Tobacco and Vapes Bill

Baroness Bennett of Manor Castle Excerpts

Committee stage
Tuesday 11th November 2025 Grand Committee

[Lord Lansley (Con)]

My Lords, I will speak to the four amendments in this group that are in my name—Amendments 78, 86, 88 and 89. Particularly perceptive Members of our Grand Committee will remember that, when they looked at the third Marshalled List, the Minister had signed my Amendment 89. I understood at the time that she had signed it not for the same reason that I tabled it—as we discovered at the last sitting of the Committee, the Minister did not move a whole set of government amendments. We will doubtless return to those issues later.

My amendments are all of a piece. The object is to dive into Clause 38 and remove those parts that relate to money that is received through fines for licensing offences from the hands of the Consolidated Fund to put it into the hands of the local weights and measures authorities or—as we might get to, in due course—the relevant authority, which is the trading standards enforcement authority. My proposition is a terribly simple one: we should prioritise the receipt of resources not only from fixed penalty notices but from the fines imposed for licensing offences and they should be made available to local authorities with trading standards responsible for enforcement.

The background is probably well known to Members of the Grand Committee. Trading standards is operating with substantially fewer members of staff than it did a decade ago. The Local Government Association has warned that trading standards may be unable to fulfil its statutory duties and the Association of Chief Trading Standards Officers has warned of a growing gap between its statutory duties and the available resources.

Happily, today we meet with a realisation that this has not inhibited trading standards departments across the country from taking effective action together with the leadership of the National Crime Agency, which reported 2,700 premises—barber shops, vape shops and other trading establishments—operating illegally. Where vaping is concerned, which is our interest here, these are being used as a route for the sale of illegal vapes—without paying the appropriate duty or doing so in due course—including to minors, which is of particular concern for many noble Lords. There is also the employment of staff who are not properly able to work in this country.

A wide range of these issues requires enforcement. My purpose is to try to ensure that the resources that are clearly coming into the system are devoted to trading standards. We know, or at least it is estimated, that trading standards enforcement costs over the next five years will total something like £140 million. We know that the Government have provided a grant of £10 million to support trading standards. There clearly will be an income to local authorities from the fines relating to licensing to the extent that they will be able to recover their direct costs, as well as from the fixed penalty notices. We do not have an authoritative estimate of what that sum will be. If the Minister has a clear estimate of what the sums accruing to local authorities will be, it will give an opportunity to see how much of that £140 million cost over five years is likely to be met from penalties and fines.

This issue was debated in the other place and the Government, as is their wont, resisted the idea that money should be paid to local authorities from these fines, instead of being paid into the Consolidated Fund, because, as the Government put it, they did not want to create a perceived conflict of interest such that the enforcement authorities seemed to have an interest in pursuing fines. We should think of it the other way round. We want enforcement authorities to do their job properly. With these amendments, I am testing the proposition that the Government should increase the support for trading standards officers. If they find a provision that makes the revenue from fines to local authorities too much to bear, I should be supportive of a commitment by the Government—if not at this stage, then later—to assess the gap between the revenue that results from the fines and penalty notices and the costs to local authorities and to meet that gap by Exchequer grant, once they know what the Consolidated Fund revenues from these fines may be.

In addition to that request in principle to the Government, I have been looking at the impact assessment, which says in paragraph 1401:

“A new burdens assessment will be completed to assess costs to local authorities ahead of the Bill being introduced”,


particularly in relation to the enforcement of the new powers relating to vapes. I cannot find the burdens assessment—my research may be inadequate—but what does it say are the costs that need to be met by local government? That too should be something that we assess: to what extent is local government going to receive fixed penalty notices or fines that enable it to meet those costs? We do not want to be constantly adding statutory duties to local authorities without the corresponding resources.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I have attached my name to Amendment 81 in the name of the noble Baroness, Lady Walmsley, from whom we have not yet heard—but that is the way the order works. I declare my position as a vice-president of the Local Government Association.

I am slightly torn because the noble Lord, Lord Lansley, has just put forward a strong case. There are indeed huge problems with the funding of trading standards. I go to a recent report in the Financial Times in which the chief executive of the Chartered Trading Standards Institute said that the underfunding of trading standards has left consumers open to rogue traders and fake goods. There is a huge problem there and, as the noble Lord said, the Government’s own impact assessment says this measure is going to increase the burden and they are already hopelessly overburdened.

However, Amendment 81 goes in a different direction, towards public health initiatives to be determined by local authorities. Either of these has a strong case. I prefer the public health case, because public health is something that I am gravely concerned about. There is a real logic to the money going from where damage is being done to public health towards dealing with damage done by illegal activity.

I talked about how much trading standards is suffering. We all know that public health in the UK is in a terribly parlous state; when we compare ourselves with other countries that we might consider similar to ourselves, we are doing much worse in public health. I suspect that the Minister will get up and say, “Yes, but in February this year we gave £200 million to public health”, but that is to go towards smoking cessation programmes —which are very relevant to the Bill—along with addiction recovery, family and school nurses, sexual health clinics, local health protection services and public health support for local NHS services, and £200 million does not sound like quite so much when I read that list out.

There is a real logic to making sure that this is not just a small drop of money going into the ocean—the Treasury—and that the money goes to where the damage has been done, to public health. Trading standards would still be better than the money going straight into the Treasury. These are simple, logical ways to make sure that we stick some plasters on to some of the crises that are affecting our communities.

[Lord Bourne of Aberystwyth (Con)]

My Lords, in relation to this group, it is essential that trading standards have the resources they need. Although the government pledge of an additional £10 million is welcome, I feel it is probably not going to be enough. It is worth bearing in mind that trading standards are supportive of the Bill, and that is good news.

I understand the desire of my noble friend Lord Lansley to push the idea of the money being ring-fenced, as it were, for trading standards. As he acknowledged, there are dangers in that approach; we can think of overzealous traffic wardens and the criticisms that they have in relation to raising money that is ring-fenced for specific purposes, and there may be a danger of that happening here too. Still, I quite understand the desire to press for additional finance for trading standards, and I hope the Minister will say something on that in response because I think that is needed.

On Amendment 74, it seems eminently sensible to have a stepped approach to fines for offenders so that it is a proportionate response and first offenders do not have such a high fine as others. I am wholly supportive of that, and I hope the Minister is listening in that regard too.

Tobacco and Vapes Bill

Baroness Bennett of Manor Castle Excerpts

Committee stage
Monday 3rd November 2025 Grand Committee

Moved by

[Baroness Bennett of Manor Castle]

33: After Clause 16, insert the following new Clause—
“Prohibition on supply of cigarette filters in England and Wales(1) The Secretary of State and Welsh Ministers must make regulations having the effect of prohibiting the supply of cigarette filters or cigarettes containing cigarette filters, whether by way of sale or not, in the course of a business.(2) Subsections (6), (8), (9), (10), (10A), (10B), (10C) and (10D) of section 140 of the Environmental Protection Act 1990 apply to regulations under this section as they apply to regulations under that section.(3) The notice required under section 140(6)(b) of the Environmental Protection Act 1990 as applied by subsection (2) in relation to the regulations mentioned in subsection (1) must be published no later than the end of the period of 12 months beginning with the day on which this Act is passed.(4) In this section—“cigarette filter” means a filter which is intended for use in a cigarette, whether as part of a ready made cigarette or to be used with hand rolling tobacco or other substances to be smoked in a cigarette.(5) Regulations under this section are subject to the affirmative resolution procedure.”Member’s explanatory statement
This new clause requires the Secretary of State and Welsh Ministers to make regulations which would prohibit the supply of cigarette filters or cigarettes containing cigarette filters.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in moving Amendment 33 in my name, I will also speak to the related amendments in this group.

Amendment 33 has a very simple aim: to ban filters on cigarettes. I must start by saying that this is healthwashing. Filters on cigarettes have no health benefits. They were developed by the tobacco industry in the 1960s as a response to growing public concern over the link between smoking and lung cancer. An exposed internal note from the tobacco manufacturer Philip Morris stated that they are “an effective advertising gimmick”. They were deliberately developed to turn from white to brown in order to increase the perception that they filter the cigarette smoke; in reality, smokers simply inhale more deeply, drawing more smoke through the cigarette butt and even further into their lungs. The more recent trend of white filter tips, as compared to the older orange ones, reinforces this message with consumers. The evidence shows that young people, in particular, perceive cigarette packs with references to filters as containing cigarettes that are significantly less harmful than those contained by packs without such references.

