Cardiovascular Illnesses

Lord Weir of Ballyholme Excerpts

Thursday 12th June 2025 Grand Committee

[Lord Weir of Ballyholme (DUP)]

My Lords, I thank the noble Lord, Lord Booth, for securing this debate. I say as an aside to his opening remarks that if the most common British response is, “I feel fine”, the greatest fear any British person has is of asking someone how they feel and actually getting a detailed response.

The significance of CVD is unanswerable. It is responsible for about one-quarter of deaths in this country and is probably the biggest single contributor to premature deaths and to people leaving the workforce early. It plays a key role in the level of economic inactivity in this country. In pure economic terms, different figures have been put about, but the British Heart Foundation calculates the cost to the UK as £29 billion a year.

Beyond the societal and economic impacts, every statistic that we will cite in this debate today represents an individual and an individual family. We are also faced with the major challenge that whereas mortality rates for CVD dipped in 2019, the figures seem to have begun to rise again after having largely been level over the past decade or so. There is a key challenge about how we can start to drive those down. I suspect that all of us will be united about what we are hoping to achieve—a reduction in the incidence, impact and level of deaths—so it is a question not of what, but of how. I will be interested in the Government’s response on a range of issues.

First, the 10-year plan for the NHS is the correct approach to look at this strategically, and I hope that it will lead to more holistic, joined-up approaches and mean that when it comes to budgeting we can look at things much more strategically. However, it has been highlighted by a range of key stakeholders in this field that there is a need for a specific cardiovascular disease plan. I would be interested in hearing the Government’s response on how we can balance the specifics of a plan with the more general strategic direction that we are seeking for the NHS. Similarly, we know that emerging technologies can play an important role, from AI to data science. Any information that the Government can give on how specifically they intend to harness those in the fight against cardiovascular disease will be critical.

Secondly, as highlighted by the noble Lord, Lord Moynihan, and others, prevention is the critical element to this. For many people who suffer from cardiovascular vascular disease, the first symptom is a major event, a stroke or a heart attack. It is quite often symptomless. Within that context, we know the range of risk factors, from smoking to obesity, alcohol and air pollution. I know that the Government are taking action on some of these fronts but, again, there is a concern, particularly given the figures, that we are starting to get diminishing returns on certain elements of behavioural aspects. It will be critical to say that in educating on the risk factors, we can act as a driver to harness that and make a real difference to people’s lives.

Thirdly, on testing, it is important that, for example, blood pressure tests are expanded and rolled out more. We know that NHS health testing could have a critical role in prevention and diagnostics, yet we see a mixed bag of take-up of those tests. In particular, we know that men can be more prone to cardiovascular diseases and have a higher incidence level but are perhaps more reluctant to go to a doctor to get those tests. This can also apply to a range of ethnic-minority groups such as the black and south Asian communities, who have statistically higher levels of CVD. I would be interested to hear how the Government can ensure that we better target testing and perhaps look at the commissioning of testing, and how we can incentivise primary carers to encourage people much more to do testing.

Fourthly, we need to raise our ambitions beyond simply the mortality rates. For strokes, for example, there is a target of a 25% reduction in deaths. I would like to see—and I ask the Minister whether there is an intention to have—a similar target of 25% in reducing severe disabilities as an impact of strokes. Allied to that is a key role for improving review and rehab facilities to ensure that, once someone has suffered a stroke or a cardiac event, it does not reoccur and we are not left with a far worse situation.

Finally—and this is not unique to CVD—there is the question of how we can have a level of consistency. I have mentioned testing already and the need for greater levels of use of community pharmacies, for instance, for blood testing. For something such as thrombectomy, the rates are very different. If you are in London, their usage is at around 10%; at the other end of the scale, in the east of England, it is about 1%. There is a range of issues around how we can drive greater consistency in treatments in the health service. I look forward to the Minister’s response.

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

Committee stage
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.