Tobacco and Vapes Bill

Lord Young of Cookham Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

[Lord Young of Cookham (Con)]

My Lords, there are two Bills that we debate this week, both of which originated with the last Conservative Government—the other one being the Renters’ Rights Bill—so this should be a harmonious few days in your Lordships’ House.

I recognise the concerns that some of my noble friends on the libertarian wing of my party may have about this Bill. They may feel that it is an intrusion on the freedom of the individual and an excessive intervention by the state. I want to try to allay those concerns. Like others who have spoken, I was a Health Minister, nearly 50 years ago. I recall a conversation that I had in the context of the debate about seat belts with a consultant at St George’s Hospital, which was then at Hyde Park Corner. He was preparing a patient for an organ transplant; the patient had a rare blood type, and it had taken him some time to procure the supplies. Just before the patient was wheeled into the operating theatre, there was a traffic accident at Hyde Park Corner. The driver, not wearing a seat belt, had life-threatening injuries. He was wheeled into St George’s and had the same rare blood type as the transplant patient, so the patient’s operation was postponed. That shows that, in the interconnected world in which we live, a decision by one person to take a personal risk has consequences for other people.

I say to my friends that the Conservative Party actually has a proud record in the history of public health. In 1973 the compulsory wearing of crash-helmets was introduced by the Ted Heath Government. In 1983, under the Margaret Thatcher Government, seat belts were made compulsory for drivers, and in 1991 they were made compulsory for passengers. As my noble friend Lord Lansley has said, the coalition Government took further steps, and the last Government introduced the Health and Care Act, which unblocked progress in adding fluoride to the water supply to promote dental health. So this measure is perfectly consistent with my party’s approach to public health over 50 years.

The Bill that we are debating, unlike others to which I have referred, would not impact on the freedom of anyone today. The Bill, as published, enables adults who buy cigarettes and smoke legally today to continue to be able to do so. My criticism of the Bill is that it does not do enough to discourage existing smokers to stop or to discourage new smokers starting. The Minister referred to the Government’s three-pronged approach to health—switching from analogue to digital, from hospital to community and from treatment to prevention —but that latter switch requires resources, currently in short supply.

When products cause harm, the polluter should pay. Again, that is a principle introduced by previous Conservative Governments: the landfill levy was introduced in 1996; the soft drinks levy was introduced in 2018; and, after the Grenfell tragedy, we introduced the Building Safety Act to make the construction industry pay for the remediation of high-rise blocks. We should apply the same principle to tobacco.

In a report commissioned by the last Conservative Government, to which my noble friend Lord Lansley referred, Javed Khan looked at three options to raise funds to implement his recommendations. His preferred option was a “polluter pays” industry levy. A tobacco “polluter pays” levy could be introduced in the form of a charge applied to a percentage of profits. It would not impact on the CPI, nor on the cost to the consumer, but it would raise hundreds of millions of pounds.

We debated exactly that proposition on 16 March 2022. Responding to Amendment 158 to the Health and Care Bill, the then shadow Minister, the noble Baroness, Lady Merron, stated:

“This strikes me as wholly pragmatic; a wide-ranging consultation would undoubtedly help to strike the right balance between all the parties involved … The scheme proposed in this group of amendments would provide a well-funded and much-needed boost, and a consultation would allow this proposal to be tested, refined and shaped. I hope that the Minister will accept the opportunity of a consultation but if the will of the House is tested, these Benches will support the amendments”.—[Official Report, 16/3/22; col. 297.]


The noble Baroness will not be surprised to learn that that commitment will be tested when we reach Report, to make this an even better Bill than it is now.

NHS Dentistry

Lord Young of Cookham Excerpts

Wednesday 19th March 2025 Lords Chamber

Asked by

[Lord Young of Cookham]

To ask His Majesty’s Government what steps they are taking to improve access to NHS dentistry.

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

My Lords, we are tackling the challenges for patients trying to access NHS dental care by providing 700,000 more urgent dental appointments per year, with integrated care boards delivering those extra appointments from 1 April 2025, which is not long away. We will recruit new dentists to the areas that need them most and to rebuild dentistry in the long term we will reform the dental contract with the sector and shift to focus on prevention and the retention of NHS dentists.

[Lord Young of Cookham (Con)]

I very much welcome the 700,000 extra appointments, which will begin to make an impact on the 2.2 million people who now need urgent care, but did the noble Baroness read the leader in the Times on Monday which said

“the scandal of NHS dentistry has dogged successive governments without resolution”?

It mentioned the 30,000 children each year who go to hospital to have rotten teeth extracted under anaesthetic and the 18 million adults and children who cannot access an NHS dentist. Does she agree that at the root of this problem is the 2006 dental contract, which has driven dentists out of the profession? When might a new contract be introduced? Given that the most effective public health measure is to add fluoride to the water supply where it does not exist naturally, when will she roll out the programme that has begun in the north-east?