Yet this is still not widely known. Look at the communications power of these merchants of death versus the health messages—of course, the merchants of death have a lot more money to put into the messages they are putting out. I acknowledge the support provided to me by Action on Smoking and Health in bringing forward this amendment; noble Lords who have received its briefing may well have noted that it strongly backs this amendment. Only one in four adults realise that filters do not protect smokers, so 75% of people still think that, because the filter is allowed to be there, it is sending a message of health: “There must be some health benefit, surely, or else why would the Government allow it?” That is my Amendment 33.

--- Later in debate ---

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I worry that this group of amendments indicates that, in the name of public health, state overreach can get completely carried away with itself. I ask that we take a step back and consider the state’s ability to interfere in the manufacture and R&D of legal products, which is completely disruptive to those products’ manufacture and design; if the state is going to do that, there needs to be a very good reason.

I want to look at some of the reasons that we have heard in relation to either a ban on or alteration of the use of filters. There seems to be some confusion as to whether this is an environmentalist issue or a public health issue. Is it litter, or is it plastic? What is it? This is a debate about tobacco and vaping, so let me concentrate on that. There is an idea that one in four adults does not know that filters are not healthy. As a long-standing smoker, I have to say that, while there are arguments about filters, I have never heard a smoker say, “I use a filter because they’re healthy”. There are a whole range of discussions about the use of filters—

[Baroness Bennett of Manor Castle (GP)]

I thank the noble Baroness for giving way. By way of correction, in case I was not clear, 75% of smokers do not know that filters do not have any health benefits; the stat is the other way round.

[Baroness Fox of Buckley (Non-Afl)]

The point I am making is that it is true that the majority of smokers do not sit around and discuss whether filters have a benefit to their health. I am quite sure that, had you asked me in that survey, I would not have had a clue. You would then say that I was being conned into using a filter. However, I would be indifferent because that is not the basis on which people smoke, either with or without filters. I am particularly bemused by the idea that, as a woman, if I saw a white filter, I would immediately think “purity” and be forced to smoke a white-filtered cigarette. I mean, goodness me—have we all gone mad?

I want to talk also about the idea of health warnings on actual cigarettes, which, again, is completely disruptive to product design and so on. It is completely petty. Sometimes, I feel as though the public health people have done everything and anything they possibly can and have run out of things to do, so they are now down to the narrowest possible thing: the cigarette itself.

It is interesting that this idea is aimed especially at young people who might be given one cigarette at a party; and that people seem to be saying that, if only such people saw that written warning, it would be enough to stop them. Were we ever young? Were we ever at a party? Did we ever read anything on the side of a cigarette that stopped us? The point I am making is that, as it happens, the majority of young people know that smoking is bad for you; many young people even give adults like me lectures on how smoking is bad for you. The idea of a written warning is not, I think, very helpful.

I just wonder what the health warning would say. Would it say, “Tobacco kills you”? What is it going to say? I have had an idea. Public perceptions on the difference between smoking and vaping are at their all-time worst. Only a minority of current adult smokers—29%—are able to recognise accurately that vaping is less harmful than smoking. So I have an idea: if we are going to have a message on the side of individual cigarettes, perhaps we could say, “Vaping is cheaper and less harmful than smoking”. That is a good message. Why do we not say that? We could even say, “Vaping is good for you”. The point I am making is that that is not where we should be putting messages; we have heard confused messages in this Committee so far.

My final thought is on the success of Canada and Australia in dealing with smoking, which has been cited and thrown into the conversation. Let us look at what is actually happening and today’s front-page headlines in Australia. The only success of Canada and Australia has been the huge growth of a black market in cigarettes and vapes. It is a disaster. Many people in public health are now saying, “Maybe we went too far”. So, before we start emulating them, maybe we should take different lessons. The front page of the Australian newspaper The Age today is about the fact that people are panicking about what they have inadvertently done. This group of amendments is the kind of thing that could lead us in completely the wrong direction.

--- Later in debate ---

[Baroness Merron (Lab)]

I will gladly add to the brief points that I am going to make to the noble Lord. I was just about to turn to international comparisons. Sometimes, I feel the answer is “How long is a piece of string?” However, quite seriously, we constantly keep international comparisons under review because we are keen to learn and see. The challenge, which I will come on to, is to draw exact comparisons, for a range of reasons, including on what we are already doing.

On the point about international comparisons, it is important that we recognise that the UK already has some of the most stringent regulations in the world on tobacco packaging, which already emphasise health harms. This includes the requirement for plain packaging and graphic picture warnings on the outside of cigarette packets. As I have already referred to and noble Lords have discussed, we have announced that we will be introducing pack inserts to cigarettes and hand-rolling tobacco. I understand the motivation for these amendments, but we do not plan to introduce dissuasive cigarettes at this time. We will continue to monitor the evidence.

We are implementing many of the recommendations of the Khan review. This point was raised by the noble Lord, Lord Rennard. For example, we are majoring on the smoke-free generation policy, which is a major shift. Not only are we implementing many of these recommendations but we continue to keep them under review.

My noble friend Lady Ramsey asked about targets. Again, they will be kept under review. Unsurprisingly, our real target is delivering the Bill and designing the regulations so that they work. Some of this is also about where we can make the greatest impact in the quickest way, which is why we are focusing on the inserts rather than looking for additional things to do at this stage.

I hope that this is of some interest and reassurance to noble Lords and that they will feel able not to press their amendments.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank all noble Lords who have taken part in this rich, full and powerful debate. The political breadth around this Committee showing concern and calling for more government action is notable. I thank the Minister for her contribution and her full answers.

I specifically want to address the questions raised by the noble Earl, Lord Russell, about so-called biodegradable filters. I understand why the noble Earl thought the figures for these and plastic filters sounded similar; that is because the figures are similar. I can quote to the noble Earl an article on this area from Waste Management in 2018 titled, “Comparison of cellulose vs. plastic cigarette filter decomposition under distinct disposal environments”. That basically comes up with plastic filters taking 7.5 to 14 years to disappear and biodegradable ones taking 2.3 to 13 years, so the figures are similar. The Government are drawing on similar figures.

The Minister said both types are harmful to the environment and the natural world. There I will point to a study published in Environmental Pollution in 2020 titled, “Smoked cigarette butt leachate impacts survival and behaviour of freshwater invertebrates”. I have now referenced all the evidence in that space that the noble Earl might like to go away and look at.

This has been a hugely rich debate. I thank in particular the noble Lord, Lord Rennard, for giving us the irony story of the day about tobacco companies being concerned about toxic ink on their products. I think we probably should have a cartoonist in the Room at this point. We have had a great deal of consensus across the Committee about the need for action; the one stand-out different position was taken by the noble Baroness, Lady Fox. However, I do not share her concern about the welfare of cigarette manufacturers or the purity of their product design. Like the noble Lords, Lord Crisp and Lord Bourne, I think public health should be a matter of government policy, and I am delighted to have signed the noble Lord’s amendment in the planning Bill later so we will be back together on that one.

I particularly thank the noble Baroness, Lady Ramsey, who very bravely brought before us two family tragedies to illustrate that, in the end, we are talking here about human lives, people’s parents, people’s children and the suffering that comes from the merchants of death. The noble Lord, Lord Patel, brought his medical expertise, and the noble Baroness, Lady Walmsley, cited an important academic study that I hope the Minister will take a good look at in terms of action.

The response from the Minister to the noble Lord, Lord Young, was that the Government could regulate. I am afraid that what we would like to hear and what these amendments are seeking is for the Government to take action. I suggest that “could” is not good enough in these circumstances. It is worth saying that we are not talking about an either/or here. I am sure everyone very much welcomes the smoking cessation efforts that the Minister referred to, but people will continue to smoke, and we want to reduce the health and environmental harms that result.

Finally, the noble Lord, Lord Young, made an important point about cigarettes being close to your eyes and the small print. I point out that most of the people we are targeting here are young people who will not, as I do, have to get the bifocals at exactly the right line to be able to read seven-point print. I think that covers all that has been said here.

One thing I will add is that the noble Lord, Lord Kamall, referred to my amendment and others as probing amendments. I am afraid that is not my intention. I am obviously going to withdraw the amendment now, but I have full intentions of bringing it back. I hope the Minister might be open to discussions beforehand. In your Lordships’ House we have medical experts and people with real expertise, and we might be able to tease out some of the issues raised today in terms of the health damage being done by filters. What would it be like if we got rid of filters?

