatic experience and that it is rarely anticipated by the parents. Many mothers and fathers are left with a high level of anxiety—a traumatic period of separation when they are not able to give comfort to their children or hold their newborn babies. That can create a feeling of separation and alienation; the report indicates the number of parents who have PTSD as a result.

A point made very well in the report is that this is not simply in the first few weeks of birth but, as sometimes happens with trauma, can kick in much later, maybe months or even a year or two afterwards. It is clear that there are not necessarily the right levels of support for that. Counselling is also not always given to parents as follow-up support.

My third and final point, which is writ large throughout the report, is on the level of variations. While there has been a considerable improvement in the number of trusts embracing a bundle of interventions, there are still gaps. We need to work on best practice models, such as the PERIPrem model, and see where we can roll them out.

A range of other issues relates to that. The extent to which training can be given is sometimes dependent upon how much trusts are able to release staff, which varies. We have seen that family integrated care is not always universal, and some trusts, according to the report, water down that national guidance.

Beyond that, a range of staff shortages has been highlighted, from obstetrics to gynaecology departments to midwifery. Indeed, the gaps in terms of midwives also mean that there is no consistency of care.

Finally, as is highlighted in the report, we have also seen sporadic follow-up in, for example, the level of knowledge of health visitors, the position on two-year and four-year follow-up and the lack of counselling for parents.

So there is a lot to be done, and we need to see a greater level of consistency. One of the startling statistics highlighted in the report, which shows the need to further prioritise this issue, is that, for every pound spent on pregnancy care in this country, less than a penny is spent on pregnancy research. This report is a very good road map and I welcome the commitments that the Government have made but, if this is not simply to be an excellent report that gathers dust on the shelf, we will need to see those commitments turned into reality by the Government implementing the report.

Complications from Abortions (Annual Report) Bill [HL]

Lord Weir of Ballyholme Excerpts

Friday 6th June 2025 Lords Chamber

[Baroness Finn (Con)]

My Lords, I apologise for not being able to attend Second Reading. I begin with the observation that, as a healthcare service, abortion is highly regulated and subject to the same oversight as any other care. As a result of the Abortion Act 1967, it is also subject to additional oversight which predates many of the regulatory and monitoring systems in place across the health service today.

This context is relevant to the Bill before us, which seeks to build on this 58 year-old framework. I am wholly in favour of monitoring all forms of healthcare provision and entirely agree that further work needs to be done on the collection and analysis of large datasets relating to women’s reproductive health. However, I have concerns that this Bill in primary legislation is not the best way to approach this important work.

I am aware that both the Royal College of Obstetricians and Gynaecologists—the RCOG—and the British Pregnancy Advisory Service have shared with noble Lords their concerns that, as the noble Baroness, Lady Thornton, has said, singling out abortion for new legislation in this way exceptionalises it and fails to treat it like other forms of healthcare. This would potentially stigmatise abortion care for both women and the medical professionals who provide the care. It would also indicate that abortion is considered to be such a high-risk intervention that it is in need of particular oversight.

The RCOG points out that abortion is a “safe and effective procedure”. Some one in three women in the UK will have had an abortion before the age of 45 and international studies have repeatedly found that abortion is of less risk to women than complications that can arise from continuing a pregnancy to term and giving birth. As a result, I am concerned by any indication that this House considers abortion to require increased monitoring and oversight, over and above that of comparable healthcare, and indeed the message that it would send to the nearly 300,000 women who access abortion services across the UK every year.

I agree with my noble friend Lord Moylan that we need to improve collection of data, but this must be done across women’s healthcare more broadly, and I would be interested to hear from the Minister about what plans the Government have to achieve this. We know that in many areas, women wait a disproportionately long time for diagnoses of devastating conditions, such as endometriosis, and in that time often suffer complications that come from lack of treatment.

It was for this reason that the previous Government published the widely welcomed, first ever women’s health strategy for England, to take a holistic approach to women’s healthcare. I pay particular tribute to my former colleague, Emma Dean, for her tireless and excellent work to make this happen. We also appointed the brilliant Dame Lesley Regan as the first women’s health ambassador to support the implementation of this strategy. I was pleased to note that the Minister for Secondary Care confirmed in the other place the Government’s commitment to the women’s health strategy, though I am concerned about the lack of progress against the strategy’s widely welcomed commitments, especially the Government dropping targets for ICBs around the creation of women’s health hubs. The RCOG has said that the existing hubs have reduced unnecessary referrals, provided training opportunities for professionals and enabled women to access support quickly.