Mental Health Bill [HL]

Lord Young of Cookham Excerpts

Committee stage
Wednesday 22nd January 2025 Lords Chamber

[Baroness Keeley (Lab)]

My Lords, I rise to explain the significance of Amendment 64 in my name, which aims to cover the situation of both young carers and young children in a family where a care and treatment plan is being prepared for their parent. I thank the Carers Trust for suggesting this amendment and providing a briefing on this issue. I also thank the noble Lord, Lord Young of Cookham, for his support for the amendment and, of course, the noble Baroness, Lady Tyler, who has just spoken of her support for it.

Briefly, the amendment adds the requirement that a practitioner preparing or reviewing a care and treatment plan must ask whether there are children in the family and take actions to respond if the children need help or protection from harm. This amendment would, as I said, cover young carers, but it would also cover young children where there may be safeguarding concerns—a topic which the Child Safeguarding Practice Review Panel highlighted as a theme in its latest annual report.

As the noble Baroness, Lady Tyler, just touched on, young carers are so often hidden, and often their needs are identified only when there is a crisis. Even then, the extent of their caring role and the impact it has on the child’s development may not be recognised quickly or fully assessed. This amendment would help to ensure earlier identification of children who might be in need of information, support or protection from potential harm. It would mean staff asking the right questions early on to ensure that the right information is recorded and actions taken. It would help with adequate signposting of information and a chance to offer appropriate support to avoid a crisis or manage it appropriately.

The amendment also mirrors the new wording in the Working Together to Safeguard Children statutory guidance, which covers adult social practitioners:

“When staff are providing services to adults, they should ask whether there are children in the family and take actions to respond if the children need help or protection from harm. Additional parenting support could be particularly needed where the adults have mental health problems”.


There is evidence that having a parent with a mental health problem is one of the biggest risk factors for a first episode of major depressive disorder in children and adolescents.

This is not inevitable. Research suggests that intervention can enhance parenting skills in households affected by parental depression, and it can change the way that children cope. In turn, this can reduce the risk of children internalising problems that may threaten their life chances. The amendment is designed to enhance the ability of agencies working individually and together to identify and respond to the safeguarding needs of families. It is about supporting the challenging work of finding out what is happening to children and anticipating risks and harm, of knowing when action is needed. In most cases, children receive the support, help and protection they need, but sometimes children are seriously harmed or, worse, they can die because of neglect.

Policy initiatives in recent years have called for a wider family focus on safeguarding children so that all staff recognise that meeting the needs of family members who may put children at risk benefits the child, the adult and the family as a whole. This amendment would support those efforts. The amendment is in keeping with guidance from the Social Care Institute for Excellence to “Think child, think parent, think family”, to ensure that the child is heard and their needs are met.

The Carers Trust believes that the amendment would unlock additional support from mental health professionals to work with parents and children to enable the child to have age-appropriate understanding of what is happening to their parent and information about what services are available for them in their situation and how they can access them.

To illustrate the need for the amendment, I have two short case studies. Aidan was four when his mother was first sectioned under the Mental Health Act. Throughout his childhood, Aidan’s mother was regularly sectioned and would sometimes be in hospital for a number of months. There were many occasions when the police were involved because his mother had disappeared, which was particularly scary for Aidan. In his words:

“To me, you only ever saw the police if you’d done something wrong, so I remember when they turned up at our house, I thought mum was in trouble”.


Seeing his mother being taken into hospital on a regular basis meant that Aidan had lots of questions and worries. In his words again:

“There were so many times where I wondered whether mum would ever come home. I knew she’d been sectioned but I had no idea what that actually meant or if she would ever get better”.


Staff at the hospital who were treating Aidan’s mother would regularly see him visiting. Despite this, none of the staff there told Aidan or his father about support that might be available or asked whether Aidan might need any help. It was only when Aidan was 12 and his attendance dropped at school that he was identified as a young carer.

The second case is Vamp’s story. This is a pseudonym chosen by her family. The case study is taken from a recently published child safeguarding practice review which found that a 13 year-old girl died as a result of taking drugs sold to her in a park. It was identified that her mother had had a period of serious mental illness, and that illness was identified as the catalyst for things deteriorating for the young person. Tragically, two years on, the young person had died. This is taken from the relevant extract from the child safeguarding practice review:

“Vamp’s mother did not feel that her daughter had been a young carer … as the mental illness was short term. However, Vamp’s sister described the situation as being so difficult for both. When their mother was discharged home from hospital, it was only Vamp and her mother at home. Vamp’s sister was only a young adult, and with her own baby to care for. She … said she felt that no one checked in on their mother. Vamp’s sister … said that professionals expected her mother to manage to parent Vamp, which she was not able to do alone, she needed professional help”.


This is a simple but important amendment to protect young carers. I urge my noble friend the Minister to consider it, and I commend the amendment to the House.