My final point, in responding to the Minister, is about the limited evidence of the harm of filters. We have strong evidence, established over decades, that there is no health benefit from filters. In the amendment tabled by the noble Lord, Lord Rennard, we are seeking to follow the leadership of Australia and Canada in putting markings on individual cigarettes, but perhaps we could be the leaders in banning filters. In the meantime, I beg leave to withdraw my amendment.

Amendment 33 withdrawn.

Human Medicines (Authorisation by Pharmacists and Supervision by Pharmacy Technicians) Order 2025

Baroness Bennett of Manor Castle Excerpts

Tuesday 21st October 2025 Grand Committee

Finally, I would like to ask my noble friend the Minister a question in relation to Northern Ireland. She made the point that no statutory registration of pharmacy technicians in Northern Ireland has yet taken place. But the process to make it a legally regulated profession has been approved and is moving forward. In fact, the Minister of Health in Northern Ireland back in 2022 issued a consultation that was actually approved. So why has there been a delay? What discussions has my noble friend the Minister had with the current Minister of Health, or what discussions will she be having in future? What seems to be the obstacle? To me, it seems practical common sense by ensuring that pharmacists can deliver face to face contact with patients, thereby freeing up the NHS and GPs.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank the Minister for her very clear introduction of this SI. It is a pleasure to follow the noble Baronesses, Lady Hollins and Lady Ritchie, and to say, perhaps counterintuitively, that I agree with both of them. It is very clear that there are arguments for steps forward because of the way in which circumstances and technology have changed: there is an argument for reform. But the questions put by the noble Baroness, Lady Hollins, are very important and we have to put those into context.

I note that a survey put out in August by the National Pharmacy Association and Community Pharmacy England said that 63% of pharmacies could close in the next year and only 6% of pharmacies were profitable. Only 25% of pharmacies are independent; the rest are either corporate or supermarket-owned pharmacies.

The concerns are obvious when we are talking about that last group. There is a risk of seeing one pharmacist having effective control and providing authorisation to a large number of pharmacy technicians where there might be corporate structures that put a large amount of pressure on financial returns rather than ensuring absolute safety and the controls that are needed. So we need to understand this SI in that context. Obviously, in some ways that is what is driving the SI, but we also need to think about the controls and where there is huge financial pressure on independence. A majority of prescriptions now come through giant corporate companies with very distant methods of control.

My second question is on timing. I note that on 1 October the General Pharmaceutical Council opened its consultation on overhauling the pharmacy technician training framework, including plans to move study from level 3 to level 4. It rather feels that we have just opened a consultation on changing the training, yet here we are bringing in regulations that almost seem to be assuming that that training has already been stepped up. Would it not be a better idea to step up and overhaul the training and then bring in the different regulations? The consultation suggests there is a very clear understanding that there is a need to improve the training of pharmacy technicians.

My final set of questions has to go back to physician and anaesthesia associates and the Leng review. I would like to understand how this SI fits within the broader framework of regulation of all the medical professions. I note, looking back over the history of this, that we go back to 2014 and the Law Commission recommendations about the regulation of a new single legal framework for health and care professionals. Under the previous Government we had consultations in 2017, 2019 and 2021, all of them in this space. So far as I have been able to discover, they did not seem to cover physician technicians: certainly not in much detail. This whole physician and anaesthesia associates débâcle, I have to say, was supposed to be part of a whole process of looking at all stages of medical regulation right across the board. How does this SI fit within that framework?

Finally, I have to note that, in the Chamber on 16 July, I was told that the Government would be delivering an implementation plan for the Leng review in the autumn. I have noticed that quite a lot of leaves seem to be changing their colour at the moment. I know that the government definition of “autumn” can be quite extended, but perhaps the noble Baroness could update us on when we can expect to see that implementation plan.

[Lord Scriven (LD)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Bennett. In fact, it is a pleasure to follow all noble Baronesses who have spoken and to be the first Baron to speak in this debate. A bit like the noble Baroness, Lady Bennett, I counterintuitively support quite a lot of what has been said, even though some of it is quite contradictory and does prompt questions, even though the generality is supported.

I also thank the Minister for outlining in a clear and understandable way the order before the Committee. In my role as vice-chair of the APPG on Pharmacy, I have been able to speak not only to a number of organisational groups but to individual pharmacists to understand some of the differences of opinion within the sector.

This is without doubt a pivotal moment, marking a significant shift in pharmacy regulation. I offer the Government our general support for the core principle of modernising an outdated legal framework to unlock clinical capacity. As the noble Baroness, Lady Ritchie, pointed out, for far too long—in fact, since 1933—regulations have been rigid, forcing highly qualified pharmacists to oversee tasks that can be safely and competently managed by other registered professionals.

This order, by introducing the concept of authorisation and delegation to pharmacy technicians, corrects this historical anomaly. The benefits are clear; it empowers pharmacists to fully embrace clinical roles: prescribing, consulting and administering services, probably as part of the new neighbourhood health services that the 10-year plan suggests. It validates the expertise of pharmacy technicians, providing them with greater autonomy, particularly in complex environments like hospital aseptic facilities. It introduces, to use the Minister’s phrase, common sense measures of allowing trained staff members to hand out pre-checked, bagged medicines in the pharmacist’s temporary absence, ending needless patient delays.

However, the consultation process responses, which saw over 5,000 replies, revealed a sector divided. Although professional bodies and pharmacy technicians largely welcomed the proposals, we must not ignore the fact that many individual pharmacists expressed profound concern, as quite rightly highlighted by the noble Baroness, Lady Hollins. It is here in the detail and the perceived risk that we must focus our scrutiny. Indeed, while welcoming the statutory instrument, there could be some unintended consequences. The issues raised are not frivolous; they are structural and require ministerial assurance.

I wish to highlight three major areas of risk. The first one is patient safety, training and accountability. The core objection from many pharmacists relates to the level of initial education and training required by pharmacy technicians to take on these new autonomous roles. As the noble Baroness, Lady Bennett, pointed out, the consultation has just started. It ends on 24 December. It will not pick up pace until at least early 2026, and then there will be the training, the qualifications for the training and the accountability for the training. Are the Minister and the Government convinced that there is enough time to roll out not just the training but to assure its quality before technicians are allowed to do this?

The noble Baroness, Lady Hollins, has really highlighted the problems that could come around with vague authorisation. If a pharmacist gives a general or oral authorisation without clearly defining the scope, conditions and limitations for the technician, it could lead to confusion and mistakes, particularly concerning high-risk medicines. I was going to ask similar questions to the noble Baroness, Lady Hollins, but I will leave those to one side.

There also is, potentially, an accountability gap. While the order notes that a pharmacist’s failure to have a

“due regard to patient safety”,

may lead to professional misconduct, establishing clear accountability when a technician makes an accuracy error under general supervision could be challenging for regulatory bodies. There is a contradiction there that needs to be understood.

Also, on dispensing queries, the new rule allowing a sale supply of ready dispensed products in the pharmacist’s absence creates a challenge. For example, will a shop assistant who has been there for one day and works in the pharmacy be allowed to do this? It does say “any member”, so I am pleased that the Minister is shaking her head. I seek reassurance on that particular point.

What if a patient has a question about the medicine? The person carrying out the transaction must know when they are qualified to answer and, crucially, when they must stop the transaction. How will this be addressed and understood by all concerned? The safety mitigation is reliant on the General Pharmaceutical Council-strengthened guidance and rules—work that is still pending, as we have heard. We must ensure that this guidance provides absolute clarity on the minimum competence standards required for authorisation and, crucially, that the professional indemnity cover for those roles is appropriate for the new scope of the responsibility.

Secondly, on the risk of undervaluing dispensing services, as the Minister said, the changes are enabling and not mandatory, yet the risk of financial exploitation is real. Pharmacies are already funded below cost for dispensing. My concern mirrored—

HIV: Testing and Medical Care

Baroness Bennett of Manor Castle Excerpts

Monday 20th October 2025 Lords Chamber

[Baroness Merron (Lab)]

I certainly agree that giving people who are attending an emergency department a blood test as part of a routine examination—unless they opt out—has assisted very much in engaging people in care and in identification. We have 79 emergency departments in the programme and they are making a substantial contribution. We will continue to assess where it is successful and how we can extend the success into areas that are not currently benefiting.

[Baroness Bennett of Manor Castle (GP)]

My Lords, there has been a decline in the rate of testing of 16 to 24 year-olds, which is deeply concerning. Are the Government going to tackle that as a matter of urgency, recognising the need to target that group in particular?