The NHS 10-year plan and monitoring of the women’s health strategy would, I hope, offer an opportunity to address the challenge of good monitoring without adding unnecessary legal burdens to the healthcare system. I hope that we can all agree that the purpose of this monitoring has to be to improve information and care for women, and that singling out abortion is unfortunately likely to do more harm than good.

Before I close, I want to touch on the practicality and operability of this legislation. I understand that the information currently used by the department to produce abortion statistics, such as the type of abortion, gestational age, and information about women accessing care, is separate in the majority of cases from a woman’s broader healthcare record. It seems incredibly important to protect this right to privacy for women accessing abortion care, particularly for women at risk of domestic abuse, honour-based abuse or reproductive coercion. I know that my noble friend will not want to place women at risk as a result of this legislation, so I wonder if the Minister can confirm that the department is able to link abortion records with wider healthcare records in the way this legislation would require, and if so, whether that would mean that abortion care would appear on a woman’s medical record, whether or not she had given consent.

Given my concerns about the impact of the proposals in the Bill on women and the wider healthcare system, I am not able to support it in its current form and support the noble Baroness, Lady Thornton, in her opposition to the clause standing part.

[Lord Weir of Ballyholme (DUP)]

My Lords, I join others in apologising for not being here at Second Reading—on medical grounds, in my case—which seems to be a consistent theme in this debate. In looking at the amendment and legislation today, it is important that we actually focus on what is there rather than debating—I appreciate that the noble Baroness does not intend to push this to a Division—something that is not there.

Tobacco and Vapes Bill

Lord Weir of Ballyholme Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

[Lord Weir of Ballyholme (DUP)]

My Lords, where we seek to restrict individual freedom, we should always approach that with a certain level of caution. However, it is undoubtedly the case that the horrendous, and often fatal, consequences of smoking go well beyond the individual. They are deeply detrimental to families, as we have heard today with so many personal testimonies from around the Chamber. They are deeply damaging to the health service and to our economy. In opening the debate, the Minister estimated the annual cost to the UK at about £21 billion. The British Heart Foundation suggests that the figure is around £43 billion. While there can be a debate around statistics, it is undoubtedly the case that the scale of the cost, both in economic and more importantly in human terms, is enormous. Therefore, the prize of seeking a smoke-free generation is one that we should support, and I strongly support the principles and aims of the Bill.

As the Minister indicated in her opening remarks, it goes beyond legislation itself. If, in this House, we could ensure virtuous behaviour within society simply by legislating, we would be living in a much easier world—but it requires a lot more than that. As we move forward, we need to have legislation that is the most practical and effective. Therefore, while we should embrace the principles of the Bill, the Government and this House, particularly in Committee, need to address the real and genuine concerns that have been raised, particularly through this debate. I will list just four of them in the short time I have available.

First, while many retailers will strongly support the Bill’s aims, there are genuine concerns raised by small retailers over issues around enforcement, age identification and the threats of potential violence to themselves and shop workers, putting them on the front line. We cannot be blasé about those claims and simply say that it is a relatively small problem that will be overcome, and it will all work out. We need to hear from the Government how they intend to address those genuine concerns and meet the concerns raised by retailers.

Secondly, it is right that the principal focus of the Bill is to try to deter young people from smoking. Mention has been made about the best routes to give up smoking. The most effective way to give up smoking is never to start it in the first place. We know that, on average, about 350 young people take up smoking each day, so it is also incumbent on the Government, if we are looking at the most practical measures, to explain in detail why what has been suggested as a different practical approach—instead of a rolling age target, having a higher fixed age of either 21 or 25—is not the way forward. The Government need to go into a greater level of detail on why that would not work, because we are all concerned about the effectiveness of this.