[Lord Young of Cookham (Con)]

My Lords, I have added my name to Amendment 64, in the name of the noble Baroness, Lady Keeley, and shall speak briefly in support. I have not contributed to this Bill before, but I have sat through many of the debates. Without sounding pompous, it struck me that this was our House at its best, dealing with a complicated Bill in a sensitive and non-partisan way and drawing on the unique expertise we have in our House.

As I listened to the earlier debates on detention and community treatment orders, I asked myself how the children in the families concerned would be informed and what the impact on them would be. We have just heard from the noble Baroness, Lady Keeley, the impact on Aidan when his mother was sectioned. By definition, the people covered by the Bill are vulnerable people; many of them will have carers, and many of those carers will be young carers. As the noble Baroness has just said, this amendment simply helps improve the earlier identification of children of parents being detained under the Act and to ensure that they have access to support, if they need it, and are safeguarded where necessary.

The 2021 census showed that there are 50,000 young carers caring for over 50 hours a week. An astonishing number—3,000 of them—are aged between five and nine. The Carers Trust has shown that those young carers at school are at risk of a poorer attendance record, lower academic achievement and more liable to social isolation and, sadly, bullying, if they are not identified early. As the noble Baroness, Lady Keeley, just said, having a parent with a mental health problem is actually one of the biggest risk factors for depression in children and adolescents. But it is not inevitable: research suggests that intervention can reduce that risk and change the way that children cope.

As a vice-chairman of the APPG on Young Carers, I know that we took evidence last year from young carers, and we heard that on average it takes three years for a young carer to be identified, with some of them taking over 10 years before being identified. Improving early identification is one of the top priorities of the all-party group, so that they can access support and not be negatively affected by their caring situation.

This amendment will help to tackle the issue, which is reported by young carer services, that many potential young carers are not identified by adult mental health services. For example, one young carers service, the Young Carers Alliance, reported that 20% of the young carers it supports are supporting a parent with a mental illness, yet they did not receive a single referral from the adult mental health services in the space of an entire year.

In our inquiry, we also heard from the charity Our Time how, when it comes to identifying young carers by mental health professionals, we are way behind countries such as the Netherlands and Norway. Both those countries have introduced requirements for health professionals to consider whether adults with mental health problems have children. This referral may not be a one-way process; if the child is a carer, he or she may have an insight into the events that trigger an episode in the parent and may actually help the professionals to identify an appropriate treatment pathway.

A final benefit of this amendment is that it would help adult mental health in-patient units ensure that they are complying with the duty under Section 91 of the Health and Care Act 2022 to consult with any carers, including young carers, before discharging an adult from hospital. Again, last year, we heard of patients being discharged without the young carer being informed, often where they were the principal carer. For these reasons, I hope that the Government can support this amendment. I look forward to the Minister’s reply.

Social Care Reform

Lord Young of Cookham Excerpts

Monday 2nd September 2024 Lords Chamber

Asked by

[Lord Young of Cookham]

To ask His Majesty’s Government what plans they have to reform social care.

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

My Lords, adult social care reform is critical to achieving this Government’s aim that everyone lives well for longer. Our vision is to create a national care service underpinned by national standards and delivered locally, supporting people to live independently for as long as possible. We will also establish the first-ever fair pay agreement for care professionals. We will engage widely with the sector and people with lived experience to inform these plans.

--- Later in debate ---

[Lord Young of Cookham (Con)]

My Lords, I welcome the proposals to improve pay and conditions for those working in the adult care sector that the noble Baroness just announced. But is she aware of the widespread dismay at the cancellation of the proposals for reform, due to come in next year, without anything being put in their place, particularly against the background of what Wes Streeting said during the campaign:

“We don’t have any plans to change that situation and that’s the certainty and stability I want to give the system at this stage”?


The former Health Minister, Lord Warner, said that the Government’s announcement was “misguided”. He went on to say, on the plans for reform:

“A Royal Commission and a vague aspiration for a National Care Service is … kicking the can along the road”.


So should the Government not adopt the proposals put forward unanimously by two Lords Select Committees, chaired by the noble Baroness, Lady Andrews, and the noble Lord, Lord Forsyth, and make progress straightaway?

[Baroness Merron (Lab)]

I understand that, whenever there is a change in direction, there is concern. I take the noble Lord’s point. The inherited commitment to implement the adult social care charging reforms, which would have been on course for next month, was undeliverable because the previous Government did not guarantee the money to do that. It would have cost nearly £1 billion next year, rising to £4 billion by the end of the decade. There were many false dawns in respect of this long—and repeatedly—promised change. It is also the case that there was not adequate preparation to implement the charging reforms. Councils warned that they were impossible to deliver in full in the previously announced timeframe. With all that in mind, I am sorry to say that we, as the new Government, had little alternative but to say that these were not funded or on course to be delivered. We will have to ensure that we offer a national care service, along with a new deal for care workers. We will continue to consult and listen to those with lived experience in order to get it right.