[Baroness Merron (Lab)]

As I have mentioned, the plan—which is due to be published by the end of this year—will include a focus on HIV testing and will take account of the groups that are less likely to be tested, because that will be key to our success in eradicating new HIV transmissions by 2030.

Complications from Abortions (Annual Report) Bill [HL]

Baroness Bennett of Manor Castle Excerpts

Committee stage
Friday 6th June 2025 Lords Chamber

For these reasons, I hope that we will move rapidly to the compliance checks, so that the NHS can take advantage of whatever suggestions or proposals are made by the statistics regulator. If public confidence in the statistics systems drains because they are based on merely partial evidence, open government will be the loser. I hope that, on Report, we can consider some of the questions again. I oppose, for the moment, the proposal of the noble Baroness, Lady Thornton.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I offer Green group support for the proposition from the noble Baroness, Lady Thornton. I almost feel that I do not need to, given that the noble Baroness, Lady Freeman of Steventon, very powerfully made the argument that the Bill unnecessarily exceptionalises abortion when there are very comparable procedures conducted in similar procedural ways—hip replacements and cataract operations. Yes, we need to improve the collection of statistics, but we do not have a Bill before us to do that. By definition, the exceptionalising that is going on is very obvious.

I want to pick up on two comments made by the noble Lord, Lord Weir of Ballyholme, and most respectfully to disagree with him. The noble Lord said that what is happening in the US is not relevant here. I spoke at Second Reading about the influence and money flowing from the United States of America into the UK. I can update your Lordships’ House on that. I was going back as far 2014, and a chapter of a book I wrote addressing these issues. This has been highlighted by Peter Geoghegan, who wrote Democracy for Sale, and others. The so-called Alliance Defending Freedom from the US provides massive funding. In 2020, it put £324,000 into a similarly named organisation in the UK. By 2024, that had risen to £1.1 million of the organisation’s total income of £1.3 million. We are debating this Bill in the context of that flood of US money seeking to influence what is happening in the UK.

I put Written Question HL6542 to the Government about this. I am afraid that the Government are not taking this with the seriousness that it deserves for defending our democracy. The Answer referred to lobbying of the Government and what measures the Government have in place. We need to think about the measures that we need across our society to deal with the inequality of financial arms that is occurring in these debates because of the money flooding in from certain forces within the US.

The noble Lord, Lord Weir, also said that the context did not really matter. However, this Bill appears before us in the context of more than 60 MPs in the other place backing one amendment—there is another one too—to decriminalise abortion, to end the exceptionalisation of abortion right across our law. That would make this Bill look particularly strange and ill-fitting. For those reasons, I support the proposition from the noble Baroness, Lady Thornton.

[Baroness Brinton (LD)]

My Lords, unfortunately, I too was unable to be at Second Reading. I speak today to support the stand part notice from the noble Baroness, Lady Thornton, and on what the noble Baroness, Lady Finn, said about the important review of data collection—actually, across the health sector, as I will explain, but particularly of data relating to abortions.

The noble Baroness, Lady Thornton, spoke of how some elements of this short Bill are inconsistent, which makes it unable to deliver what the noble Lord, Lord Moylan, hopes for, despite what he said—I will come on to explain why—even if it were the right thing to do. I agree with the points that the noble Baroness, Lady Thornton, made.

One issue at the heart of this inconsistency is the use of patients’ confidential health personal data. There is an absolute presumption by patients that their health personal data will always be kept confidential between them and their medical practitioners. Indeed, noble Lords may remember, when the then Government proposed care.data plans a few years ago, it became clear that we were likely to move to a US-type system of allowing researchers, insurers et cetera access to anonymised and pseudonymised data. I can tell the noble Baroness, Lady Lawlor, that, during that debate, it was important to note that it is possible to reverse most anonymised and pseudonymised data, particularly when dealing with an unusual circumstance. Once you have one or two identifiers, you can get to a very small geographic position very quickly—sometimes to a postcode, frankly. Therein lies the problem: confidentiality is lost.

More worrying were the original proposals in the Bill that became the Police, Crime, Sentencing and Courts Act 2022, which gave the police and the Home Secretary—then Priti Patel—the power to demand from any relevant person or authority, which included health authorities at the time, to see data that might be of interest in an investigation. I was working on that Bill and, when I queried this power in your Lordships’ House, it transpired that it was not just for suspects of crime but for anyone connected with the incident, who might or might not be a witness. That went completely against everything in a doctor’s sacred oath of confidentiality with regard to their patient. I am pleased to say that, following my amendments to that Bill and pressure from doctors, the then Clause 16(4)(a) was modified to prevent access to health data compared to data from other bodies, where it still sits.

That was followed by a debate, on the Health and Care Bill, about the use of patients’ personal health data for research. My noble friend Lord Clement-Jones, other noble Lords and I made it very clear that assuming that anonymised or pseudonymised data could not be reverse-engineered was not acceptable. Out of that, a new system of a black box, where the anonymity of patients is guaranteed, was introduced.

However, abortion data is different because it is not within these safeguards. The Abortion Act 1967 requires that the woman’s name and date of birth or a personal identifier must be submitted on every abortion and provided to the Chief Medical Officer via the abortion notification system. While, as others have said, this data includes complications prior to discharge, the “Hospital Episode Statistics” referred to in Clause 1(3)(b) of the Bill from the noble Lord, Lord Moylan, are based only on abortion data from trusts, which are not linked to abortion records. This means that the data is coming from two different sources, which are collecting different data. As the briefing from BPAS tells us, neither dataset actually captures all abortion complications, nor can the hospital episode statistics be analysed by methods of gestation or abortion—another difference, yet again. I do not think that the noble Lord, Lord Moylan, covered that point of disparity when he spoke earlier. My worry is that the annual report would not actually reflect the wider picture.

The second issue that I will raise is of those other delicate areas that might inadvertently be drawn into this type of reporting on complications of abortion. In the debate earlier today in your Lordships’ House, we discussed miscarriages and preterm births. Nearly 50 years ago, I had an early miscarriage and, when I went to the hospital, I was told that I was having a “spontaneous abortion”—a ghastly phrase. I still had remnants inside my body that needed to be removed to ensure a “complete abortion”—an even more ghastly phrase. In the middle of my grief at losing my first baby, the medics were talking about “abortion”.

The very helpful briefing from the Royal College of Obstetricians and Gynaecologists points out that the differing terms that can be entered into hospital coding are “induced miscarriage” and “spontaneous abortion”. It says:

“This can result in a code being applied for an abortion complication when it should have been for a miscarriage complication and vice versa.”


This is not just about words such as “spontaneous abortion”. Following on the speech from the noble Baroness, Lady Bennett, in the USA, since the Dobbs case, miscarriage has increasingly been brought into the debate about abortion. West Virginia has one of the toughest sets of abortion laws, allowing it only for cases of rape, incest or if the woman has an ectopic or totally non-viable pregnancy. But it gets worse. Last week, in Raleigh County, West Virginia, the prosecuting attorney, Tom Truman, advised women to get in touch with police, law enforcement or a doctor if they were worried that they might be charged with mishandling foetal remains. The example cited was the arrest of a woman for disposing of foetal remains in her bins. He said that a number of criminal charges under state code, including felonies, could be levied against a woman who flushes foetal remains, buries them or otherwise disposes of them following an involuntary abortion, also called a miscarriage. A West Virginian woman in my situation, which I talked about earlier, could well be prosecuted. The miscarriage that I referred to is not unusual. I lost the tiny foetus down the toilet, and I was distressed beyond measure. In West Virginia, you would now have to retrieve the foetal remains or be at risk of prosecution.

I am sure that there is absolutely no intention in the UK for this to happen, but the debate happening in the US is beginning to colour the debate we are having here. I am very clear that the problem is that some people want miscarriage to be treated as suspicious. They clearly are not medics. It is thought that 15% to 20% of pregnancies end in miscarriage. It is surprisingly common, and good luck to that prosecutor in West Virginia. He is going to spend his entire time on people reporting miscarriage. Above all, the issue of miscarriage and spontaneous abortion is yet another that muddles the data proposed in this annual report and demonstrates, sadly, that it is not fit for purpose.

Preterm Birth Committee Report

Baroness Bennett of Manor Castle Excerpts

Friday 6th June 2025 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I join in the general and fervent thanks to the noble Lord, Lord Patel, and his committee for this terribly important report. I also thank the noble Lord for his introduction to this debate.