Thirdly, as has been highlighted by the noble Lord, Lord Dodds, and the noble Baroness, Lady Hoey, it is welcome that we have a Bill that operates throughout the United Kingdom. The Minister was right to say that that is critical to the Bill’s effectiveness and to the equality of its impact. However, a strong concern has been raised because of Northern Ireland being linked in with the European Union tobacco directive and its implications through the Windsor Framework. We have seen the tobacco directive have a major impact on what has happened in Europe. The Republic of Ireland—which, to its credit, was the brand leader in taking action against smoking; I think it was the first jurisdiction in western democracy to ban smoking indoors—has been prevented from taking measures of this nature because of that directive.

It is undoubtedly the case that those associated with the tobacco industry will seek to challenge this legally through judicial action. We need to see more substance than simply the Government saying that they are confident that that will not succeed. There is no point in passing legislation only to find, six months or a year down the line, that this loophole is opened up again in Northern Ireland because of a court decision, and we all just shrug our shoulders. The Government need to address this seriously, through amendments.

Finally, we need to acknowledge that there is a real risk of both smuggling and additional criminality. That has been the experience of prohibition in any set of circumstances. It is not the case that we should say that we must abandon prohibition—otherwise, we would simply legalise everything—but it is incumbent on the Government to say what additional measures will be taken to ensure that organised crime is combated. It cannot be more of the same. I look forward to the Minister’s response and to detailed scrutiny in Committee and on Report.

Dementia

Lord Weir of Ballyholme Excerpts

Thursday 18th January 2024 Grand Committee

[Lord Weir of Ballyholme (DUP)]

My Lords, as both a member of the APPG and formerly a carer for my late mother, who suffered from vascular dementia, I welcome this debate and thank the noble Baroness, Lady Browning, for bringing it forward.

We are facing a tsunami of additional care needs in this country as a result of dementia, and it will require a step change from government, of what whatever political complexion. A myriad of solutions is required—some of them have been outlined today—but the noble Baroness, Lady Browning, was right to highlight a key component: parity of esteem between healthcare and social care.

Some of the implications of that lack of parity at present can be seen. It has been mentioned already that 45% of the social care workforce does not have direct training in dementia. The number of vacancies within social care is estimated to be 192,000, because there is a difficulty with both recruitment and retention of staff. The implication for individual dementia patients and their families across the country is a postcode lottery where both the quantity and the quality of care are deeply variable. For many of those families, the gap in what can be provided to them means that what they get simply does not cover the needs of the individual patient, and, somehow, they have to cope both financially and from a caring point of view to fill that gap.

If we can meet this issue of parity, there are a number of benefits. First, in many ways, we are facing an even greater difficulty than the official estimates of numbers show. Fortunately, we are beginning to see some solutions. New drugs are likely to appear in the near future, and they will at the very least slow the progress of dementia. That is a very good thing—it will mean that people live longer—but the implication of it is that, ultimately, we will probably have a lot more people with dementia. It will also shift the pressures from healthcare directly and to a much greater extent on to social care.

Secondly, parity will act as a driver for a much more joined-up approach to tackling dementia. In Northern Ireland, healthcare and social care have always been under one department and one system. That is not necessarily a panacea, but no one in Northern Ireland would try to disaggregate those two elements—it is perhaps one of the rare occasions when the rest of the country could learn something from Northern Ireland.

Thirdly, as indicated, parity would have major financial implications for the country’s healthcare. Too many people are unnecessarily in hospital and too many are not only admitted to hospital when they do not need to be but bed-blocking because there is nowhere to place them. Most of all, it will increase choice for families. For many who have dementia, being in hospital or in a residential home is either a choice they make or, from a practical point of view, there is not really an alternative. However, on many occasions, it has been forced on people because they do not have the choice.

Dealing with the issue of parity between healthcare and social care will be a key driver in ensuring that we can look after those with dementia and their families to meet the needs not just of now but of the future.

Organ Donations

Lord Weir of Ballyholme Excerpts

Tuesday 12th December 2023 Lords Chamber

[Lord Weir of Ballyholme (DUP)]

My Lords, I welcome the debate brought forward by the noble Lord, Lord Hunt, and the focus that it enables on this issue. I am supportive of the principle of the legislation that he brought forward, which balances out the opportunity for increasing those making life-saving organ donations, while still being wedded to the principle of voluntary decisions to donate.