The noble Lord, Lord Patel, mentioned an issue that I would like to start with: the situation of our current final year midwifery students. The Royal College of Midwives did a survey and found that 84% of them said that they are not confident that they are going to find a job after graduating this year. This makes no sense at all. We are in the middle of calculating the formula for exactly how many midwives we need, but, if we look at the figures from the Royal College of Midwives, we see that a survey of members recently found that midwives and maternity support workers were working an estimated 118,000 unpaid hours of overtime each week to meet the needs of their patients. We should be grabbing those graduating midwives with both hands and making sure that they have a secure future because, of course, they now face the enormous weight of student debt, with many of them being previous graduates who are doing this as a second degree. There is a risk that they will go and do something else because they need to put food on the table and keep a roof over their head. Of course, this is a situation that many resident doctors and anaesthesiologists already face; as the Minister will know, I have put down Written Questions on that issue.

I turn to the specific issue of preterm births. Here, I will focus not on the care but on the public health issues. We have heard in this debate a great deal from many expert figures about the fact that, in many cases, we do not know the cause of a preterm delivery. However, one thing we do know is that poverty, inequality and discrimination increase the level of suffering around preterm births. The most recent figures show that the neonatal mortality rates associated with preterm birth in the most deprived areas have just increased for the third year in a row. We are going backwards.

The data on preterm birth and neonatal mortality is not nearly good enough, but it is clear that minority communities are suffering a double, intersectional disadvantage. Let me make a statement of the obvious: reducing deprivation and poverty would reduce preterm birth. I do not believe that anyone would disagree with that. Drawing on the Bliss briefing, I ask the Minister this: in terms of the Government’s response to the committee’s first recommendation, what are the future metrics, targets and ambitions? Are the Government making progress in that area?

Most of my speech will address an issue that no noble Lord has yet addressed—nor, I suspect, will address. I am going to focus on One Health and the environmental health aspects that undoubtedly contribute to preterm birth, even if we do not understand the precise details.

Our environment is in a terrible state, and those who are pregnant are particularly vulnerable to that disastrous environment. Our planet has been choked in plastics and soaked in pesticides. We have seen drugs ending up out in the environment, creating antimicrobial resistance and other deleterious medical effects.

I start with a deeply shocking study, which came out after the committee reported. It is only one study, but it is seriously indicative. It was presented to the Society for Maternal-Fetal Medicine’s annual meeting early this year—the pregnancy meeting. Investigators at the University of New Mexico analysed 175 placenta, 100 deliveries at term and 75 pre term. The level of microplastics and nanoplastics in the placenta was significantly higher with the preterm births and much higher than previous levels of microplastics and nanoplastics that have been measured in human blood. Clearly, the placenta is concentrating microplastics and nanoplastics in the maternal blood. However, what is deeply concerning is that the preterm births have higher rates than the full-term births, which is counterintuitive. If this was a gradual accumulation over a time that was not associated with the preterm birth, you would expect the longer-term ones to have more plastic.

I come now to PFASs, generally known as “forever chemicals”. Two studies were published in 2023 showing an association between the level of PFAS in maternal blood and the rate of preterm birth. The study in environmental health, Siwakoti et al, showed that it was particularly affecting male babies, and that the accumulation in male babies was higher than that in female babies. Noble Lords here who are experts will tell us that male babies are more fragile at birth. PFAS is concentrating more in those babies, with potential effects which we do not yet understand but which are deeply concerning. Another study, from the Emory University, found that mothers with higher levels of PFAS in pregnancy are 1.5 times more likely to have a baby born three weeks before their due date or earlier—the preterm babies we are talking about. The early term, one to two weeks before, is also raised.

We also know that we have pesticides all around our environment. Noble Lords might have seen a recent environmental study which showed extraordinarily high levels of glyphosate—the chemical to which we are all very heavily exposed to—in tampons. Glyphosate in maternal blood levels is associated with higher levels of preterm birth. More broadly, on pesticide exposure, a lot of this is uncertain, and all of it is very complicated, but another a meta-analysis suggests some of the ways in which pesticides might be having impacts on preterm birth. They might be triggering inflammation and oxidative stress and disrupting endocrine functions.

Finally, there is the microbiome. The noble Lord, Lord Winston, mentioned our starting to understand that the vaginal microbiome is significant in terms of preterm birth and many other aspects of health. A study from 2023 showed that there was a unique genetic profile in the microbiome of preterm births. There was a higher richness of diversity of microbes and a greater diversity of antimicrobial resistance genes. We have here a real problem with the vaginal microbiome and issues that we do not yet have much understanding of. Unfortunately, the noble Lord, Lord Leong, is not currently in his place, but I cross-reference here the debate that the noble Lord and I had, and an amendment that this House voted on, about regulating period products. An issue that I raised in the context of period products was reusable period products that have high levels of silver and nanosilver, which demonstrably have negative effects on the vaginal microbiome. Also, with the tampons I was talking about earlier, there are the pesticides but there is also evidence of heavy metals, which will have impacts on the vaginal microbiome.

I apologise for this having been a rather depressing speech. However, this situation is not inevitable. Companies are making products that are threatening the health of all of us very broadly, but particularly the most vulnerable in our society—those who are pregnant and the young babies who will be born prematurely. This is an area in which we need urgent government action. I have cited very recent studies, and the knee-jerk reaction to the Government from the Civil Service on these kinds of issues tends to be, “We’ve got to wait for more data and information”. However, if noble Lords look at the list of things that I have gone through, they will see that each one was a case where researchers were looking at one product and one factor, in isolation. No pregnant person is exposed to just one of these factors; everyone is being exposed to all of these as a cocktail, and the levels of all of them are going up all the time. Once we have put them out into the environment, we are unable to take them out. Surely, on preterm birth, on the state of the health of the nation, we need to apply the precautionary principle and take urgent action to rein in the corporates who are exposing us to all these threats.

Creon

Baroness Bennett of Manor Castle Excerpts

Thursday 5th June 2025 Lords Chamber

[Baroness Merron (Lab)]

I believe that we are looking at this very seriously. Of course, medicine supply chains are complex, global and highly regulated, so there are a number of reasons why supply can be disrupted and a number of reasons why supply might not be specifically as we would like. Unfortunately, some of those are out of government control. To be honest, we cannot prevent all medicine shortages, but we can take as many steps as possible. I can assure my noble friend that the whole point about increasing resilience of the UK medicine supply chain remains a key priority. We work with industry, we work with the regulator and we will improve the position of the UK as a destination for life sciences and manufacturing in this regard.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Minister referred to Creon being needed for a number of conditions. In Sheffield, when I was visiting POLARIS, the pulmonary lung and respiratory imaging centre, I met a mother of a cystic fibrosis patient—a young child, quite a small child—and that mother was suffering significant distress at having to spend time chasing around Sheffield to try to lay hands on Creon. The Minister just said that this is out of government control. Does she agree that this is a case where relying on markets to supply essential drugs is not working and that there needs to be more government control in the supply chain?

[Baroness Merron (Lab)]

The noble Baroness puts forward an interesting perspective. There will always be a number of matters that are outside any Government’s control. What is in the Government’s control is what action we can take. In terms of alternatives to Creon, for example, supplies of Nutrizym have more than doubled since last year, and Essential Pharma has also secured additional manufacturing capacity for Pancrex. In May last year, pancreatin preparations—the active ingredient in the medicine we are talking about—were added to the list of medicines that cannot be exported from the UK or hoarded in order to reserve supplies. These actions, along with some of the ones that I have just mentioned and more, all show a very active government position.

Health: Ultra-processed Food

Baroness Bennett of Manor Castle Excerpts

Tuesday 3rd June 2025 Lords Chamber

[Baroness Merron (Lab)]

As the noble Lord will be aware, we are committed to implementing the TV and online advertising restrictions for less healthy foods and drinks. That is one of a number of steps that we are taking to tackle obesity, as per the question from the previous noble Lord. There is a direct link between advertising and intake, particularly with children, so I am glad that we will be introducing regulations to take effect in January—in fact, the industry has agreed to comply in advance of that, which shows a constructive approach. As for further information, the Scientific Advisory Committee on Nutrition will consider evidence again in 2026, next year, and make dietary recommendations. The Government continue to invest in research through the NIHR and the UKRI.

[Baroness Bennett of Manor Castle (GP)]

Further to the regulations that the Minister mentioned that are coming in January, the Labour manifesto promised to prohibit unhealthy food ads online and before 9 pm, which was to come into effect in October. Can the Minister confirm that the rules that are coming in January are in fact watered down and will not forbid the advertising of brands? Does she think that advertising a brand but not a product—say, McDonalds, Kentucky Fried Chicken or Greggs—will promote the consumption of fresh fruit and vegetables?

[Baroness Merron (Lab)]

First, I do not accept that the advertising restrictions represent any watering down. In May, a Written Ministerial Statement set out, to the noble Baroness’s point, that the Government will provide a brand exemption in legislation. The restrictions will come into force officially on 5 January. I realise that the noble Baroness regards this as not the position that she would choose, but I believe that it will provide certainty for businesses to invest in advertising campaigns with confidence and encourage them to develop more healthy products—that is the situation that we want—as well as protecting UK children from the harms of junk food advertising.

Tobacco and Vapes Bill

Baroness Bennett of Manor Castle Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, coming so far down the list in your Lordships’ debate—the number of speakers demonstrating the strength of feeling on the issue on all sides of the House, mostly slanted in the direction of seeking to do more to take on big tobacco—I am seeking not to repeat what has already been said, but rather, to highlight a couple of issues that I expect to pick up in Committee.

However, first, I will answer the question of the noble Lord, Lord Vaizey of Didcot, not currently in his place, about what the Bill is for—or rather, what the Green Party thinks it should be for. The Bill should aim to sound the death knell of big tobacco: the merchants of death who have preyed on vulnerable people, particularly children, hooking them for life. Their products have shortened lives, as the noble Lord, Lord Stevens of Birmingham, pointed out, at great financial and personal cost to those individuals, while providing spectacular profits for those companies. As regulation has sought to restrict their indefensible trade, they have twisted and turned, lobbied and wrestled, dodged and shapeshifted into new and harmful forms.

One of those forms is nicotine pouches, as the noble Earl, Lord Howe, highlighted. This issue was brought home to me on 9 September 2024; I know that because I documented what I saw on social media. At Manchester Piccadilly station, a giant yellow booth almost blocked the entrance. It was surrounded by a group of smiling young people, welcoming and warm, seeking to hand out such pouches to random passers-by. The company’s name is Velo, and a little research uncovered that it is owned by British American Tobacco. Well, shame on you, British American Tobacco, for peddling to young people, at random, a dangerous and addictive poison. You are besmirching the good name of our country by your actions.

Of course, those actions are taking place around the world. Our focus today has been on the UK, but I ask the Minister—I will understand if she chooses to write to me later—what steps the Government are taking to stop British-based and British-linked companies continuing their immoral peddling around the world. The UK was known back in the age of the opium wars as a narco-state; we surely do not want to be one today. I am going to see whether it is possible to address this issue in Committee.

The World Health Organization estimates that there are 1.25 billion adult tobacco users around the world. So, about one in five adults worldwide consume tobacco, which is an improvement on the figure for 2000, when one in three did so. But that is not on track to meet the global goal of a 30% reduction from the 2010 baseline. Why? Let us take a clue from the slogan for this year’s World No Tobacco Day, which is 31 May. The slogan is:

“Protecting children from tobacco industry interference”.


My final point picks up an issue raised powerfully by the noble Baroness, Lady Northover, about the deceptive, deceitful behaviour of the industry and its regular indulging in healthwashing, greenwashing and astroturfing—all the techniques of well-funded dodgy public relations. On the subject I am about to raise, the industry even took a shot at me. The email to me came from [e-mail] via parliament.uk, and was signed “Mariana”—first name only, no company name, no other identification. It asked me to back an amendment to bring in a ban on plastic filters on cigarettes.

In my reference to this, I am drawing on the great work of Action on Smoking and Health to highlight the fact that cigarette filters offer no health benefits. They were introduced by the tobacco industry not to protect health but to create the illusion of a safer cigarette. They have rightly been called the deadliest fraud in human history. These filters are made from single-use plastics and are an environmental disaster. In the UK they account for two-thirds of all littered items and cost councils £40 million a year to clean up. But so-called biodegradable filters are still toxic, break down only under certain conditions and provide a false sense that there is some kind of eco-responsibility so you do not have to worry about the problem. They give tobacco companies the chance to continue their greenwashing and healthwashing. The real solution is simple: ban all cigarette filters. I hope the Government will consider bringing in such a ban.

Mental Health Bill [HL]

Baroness Bennett of Manor Castle Excerpts

Report stage
Wednesday 2nd April 2025 Lords Chamber

[Lord Meston (CB)]

My Lords, I support the introduction of a commissioner. There seem to be three basic arguments that suggest it would be a good measure to take at this stage.

The first is the proven value and quality of work done by other independent commissioners, particularly the Children’s Commissioner, the Domestic Abuse Commissioner and the Victims’ Commissioner, as already mentioned. The second is the need for a commissioner to oversee the prolonged implementation of this Bill when it is enacted and the wide-ranging scope of work to be covered by the new legislation. Thirdly, a commissioner will enable standards of good practice to be maintained and raised. The existence of a dedicated commissioner should in fact remove, or at least reduce, the need for periodic statutory reviews of specific areas of work and functions in the field of mental health.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I have attached my name to Amendment 47, in the name of the noble Baroness, Lady Tyler, and I raised this issue at Second Reading.

A powerful case has already been made for a mental health commissioner, so I am just going to make one comparison here. At the same time as this Bill has been going forward, in the other Chamber I have been dealing with the Armed Forces Commissioner Bill. An Armed Forces ombudsman was created, which in some ways has parallels with the Chief Inspector of Mental Health and the CQC. It was found that that was not effective or strong enough, and now the Government themselves are going for the Armed Forces commissioner model.

There is another parallel. One of the reasons why it is felt so strongly that there needs to be an Armed Forces commissioner model is that members of our Armed Forces do not have the same rights. They have certain responsibilities laid on them and are treated differently from other members of society, which is why they need a special advocate. The parallel with people who are potentially subject to the Mental Health Bill is obvious.

In the health space, I have been heavily involved over the years with the Patient Safety Commissioner, which was initially resisted by the Conservative Government of the time. Eventually the fight was won, and it is now seen to be a huge success. This is a model that we can see working and that is seen to be necessary.

The Government have expressed a desire to get rid of arm’s-length bodies and make decisions themselves. The Government devolve decision-making to those so-called quangos—the arm’s-length bodies—but that is not the case with the Patient Safety Commissioner; there is no parallel here. They are a person who is there as an advocate and to have oversight; they are not making decisions. I do not think the Government can shelter under that umbrella.

[Lord Kamall (Con)]

My Lords, I thank the noble Baroness, Lady Tyler, for, as others have said, the eloquent way in which she introduced her amendment.

I know this is a topic that noble Lords across the House feel strongly about, and I appreciate the arguments in favour of the creation of a commissioner. Indeed, as other noble Lords have said, it was a recommendation of the pre-legislative Joint Committee.

Having listened keenly to what the noble Baroness has said, and having discussed this issue with her and her noble friends, I have to say that I agree with the noble Lord, Lord Bradley, when he says that the landscape has changed. We are now at a time when the Government are looking to reduce duplication and arm’s-length bodies—something that I believe a responsible Opposition should support. We believe it should not be necessary to have a new, separate, independent mental health commissioner.

We were going to group this amendment with the ideas about strengthening the CQC, but that has been ungrouped and we will talk more to it in the next group. When I had some conversations with those who supported the independent mental health commissioner, they said I should look to Children’s Commissioner as an example. I looked at the Children’s Commissioner; it does a great job, but it has a staff of 25, a temporary staff of 31, and expenditure of £3 million. That may not sound a lot of money but I wonder whether that amount of money could be better invested in strengthening the CQC. One of the things about any bureaucracy is that they grow and have more non-essential roles as other bits of legislation bring them in. I worry about the cost and duplication of functions.

I completely understand the argument from those who say that the CQC has not been doing its job and those who have criticised it for being ill-equipped. That is why we tabled our amendment, which will be discussed in the next group, about strengthening CQC functions. However, rather than saying all that now and repeat it in the next group, I do not wish to detain the House any longer. I believe there should be a comprehensive review of the CQC and proper accountability, and I hope we can achieve that without an independent commissioner.

--- Later in debate ---

[Baroness Tyler of Enfield (LD)]

My Lords, Amendments 48 and 49 are in my name. I thank the noble Baroness, Lady Bennett, for adding her name to Amendment 49.

As debated throughout the passage of the Bill, a primary driver of the review into the Mental Health Act was the shocking racial injustices in the use of that Act. The figures are well known to us: black people are disproportionately more likely to be detained and put on a CTO, and experiences and outcomes for people from racialised communities are, on average, worse. One of the main policy objectives set out in the Bill’s impact assessment is to

“reduce racial disparities under the MHA and promote equality”.