In the short time available, I will concentrate on a point touched on by the noble Lord—the specific position of those suffering from cystic fibrosis. This covers about 10,500 people in the United Kingdom, and organ donation is particularly relevant to them because it is highly likely that the vast majority will require it at some point in their lives. Normally that is in the nature of a double lung transplant, but it can also have impact on organ donations involving the stomach. As he indicated, it is not simply a question of widening the pool of people willing to give a donation. The latest figures suggest that in 2022 there were 33 donors providing lungs within the system, but only six operations involving a lung transplant. The figure cited by the Cystic Fibrosis Trust makes reference to about 15%. That led, in part, to the Government’s establishment of their own Organ Utilisation Group, which reported in 2023 and highlighted a wide variety of practice in both the type of organs and between different units.

We have also seen barriers to utilisation that can happen for non-clinical reasons—for example, the absence of a theatre where the operation can be performed. Arising from that report were 12 recommendations. It would be useful if the Government could indicate whether they are committed to all 12 of those recommendations, and any progress they have made on their implementation.

With cystic fibrosis we concentrate very much on the issue of organ donation supply, but demand is also critical. We know that the modular treatment developed in the past few years can reduce the pressures of demand. Agreement was reached in 2019 between the NHS and those providing medications that lead to modular treatment. On the face of it, the initial reports suggest there is clear clinical evidence that it is of benefit. For example, 96 people joined the cystic fibrosis transplant waiting list in 2019, while in 2022 the figure was just 22. What is concerning is that the initial conclusion drawn is that this provides something clinically effective, but there is a question mark over value for money. It is critical that this be resolved, because it is leaving many families in a very difficult position.

This highlights that widening the pool of people giving consent for organised donation is critical for individual families. That is only one part of the picture—the other issues of utilisation of organs and demand is critical as well. That provides us with the full picture and jigsaw, and I am interested in the Minister’s response on those issues.

Adult Social Care

Lord Weir of Ballyholme Excerpts

Wednesday 22nd November 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct; they are the bedrock and are valued, and it is important that we make them feel valued. As I said, we are reforming the process in order to give them a qualification, which means that that work in the social care setting will be transferable between positions. In addition, if they want to go further into the medical service, be it nursing or other areas, a modular qualification system will enable them to build towards that, so that they not only feel valued but are in a long-term career structure.

[Lord Weir of Ballyholme (DUP)]

My Lords, many families seeking adult social care can find that availability and quality are patchy; and particularly for those living in rural areas, the help they receive can effectively be a postcode lottery. What steps are the Government taking to drive consistency and equality throughout the system, so that every family can receive the level of adult social care that is needed for their loved ones?

[Lord Markham (Con)]

That is a good point. We have given the CQC responsibility for measuring local authority provision of care. Overall, we are seeing a high satisfaction rate—89%—and the number of complaints went down by 16% in the last year, so these things are making a difference.

Adult Social Care (Adult Social Care Committee Report)

Lord Weir of Ballyholme Excerpts

Monday 16th October 2023 Lords Chamber

[Lord Weir of Ballyholme (DUP)]

My Lords, I too commend this report and thank the noble Baroness, Lady Andrews, and the committee for producing it, not simply in my capacity as a Member of this House but as a former carer of my late mother.

The report is deeply prescient. For too long, the issue of the need for change in adult social care has been long-fingered, and it is understandable why parties of different complexions have not grasped the issue, given the toxicity particularly around how we pay for the additional needs of adult social care. But that luxury of putting things on the long finger is something that we cannot afford to ignore any longer.

Mention has been made of an estimated 10 million people in this country being impacted by adult social care, and that number is set to grow almost exponentially, particularly as we see advances in medical science which mean that people will die less of particular conditions but will have to live with them. Nowhere is that more pertinent than with dementia and Alzheimer’s, where the numbers are probably set to double in the next few years.

In the time available to me, I want to touch on three aspects of the report. The first is the need for codesign in any plan for care—codesign with carers and also those in receipt of care. If we simply look for a one-size-fits-all solution for individuals, it will not work; similarly, if we simply seek to impose it on people, it will be a recipe for disaster.