That is great but, given that, I have found it surprising from the outset that race and racial disparity were not mentioned anywhere in the Bill or the Explanatory Notes.

Instead, there has been an expectation that non-legislative programmes—in particular, the patient and carer race equality framework, which is a contractual arrangement—and some of the Bill’s broader reforms will reduce racial disparities without specific legislative requirements. I was grateful to the Minister for organising a helpful recent round table on reducing racial disparities. I learned a lot about the operation of the PCREF, if I might call it that; I will return to it shortly.

I believe there is currently insufficient collection and reporting of data on the experiences and outcomes of people from racialised communities under the Act. That in turn hinders the ability to scrutinise progress being made in reducing racial disparities. I know from our deliberations on Monday that further thought is being given to this and that new research is being commissioned. I very much welcome that, so what would my amendments do?

In brief, my Amendment 48 would require the Secretary of State and Welsh Ministers

“to review and report annually on the use of treatment and detention measures”,

broken down by detected characteristics. This would enable us to understand whether these reforms are fulfilling their intended purpose of bringing down inequalities and to identify any further action needed. However, I firmly believe that this needs to be accompanied by Amendment 49, which would introduce a new responsible person role at hospital level in mental health units to tackle and report on racial and other inequalities, as recommended by the Joint Committee.

The Minister has expressed concerns that a responsible person role may duplicate existing roles and duties, such as those under the Equality Act. I do not believe that will be the case. Where there are people performing similar roles, they can take this on but, in many places, local PCREF leads do not exist. Where they do, they can take on the responsible persons role and that is absolutely fine. I think this role would actively assist providers in complying with PCREF and their Equality Act duties. It would also help to drive implementation of other measures in the Bill, such as advance choice documents and opt-out advocacy. These important measures are much more likely to succeed if someone is clearly tasked with ensuring that the mental health unit implements them, everyone knows who is in charge and who is accountable.

There is a model for the use of a responsible person at unit level, in the Mental Health Units (Use of Force) Act 2018. Under that legislation, the role is accountable for ensuring that the requirements of the Act are carried out. It is a senior role which may be carried out by an existing member of staff, such as a medical director or director of nursing. That would be a good model to follow. Giving an existing senior clinician with the necessary clout the responsibility to make things happen and creating clear accountability would really help to bring down disparities at local level.

The scope of the PCREF, which is NHS England’s anti-racism framework, is rightly much broader than the Mental Health Act. The responsible person in my amendment would be accountable for ensuring that the voices and interests of detained patients and their carers are properly reflected in the PCREF.

Finally, I was very grateful to the Minister for our recent correspondence following the helpful round table I referred to. I was very struck by the acknowledgement at that event of the big difference that a responsible person could make in enabling the patient and carer race equality framework to reduce both racism and racial inequalities in the way the legislation operates. As the Minister knows, I have made the—hopefully—helpful suggestion that some form of pilot of the responsible person role could considered at an appropriate time when the PCREF has bedded down and with some idea of how effective, or otherwise, it might be. Any assurances the Minister could provide would be much appreciated. I beg to move.

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Tyler. I have attached my name to the noble Baroness’s Amendment 49. As the noble Baroness said, like Amendment 48 it addresses one of the primary reasons for reviewing the Mental Health Act in the first place. Black people are over 3.5 times more likely to be detained under the Mental Health Act than white people, and over seven times more likely to be placed on a community treatment order. Their experiences and outcomes are worse. All of those are facts. As the noble Baroness, Lady Tyler, said, the Bill somehow does not seem to be addressing that. We are taking an overall systemic view but not addressing the issues of a particular population. The reason I chose to sign Amendment 49—we are going to come shortly to the amendment in the name of the noble Lord, Lord Stevens, looking at the resources being put into the Mental Health Act—is that this is another way of putting resources into what everyone agrees is a crucial issue. This is a different way of allocating resources.

The noble Baroness, Lady Tyler, has made the case that PCREF is not the same thing. The Care Quality Commission does not have the same kind of situation. We are talking about people at a local trust level here; that is where the responsible person would be. As the noble Baroness said, if there is already someone, because of local arrangements, fulfilling this role, they can simply adopt this along the way. It does not have to be any kind of duplication. I note that the campaign group Mind very strongly backs this amendment. It delivers where we started from on this whole Bill.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I will speak to Amendment 61, which calls for a review into the causes and consequences of the huge spike of diagnoses of mental disorders. It should also investigate the impact of this on the availability of services that we envisage treating people with a mental disorder that this Bill seeks to help.

If, in our best efforts to provide alternatives to detention for the severely ill, we hope to ensure that adequate care in community settings exists, we must look at the phenomenon that threatens to squeeze out those who most need access to such services. Implicit to this endeavour is to ask if, inadvertently, some aspects of policy set in train a self-fulfilling prophecy. Rebranding any deviation from the norm, troublesome behaviour, anxiety or even, according to the Government’s curriculum review, GCSE exam stress, under the therapeutic language of mental health has consequences. As Tony Blair has noted recently:

“you’ve got to be careful of encouraging people to think they’ve got some sort of condition other than simply confronting the challenges of life”.

Yet the young especially are prone to internalising the narrative of medicalised explanation and adopt an identity of mental fragility and illness. This can create a cohort of citizens demanding official diagnoses, NHS intervention and treatment.

This week, the media has featured the new book by Dr Alastair Santhouse, a neuropsychiatrist from Maudsley Hospital. In the book No More Normal: Mental Health in an Age of Over-Diagnosis, Dr Santhouse argues that it has become crucial to reassess what constitutes mental illness:

“so that we can decide who needs to be treated with the limited resources available, and who can be helped in other ways”.

He worries the NHS has

“buckled under the tsunami of referrals”.

Other state services are straining to the point of dysfunction as well. Despite the fact that the number of children with education, health and care plans has more than doubled in less than 10 years, parents are still desperately complaining about waiting for years for autism and other assessments. In other words, the demand is just galloping.

All of this is leading to at least 18 councils being at risk of insolvency, according to the Guardian on Monday. The present row over PIPs and the welfare system collapsing under the costs of ever greater numbers claiming disability payments for mental disorders is now a major political issue. I have been partly inspired to table this amendment by the Health Secretary Wes Streeting’s concern about overdiagnosis of working-age adults leading them to be “written off”, as he said. It is especially tragic that this is happening overwhelmingly among young people.

My concern, and the point of this amendment, is that this can skew NHS provision. A Savanta poll of 1,001 GPs for the Centre for Social Justice’s report Change the Prescription reported that four in five, 84%, of GPs believe that the ups and downs of normal life are now wrongly being redefined by society as mental disorders. Of those GPs, 83% now believe that anti-depressants are too easily prescribed to patients. But the GPs are under so much pressure from patients demanding treatment that they prescribe them. Similarly, in 2013 and 2014 just 1,800 adults were prescribed drugs for ADHD, but last year 150,000 adults were prescribed with ADHD medication. Waiting lists keep growing and lots of anger continues.

When I last spoke on this topic in the Mental Health Bill debate, the media picked up on it and I was inundated with emails, largely from people furious with me for challenging overdiagnosis; I had a tsunami of hate mail. There was even a formal complaint sent to the standards committee of the House. People said, and I understood it, “How can you say there is an issue with overdiagnosis when I can’t get a referral for myself” or “for my child” and so on. It is true that a GP cannot formally diagnose ADHD as it requires specialist assessments. The average waiting list for an ADHD referral on the NHS is now three years. This lack of formal diagnosis is not necessarily stopping service provision becoming overwhelmed and distorted, and I think this mood will have a very damaging impact on what we want this Bill to do.

I will finish with an apocryphal tale from the University of Oxford’s disability report from 2022-23. It reveals that the university has, under pressure from students, agreed to

“accept a wider range of disability evidence”

as a key to giving 25% more time in exams and the use of computers in exams. The university’s explanation is telling. It talks of

“a wider context of extensive and ever-growing waiting times for ADHD and autism diagnostic assessments”,

so it aims to reduce “administrative burdens and barriers” for disabled students.

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[Lord Stevens of Birmingham (CB)]

My Lords, this Bill has been years in gestation, and we have heard, in Committee and on Report, that it is going to be years in implementation. The Government, not unreasonably, have pointed to two principal rate limiters for that: workforce and funding. As we have just heard in the powerful speech from the noble Baroness, Lady Tyler of Enfield, her Amendment 50 is responsive to the staffing constraints and concerns, and my Amendment 59 tackles the funding question. I am grateful for her support and that of the noble Baroness, Lady Bennett of Manor Castle, and the noble Lord, Lord Scriven.

In a nutshell, as the noble Baroness says, this amendment does not seek to tell the Government, or indeed the House of Commons under its privilege, how much to spend on the NHS. All it says is that there should be a floor on the share of that total going to mental health for a time-limited period while the Act is being implemented; in other words, the Government would continue to decide the size of the NHS pie. The Government, of whichever complexion, could decide to grow or shrink it, but the slice of that pie devoted to mental health would be protected for a time-limited period, not only at the local ICB level but nationally.

We had a debate on this in some detail in Committee, so I will not repeat the arguments in favour, but I will update the House on two developments since then. First, in consultation with the Public Bill Office, this Report amendment is more tightly drawn, focusing specifically on the mental health services that are in scope of this Bill and are required for its implementation. Secondly, as the noble Baroness, Lady Tyler, has just noted, since we debated this point in Committee, new evidence has emerged, sadly, as to precisely why this amendment is needed. Previously, Ministers have argued, in good faith, that the Government are committed to protecting the mental health share anyway, whereas last Thursday, the Written Ministerial Statement disclosed that the Government now intend to shrink the share of NHS funding on mental health services in the year ahead.

The Written Ministerial Statement says:

“This is because of significant investment in other areas of healthcare”.


That is not a justification; it is a mathematical tautology. It reveals a preference entirely antithetical to what will be required over the years to get this Bill implemented.

It may be argued that it is a small percentage reduction, even though it is an important negative new precedent that has been set. However, a small percentage reduction on a large pound note number itself constitutes a large pound note number. Mental health services will be missing out on hundreds of millions of pounds more, not only in the year ahead but over the decade that it will take to implement the Bill. If that is not corrected in subsequent years, over £1 billion of funding has, in effect, been removed from mental health services and the implementation of the Bill as a consequence of that decision.

In summary, there are, sadly, real grounds for concern about whether the implementation of this Act will be properly and expeditiously resourced. If the Government want to argue that this amendment is unnecessary, because they are going to do what it says anyway, it is not clear why they would therefore object to its inclusion in the Bill. But if the Government’s argument is that they do not support the amendment because they would like the flexibility to cut mental health funding shares, then, to my mind, that really points to the necessity of the amendment.

[Baroness Bennett of Manor Castle (GP)]

I rise briefly, having attached my name to Amendment 59 in the name of the noble Lord, Lord Stevens, and backed by the noble Baroness, Lady Tyler, and the noble Lord, Lord Scriven. We saw in Committee multiple amendments all trying to address the resource issue. We have focused on this one because it is both an elegant solution, as the noble Lord, Lord Stevens, just outlined, and it is—emanating from the Cross Benches—a moderate solution that can and I think will attract wide support from around the House.

As the noble Lord and the noble Baroness have said, parity of esteem has never been achieved and, on the current figures, is currently going backwards, in the wrong direction. We have to focus on the fact that the waiting lists for community mental health care for adults and young people and children are twice as long as those for physical healthcare. That is the outcome of the inequality of esteem with which mental health is being treated. I note that the Rethink Mental Illness Right Treatment, Right Time report found that most people living with a severe mental illness experienced worsening mental health while waiting for treatment, with 42% requiring urgent care and 26% being hospitalised. We are aiming to shift from hospital care—in-patient care—to community care, but we are actually forcing things in the other direction because people reach such a state of crisis. I have to preface the horror of what I am about to say with a warning. The Right Treatment, Right Time report found that 25% of people whose mental health deteriorated while waiting for treatment attempted suicide, which highlights how the lack of funding for mental health care impacts on that awful statistic.

This is a step to create a framework that heads in the right direction. As noble Lord, Lord Stevens, said, how could you possibly oppose this?

[Baroness Fox of Buckley (Non-Afl)]

My Lords, very briefly, I will say that I absolutely support this amendment. I think it is worth clarifying what I said earlier about overdiagnosis. The danger is that that can be interpreted as meaning that I want cuts; what I actually want is targeted intervention for the right people, rather than saying, “Oh, everybody’s been calling themselves mentally ill, so let’s cut the services”.

I completely agree with the noble Baroness, Lady Tyler of Enfield, that, if we do not sort out the amount of community provision, what we have done over the last few weeks, never mind the years preceding it, will have been a waste of our time, because the Bill will not be worth the paper it is written on—that is the danger. It is very tempting, in a period of intense economic difficulties, to suggest that this might be one of the first things to go—so I do think this is a very good amendment.

I will remind the House of a discussion we had late the other evening on the plight of prisoners. If there is no community resource for people leaving prison—ex-prisoners—they will deteriorate and end up becoming very ill in the community and being incarcerated again. I discussed that in great detail. In other words, this is essential if we are serious about saying that we do not want to lock people up but, instead, want to treat them appropriately.

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Moved by

[Baroness Bennett of Manor Castle]

63A: After Clause 51, insert the following new Clause—
“Duty to implement preventative policies for mental disorders(1) The bodies listed in subsection (3) must implement policies which take a preventative approach to the management of mental disorders which are likely to lead to detainment under the Mental Health Act 1983.(2) The policies must be adapted to the needs of the local community that those bodies serve.(3) The bodies in subsection (1) are integrated care boards, local health boards and local authorities.”Member's explanatory statement
This amendment seeks to ensure that ICBs, LHBs and local authorities take a preventative approach to the management of mental disorders which lead to detainment and adapt their approaches to the needs of their local area.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I am acutely aware of the hour so I will be very brief. My Amendment 63A would provide for a duty for ICBs, local health boards and local authorities to implement preventive policies for mental disorders.

I join the noble Baroness, Lady Tyler, in regretting how the debate on this crucial Lords-starter Bill has been squeezed. However, I am in a lovely position because, in responding to the group beginning with Amendment 48, the Minister essentially supported my amendment. She said that if support can be provided much earlier, mental ill-health can be prevented. That is essentially what this amendment seeks to do.

I am obviously not going to divide the House at this stage of the evening, but I have spoken over the years to so many public health professionals, consultants and directors in local authorities, and they continually express the frustration that everyone knows that investment in preventive healthcare is the way to take pressure off the NHS. Understandably, when someone turns up with an acute mental health crisis or a broken leg, we have to treat that, and that is where the resources go.

This amendment is an attempt to write into the Bill—I hope it might be revisited in the other place—the duty of prevention. And it has to be a duty. This aligns very much with the Government’s rhetoric and their approach to public health. I will not press the amendment to a vote, but I hope this can be the start of a discussion.

[Lord Scriven (LD)]

My Lords, because of the lateness of the hour I will be very brief. These Benches support the aim of the amendment in the name of the noble Baroness, Lady Bennett of Manor Castle. It is important that, throughout all this, there is an element not just of treating the acute phase of mental ill-health but trying to ensure that prevention is there within the health service and across the whole of government, national and local. We believe on these Benches that a mental health commissioner would have been really helpful for that, as they could highlight elements that could help with prevention—but the House has made its decision on that.

I have only one question for the Minister. One of the three shifts of the Government is towards prevention. How do the Government see prevention of mental ill-health fitting into that shift, not just in NHS services but, as I said, across the whole of government, including local government, to determine how they can use their resources and levers to bring about what the noble Baroness, Lady Bennett of Manor Castle, is trying to achieve?

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[Baroness Bennett of Manor Castle (GP)]

I thank the Minister for her detailed response and the positive mention of Trieste. I echo the noble Lord, Lord Kamall, in thanking the Minister for her genuine engagement in the debates on this Bill. On this final point, it is worth noting that a very small number of noble Lords put in an enormous amount of work into the Bill. It would be nice to see a wider engagement across the House rather than the weight being carried by such a small number of people.

On the amendment, I thank the noble Lord, Lord Scriven, for his expressions of support for the general intention at least. On the point made by the noble Lord, Lord Kamall, on whether the duty should potentially rest with the Secretary of State rather than locally, we come back to some of the debate that we had in the earlier group when we were talking about a responsible officer. It is about laying duties down at the level where services are delivered, which is why I took this approach.

None the less, given the hour, I shall stop there. The Bill is now going to the other place, and I hope that we see a real level of attention and focus there as well, as there has been in your Lordships’ House. I beg leave to withdraw the amendment.

Amendment 63A withdrawn.