Secondly, we need a consistency of approach across the country. We are all too aware, as is highlighted by the report itself, that for many people the quality and quantity of availability of adult social care is a postcode lottery. I know that, even in Northern Ireland, where there is a greater level of co-ordination, because health and social care are within the same department, that is no guarantee of a perfectly consistent result. I was very fortunate in my own circumstances that the company providing the care for my mother was a very good one, but I know that if I was maybe 10 or 15 miles either side of where I live, that level of care might not necessarily have been available.

As indicated by the report, we need investment in the extent of training required for the workforce—and, frankly, we need to raise the salaries of the workforce to ensure that we attract and retain sufficient numbers to be able to provide that level of social care. On consistency of provision, we need to ensure that the pathways for carers are clear and that it is easy to obtain help. As someone who was an elected representative, filling in the forms and accessing the care was quite easy for me—but many others are left in a very difficult position. I also know that, perhaps because of the level of support that I and my family were able to give my mother through finances and savings, we were able to bridge the gap between what could be afforded and what was required. But for many families that is not available.

Thirdly, we need a level of co-ordination in the system. I have mentioned that in Northern Ireland health and social care are within the one system. That in itself is not a panacea for all issues—but we have seen in a whole range of health issues that within the broader health service there is a level of silo mentality that still maintains. A number of us had a meeting today about palliative care, where again the failure perhaps to realise where there can be investment to save and to ensure a co-ordinated approach damages what can be provided and the quality of that provision.

The report highlights a cocktail of measures that are required to improve adult social care. Ultimately, it requires all of us to commit to a step change in what we can provide in adult social care. I agree with the remarks of the noble Lord, Lord Polak, when he talked about the need to take the politics out of this issue. Rather than try to create a political football in which we blame one party or another, we need to work together to try to deliver a consensus. It is often said that we have a health service in this country that is in danger of being broken. If we do not tackle properly adult social care, it will not be a question of it simply being broken—it will be irretrievably and irreversibly unfixable.

Mental Health Services: Huntington’s Disease

Lord Weir of Ballyholme Excerpts

Monday 12th June 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness makes a very good point; it is a whole-family problem. The investment we are talking about, in allowing us to access 2 million extra mental health patients, is about making sure we have got the numbers. The digital therapeutics are another way we are making sure there is access. The specific point the noble Baroness makes about looking at the families of people with Huntington’s disease is a good point that I will take back.

[Lord Weir of Ballyholme (DUP)]

My Lords, there is also a great deal of evidence that Huntington’s disease can be one of the conditions which can lead to dementia. It is a concern both in Huntington’s disease and dementia that there is a level of underreferral for mental health services. What specific action is being taken to tackle this issue, given that figures suggest the number of referrals for those suffering from Huntington’s disease and dementia to mental health services is minuscule compared with the level of demand?

[Lord Markham (Con)]

The research from the Huntington’s Disease Association, albeit with a small sample size of only 100, suggests there is an issue here. That is why I spoke to Minister Whately about this just this morning. She is being very firm in terms of tasking the NHS to come back with a plan to make sure we get that diagnosis. We will not know until we see the situation across a larger sample size, but clearly it is something we need to work more on.

Social Care: Workforce Strategy

Lord Weir of Ballyholme Excerpts

Wednesday 22nd March 2023 Lords Chamber

[Lord Markham (Con)]

I apologise because, in some ways, the timing is slightly unfortunate with the report coming out before the Recess, as is my understanding. I am not allowed to steal much of Minister Whateley’s thunder on that, but I will answer as best as I can. I hope that noble Lords will be pleased that questions around training, recognition of the importance of the service and career structure are all addressed in the report.

[Lord Weir of Ballyholme (DUP)]

My Lords, in my experience, many families in need of social care for members of their families find themselves in a form of postcode lottery, where the quality and quantity of social care that they receive is very much dependent on the local availability of social care workers. What further steps are the Government taking to try to ensure consistency of social care provision for people throughout the country?

[Lord Markham (Con)]

The noble Lord is correct, in that this is pivotal to the whole health service and to health and well-being. It is very much the duty of the integrated care boards, and our Ministers are personally holding them to account on this. I have frequent meetings on seven integrated care boards, and this is very much on the agenda. The other six Ministers have 42 in total, seven each, so that we can make sure we hold them to account.